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Wednesday, December 11, 2013
Trinidad & Tobago Guardian Online
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Safety plan for PoS hospital surfaces
Confusion surrounds the existence of a detailed brief to improve the safety of the Central Block of the Port-of-Spain General Hospital. Local architect Geoffrey MacLean is insisting he did provide such a plan to the North West Regional Health Authority’s (NWRHA) chief executive officer, Judith Ramoutar, while Ramoutar, however, has strongly denied any knowledge of MacLean and of the plan.
A brief is Stage A of the Trinidad and Tobago Institute of Architects Conditions of Engagement. The hospital’s Central Block was described as a disaster waiting to happen in a 2009 report conducted by the Pan American Health Organisation (PAHO). MacLean also is insisting he is still owed a substantial amount of money by the NWRHA as his work continues to gather dust on the shelves even though Ramoutar gave the green light to MacLean to go ahead with the plan.
Two weeks ago, during a tour of the hospital, Health Minister Fuad Khan lamented to the media: “Believe it or not we never had a plan of the hospital. That’s what we are trying to establish now and we are working on improving the safety of the hospital.” When questioned subsequently about MacLean’s plan, Khan, however, said no such plan was submitted personally to him, adding if there was one in existence, as Health Minister, he should have been furnished with a copy.
Ramoutar was also present during the tour of the hospital. In an interview, MacLean insisted he did in fact meet with Ramoutar on at least two occasions adding: “I was called to a meeting at which Ms Ramoutar was present and I was asked to assist in developing a planning strategy—in other words a detailed brief—for a new wing to improve and replace the accommodation of the existing main building which is the building of main concern.
“If a woman can attend a meeting and then say she has no knowledge of it then something is definitely wrong with her.” MacLean’s concerns regarding the stability of the hospital’s Central Block has been supported in a report conducted by the Pan American Health Organisation (PAHO) in 2009 which investigated the safety of hospitals buildings entitled, “Safe Hospital Index Report” and identified the Central Block as the most at risk for a disaster, specifically an earthquake.
MacLean said the matter was brought to the attention of the Ministry of Health since 2009. A copy of the MacLean’s plan was obtained by the T&T Guardian and senior officials of the NWRHA have acknowledged receiving the plan and holding meetings with MacLean. According to MacLean, his concerns about the safety of the hospital were first sent to the Ministry of Health on October 4, 2010.
A statement also was submitted to the office of Disaster Preparedness and Management (ODPM) which officials said was acknowledged and also forwarded to the Health Ministry. On June 15, 2011, concerns of the hospital were also submitted to Port-of-Spain mayor Louis Lee Sing. MacLean also insisted that on September 26, 2011 he met with Ramoutar to “discuss scope of work to replace the existing main block of the hospital with a new block in the southeast corner of the site.”
He then met with engineers the following day and on October 5, 2011 he submitted a letter to Ramoutar confirming the proposed plan. “We submitted the following proposal to prepare a detailed study and a brief for a new medical wing, south of the existing operating theatre building,” MacLean wrote in a proposal. He said in terms of his involvement, he discussed the “necessity” of addressing the problem and offered his assistance in preparing a detailed brief in preparation for possible tenders.
“In addition, independent engineers were invited by me to assess the situation and provide advice on options,” MacLean added.
The brief included general accommodation requirements over six floors;
• G round Floor:
Food court, lounges, locker/changing rooms for approximately 300 people. It was also noted that the hospital would be staffed by approximately 1,000 people at one time;
• First Floor:
Intensive Care Unit, Coronary Care Unit, Burn Unit and generally acute cases;
• Second Floor:
Orthopaedic Unit, neurosurgery, eye care and Critical Surgical Ward;
• Third Floor:
General surgery, urology and plastic surgery
• Fourth Floor:
Medical wards, lecture theatre, two small lecture theatres; and
• Penthouse Floor:
Library and amphitheatre. Each floor was also to include four doctor’s offices and shared secretary and office for a nursing supervisor. Nurses lounges and kitchens were also to be provided in appropriate areas on each floor. Ramoutar, in a letter, was also told of the urgent need which must be made a mandate to reduce the risk of mortality and morbidity if any major disaster was to occur.
$6.3m relocation plan
Ramoutar also was provided with a detailed document titled: “Relocation of patients from the Central Block”, identifying various steps to be taken and proposed remedial works to be done at a cost of $6,323,350. The relocation or decanting proposal was presented to her during a meeting on September 22, 2011 at the hospital in the conference room, it was stated.
It included among others, Alfred Arthur, project manager, Raees Patel, facilities manager and health and safety officers Jankiepersad Ramoutar and Devika Motilal. The objective was identified as “Disaster Risk Reduction”. The document stated: “Based on the PAHO Safe hospital Index Report, certain red flags were raised re: the structural integrity of the Central Block.
“The report stated that the Central Block should be evaluated. In order to achieve this, a team, has been selected to formulate and oversee the execution of a contingency plan to reduce the level of occupancy in this area.” The goals were outlined as:
• Reduce the level of occupancy and activities in the Central Block; and
• minimise the loss of lives and limbs
The methodology was to relocate patients from the Central Block to other areas within the North West Regional Health Authority buildings.
Arising out of the meeting it was suggested that the following areas be marked for relocation:
• Ward One (gynaecological);
• Ward 42 (gynaecological);
• Ward 16 (ophthalmology);
• gastroenterology, Ward 52 and haematology, Ward 44;
• Ward 3, Physiotherapy Department;
• Ward 17, social cases;
• Ward 13, 14, 41, Orthopaedic Wards;
• Operating facility; and
• Expand clinic areas to accommodate day care services.
The decanting plan, according to an NWRHA official, was to lower the occupancy of the Central Block with the objective being to prevent loss of lives in the event of an adverse occurrence. The first strategy was to examine the availability of space in the North Block and in the Maternity Building of the hospital. The official explained: “Ward 17 was earmarked for the Maternity Bbuilding and physiotherapy services were to go to the St James Medical Complex.
“Ward 42 of the Central Bblock was scheduled for the Maternity Building in Ward 201. Ward 13, 14 and 41 from the Central Block was to go to the former male and female Psychiatric Ward at the St James Medical Complex.” Other NWRHA officials said the proposal was put into effect but the work was halted and in some cases “reversed.”
Hospital at risk — PAHO
PAHO’s 2009 report investigating the safety of hospital buildings entitled, “Safe Hospital Index Report”, identified the Central Block of the Port-of-Spain General Hospital as the most risk for a disaster, specifically an earthquake. MacLean said: “For nearly two decades engineers with a knowledge of the fundamentals of an earthquake-resistant design who have visited the Port-of-Spain General Hospital have been commenting on the clearly and seriously vulnerable concepts of the six-storey main Central Block.
“It is understood that this was brought to the attention of the authorities as long as the early 1990s and on several subsequent occasions.” He cited the reasons as manifest because they have to do with the fundamental geometrical characteristics of the Central Block.
“Some of these are the “soft” first storey (more flexible than the ones above it); the absence of longitudinal beams on the inner grids of columns which can be in the under croft (only the two outer grids have beams); the column sizes and the distress to several of them; the lack of plan symmetry brought about by the off-set vertical circulation areas (elevators and stairs); and the widths of expansion joints,” MacLean wrote.
He noted it was also evident that at least three of the main column supports on the ground floor were showing signs of distress “appearing to be compressed at the bases by the gravity loads of the building.” These points of weakness, MacLean added, would further compromise the stability of the structure during an earthquake. “The concrete has spalled to expose reinforcing stirrups that appear to be more widely spaced than one would expect for a structure of this nature,” MacLean noted.
To compound the problem, he said, was the fact that oxygen tanks were located “dangerously close” to the Central Block. Saying that all of these features were noticeable to any private visitor, MacLean described the situation as “urgent.”
MacLean’s brief never brought to me—Khan
Questioned whether he had knowledge of MacLean, Khan said: “I can’t recall. Maybe if I see him.” He said, however, that the relocation of patients from Central Block already had begun.
Ramoutar: Who is Geoffrey MacLean?
Ramoutar blatantly denied she knew or ever met MacLean when contacted. When told of MacLean’s plans and his meetings with the NWRHA, Ramoutar immediately distanced herself saying: “I have no knowledge of Geoffrey MacLean. I do not know who Geoffrey MacLean is, I have never met him and he was never contracted to do work for the NWRHA. Is this a story about Geoffrey MacLean?” She further stated that if in fact MacLean did any work for the NWRHA he must present a bill of purchase to verify such claims.
PAHO’s findings on structural safety Concerns were noted particularly in respect of:
• Communication system;
• location and anchoring of medical gas tank;
• securing of shelving and computer equipment;
• condition of safety of doors and entrances;
• condition and safety of windows;
• condition and safety of roofing;
• condition and safety of fire protection system;
• condition and safety of floor coverings;
• hospital access routes; and
• emergency signage.
“Generally the structural condition of the buildings was very poor and urgent remedial action is recommended. “Of particular concern are the Central Block and the association building housing the operating theatres and central sterile supplies department,” the report cited.
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