Parents of NICU babies want NWRHA investigation report

ATTORNEYS representing the parents of babies who died at the Port of Spain General Hospital's (POSGH) neonatal intensive care unit (NICU) have filed a request under the Freedom of Information Act to get a copy of the North West Regional Health Authority's (NWRHA) internal investigation report into the deaths of the children.

In a letter sent to the NWRHA's attorneys Pollonais, Blanc, de la Bastide & Jacelon on July 21, Freedom Law Chambers requested a copy of the report along with six related documents.

These are copies of all statements taken relative to the investigation(s), copies of letters of appointment given to the investigators, a copy of the terms of reference of the said investigation(s), copies of the terms and conditions of appointment of investigators including the issue of remuneration, a copy of any disciplinary charges that have been preferred against any member of staff from the NWRHA from the POSGH as a result of the findings in the NWRHA’s and/or the PAHO investigation and the death of these babies, whether any disciplinary action will be taken against any member of staff and if so, what is the procedure and timeframe for same.

The letter cited an April 14 Newsday article where NWRHA CEO Anthony Blake said there would be full disclosure and transparency on the investigation.

"After receiving such public assurances from NWRHA’s CEO, our clients understandably anticipated that the NWRHA would fulfil its commitment to transparency and provide them with prompt access to the internal investigative report as promised."

However, it said the NWRHA's attorneys declined to release the report in a letter dated June 5. The attorneys said this was due to the several preaction protocol letters sent to the RHA.

"Upon receipt of your pre-action protocol letters, the investigation is now being done solely for the purposes of litigation and to allow our client to answer the allegations contained in your letters. Accordingly, on that basis, the investigation report will be a privileged document that will not be disclosed to you."

However, Freedom Law Chambers criticised this move as absurd saying the NWRHA retained a powerful battery of lawyers who would have no doubt been advising it from day one in this matter.

"We must therefore assume that when the CEO Mr. Blake gave these assurances that the investigative report would be disclosed, he did so, with proper legal advice."

It also argued Blake's statements along with those made by Minister of Health Terrence Deyalsingh assuring transparency created a legitimate expectation on the part of its clients and the public that this investigative report would be disclosed upon completion.

Apart from the CEO's public statements, Freedom Law Chambers argued the parents were entitled to the report given the Pan American Health Organization's (PAHO) investigation concluding the infants' deaths were due to nosocomial infection (an infection acquired at hospital).

This, it said, qualifies the deaths as an adverse event which, according to the NWRHA's policy entitles the clients to a copy. It also said that given PAHO's findings, it was clear there is "serious mismanagement and inefficiency in the NWRHA."

"The NWRHA is not therefore entitled to keep this report secret. The public is entitled to have full and frank disclosure of same. Our clients are likewise so entitled because they are concerned to ensure that the systematic deficiencies and gross incompetence that led to the death of these babies is publicly/properly addressed and remedied to prevent a recurrence."

The letter reiterated the clients were willing to settle the matter but only if the NWRHA admitted liability for negligence and wrongdoing. Seven babies died at the POSGH between April 2 and 9 due to bacterial infections, prompting the NWRHA to initiate an internal investigation and the Minister of Health commissioned an independent probe by a team of PAHO investigators.

The team comprised professor of paediatrics, global health and epidemiology at George Washington University in Washington DC, Dr Nalini Singh; clinical microbiologist and head of microbiology at Centro de Asistencia Medica Soriano in Uruguay, Dr Grisel Rodriguez; and newborn intensive care specialist and head of the Neonatal Care Intensive Unit at the Queen Elizabeth Hospital in Barbados, Dr Gillian Birchwood.

Laid in the House of Representatives on June 28, the PAHO report concluded the babies' deaths were due to poor infection prevention and control at the NICU. Among several shortcomings found, it rated the unit's precautionary measures at just 29 per cent.

Among PAHO's recommendations were for breast-feeding within 24 hours of birth, better hand hygiene, active screening of bacteria cultures during outbreaks, better nurse-patient ratios, policies and procedures for cleaning and for high-level disinfection and external performance evaluation of the laboratory.In the wake of the report, Deyalsingh raised several concerns about its contents and wrote to PAHO for clarification.

"Did you know that the head of NICU was not interviewed? Do you know that the chief of staff of PoS General Hospital was not interviewed? And as I said in my statement (in Parliament on June 28), many of the recommendations that they have for the medium- and long-term are already and have already been a part of our standard operating procedures," he said to reporters at a health fair on June 29.