A culture of data-driven accountability is the gaping hole in the medical system
I wish to express thanks to Stabroek News for highlighting the heartbreaking case of Padminie McRae, who “when an accident at the Infectious Diseases Hospital forced the amputation of her left leg from above the knee, after she was mistakenly admitted as a positive COVID-19 patient” (SN April 20, 2021).
While the details of the case, one month after it apparently occurred, are not yet clear in the public domain, in Ms. McRae’s own words quoted in the Stabroek News she said as she was crying: “I am just depressed right now… it is because of the hospital negligence that make this happen to me… It is like I went in hell… Right now, I am very emotional because I went in there with both feet and I come out back with one…” (SN April 20, 2021).
This is another in a long list of cases in Guyana where individual “patients” have been allegedly harmed by clinicians. Several years ago, my own, healthy, and young first cousin, checked into the New Amsterdam hospital to deliver her first child. She died (allegedly killed) during childbirth. Newspaper stories have also carried allegations of medical malpractice. The system, laws, incompetence, poor oversight, and corruption have collectively worked against patients. I am not aware of any clinician in Guyana who was tried or found guilty of medical malpractice. From the record or lack of, one can falsely conclude that medical malpractice does not exist in Guyana, just like saying that Pakistan does not have LGBTQ.
Padminie’s life has been irreversibly affected due to her amputation and she will be faced with lots of difficulties, even though she gets the best medical, social, psychological, infrastructural (appropriate to the disabilities induced by the amputation) and economic facilities at her disposal. Things like phantom pain, she will have to deal with. I hope she gets financial compensation, but most of all continue to fight for justice, boldly, without fear or intimidation. She should not listen to any politician or their operatives who do not want her to speak out publicly and to the media seeking justice. Regarding the allegation of being
“mistakenly admitted as a positive COVID-19 patient” last year out of an abundance of caution, I wrote a letter, “There is a substantial lack of critical data regarding the epidemiology of COVID-19 in Guyana” and queried the positivity and reproducibility rates of the tests (SN, Sept 27, 2020). For too long politicians have been offering hints about the great work they have been doing to advance medical/public health in Guyana, but these have been viewed as cynical by the readership – the top clinics and hospitals are all located in Georgetown where the political elites reside. Yet, many of the politicians and wealthy class get their medical care and surgeries outside of Guyana. The extent of medical errors and harm to patients in Guyana need extensive investigation by qualified and experienced scientists.
It is encouraging that the Medical Council of Guyana (MCG) has recently embarked on efforts to overhaul the Medical Practitioners Act 1991 and the Code of Conduct and Standards of Practice Regulations 2008. It is also great to read that the current Attorney-General, “recounted
his experiences as a lawyer in private practice when he had lodged many complaints with the Council for and on behalf of victims of alleged medical malpractice, but these were never investigated because of these same deficiencies” (SN April 3, 2021). I applaud the current efforts, but because of the nature of political cronyism in Guyana, I do not think patients, most of whom are poor, would benefit any time soon. Who are the members of the delegation working on the reforms? Does any member of the delegation have conflicts of interest related to medical malpractice? Has any member been credibly accused of medical malpractice by a patient? There should a request for information (RFI) to get public input regarding their experiences with medical care and malpractice in Guyana. Such an RFI would provide insight into the scope of the problem and how to handle them.
The public health burden due to medical errors and malpractice by clinicians will continue due to several factors, the most important one being the lack of vision by policymakers and lack of investment in scientific research. Without a cadre of scientists empowered to conduct investigations in the health care sector related to patient outcomes research, standards of care protocols, diagnostic errors, drug prescriptions, monitoring medical equipment and devices, diagnostic radiation use patterns, utility of certain types of surgeries, screening errors, patient follow-up care, treatment side effects, and mortality rates from medical procedures, etc., the problem will continue, and many other people, like my cousin, will be killed. Name one such scientist who is member of the MCG delegation? A culture of data-driven accountability is the gaping hole in the medical system which remains unaddressed.
As early as in 2008, for example, when heart surgery was introduced in Guyana, I noted that it was welcome, but basic public health still leaves a lot to be desired (SN, August 12, 2008). At the time, I noted other aspects of public health – filth, urine, garbage in the streets, and the crime epidemic. If one is to look, one will see that the crime epidemic has not only continued, but it continues to hide the race of the victims and the perpetrators, defying all conventions of epidemiological data collection and dissemination, making it impossible to implement effective crime prevention programs. In terms of public health statistics, there are some signs of progress, but one also sees that since 2008 major problems remain. For example, cervical cancer is the most frequent cause of cancer deaths among Guyanese women, and comparatively, cervical cancer incidence and mortality rates in Guyana are almost twice the rates in Latin America and the Caribbean. It is also widely speculated that cervical cancer, incidence, prevalence, and deaths are heavily underreported in Guyana. In terms of share of the population, as examples, those with alcohol abuse disorders continue to rise, share of deaths due to heart disease continue to rise, and share of adults who are obese continue to rise. There is no data on medical errors or medical malpractice.