Non-availability of life-saving drug costs life of patients

Published February 17, 2015
A view of Sir Ganga Ram Hospital - Photo courtesy: FJMC/Ganga Ram Hospital
A view of Sir Ganga Ram Hospital - Photo courtesy: FJMC/Ganga Ram Hospital

LAHORE: An elderly poor patient, who was admitted to Sir Ganga Ram Hospital a few weeks back for the treatment of life-threatening fungal infection, died late on Sunday night shortly after he developed complications due to `non-availability’ of a drug in the facility’s stock.

He was diagnosed with mucormycosis, a rare infection which, according to the medics, can spread throughout the body if not treated timely.

The life-saving injection, amphotericin B, was said to be the only remedy to stop the infection from spreading to other parts of the body of patients.

It was not the only a case of the alleged medical neglect in public sector hospitals of the provincial capital, many similar complaints are going unchecked due to the absence of clinical audit system and accountability mechanism.

Since a majority of poor patients are admitted to government hospitals, most of them do not pursue medical negligence cases due to technicalities involved in probing the matter and for lack of knowledge.

The amphotericin drug was prescribed more than six times in the treatment notes by doctors during his one-month stay at the hospital, but the management failed to ensure its provision timely.

Consequently, the oral fungus, which was treatable in the early stage, progressed to some other critical body organs of the patient and ultimately proved fatal, a doctor who requested not to be named told this reporter.

He said the infection might have spread throughout the body of the patient due to delay in applying anti-fungus therapy taking the disease to non-reversible position. He, however, said the provision of medicines was not the job of doctors treating patients.

Mohammad Sharif, 65, was under treatment at the Medical Unit-I of the Sir Ganga Ram Hospital, which was headed by Fatima Jinnah Medical College Principal Prof Dr Fakhar Imam.

Patient’s son Shahzad held the doctors responsible for the death of his father, alleging that they did not take the disease serious in early stages.

He further alleged that under-training doctors had been treating his father ever since he was hispitalised on Jan 15.

The treatment notes pertaining to the elderly patient categorically mentioned three times that ‘the amphotericin B injection is not available’.

After completing work up, including diagnostic investigations, a medical officer had strongly recommended anti-fungal drug to stop its spread from mouth to other body organs.

The MO had also written twice (first time on Jan 17 and then on 23) on the treatment notes opinion from ENT consultants for the elderly patient, but the request was rejected for some unknown reasons.

The doctor later shared in the notes that the ENT department had refused to evaluate the patient but did not mention the reason.

The documents further revealed difference of opinion of doctors of the same department about the patient’s state of health.

A doctor visited the patient on Feb 2 and wrote on the file ‘the patient is stable and considered to be discharged tomorrow’.

Earlier, another doctor examined the patient (on Feb 1) and mentioned his health condition ‘static’ recommending MRI test. However, the documents showed no reason as to why his condition deteriorated all of a sudden.

Finding the infection progressing and getting out of control some two weeks before patient’s death, the doctors extensively recommended the drug and also shared status of its non-availability.

The doctors wrote on the treatment notes on Feb 4 (start anti-fungal), on Feb 6 (arrange amphotericin), on Feb 7 (amphotericin not available), on Feb 8 (uncontrolled BSL, injection amphotericin is not available), on Feb 9 (amphotericin not available, BSL is still uncontrolled), and the same day it was again mentioned on the notes that the Zakat form has been given to the patient’s attendant for arranging the drug.

The very next day (on Feb 10), an on-duty doctor categorically wrote that the patient’s condition was deteriorating and also shared that ‘the injection amphotericin will be arranged in four days. (The patient died after four days of this prescription).

Shahzad lamented that during a month-long treatment process of his father, he found the doctors inhuman towards patients and their attendants.

“I am witness to the death of three more patients at the same unit and I am sure these patients had also died due to negligence of doctors,” he claimed demanding a probe into the deaths to bring facts to the public.

AIMC Prof Fakhar Imam did not respond to calls and text messages.

Sir Ganga Ram Hospital Medical Superintendent Dr Waqar Nabi Bajwa said though it was very difficult to manage all kinds of medicines at state-run hospitals, his teaching institute was at the top among other health facilities in providing life-saving drugs to every patient.

He said there was a laid-down system to provide ‘not available’ (NA) drugs to patients at the Sir Ganga Ram Hospital.

“If a drug was not available then it was the responsibility of doctors treating patients to convey to the duty staff nurse to mention it on the Local Purchase (LP) register,” Dr Waqar said adding that hospital also provided alternate or substitute for the NA drugs.

He said it was not easy to establish the cause of death of a patient without investigation.

He, however, said the hospital management was ready to conduct an internal inquiry into the death if relatives of the deceased patient approached for the purpose.

Published in Dawn, February 17th, 2015

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