Last update: 29-Jul-2014 7:06 am
Tuesday, July 29, 2014
Trinidad & Tobago Guardian Online
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Horror brain surgery
A routine surgery to insert a shunt to drain cerebrospinal fluid from the brain of Agatha Colina has left the 61-year-old woman horribly scared, unable to move her limbs, eat or swallow, her family claims. Colina’s daughter, Roxanne Lawrence-Owen, is now demanding answers and justice from authorities at the Eric Williams Medical Sciences Complex, Mt Hope.
She told the T&T Guardian that her mother now cannot respond to instructions or voices and her throat has to be regularly suctioned as it continually builds up with mucus which could choke her. Lawrence-Owen said while her mother was hospitalised she developed a sacral ulcer on her lower back, the size of a fist. The flesh around the ulcer rotted and it was so deep you could see Colina’s bone.
In an interview with the T&T Guardian, Lawrence-Owen said a formal complaint was made to the hospital on April 23 and the family is now contemplating hiring an attorney. In recounting the events, Lawrence-Owen said her mother was diagnosed with a brain tumour and admitted to the hospital on January 25. Three days later it was removed. Lawrence-Owen said her mother recovered well and when she came out of the anaesthetic she was laughing and chatting with family members.
But a few days later it was discovered the spinal fluid was not drying up and was preventing the incision point from healing. “Her doctor was concerned about her getting an infection and strongly advised that a shunt be installed to divert the fluid from the wound.
“Mom continued to improve and even started physiotherapy to start walking, except for the leak of spinal fluid. After observing her for about a week, there was no improvement in the leak and we were advised the procedure to install the shunt would be done on February 8,” Lawrence-Owen said. She said the family was told this was not a high risk procedure and was considered routine. The surgery, which was approximately two hours, was done on February 16.
“We arrived at the hospital after 4 pm for visiting hours. We were very surprised to find her unresponsive and very different from the major surgery she did a week ago,” Lawrence-Owen said. “Her doctor was contacted to find out if anything occurred during surgery that was causing her lack of response and we were told no. “After further probing we were told that another doctor had done the procedure. We weren’t happy about this and would have preferred to have been notified about this decision.”
She said a CT scan was done to determine if the shunt was installed correctly and if there was anything visible that was causing the lack of response. The family was then told nothing was wrong, but the cause of Colina’s unresponsiveness remained undetermined. Lawrence-Owen said her mother’s bed was moved closer to the nursing station so she could be kept under closer observation. She said February 16 the doctor was again told Colina was still not responding.
“He said he would be putting her on a high dose of intravenous antibiotics because this was a risk with fluid leak. I indicated that there was an obvious rapid decline in her condition and he said that the drain is causing low pressure in her head,” Lawrence-Owen said. She said on February 21 when she went to drop off clothes for her mother, she noticed she was shaking as if getting a seizure. She said the right side of her mouth had drooped and her right hand was “turning in.”
“The doctor on the ward told me they had given her anti-seizure drugs and would start her on Dilantin to prevent further occurrences,” Lawrence-Owen said. Four days later the family was told Colina had a stroke which left her unable to speak and swallow. A nasal gastric tube was also installed.
Lawrence-Owen said her mother regularly experienced spikes of high fever during this period and was given antibiotics. She added wet cotton rolls were placed under her arm and a fan was put directly on her during this period. “On March 5, we requested mom to be taken off all the meds because she seemed to not be responding to them,” she said.
“The doctor advised that she appeared to be septic and that tests would have to be done to confirm. All antibiotics were stopped on March 6 and the doctor then said she was not septic. “She still had the shunt in at this time but this was removed on March 7. When we visited her the next day she appeared slightly better but looked as if she was still experiencing seizures. I asked the doctor check the catheter and for bed sores.”
Lawrence-Owen said on March 19 when she went to the hospital she noticed her mother was still on antibiotics. She was told this was because of the high temperature spikes. She said her mother also appeared to have an eye infection.
“Our family visited every day and would regularly inquire about her condition from the nurses. They were never able to provide an update and would refer us to her doctor,” Lawrence-Owen said. “We also asked about whether she had gotten any bed sores and were told that this was expected because she is not moving on her own. I notified the doctor her eyes were red again and asked if the infection returned.
“I also noticed she was receiving antibiotics and asked whether it was due to her eye being infected. That was when I was told she had a sacral ulcer.” She said when she asked whether it was bad she was told it was the size of a fist and despite asking to see it she was refused. On many occasions, Lawrence-Owen claimed her mother’s bed and side table were overrun by ants. Another time, she added, she told a nurse a silver container used to give her mother water was dirty and needed washing.
“I volunteered to wash it because the nurse said she was too busy. I took some liquid soap and a wipe and washed it. The inside of the metal container had mildew growing on the inside of the cover,” Lawrence-Owen claimed. The family then decided to remove Colina from the hospital.
Just before Colina was taken to a geriatric home, Lawrence-Owen said she asked that the nasal gastric tube, catheter and dressings be changed. “The catheter was changed but we noticed the tube was not and there were also sediments inside. We were told by the nurse the doctor examined it and advised it was fine,” she said.
“Although we were upset, we just acknowledged the doctor’s recommendation. When we were cleaning her face we turned her face and noticed the bandage on her right ear was soaked and that her ear was oozing liquid onto the pillow.” Lawrence-Owen said when she asked that the bandage be changed the nurse insisted it was already done. It was only after she protested this was done. When Colina was taken to the home, Lawrence-Owen claimed that it took some four hours for her to be properly cleaned.
On seeing the ulcer for the first time, Lawrence-Owen said, "The owner of the home insisted I see it for myself because it was difficult for her to explain the condition of it. When she removed the bed pad I almost fell to the ground when I saw the ulcer,” Lawrence-Owen said. “It was down to her bone, which was already rotting by the obvious blackened appearance." She said when she called the doctor at the hospital the family was told it was a month old.
"We have spoken to two doctors and four nurses, who said an ulcer of this magnitude and condition had to be older than that. We had a doctor go by the home to change the tube and when it was removed, the end was dark brown to black, which indicated it was inside for a long time,” Lawrence-Owen said.
"He was also asked to remove the bandages on both ears. When removed pieces of her ear came off with the bandage, which meant they were not at all changed," Lawrence-Owen said. Apart from paying for the home, she said the family has had to pay $150 per visit for a nurse to apply special dressing, including a medical gauze, to the ulcer.
Contacted on the matter, chairman of the North Central Regional Help Authority (NCRHA), Dr Shehenaz Mohammed said, on Friday, the general manager of nursing and the hospital's chief executive officer had been notified of the case. But she urged people who had complaints about treatment at the hospital to immediately lodge complaints. "I am pleading with the public that anytime they believe they are unjustly treated, there is a process for complaints to be lodged," Mohammed said.
She said a Patient’s Complaints Bureau would be set up at the hospital to ensure complaints were speedily processed. The bureau, Mohammed added, would be fully resourced and run by quality customer relations officers who would have direct contact with the relevant authorities.
Sacral ulcers, also known as decubitis ulcers, are changes in the body’s blood supply as it flows to the dermal tissue. This in turn will cause that area of the skin to break down, forming red welts, blisters and open sores. The sacrum is located at the base of the spine, in the tailbone. When this area has too much pressure sacral ulcers will appear, resembling blisters and/or crater-like wounds.
Along with too much pressure applied to the skin, sacral ulcers can be caused by malnutrition or dehydration, by staying in bed for too long without movement, urinary incontinence and certain diseases such as diabetes or a vascular disease.
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