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24/09/2008

A Brimingham hospital is to be reported to Justice Minister Jack Straw over a catalogue of blunders surrounding the death of an elderly patient who died from superbug Clostridium difficile(C.diff).

City coroner Aidan Cotter recorded a verdict yesterday that Bernard Galloway died from natural causes after receiving an unsatisfactory standard of medical care at Heartlands Hospital over the preceding two days.

He said Heartlands had committed 14 failings in the care of the 76-year-old, which he would highlight to the Foundation hospital’s overseeing body, Monitor, and Justice Minister and Lord Chancellor Jack Straw in a bid to prevent any more patients dying in similar circumstances.

Errors included Mr Galloway not being seen by a consultant for more than 60 hours after being admitted to hospital; not being given the prescribed fluids even though he was dehydrated; not being seen on any ward round because he was missed off a consultant list due to ‘human error’ and nurses not recording patient observations or alerting a ward sister that they were unable to cope.

The family of Mr Galloway, a retired engineer from Lucas, who lived with wife Valerie in Ebrington Avenue, Solihull, said they now plan to sue the hospital.

Mr Cotter said: “The failures did not cause Mr Galloway’s death but they do raise the possibility that he might have lived a little longer if they had not occurred.

“I believe that it is of the utmost important that Mr Galloway’s time in hospital is reviewed by a body with the necessary skills and expert knowledge to determine what failures there were and what action if any should be taken to prevent such failures occurring again.”

The four day inquest heard Mr Galloway’s condition rapidly deteriorated after being admitted to Heartlands in March 2006 with C.diff, which causes severe diarrhoea and dehydration.

But the seriousness of his condition was not realised for more than two days by medical staff, until the day he died.

A Heartlands Hospital spokeswoman said a nurse was dismissed over the incident and added: “The failings highlighted by the Coroner have already been identified through our own internal investigation and appropriate actions have been taken.

“As a trust we remain keen to learn as much as possible from Mr Galloway’s death with the aim of preventing other similar incidents

The most serious allegations against a family doctor accused of endangering his patients by performing cosmetic surgery without proper training were dropped yesterday as he pleaded no contest to lesser allegations and the College of Physicians and Surgeons of Ontario restricted him from performing most surgical procedures.

Jimmy Poon, a Toronto-area family physician, performed invasive procedures including liposuction, breast augmentation and vaginoplasty without formal surgical training, until a patient complaint launched a college investigation. He will be allowed to continue his family practice, but will be subjected to unannounced inspections and required to take a physician review course.

The decision was based upon a joint submission from Dr. Poon’s lawyer and the lawyer for the college, and approved by a disciplinary panel consisting of three doctors and two members of the public.

It comes more than a year after the death of Krista Stryland, a 32-year-old real-estate agent who died shortly after a liposuction procedure performed by another general practitioner. That renewed pressure on the college and the province to more effectively police cosmetic surgical procedures not covered by OHIP.

Piecemeal regulation changes were recently proposed by the college to Queen’s Park, but have yet to take effect. As the first disciplinary hearing relating to cosmetic surgery, Dr. Poon’s case has set a precedent.

Despite evidence that Dr. Poon “fell below the standard of practise in his performance of cosmetic procedures, his administering of anesthesia for cosmetic surgical procedures and in his charting, there’s no evidence of misconduct or standards issues in relation to his family practice,” college lawyer Lisa Spiegel said.

Dr. Poon’s lawyer, David Leonard, who appeared at the hearing on his client’s behalf, pleaded no contest to allegations that Dr. Poon failed to maintain the standard of practice of the profession.

“They’ve struck an appropriate balance in terms of what the college is concerned about with Dr. Poon’s practice, addressing the public’s concern and allowing him to carry on the rest of his practice, where there were no concerns expressed,” Mr. Leonard said.

In three separate reviews of Dr. Poon’s patient charts submitted to the college’s discipline committee, experts found evidence of “unsafe” and “unacceptable” practices. These included the discharge of patients minutes after eight- and 10-hour-long procedures, administering nearly double the recommended safe dose of local anesthetic and performing numerous complex procedures at once on a single patient.

“Dr. Poon’s care displays a woeful lack of knowledge and judgment,” wrote one of the reviewers, Peter Neligan, chief of plastic surgery at the University Health Network.

Allegations that Dr. Poon “breached a term, condition and limitation on his certificate of registration,” that he “engaged in disgraceful, dishonourable or unprofessional conduct,” and that he is “incompetent,” were dropped.

Writing by Alaa Shahine, Editing by Clar Ni Chonghaile

CAIRO (Reuters) – The video shows a poorly lit hospital nursery filled with premature babies in incubators. Doctors are frantically trying to resuscitate some babies while others wail in the background after a night-time power cut.

“God help us! Five are suffering from (cardiac) arrests?” a voice in the background says angrily. “We can handle one or two at most, but five?”

“This is natural, doctor. It’s been an hour and a half,” says another male voice, apparently referring to the length of the power cut.

A mobile phone camera caught this scene at Cairo’s state-run Al-Matariya Educational Hospital in late May on a night when the electricity was cut for nearly three hours after midnight and back-up generators failed to work.

Doctors at the hospital said the outage led to the deaths of four infants. The health ministry, which has referred the matter to the public prosecutor for investigation, says two babies died but that was before, rather than during, the power cut.

The video, which surfaced on YouTube and several Egyptian blogs in June, has sparked a national uproar over a health-care system suffering from a lack of funds, a long legacy of mismanagement and allegations of corruption.

For decades, the government has provided poor Egyptians with subsidized food and fuel, free education and health care.

But public spending on health care has fallen behind over the last six years, accounting for 1.3 percent of gross domestic product in 2006, compared with 2.4 percent in 2001, data from the United Nations report on human development in Egypt showed.

Robust economic growth of around 7 percent over the last two years has swollen the ranks of Egypt’s wealthy, but left millions of unskilled, poorly educated people struggling to cope with inflation running at a 19-year high.

This widening gulf between the rich and poor in the Arab world’s most populous country is also visible in the health-care system.

Private hospitals offer superior care for those who can afford it — not much consolation to most in a country where one-fifth of 76 million people live on less than $1 a day.

A 2004 study by Christian Gericke of the Berlin University of Technology said poor Egyptians “pay relatively more (both out-of-pocket and through the tax system) and receive relatively less in benefits than the better-off social strata.”

“There is a huge disparity in financial access to care,” the study said.

NOT ENOUGH BAGS

Doctors at Al-Matariya hospital posted the video of the power cut on a blog (https://www.akroot4ever.blogspot.com), along with details of what they described as “tragedies” at the hospital.

“Two babies died during the power cut. I saw them with my own eyes,” a doctor, who said he was in the nursery during the power outage, told Reuters in a telephone interview.

“A third died after electricity was restored and a fourth the following day,” he added. The last two deaths, he said, were a direct result of the power outage.

The doctors said the back-up generators did not work because of poor maintenance.

The video shows doctors trying to help the babies with Ambu bags, hand-held devices used to provide ventilation to patients who have trouble breathing.

“We had five cases that needed this. We only had two Ambu bags,” the doctor interviewed by Reuters said. He said a third bag later came in from another department at the hospital.

Another doctor, who also runs the blog, said: “How come a hospital with six intensive care units relies on one source of electricity?” Both doctors spoke on condition of anonymity, fearing management retribution.

But Mortagi Negm, secretary-general of educational hospitals and institutions, a government department, said the power outage had no effect on the health of any baby at the nursery.

“Two babies died before the electricity went off,” he told Reuters. “The law states that they must remain on the machine for two hours after death.”

Reda Salama, the mother of 20-day-old Ali Gamal who died that night, does not believe this. She says gross negligence by the hospital led to the death of her son.

“I want those who caused the murder of my son dead. Even if I strangle them myself, it won’t satisfy me,” she said, sitting in a small room in her dilapidated home in Bahteam, a poor district in Cairo. She was wearing a black dress and a black headscarf as a sign of mourning.

“GREAT SYSTEM ON PAPER”

Salama, who sells fruit and vegetables on the street while her husband works at a textile factory, said she was not seeking financial compensation.

“This is negligence,” she said in a loud, angry voice as she sat surrounded by relatives. “If I give up the rights of my son and others do the same, what will become of us?”

The deaths at the hospital received front-page treatment in independent and opposition newspapers. Dozens of people phoned television talk shows and sent messages to online forums attacking the government’s health policies, which they blame for the run-down system.

The Ministry of Health will spend some 12 billion Egyptian pounds ($2.24 billion) on health care this year. In comparison, the government spends nearly 80 billion on food and fuel subsidies, and spending on defense and security will be about 22 billion pounds next year.

Health Minister Hatem el-Gabali has vowed to “chop off the heads of those responsible” if investigations prove the power outage caused the death of any infants. He acknowledged that public hospitals in Egypt were battling many problems.

“Funding is scarce,” he told state-run Egyptian television in an interview. “On paper, we have a great system. On paper, the powers, obligations and rights are great.”

Gabali said state-run hospitals were in reality negligent and that connections and favoritism played a role in the appointment of employees. “And who pays the price? You and the citizen,” he said.

Al-Heseniya Fever Hospital east of Cairo showcases the problems Gabali mentioned.

Patients sleep on worn-out cots in dirty rooms, where walls are daubed with graffiti.

Director Moustafa Abdel-Aal said he cannot hire permanent workers like cleaners because of budget restraints. He said the hospital, with a capacity of 70 beds, has only five doctors.

“We should at least have 10 or 12 doctors,” he said.

Several doctors interviewed by Reuters said government wages were too low at state-run hospitals.

“The salary of a young doctor is 250 pounds ($47) a month,” said Amr Abu El-Ela, a doctor at Al-Sahil hospital in Cairo.

“I have a doctorate and my salary is 415 pounds … You cannot ask a human being to work hard (with these wages).” he said. “This is the crux of the issue.”

Writing by Alaa Shahine, Editing by Clar Ni Chonghaile

(Reporting by James Grubel; Editing by Paul Tait)

CANBERRA (Reuters) – A U.S. surgeon faced an Australian court on Monday on 14 charges of manslaughter, negligence and fraud after arriving back in Australia from the United States.

The doctor, Jayant Patel, 58, a U.S. citizen born in India, could face life in prison if convicted of the charges which relate to his time at the Bundaberg Base Hospital, in northern Queensland state, between 2003 and 2005.

His return to Australia early on Monday in the custody of Australian police marked the end of a three-year campaign by victim support groups to ensure Patel faces trial.

Patel sat handcuffed in the Brisbane Magistrate’s Court before Magistrate Brian Hine ruled he could be released on bail, as long as he surrenders his passport and reports regularly to police.

“There is such a sense of relief,” Beryl Crosby, from the Bundaberg hospital patient support group, told Australian television after the plane carrying Patel from the United States touched down in Brisbane.

A judicial inquiry in 2005 linked Patel to the deaths of at least 13 patients and the harm of at least 31 others. He had returned to Oregon in the United States before charges could be laid.

Police in the United States detained Patel in March after Australia officially applied to have him extradited to face charges. Patel has previously said he is innocent of the charges.

Patel’s case has attracted widespread publicity across Australia but authorities on Monday said he would still receive a fair trial.

“I believe that any person facing trial before a criminal court can receive a fair trial,” Queensland Attorney-General Kerry Shine told Australian radio.

Legal proceedings are expected to take several months.

(Reporting by James Grubel; Editing by Paul Tait)