PHOTO: FILE
The committee's report, a copy of which is available with The Express Tribune, claims that the hospital had tampered with documents and failed to counsel the deceased's parents about her critical condition. It further states that the NMC was not registered with the SHCC at the time of the incident and was only registered later, on October 15, 2018. Even now, the report reveals, there is a lack of facilities, proper policies and training in the NMC emergency room (ER).
Stating that there was "clear evidence of misconduct…for not providing basic emergency care" to Amal, the committee imposed the maximum penalty of Rs500,000 on the hospital under Section 28(1) of the SHCC Act of 2013. It added that any chance of Amal's survival was negated by the NMC's actions that night.
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In January, a Supreme Court committee had held the NMC, Aman Foundation and the SHCC responsible for Amal's death. At the time, NMC had denied responsibility and SHCC had supported the hospital.
When the system failed Amal
On the night of the incident, Amal, her younger sister and parents were on their way to a concert when they stopped at a traffic light and a robber looted the family at gunpoint. After the robber moved on to a car behind them, while they were waiting for the signal to turn green, a gunshot hit Amal in the head. The bullet that hit Amal was fired by a policeman attempting to kill the bandit. The family rushed to the nearest hospital - NMC - where they were told by the doctor on duty to take the child to either Jinnah Postgraduate Medical Centre or Aga Khan University Hospital.
The hospital, according to the parents, refused to help with calling an ambulance. It also turned down the parents' request to let them take or show them how to operate the ambu bag given to Amal to pump oxygen manually while she reached another hospital. The parents had also requested to be accompanied by a staff member for assistance to transfer Amal to another hospital. This too was denied.
Meanwhile, an Aman Foundation representative refused to send an ambulance till "arrangements were made" at Jinnah hospital. By the time an ambulance was finally arranged, it was too late. Amal had already passed away for want of emergency medical aid.
Failure to provide first aid
According to the SHCC report, despite her records indicating that she was in dire need of cardiopulmonary resuscitation (CPR) and ventilator support, neither of these was provided; no emergency consultant or neurosurgeon was called either. The report adds that no X-rays were taken and no blood arranged for the patient.
Not only did the NMC fail to provide first aid, its refusal to send a paramedic with Amal to another hospital also violated the Sindh Injured Persons (Medical Aid) Act (SIPMA) of 2014, states the report. Hospital staff further failed to inform her parents that Amal needed a ventilator; the parents were only told this when the Aman Foundation operation said they had to make arrangements for it themselves before shifting her.
Discrepancies
A number of statistics were missing in the NMC's records for Amal, such as her blood pressure and pulse reading, despite being noted by the doctor on duty. Even her gender was noted down incorrectly on her electrocardiogram report.
There were also clear discrepancies in the hospital's timeline of the events that occurred that night. The admission form, for example, states the time of arrival as 10:10pm, while Amal had reportedly been brought to the hospital before that. The time of death on the hospital death certificate is also given as 10:10pm, in an apparent attempt to show that she had passed away before arriving at the NMC. The report notes that the doctor on duty, in his statement, said Amal passed away at 10:45pm.
According to the report, video footage of the ER that night was not saved by the NMC administration; there is no CCTV in the minor operating theatre.
Lack of facilities
Even after the life of a young girl was lost in the NMC emergency room, it appears many flaws still remain in its operations.
Although an estimated 300 patients are treated there every day, the ER has only eight beds - a number deemed 'unrealistic' for this volume of patients by the SHCC committee.
According to the report, there is no ventilator in the ER or the minor operating theatre. The crash cart, which is meant to carry medicine and equipment for emergency resuscitations, is not properly maintained, with some vital equipment being improperly packaged.
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More worryingly, rusted, unclean instruments were found in packages of 'sterile' equipment, with staff unsure about when they expired. Fluctuating temperatures in the refrigerator also means that medications that need to be kept at a certain temperature are compromised.
The SHCC claims that some of NMC's ER staff are also insufficiently qualified, including even community midwives. There is also no code blue team to deal with patient emergencies, and no written policy regarding resuscitation or medico-legal cases.
New rules
In the wake of the tragic incident, the Amal Umer Bill - the Sindh Injured Persons' Compulsory Medical Treatment Bill - was passed by the Sindh Assembly, making it mandatory for all hospitals to provide medical aid and treatment to any injured person without waiting for 'medico-legal formalities.' The bill also required hospitals to have and maintain at least two fully equipped and functioning ambulances stationed at their premises at all times.
The provincial government had previously passed the SIMPA Bill in 2014 to mandate the treatment of all patients without waiting for police clearance, but failure to implement it meant that it did not have the desired effects.
Published in The Express Tribune, December 17th, 2019.
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