The bed shortage at the San Fernando General Hospital has taken a new twist with doctors accusing medical director, Dr Anand Chatoorgoon, of sending critically ill patients home to die in order to free up bed space. Some doctors have objected to the proposal outlined by Chatoorgoon in a letter to Health Minister Dr Fuad Khan to stop housing patients awaiting haemodialysis.
Chatoorgoon’s colleagues say his letter, advocating the need to reserve hospital beds for patients “with reversible, salvageable pathology,” is tantamount to playing God. “He is making a decision who should live and who should die. People would do all they can to ensure the survival of their loved ones,” one doctor said. They are also upset that Khan has agreed to the “practical suggestion.”
But Khan and Chatoorgoon see a need to free up scarce beds for new patients who have a chance of recovery. In the e-mail exchanges about the patients requiring haemodialysis, Chatoorgoon wrote: “I do not mean to sound uncompassionate but in my respectful view they should be sent home and not be kept here at the SFGH at expense cost to the SWRHA while waiting haemodialysis.” He said “beds are at a premium here at the SFGH where overcrowding haunts us night and day.”
So, he suggested, until arrangements were made for such patients with the social worker, “we send them home.” “Some of them may well be able to afford one or two haemodialyses on their own per month,” he said, pointing out those who can't do so can return to the SFGH which would then find a slot to haemodialyse them and send them home.
What some other doctors are frowning upon is Chatoorgoon’s written suggestion that “death is a graduation, a promotion, says my Lord, Fuad, and there comes a time when we have to allow patients to die, for death is inevitable. “And so, I seek your blessings and permission to send home those patients who require haemodialysis as opposed to keeping them here at the SFGH and awaiting an available slot to fit them in.
“Some of these patients have been here with us for weeks and I want to put a stop to that. I am not being uncaring and uncompassionate but we need the beds for patients with reversible, salvageable pathology until some such time that we can have more beds to accommodate the end-stage-renal-failure patients.” In another letter to Khan, Chatoorgoon pointed out, “Ethical issues, such as this one is, have become the order of the day for medical institutions across the world.
“Life is about choices and bearing in mind how expensive the practice of medicine has become and bearing in mind the global economic recession, medical practitioners and administrators are now forced to make ethical decisions and choices, no matter how painful that may be.”
What Fuad said
In an e-mail response to questions from the T&T Guardian, yesterday, Khan, who is out of the country, agreed that while there was a great need to treat acutely ill patients, “the chronic dialysis patients can be dialysed as outpatients. They can come into the hospital and have their dialysis on their days or otherwise. “Keeping them there just to hold them and deny new patients who are ill a bed seems unfair to the new patients.”
Khan said: ” Dr Chatoorgoon has indicated a practical approach. This will allow more patients to be treated. Those who complain against this may be the ones responsible for having the patients who are ill and new admissions sit on corridor chairs and trolley or go to private institutions where they benefit. Dr Chatoorgoon is trying to avoid that happening.”
Chatoorgoon speaks
Responding to the criticisms of his colleagues, Chatoorgoon said the approach had to do with solving the overcrowding problem at the hospital rather than have patients waiting on benches, trolleys and chairs for an available bed. “For many years now, overcrowding has been and continues to be a great challenge at the SFGH, which has only approximately 650 beds and which serves a catchment area of 600,000 people.
“It is hoped that with the availability of the San Fernando Teaching Hospital at Chancery Lane in the not-too-distant future, more beds will become available for those patients who seek medical care at the SFGH. “In the meantime, the South-West Regional Health Authority (SWRHA) has embarked on a series of initiatives with the intention of making beds available for patients who genuinely need hospital admission.”
He said those initiatives included accommodating patients at the Point Fortin Area Hospital, fast-tracking radiological and haematological investigations to minimise the stay of patients at the SFGH and making alternative arrangements for patients with irreversible pathology to be looked after at home with assistance from the district health nurses and doctors attached to the nearest health centers.
The challenge, however, Chatoorgoon specified, was that “many of our patients with end-stage kidney disease or with terminal cancer but who are fully conscious do not want to leave the hospital for fear of dying at home. “All of these patients have what we call comorbidities which means other life-threatening conditions, such as severe heart disease or severe diabetes or severe hypertension, and so they want to stay at the SFGH where they can be treated in the event that any complication sets in.
“With the development of intensive care units, high dependency units, modern drugs and equipment to prolong life, families, relatives and friends too are reluctant to take these patients home. “If we are not careful and wise, the hospital could soon be filled up with cases such as these, thereby denying beds for patients with treatable and reversible illnesses who can benefit from being in the hospital.”
What the CEO said
CEO of the South West Regional Health Authority Anil Gosine said even though the hospital had 11 dialysis chairs and operated six days a week, it still lacked the capacity to deal with the number of patients needing dialysis. Gosine said there was a steady intake of patients with approximately 60 new patients being treated every six months and 25-30 patients being treated at home. The hospital provides both haemodialysis (renal) as well as peritoneal dialysis treatment.
The Nephrology Unit is to be relocated to a dedicated, bigger space to accommodate more dialysis machines so that more patients can be treated daily. There are also plans to equip the Penal hospital with 20 additional dialysis chairs when that comes on stream.
