Thank goodness the Health Services Authority issued a statement regarding exporting routine medical procedures, “within the constraints of the law” because something tells me the “constraints of the law” will be visiting them very soon.
At least we know the HSA spin doctor is qualified to practice.
Try as they may, the HSA public relations team will not be able to spin this in such a direction as to make them look any less like the incompetent and reckless quacks they are. I’m sorry but regardless of the truth as the HSA says, or as the patient alleges, at the very least the patient should never have been released for air travel after her water broke on a pre-term pregnancy.
Although the HSA claims that, “As a point of interest ruptured membrane in early pregnancy is not a contraindication for air travel,” several websites including Caremark Health Resources state: Women who have any of the following conditions should not fly while they are pregnant: Severe anemia, sickle cell disease, history of blood clot, placental abnormalities, RISK OF PREMATURE LABOUR,… I included this for Caswell Wolford and the HSA as a “point of interest.”
Another women’s health resources website states that premature rupture of the membrane (PROM) could lead to full-blown labour within 24 hours; and PROM prior to 37 weeks could lead to infections and problems. The website states also that:
In the time between the PROM being diagnosed and labor starting, there seems to be little consensus on where women should be managed. Many doctors prefer women to remain as hospital inpatients during this time. This allows a regular check on temperature, pulse rate and development of womb tenderness which may indicate infection. Twice weekly blood tests looking for signs of a response to infection and weekly vaginal swabs are often instigated. Increasingly, however, doctors are beginning to feel that the risks of infection with PROM have been previously overstated, and many are now happy for women to be managed at home after an initial period in the hospital.
The above suggests that the patient should be observed both on an inpatient and a homebound basis. Regardless, it appears (according to this information and not HSA protocol) that the HSA doctor mismanaged this case at a very basic level and, at the very least, failed to effectively convey the potentially serious consequences not only of the patient flying but of the patient simply leaving the hospital – at least initially.
We as patients have very few resources upon which we can depend in times of need. We have to take our doctors’ counsel as being accurate and appropriate in spite of the presence of a multitude of studies, opinions and research. For every study that contradicts our doctor’s advice there are just as many that support it. And I’m sure for every pregnant woman who has gone into labour on an airplane there are hundreds who have not.
But I'm sure we can all remember quite a few instances where the HSA has stabilized first and exported second. This case should have followed THAT protocol instead of the resulting "CYA" protocol.
In this instance the patient was admitted as a result of her condition and presented with symptoms that indicated a likelihood of premature labour which IS a contraindication for air travel – at least according to a couple of websites. She was counseled that it was okay to fly, left the hospital with a doctor’s note and was subsequently returned to the HSA for further observation – and then allowed to leave the HSA again to fly. She did fly, she delivered in flight, and now it's her fault in spite of the fact that HSA protocols were followed and her condition is not necessarily a contraindiction for her results? BS.
Here's a scenario: Self-inflicted gunshot wounds to the head are not necessarily a contraindication for life. HSA - don't believe me? I'll write a note saying it's okay to do it.
I don’t believe for one moment that “all protocols were followed... (with) due concern for the welfare of the patient and her unborn child” as the HSA release states. What I think is that the HSA failed to provide effective counsel and in the absence of common sense severely jeopardized the lives and well-being of both mother and child. Now they’re covering their butts by blaming everyone BUT themselves for their own irresponsibility.
What ever happened to erring on the side of caution? How can a prudent person possibly be expected to grasp the notion that it’s okay to release a first-time mother with a ruptured membrane during a pre-term pregnancy to get on a plane after she had been hospitalized twice? At the very least she should have been given 24- to- 36 hours for her membrane to recover a bit; at least according to web information.
The HSA release blames the patient for flying even though she was released to fly by the HSA; the HSA release uses only moderately accurate information regarding contraindicative activities for PROM; the HSA release claims all protocols were followed and; the HSA states “any attempt to smear the integrity of the professional team of the HSA is very unfortunate given the patient’s decision to travel, even after all options were explained.”
I don't think it's a bit unfortunate that anyone would try to smear the HSA's integrity. What I DO think is unfortunate is that the HSA believes it has integrity by blaming everyone else for their mistakes.
Here’s how the HSA press release should have read:
We at the HSA sincerely apologize for any failure on our behalf to effectively communicate the delicate nature of the patient’s condition prior to her boarding CAL flight 600. While we are very sorry for the incident and understand the public's concern regarding this situation, we at the HSA are taking every step to address the breakdown in communication that led to the event and we will do everything in our power to hasten the mother’s and the child’s return to Cayman where both will be well looked after. We are pleased that mother and baby are doing well and we will do everything we can to ensure they both make a speedy and full recovery.
An attorney might call this a "blanket admission of guilt." I call a letter authorizing travel for a PROM patient with a pre-term baby a blanket admission of guilt - I would call the above press release an apology and sympathetic appeal for forgiveness. Of course to do something like that would mean the HSA would have to exercise a bit of integrity.
In spite of how this all pans out, shame on the HSA for pointing their fingers at anyone but themselves. Shame on the HSA for not addressing the root issue of the problem. And shame on the HSA for deriding the public opinions of those of us who now have even less confidence in their ability and integrity due to their own irresponsibility and negligence. Your failure to instill even the slightest bit of public confidence is very telling.
I could be wrong, but if the HSA had an ounce of integrity the Cayman Islands Medical and Dental Society would already have announced they supported the hospital's actions. Funny that the organization comprised of health care practitioners hasn't yet made a statement on the behaviour of members of their professional organization. But I suppose it's just another case of more rats seperating themselves from the sinking HSA ship.