THE five-man commission appointed to probe conditions at the New Amsterdam Hospital in Berbice following two deaths there late last year, has recommended the General Surgeon be transferred for a period to the Georgetown Public Hospital Corporation (GPHC) where the team believes he "will benefit from a busier and more structured service."

The team was appointed after businessman Shahabodeen Kassim, who was shot by bandits, died there on November 24, amid allegations of negligence by doctors at the hospital.

In a report, the Government Information Agency (GINA) said the commission found that "the patient's injury was so serious that a different outcome was unlikely, given the available service at the regional hospital".

It found that very major blood vessels were damaged, which caused severe blood loss - so severe that the patient was in shock, the agency said. Additionally, both small and large bowels were injured, as revealed in the post mortem report, it said.

The commission found though that "there was a prolonged delay" of over one hour at the Accident and Emergency Unit (A&E) of the hospital. Part of this delay was attributed to the family's wish to fly the patient to Georgetown, with additional delay due to arrangements having had to be made for helicopter transport and receiving team, among others, as well as being in the ward from 7:40 to 8:55 p.m.

The probe team also found that it took 40 minutes after the General Surgeon's visit for the patient to be taken to the operating theatre.

GINA said the commission found that doctors did not write appropriate records and urged that the service of the hospital be urgently improved as it relates to professional assets, medical personnel and laboratory services.

The commission was also of the view that doctors and essential staff ought to be provided with live-in or call-in accommodation within the hospital complex or nearby.

It noted in the Kassim case discrepancies between the times quoted by the father of the deceased and the professional staff, in relation to the events following the businessman's admission to the hospital after he was shot.

After investigating the case, the commission recommended that "severely injured patients" who need management in the operating theatre, be transferred without need for admission to a surgical ward, as this would accelerate the process of surgical care.

GINA said the commission noted that doctors' and nurses' reports were verbal, not documented, and not complete, and there was no way of reconciling the differences.

"The investigation was conducted on the basis that the sequence of events included a call to the Orthopedic surgeon at approximately 6:45 p.m. He ordered that the patient be admitted to the ward, and this was done 15 minutes later. He then requested the services of the General Surgeon who responded at 8:15 p.m.", GINA said.

The patient was transferred to the operating theatre at 8:55 p.m. and died at 9:15 p.m. on November 24, 2001.

In the other case investigated, the team expressed serious concerns pertaining to the clinical management of a 62-year-old patient who was discharged from the hospital on October 31, was readmitted and subsequently died. The doctors on the commission were concerned that a patient with a history of complications, including evidence of multiple stroke, was treated as a surgical day case, GINA said.

The report also pointed to the surgeon's failure to "treat the patient appropriately when he was presented in shock on re-admission, and his failure to ensure that the patient's consent form was completed before surgery."

The patient was scheduled for surgery at the New Amsterdam Hospital during the first week of November, but was discharged by the General Surgeon, presumably at the patient's request on October 31, after which he visited the doctor's private office on November 4, where day case surgery was performed, GINA said. The patient was sent home, but was re-admitted to the regional hospital in 'shock' the following day, and subsequently died.

The commission recommended strongly that the A&E doctor needs to be trained, at least in basic emergency life support, and must be confident enough, not only to manage the patient, but also to advise on possible outcomes, and the need for possible transfer to another institution.

It advised that arrangements be put in place for senior professional staff to discuss outcome with patients' relatives. It was also recommended that the referring doctor should speak to the consultant on duty directly, and provide likely diagnoses and details of the patient's key clinical status, as the present arrangement of the 'nurse contacting consultant' is unacceptable.

Members of the commission were Mr. Bud Lee and Mr. Deen Sharma of the Woodlands Hospital; Dr. Parlaparti Santosh of the GPHC; Dr. Gladstone Mitchell of Medical Arts Centre and Dr. Davis Dennison, Director of Standards and Technical Services at the Ministry of Health.