Apart from exposing how vulnerable Guyanese continue to be at the hands of ruthless killers, the death of Shahbodeen Kassim at the New Amsterdam hospital has raised a heap of concerns about patient care at that institution and inevitably others.

The incontrovertible facts are that he was shot a little after 6 pm on November 24 and got to the hospital at around 6.30 pm. He was seen by a junior doctor, then an orthopaedic surgeon and then a general surgeon. Kassim sustained a bullet wound to the right buttock and died at 9.15 pm just prior to surgery.

A report by the Chief Medical Officer (CMO) Dr Rudolph Cummings has said that there was no gap in medical care. He said that on arrival, the patient's condition indicated shock and primary measures were undertaken to stabilize him. This was followed by a blood transfusion and the patient was seen sequentially by the orthopaedic and general surgeons in a "timely manner".

This account conflicts with the views expressed by Health Minister Dr Leslie Ramsammy that doctors at the hospital were tardy in responding to the case. An investigation will be mounted into this death and specific areas for improvement will also be pinpointed. In the interim beepers or cell phones will be provided to the doctors to improve communication with the hospital and accommodation facilities for doctors on call will be refurbished. We hope this enquiry will be conducted expeditiously and the full results made known to the public. This case further demonstrates the pressing need for the medical community and the government to have the Medical Council of Guyana activated under the recently passed amendment.

From the perspective of the layman and the Kassim family, what transpired on the evening in question seems quite unacceptable. If the patient got to the hospital at 6.30 pm, the surgeon who eventually had primary responsibility for his care should have been there within reasonable time. Under no circumstances should it have taken slightly over two hours for the surgeon to arrive. While there may have been no gaps in care in the opinion of the CMO, the key question is whether the management of the Kassim case might not have been different and life-saving if the general surgeon who was sought immediately had been there from the very start.

Kassim's case was not one that could be handled by the junior doctor or orthopaedic surgeon and while they may have made interventions would these have been the same had the general surgeon been present? While the patient was in shock and blood work had to be done it is quite possible that the decision as to when the patient had been sufficiently stabilized and ready for surgery might have been different had the general surgeon been present. As it was, Kassim was wheeled into the Operating Theatre minutes after the arrival of the general surgeon but passed away before he could be operated on.

His buttock wound might have masked internal injuries necessitating expeditious surgery.

The New Amsterdam hospital has an emergency section and an operating theatre. Kassim's case was one that should have ranked eminently as a grave emergency and once his wound was diagnosed the appropriate physician should have been on hand.

Of course, the reality of an emergency room in this country is far from the TV version that people see on ER where patients are swept up in a whirlwind of fast-paced decisions, action and results and harried doctors always seem to be on duty. The least one expects here is that if a surgeon is on call and required for an emergency case that he/she would be at the hospital in reasonable time and it wouldn't require a desperate search or the summoning of a helicopter from the capital to transport the patient elsewhere. The account by Dr Ramsammy also spoke of the case of a child with a broken limb on the same day who was only attended to after doctors arrived to handle the Kassim case. The child had sat there from 2 pm while Kassim's treatment started at around 6.30 pm.

The handling of the Kassim case is primarily the responsibility of the New Amsterdam hospital's administration to explain and defend. Those who should be responding have been silent. The administration must be heard from on this and the other cases in which an insouciant response by doctors has been alleged.

State health institutions must in the meanwhile review their procedures and staffing arrangements for emergency cases to ensure that patients who are seriously ill are promptly attended to.