Deyalsingh slams PAHO probe into NICU deaths

HEALTH MINISTER Terrence Deyalsingh is criticising the Pan American Health Organisation  (PAHO) for its procedures in the investigation into the death of seven babies as its report on the Neonatal Intensive Care Unit (NICU) at the Port of Spain General Hospital was released on June 21.

In a release on April 11, the NWRHA confirmed that seven babies died at the Port of Spain NICU between April 4 and 9.

The PAHO team that compiled the report included 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.

The report said the babies deaths were linked to poor infection prevention and control and listed several recommendations including monitoring of donning and doffing procedures for PPE and contact precautions, and sterile unit dose preparation of all NICU medications by pharmacy.

Speaking at a Health Fair hosted by the North West Regional Health Authority at the Mt Hope/Mt Lambert Community Centre on June 29, Deyalsingh said there were many parameters in which the Port of Spain General Hospital scored 80 - 100 per cent.

He said there were areas of concern the ministry had to raise with PAHO that the organisation had to address.

“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 although the PAHO report pointed it out, no one was paying attention to the fact many of the babies were “severely” premature and underweight, which posed many challenges.

Deyalsingh said the ministry will host a press conference next week to respond to various issues raised by the Opposition, the media and members of the public.

Meanwhile, the Trinidad and Tobago Registered Nurses Association (TTRNA) president, Idi Stuart, said while the report was not all bad, the unit still fell short and if international standards were enforced in Trinidad and Tobago, there would be no NICU departments in the country.

He said, in general, when the hospitals knew the minister or other authorities were to visit, there would be mass cleaning exercises, the best bed sheets were applied and the wards were properly staffed so it was possible the minister would not be aware of how wards were usually run.

With that I mind, he said although the unit had days to prepare for PAHO’s visit, it still could not hide the deficiencies and fell short of the mark.

He pointed out several of the recommendations in the report were suggested by the TTRNA back in April when the matter was first addressed. These included a minimum of 150 square feet between cots or incubators and the implementation of a one-on-one nurse to patient ratio.

Stuart expressed fear the ministry would trivialise PAHO’s report and neglect fixing the issues.

“Yes, we have a lot of policy. However, when PAHO looked at the implementation of those policies, several deficiencies were pointed out. From example, simple scenarios like having hand-free sanitiser stations were not present.

“We have about 50-70 per cent of the policies we ought to have in the health facilities, and it’s not limited to the NICU, but due to the fact there is no external oversight body to the Ministry of Heath to consistently monitor standards within the health facilities, it allows for the management of the regional health authorities to decide for themselves what they would implement as opposed to what they don’t see as important or they don’t have the money to do right now.”

Stuart said a former PNM Health Minister stated their intention to lay a bill to set up a Health Sector Accreditation Council in Parliament in 2007 and former Health Minister Fuad Khan introduced The National Health Services Accreditation Authority Bill, 2013 to establish a National Health Services Accreditation Authority of Trinidad and Tobago in April 2013 but it lapsed.

“We (the association) place the tragic deaths of those babies at the feet of the individual who fails to bring that bill to parliament and establish the necessary council.

“So if months pass and the Minister of Health does not signal his intention to bring that bill back to Parliament, then the Minister of Health would have failed in his duty.”

He added that the association was calling in the government to start negotiations to update the current 2013 salary and encourage nurses to remain and work in Trinidad and Tobago rather than migrating to make a decent living.

Former attorney general Anand Ramlogan SC and his team from Freedom Law Chambers are representing the families of the seven babies who died at the NICU between April 4 and 7. They have initiated legal action against the North West Regional Health Authority (NWRHA).