By Michael Jordan
Although she was a high-risk maternal patient, no ultrasound was ordered for acting headmistress Esther Dwarka-Bowlin, no blood was available for her when she needed a transfusion, and no doctor was present when she was ready to deliver.
These are some of the findings that have emerged in a preliminary report into the October 16 death of 29-year-old Dwarka-Bowlin, and the recent deaths of three other maternal patents from the Skeldon and New Amsterdam Hospitals.
A complete review of the four cases is to be done by the Expert Maternal Mortality Committee set up last week.
This report would be followed by a comprehensive report fashioned by an ongoing investigation.
Nadira Sammy
Rebekah Chinamootoo
The preliminary reviews were done by the Ministry of Health into Dwarka-Bowlin’s death, as well as those of Nadira Sammy, a 15-year-old from Number 69 Village, Corentyne, who died on September 16; Rebekah Seegobin (also called Rebekha Chinamootoo), 27, of Number 36 Village, Corentyne, who also died in September; and Heerawattie Bisham, 21, (also called Yogeeta Bisham), who died on October 20.
The report raises several questions about the quality of treatment that the women received.
Among the observations made was that high-risk patients were left in the hands of junior doctors, who were unable to handle emergency maternal cases.
A similar observation was made during the Guyana Medical Council investigation earlier this year into the deaths of high-risk maternal patients Tricia Winth and Salima Ram at the Linden Hospital and the West Demerara Regional Hospital. No staffers were disciplined, although investigations revealed that negligence contributed to their demise.
The report on Esther Dwarka-Bowlin states that hers was a post-term pregnancy (a pregnancy lasting 42 weeks or more). She was referred to the High Risk clinic at 36 weeks and again at 41 weeks.
According to the report, Bowlin was admitted to the Skeldon Hospital 44 weeks into her pregnancy on October 15,? at 19:45 hrs. It said that her blood pressure increased on two occasions, and she was given Aldomet (a medication for hypertension) and advised to rest. The report stated that giving a patient aldomet at this stage “is a waste of time.”
According to the report, Dwarka-Bowlin pushed through an undilated cervix at 23.38 hours (delivering a baby boy).
It also added that the patient was not monitored during labour.
The report stated that at around 05.30 hrs, Bowlin’s condition deteriorated. However, though she needed a transfusion, no blood was available at the Skeldon Hospital. She became unconscious, and ceased to breathe at 05.40 hrs. A post-mortem showed that Bowlin died from internal injuries.
In a section of the report marked ‘questions’, queries were raised as to why no ultrasound was done on the patient.
Cabinet Secretary Dr Roger Luncheon has since summoned officials from the Skeldon Hospital to appear before a special Cabinet sub-committee, to explain the circumstances that led to Dwarka-Bowlin’s death.
The review on the death of 15-year-old Nadira Sammy of Number 69 village, Corentyne, stated that she had 15 ante-natal clinic visits at the Skeldon Hospital.
She was referred from Skeldon Hospital and admitted on September 16 to New Amsterdam Hospital at around 14.05 hrs.
No vaginal examination was done because the patient was not complaining of abdominal pains.
According to the report, at around 21.25 hrs that night, the teen was seen by the consultant. This was some seven hours and five minutes after she was admitted to the institution.
The report said that the teen subsequently developed shortness of breath. Her condition deteriorated and she ceased to breathe. She passed away before delivery.
A post mortem report stated that Nadira Sammy died from cerebral haemorrhage and eclampsia (a condition that causes seizures or coma in a patient).
Esther Dwarka-Bowlin
Yogeeta Bisham
Under the section marked ‘questions,’ the report queried why the consultant was not informed about Sammy when she was admitted to hospital. It also stated that there was a delay in the management of the patient for Pregnancy Induced Hypertension. According to the report, the junior doctor who treated the teen failed to recognise the signs of imminent eclampsia and inform the consultant.
“Protocol of care was not adhered to,” the report concluded.
The report on 27-year-old Rebekah Chinamootoo (called Rebekha Seegobin in the report), of Number 36 Village, Corentyne, said that she attended the ante-natal clinic on four occasions
She was described as a high risk patient. She was admitted to the New Amsterdam Hospital on September 16 at 08.25 hrs. She had a history of lower abdominal pain.
According to the report, a junior doctor directed that the patient be given buscopan, which is used to treat intestinal spasms and stomach cramps. The report stated that Seegobin refused treatment and signed a self-discharge form and left the hospital. The report said she was readmitted to the hospital at 18.35 hours.
After the patient failed to have a normal delivery, the Consultant ordered that Seegobin undergo a Lower Segment Caesarean Section. The surgery was completed at 17.00 hrs and Seegobin delivered a baby boy.
At 17.05 hrs, Seegobin was shown to have an “altered level of consciousness” (a semi-comatose state). No blood pressure was recorded.
There was also haemorrhaging in the uterus.
According to the report, the consultant removed clots and ordered blood to be given to the patient.
However, Seegobin eventually succumbed.
The report on Heerawattie Bisham, 21, (also called Yogeeta Bisham) said that she joined the antenatal clinic 18 weeks into her pregnancy. She had 12 antenatal visits to the Skeldon Hospital clinic.
Seegobin was admitted to the New Amsterdam Hospital on October 20 at around 06:00hrs, with a referral from the Medical Doctor at Skeldon Hospital. She had a history of spontaneous delivery and a blood loss of 800 mls.
It said that the uterus contracted but the patient was still bleeding and was “very uncooperative and not allowing examination of the cervix.”
The report said that when Bisham arrived at the New Amsterdam Hospital at 06:00 hrs, her pulse was weak and ‘thready’, her extremities were cold and clammy and she was not responding to touch.
There was profuse bleeding from the vagina, she had no blood pressure and was in a state of hypovolaemic shock (caused by the severe blood loss). She was received by a consultant/ obstetrician and a junior doctor, anaesthetic nurse and doctor.
However, the patient succumbed despite all efforts to revive her.
A summary of the report questioned whether the Skelton and New Amsterdam Hospitals were adequately prepared to deal with such emergencies. It suggested that nurses need to allow doctors to decide what drugs a patient should be given and not administer the medication themselves.
“Nurses need to call doctors promptly when there is an emergency. Delays lead to poor outcomes.”
It also noted that “standards of nursing care need immediate intervention by the General Nursing Council.”
The report also said that junior doctors needed to be mentored in obstetric emergencies.
In Skeldon and New Amsterdam Hospitals, both junior doctors could not recognise signs of imminent eclampsia.”
“Junior doctors cannot be allowed to work unsupervised in a hospital. Continuous training is needed on the job for these junior doctors.”
The report also noted that the care was “fairly good” at the antenatal clinic, but in two cases the patients could have joined earlier. It suggested that every pregnant woman admitted to the labour ward must be seen by the doctor and any deviation acted on promptly
It added that blood products should be available on a 24-hour emergency basis at the district and regional hospitals. “Ambulances must be in place at the district hospital which offers deliveries so that in the event of an emergency there would be no delay in getting to a higher level of care. In a resource-limited and challenging regional sector, the shortage of skilled midwives and specialized staff (obstetrician) compounds the vulnerable situations. There is need to relook at the placement and allocation of midwives on the night shifts.”
Meanwhile, a report is still due on 40-year-old Registered Nurse Charlene Amsterdam, who succumbed last month at the Georgetown Hospital, two days after delivering a baby girl.
Amsterdam, of Q 79 Samon Street, Tucville, and of Amelia’s Ward, Linden, died sometime around 03:15hrs on October 24 at the GPHC, after undergoing a caesarean section.
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