The Tribune

By ADRIAN GIBSON

ajbahama@hotmail.com

THIS week, the Princess Margaret Hospital (PMH) finds itself at the centre of yet another public relations disaster where apparent claims of medical malpractice are being levelled against the facility by an American man.

Admittedly, I am no fan of PMH as I see it as a horrid mess where the unprofessional attitudes of certain staff members, the unkempt and dilapidated wards and long wait times leave much to be desired.

However, in no way does this column affirm the particular story told by American Jake Beiersdorf in a now controversial interview on US television station Fox-9 that referenced his nightmarish experience at PMH which began in January when he came to The Bahamas to work at an annual poker tournament. According to Mr Beiersdorf, days after his arrival, he began to feel “excruciating pain in his lower right side” and was rushed to PMH.

There, Mr Beiersdorf alleged that he was made to wait for 14 hours in a filthy room before doctors told him the pain was coming from his appendix. He said doctors gave him anaesthesia and operated. Mr Beiersdorf alleges that when he woke, he found an incision more than a foot long, from his breastbone to the top of his groin, that ran vertically through the centre of his body.

He said he was also surprised by the look of the incision. Mr Beiersdorf alleged that doctors told him the large incision was needed because his “appendix burst” and they needed to “clean out” his insides. He also claimed that doctors gave him about “13 loosely sewn, superficial epidermal stitches” for an incision he later found out required around 45 staples. He also alleged that he spent four days in a disgusting room with about 15 people and his “bedding was never changed”.

Following his hospital stay, Mr Beiersdorf said he spent five days in his hotel room and returned to the hospital to get discharge papers and have his bandages changed in a room he now describes as a storage closet.

What’s more, Mr Beiersdorf claims that on his return to his home state of Minnesota, he went from the airport to the emergency room at Fairview Southdale Hospital where doctors operated on him to determine what happened to his body in The Bahamas. He claimed that doctors there told him that his appendix was still inside him and that his organ was healthy and subsequently removed by American doctors. He also claimed that his Minnesota doctors told him that he had not been properly stitched in The Bahamas and added around 40 staples.

Whether Mr Beiersdorf’s account is true or not, it does not bode well for PMH or The Bahamas, particularly since we have been flaunting the new stem cell legislation and seeking to promote the country as a place that would cater to medical tourists.

I have spoken to several senior officials at PMH. Many of the doctors are irate. Two high-level sources spoke to me on condition of anonymity and revealed certain facts that leads me to believe that the doctors and staff at PMH, who handled this operation, did in fact follow all medical protocols and offer the most credible story in this affair.

Both officials told me that Mr Beiresdorf entered the hospital complaining of abdominal pain and that doctors were informed that he had been experiencing such issues for two days beforehand.

“The appendix was black like tar and the abscess on the appendix was ruptured. Poisonous fluids had entered the stomach cavity. The patient was suffering from acute appendicitis. Once he was operated on, the staples that held his abdomen together were temporary because doctors had to wash his internal organs with a solution every five hours to ensure that he would live, to ensure that the infection didn’t spread and that we cleared that cavity. He agreed to the surgery, he even signed a waiver. He had a perforated appendix and pus was in his belly,” one of the officials said.

“When the patient was discharged, he was stitched. After a few days, the wound was closed with sutures. For very sick people, sometimes we don’t even staple the wound, sometimes we stuff it and leave it open. We have his appendix at PMH. The problem with this story is that Fox-9 didn’t fact check the allegations. They just went on a patient’s statement and we wonder if they even called the hospital in Minnesota with regard to the second operation before running their story. We have the appendix. This is simple: we can just do DNA testing and prove it,” one of the sources said.

“The patient was not in a closet. He was in a small room that is set aside for dressing changes. His story could have been a good story about the inadequacies and challenges at PMH, his story could have given the fight to better PMH more weight, but the additional add-ins have totally thrown things off, it has totally misrepresented what happened! It is disparaging medical professionals and to our country.”

I am told that Mr Beieresdorf’s procedure was supervised by Dr Delton Farquharson. Both of my sources swear to Dr Farquharson’s experience and professionalism.

PMH is an ancient institution built in 1955. Except for various extensions and upgrades, it is functionally similar to the way it was when it served a smaller, less ill and less violent populace. Notwithstanding the change in medical service needs, the institution has not kept up. The infrastructure is inadequate, there is insufficient space and inadequate equipment. Despite this, consecutive governments appear to expect this archaic institution to serve the needs of a country of nearly 400,000 citizens and millions of visitors. Our governments have adopted a short-sighted view relative to healthcare and though the National Health Insurance plan may have benefits, such a plan cannot effectively work when the infrastructure, staff and training is not in place.

Any healthcare initiative must address the demands at PMH in order for that facility to meet the needs of the public. Even the most recently added Critical Care Block was modified to reduce the number of clinical beds available to patients with inconsiderate big wigs choosing to convert an entire floor into posh administrative office spaces.

There is no question that the emergency room should be replaced with a facility big enough and organised in such a way to cope with the trauma heart disease, chronic non-communicable diseases, infectious disease, maternity and paediatric issues that face a very busy national hospital.

Services at PMH should be outsourced. The services that could be easily outsourced include the clinics, dialysis and some other diagnostic services that could be off site. The morgue, which serves as a coroner’s office, should not be on-site. The blood-bank at PMH should be downsized to become a satellite of a national blood bank that is situated elsewhere.

Overall, many of the wards at PMH are inadequate. The facilities they offer are pitiable, bathrooms are usually not operational and the ambience totally off-putting. It is difficult to appreciate the quality of that care in a general environment that conjures up a feeling of squalour. These wards ought to be systematically replaced. Many of the upgrades are decades overdue.

The attention to staff training and re-training as well as failures to modernise telecommunications, information technology and record keeping are all examples of a facility that continues to function in the 20th century though we are two decades into the 21st century. What’s more, the facility remains lop-sided relative to staffing, serving as an employment agency of sorts to persons working menial jobs or in minor supporting roles whilst being challenged due to understaffing of nurses and top-class physicians. As it stands, PMH has one consultant radiologist. The ratio of support staff (parking lot attendants, auxiliaries, etc) to clinical staff is excessive when compared to virtually every other hospital in the developed world. The Sanigest Internacional report, commissioned by the government, says as much.

There are people waiting in lines for X-rays, laboratory tests, surgery, clinics, delivery of babies, to use bathrooms and in emergency room queues at the PMH. Further, the parking is inadequate and suggests that we have not adjusted the care delivered at PMH to the demands of 2015. When prisoners or criminals enter the emergency room or evade custody, there is pandemonium. Why is there no lock up unit at PMH? Criminals in shackles lie side-by-side with innocent civilians.

I am told that there is a problem with retaining the best nurses as many of them leave for better paying, less stressful jobs in the private sector. I cannot blame them for pursuing their interests. However, in a recent visit to PMH Accident and Emergency with my 82-year-old grandfather, some of the worst nurses in the world must have been on duty at that time. They simply were unprofessional, uncaring, belligerent and, if I had the power to, I would have fired several of them on the spot. I would not trust certain nurses and so-called healthcare professionals with a piece of cardboard.

That said, I must credit physicians such as Dr Darius Unwala and Dr Gabarone. These two men are two bright stars at PMH. Give both of them pay raises. Dr Unwala is a caring, down-to-earth physician who, as he tells me, does it because he loves people. I cannot find enough superlatives to describe and the great job he does. If only some of the nurses and certain wayward doctors could take a page out of their book.

I think that the Public Hospitals Authority (PHA) must also be revamped and become more effective at decentralising the decision-making from government and the Ministry of Health. This would likely allow the PHA and the institutions it runs to become more like private entities. There remains too much government influence in the PHA.

I would advise any government looking to improve the facilities at PMH to act on plans (that already exist) and gradually build a new hospital on site by building a hospital of several floors.

ajbahama@hotmail.com