by MONACHORUM

I refer to your recent report regarding the sad loss of Baby Yok Shan’s left arm following an antibiotic infusion into the premature baby’s limb that went wrong.

Pictures and follow-up reports of the baby’s condition and arm were published nationwide. It was obvious that the left forearm was gangrenous with the margins showing features of acute infection.

As reported this could have been the result of an intravenous infusion that extravasated at the level of the elbow causing compartment syndrome, cutting off blood supply further down the forearm, giving rise to the gangrene and subsequent infection.

Alternatively, it could also be possible that the doctor who inserted the IV, could have done so directly into the brachial artery which is the main artery that supplies the forearm. An injection such as vancomycin into this artery could result in disastrous circumstances including obvious shut-off of blood supply and death of tissues that this artery supplies.

A remote and far more unusual way of inflicting infection would be to actually insert the IV needle intraosseously (into the bone) also at the level of the elbow which will result in infection of the bone or rarely pulmonary embolism transmitted via the marrow. Gangrene is an unusual occurrence.

It was reported that the findings of a committee formed to look into the mishap found that the gangrene was the result of an injection given by an unsupervised house-officer and a pediatrician who was consulted only by phone which is not unusual if the pediatrician had been on-call too frequently.

More relevant is the question of what was the house-officer doing with a neonate, and that too a premature one, in the first place? Was this baby managed in a neonatal unit and were there any qualified neonatogists in this hospital. If there were, it is not usual practice to have house-officers in a neonatal unit which are usually managed exclusively by neonatologists and medical officers and not by general pediatricians.

But if there were no neonatologists, why wasn’t this baby referred to the nearby University Hospital or any other neonatal unit?

Only last week the Health Minister growled that specialists should confine themselves to their specialties. By the Health Minister’s own logic why didn’t the pediatrician and hospital confine themselves to their areas of competence and specialties? A misfortune of this nature could perhaps then been avoided.

Today, news reports suggested that the baby was to undergo a two-hour surgery but this was clarified later when an orthopaedic surgeon stated that the procedure was over in ten minutes.

Now anyone dealing with controlled dry gangrene of limbs will tell you that auto-amputation of that body part will take place eventually without too much surgery.

Why this “sandiwara”? Fault-finding after an event is almost always a cinch but the Health Minister’s frequent application of double standards at various medical communities in this country should tutor him that in medicine, no one likes complications, mortality nor morbidity and that it can happen even if all precautions have been taken even in his own backyard which appears greatly in need of both administrative and professional help.

Frequently playing to the gallery at the expense of the stage must have its consequences as in this case if the baby’s young parents decide to sue.

The Minister seriously must now look into the quality of healthcare that his ministry is meting out onto many poor and sometimes ignorant patients.

Perhaps this Minister’s advisors should advise him to refrain from using the duty of care as a bargaining tool to gain political mileage as any benefits gained by him this way may be at the expense of someone’s life… ….. or arm.