HYDERABAD: A second inquiry into the death on July 29 of a patient with a pierced iron rod at Liaquat University Hospital has found that doctors in the casualty department were not formally trained to handle such case and failed to activate multidisciplinary approach as per hospital protocol due to communication gap.

The inquiry conducted by a committee, which was formed by LUMHS vice chancellor Prof Dr Ikram Din Ujjan on July 30, recommended improving communication between hospital’s departments and specialists.

35-year-old Ayub Qureshi, a mason, died in surgical operation theatre after he was brought with a pierced rod in his back. He died apparently from profuse bleeding and inattention at the hospital.

Initially, Hyderabad deputy commissioner had formed a committee headed by District Health Office (DHO) Dr Lala Jaffar but it failed to gather substantive findings because LUMHS’s faculty did not appear before the committee.

The second committee concluded its findings and submitted the report about a week ago. It noted although since the patient’s arrival he was continuously observed and vigilantly managed by the hospital administration, doctors and paramedical staff but despite their efforts he did not survive.

It said that the committee had found some important limitations in this particular incident. “Due to prone position of patient with an unusual impalement injury, exact location of the exit wound could not be ascertained,” it said. Besides, duty doctors tried to immediately shift the patient to operation theatre due to the presence of an irritated mob, it said.

It found the casualty department lacked security with limited number of security guards, who were unable to control the mob of over 100 people. There was also communication gap as a formal written call was not sent to activate multidisciplinary approach, it said.

Doctors at the casualty contended that because of severity of the injury and presence of agitated mob they were unable to send the written call because it would have caused delay, hence they informed through WhatsApp and mobile phone call the focal person of thoracic surgery team, said the report.

It said that thoracic surgeon had reached the operation theatre for emergency surgery at 3.40pm and the patient was vitally stable till then but due to possible involvement of major neck vessels, the surgeon Dr Khalil Ahmed Shaikh abstained from intervening as “in absence of vascular surgeon” he feared certain mortality. Other important limitation pertained to human resource, said the report.

In addition, the “doctors working in the casualty were not formally trained,” it said and added only one thoracic surgeon was appointed in the hospital/university. The patient could not be shifted into the ambulance properly as it might have led to movement of iron rod, causing massive bleeding due to termination of tamponade effect from suspected vascular surgery.

“The OT staff… said they were unable to reach the patient for shifting him properly as he was surrounded by an agitated mob,” said the report.

The committee recommended regular training of doctors and paramedical staff at the casualty department to avoid such incidents in future. Proper and stronger security measures should be implemented to manage agitated crowd, which could hinder work and healthcare providers, it said.

It said the hospital should have a specialized trauma team (multidisciplinary) that could be immediately mobilised in case of such complex injuries and it should be ensured that necessary resources were readily available in emergency and surgical departments.

There was dire need of improvement in communication between departments and specialists. “Doctors should be educated in communication skills, specially with patients’ attendants and dealing with mob in such situation,” it suggested.

It said that guidelines should be defined about “safe transfer of patient” and recommended that emergency surgical OT facility in terms of human resources and equipment must be appropriate as per requirement of a tertiary-care hospital.

The committee noted that attendants of deceased initially declined to give ‘high risk consent’. The situation remained tense as a mob was there and using abusive language. “High risk consent was obtained later,” it said.

Dr Khalil noticed, on close examination, that the rod was exiting from the neck and he did not find himself “appropriately trained” to deal with such case as the injury involved major neck vessels and a vascular surgeon was needed to deal with the injury.

When the patient was being moved into the ambulance, the rod was accidently dislodged slightly and the patient started to collapse because of massive blood loss due to suspected vascular injuries. He was again shifted back to the OT but the attempt remained unsuccessful and the patient expired, said the report.

Published in Dawn, October 10th, 2024