by AHMAD SOBRI

I read with anguish the recent death of Madam Yek Yow Ngan, 51, a marketing executive at the Nanyang Siang Pau. Madam Yek was apparently involved in a car accident on Sunday morning, 27th May at about 3am at the 8th mile Puchong Road and was subsequently surrounded by a group of men with parangs and iron rods.

She was rushed to the Assunta Hospital where she was admitted at 4.10 am by her son, Allan Yeong Hon, with multiple injuries and in a state of coma.

Active resuscitation was apparently carried out at the emergency unit at the Assunta by the nurses and doctor there including intubation and infusion of 4 units of blood. Her condition stabilized at about 5am.

She was subsequently wheeled in for CT scans and X-rays and was being transferred to the ICU when the question of costs arose.

The son, apparently unable to afford the charges, requested for a transfer to a government hospital.

She was subsequently transferred by ambulance at 5.45am in a “stable condition” to the General Hospital, Kuala Lumpur when there was no response from the nearby University Hospital. She arrived at 6.10am. She however died 3 hours later at the GHKL at 9.40am, Monday morning 28th May.

Her distraught family, unhappy with the medical turn of events, complained to the Ministry of Health. The Health Minister has seemingly absolved Assunta Hospital, saying that the Hospital had followed proper procedures.

He further clarified that since emergency treatment had been rendered before the question of payment arose, “the hospital had done nothing wrong” and this he deemed was fair. These events were apparently further confirmed by officers of his “medical practices” division which concurred with him.

There are two pertinent issues here, as in almost every emergency case reported in the media.

The first is scene time, so critical in emergency responses, and this; the victim’s son has appeared to have done well by rushing her to a hospital in less then an hour. In fact, he is quoted as saying, “”We sent her to Assunta Hospital as it was the nearest hospital from the scene of the accident”. Certainly he appears to have brought her to the appropriate hospital.

The second, more contentious issue, is the question of funding.

It must be emphasized that trauma and emergency victims frequently brought to private hospitals but later turned away or transferred out has never been about the absence of emergency and definitive treatment but in fact has always been a question of funding.

Who funds this treatment? Private Hospitals are on their own and as in New Zealand recently, risk having their electricity cut if they don’t pay their TNB bills. There is no bail out here.

Madam Yek required 4 units of blood, meaning she could have been bleeding actively and definitive treatment in the form of surgery could have been urgently required.

There are today time bars for trauma victims and patients with acute coronary syndromes (heart attacks) where response time needs to be less then 60 minutes and 90 minutes respectively.

In fact, in patients with severe trauma, this “golden hour” may even be as short as 15 minutes before certain factors set in that may make the shock irreversible. Strategies such as “Damage Control Surgery” (DCS) are currently employed where trauma surgeons frequently operate on patients just to stop the bleeding first for fear patients exsanguinate.

It is also as a result of this “time-bar” to treat these life-threatening conditions that Tony Blair recently authorized the upgrading of emergency units in the NHS at significant costs.

Sadly though, for Madam Yek, while the haggling, arguing and bargaining was being carried out, her 60 minutes was running out and with it her life was slowly slipping away from her.

The Assunta Hospital certainly knows the consequences of delayed definitive treatment for patients in hypovolemic shock but chose to stall after administering emergency treatment knowing very well that there could be dire consequences.

As for the MOH, it must now realize that no amount of regulations nor Acts of parliament is going to bring back Madam Yeh’s “golden hour”.

In fact all these rules being enforced by it’s so called” medical practices division” is a charade, clearly missing the wood for the trees.

The MOH has to solve this problem of funding for emergency patients especially when the appropriate hospital is a private one and patients are locked into this time bar.

The MOH must realize that real hard work is required in determing a minimum fee schedule for patients stuck in this limbo. The State cannot wish this one away as the Will of God especially since Malaysians today have seen the colossal waste that is going on in almost every Ministry.

A billion ringgit can save a 100,000 patients at RM10,000/- per patient. Whatever happened to the public funds donated that were placed in the Ministry’s Trust?

The Ministry should forget about all its grandiose telemedicine projects, questionable traditional medical schemes and unnecessary Acts and solve real problems such as first responders, pre-hospital care, ambulance services, health economics, health prevention and education.

These real life and death problems are the ones doctors, nurses, patients and hospitals face everyday.

Madam Yek was brought to the nearest appropriate hospital alive but for reasons of finance was transferred to another hospital after a time lag of two hours which may have led to her death.

Both the Ministry of Health and Assunta, in their frantic attempts to clear each other of all blame, appear to have forgotten a very important detail in the death of this unfortunate lady — it is called conscience, something no qualifying examination is ever going to teach you and a quality which appears to be in short supply both at the Ministry of Health and Assunta Hospital.