Make overdue healthcare changes

The official investigation into the death of 29-year-old Chrystal Boodoo-Ramsoomair at the San Fernando General Hospital offers an insight into the scandalous collapse of procedure, protocol and systems that led to the death of the young mother on March 04. The death of the young woman led immediately to turmoil in the public health sector as the Government reacted strongly to the situation, provoking an equally robust response from bodies representing doctors in this country. That situation was mercifully and quickly brought under control through the intervention of Prime Minister Kamla Persad-Bissessar, and the unproductive bickering gave way to an investigation, the contents of which were reported exclusively in the Sunday Guardian.

The committee appointed to investigate Boodoo-Ramsoomair’s death, NWRHA CEO Claudine Sheppard, the CRHA’s Celia Hutson, Integrity Commissioner Gladys Gafoor and chairman, UWI Lecturer Dr Bharat Basaw delivered, to their credit, a swift and effective evaluation of the circumstances that led to the tragedy on March 04. The systematic failures in both public healthcare and by the medical and nursing staff on duty that Friday suggests that Chrystal Boodoo-Ramsoomair, in the cradle of San Fernando’s oldest and largest healthcare institution, never stood a chance. A high-risk procedure was assigned to a junior doctor in defiance of established Ministry of Health protocol, there was poor monitoring of the patient after a serious medical procedure, and that lack of oversight led to major blood loss and ultimately death, listed as the result of hypovolemic shock, the result of debilitating blood loss leading to fatally diminished blood pressure.

Institutional failures at the hospital and indeed, in the public healthcare system as a whole, were cited in the report as key contributors to the young mother’s death: There wasn’t enough equipment; key equipment and drugs were not available to arrest the post surgery haemorrhage. There weren’t enough people and shortages in staff led to critical understaffing in the obstetrics department and a lack of cross-disciplinary response. There wasn’t enough blood. There were critical delays in sourcing whole blood and plasma from the National Blood Transfusion Service. This startling list of failures must have come as an unwelcome déja vu to the deputy chairman of the investigating team, Gladys Gafoor, who chaired a Commission of Enquiry into the public health sector, producing an exhaustive report, delivered in 2006, of the failings in healthcare that needed to be urgently addressed.

To date that report, despite being forwarded by former prime minister Patrick Manning to the Director of Public Prosecutions and the Integrity Commission and being tabled in Parliament in August 2007, has never been substantially implemented and more than 400 specific recommendations, made five years ago, await action. If there’s anything that the unfortunate and needless death of Chrystal Boodoo-Ramsoomair should make clear to the Government and specifically to the Ministry of Health, is that the cost of setting aside critically needed corrective measures in the public health sector is paid for in human life and suffering. It is still unclear whether the report on Boodoo-Ramsoomair’s death will become grounds for criminal proceedings in a court case for manslaughter.

That determination will probably drive considerations about how widely the report can be disseminated, but it seems clear that appropriate transparency and public disclosure should be one of the hallmarks of this report into the failings of the public healthcare sector. This investigation into the serial failures that led to the death of Chrystal Boodoo-Ramsoomair in March must mark a point of fundamental change in the management of institutions dedicated to public healthcare. As the Gafoor Commission of Enquiry into the healthcare sector has amply illustrated, it is simply not enough to probe an unsatisfactory situation, review it in depth and make substantive recommendations on improvement. There must be matching political will to move advice into action and to create an environment of accountability and service in the public health sector that matches this nation’s aspirations to first world status.