More than a month after a patient attendant filed a complaint against the Jigme Dorji Wangchuck National Referral Hospital (JDWNRH) staff on duty for negligence, the hospital’s investigation stated that pulmonary embolus or cardiac arrest might have caused the death of the patient.

Findings of the investigation were shared with the complainant, the patient’s brother, through a letter signed by the hospital’s president, Lhab Dorji. The letter was drafted on May 31.

Bali Man Rana, 35, from Dagana’s Tshendagang gewog on April 11 had met with an accident where a log hit his stomach at the work place in Paro.

Paro hospital had referred the patient to JDWNRH on April 12, a day after the accident. The patient died around 3.30am, about eight hours after the surgery on April 13.  He was a carpenter.

The hospital stated, “The conclusions of the quality assurance and standardisation division investigation are that your brother’s death was unavoidable, sudden, and due to known complications of severe blunt force trauma to the abdomen. It is likely that pulmonary embolus or cardiac arrest may have caused the death.”

The hospital stated in the letter that the hospital staff did not continue with hourly monitoring of vital signs since the vital signs were stable and the surgery uncomplicated. The patient’s condition, according to the hospital, changed suddenly eight hours after the surgery and did not respond to resuscitation efforts.

“The vital signs – blood pressure, pulse rate, SPO2 – were all normal. The staff did not find any serious signs and symptoms that would require the patient to shift to the intensive care unit/high dependency care unit,” the hospital stated.

“We asked surgeons what, if anything, could have been done differently to prevent your brother’s death. None could identify any deficiencies in care at JDWNRH, nor any additional measures should have been implemented,” it added.

Jit Bdr Rana, the brother of the deceased, said he would pursue for actions against the doctor and nurses for alleged negligence.

Jit Bdr Rana said he was not satisfied with the findings and that he would appeal to a higher authority.

“When my brother’s condition was deteriorating, we requested the nurses on duty to call a doctor. Why didn’t the doctor come despite our repeated requests?” he said.

Such negligence, he said, would not only damage people’s trust in health professionals but also discourage people from taking medical services.

Jit Bdr Rana alleged that there could be possibilities of the investigation report being manipulated to protect the doctor and the nurses. He also said that the hospital has given contradicting statements. “On one hand, the investigation report states that the vital signs were normal. On the other, they say that the patient had little chance to survive,” he said.

He also questioned why the patient was not shifted to the intensive care unit when the patient’s condition was severe.

“All the nurses on duty had slept in a dark room. I had to use my cellphone’s torchlight to look for the nurses. I am so disheartened that the doctor didn’t come,” he said, addiig that no doctor came until he was breathing his last.

He added that the family could have done more if the hospital had informed about the severity of the patient’s condition.  “We found later that it was a major operation.”

The hospital informed Jit Bdr Rana that the patient was quickly diagnosed and emergency laparotomy surgery was performed followed by two units of red blood cells to treat his lost blood. However, the patient’s brother said that only a unit of blood was given.

The hospital claims that the patient’s medical record shows that the patient was closely monitored in the surgical ward for any worrisome signs after the surgery.

Paro hospital overlooked patient’s condition 

The deceased’s brother said that the patient could have survived had the doctor at Paro hospital understood the severity of the condition and referred the patient on time.

He said that the patient was first rushed to Paro hospital but the doctor returned the patient home after prescribing some medicines on April 11. The next morning, however, he suffered difficulty in passing stools and urine.

“The Paro hospital referred the patient to JDWNRH only after the family members requested the doctor there,” Jit Bdr Rana said.

The hospital president’s letter to Jit Bdr Rana, states, “Please understand that the injury caused by the log was very severe. Even with more rapid diagnosis and surgery, it cannot be said with certainty that the outcome would have been different because the injury was severe.”

The letter further states, “Your actions in getting your brother to the Paro and Thimphu hospitals after the unfortunate incident, and notifying health care professionals when you noted deterioration in his condition, were appropriate.”

Lhab Dorji told Kuensel that the investigation was carried out professionally and that Jit Bdr Rana can appeal if he is not satisfied.  He also said that the patient’s condition had worsened when he reached JDWNRH.

MB Subba