The Ombudsman has just commented on the sudden death of a 16-month old child from an overwhelming bacterial infection. The child had been seen at Mater Dei Hospital three days previously and was found to have croup, for which treatment was advised. However, the baby was found dead in bed in the morning by the parents, his condition having probably deteriorated suddenly during the night.
Such tragic personal events are rare but they do happen and young children, with immature immune systems, are particularly susceptible to invasive bacterial disease, such as pneumonia (chest infection) that could cause a sudden and irreversible deterioration, leading inexorably to death. In this case – which occurred almost two years ago – the parents sought the Ombudsman’s intervention as they were distressed by the attitude of the hospital authorities. After being counselled once on the day of their child’s death by a senior paediatrician, they complained they were left in limbo and the Ombudsman’s report highlighted several deficiencies, all of which can be rather easily corrected.
It took an inordinate amount of time for the findings of the magisterial inquiry to reach the parents and, incredibly, the child’s death certificate had still not been completed 10 months after his death! The hospital authorities did not attempt to meet the parents to explain the likely chain of events that led to their son’s demise. A letter by the parents’ lawyer to the hospital authorities, several months after the event, requesting information on the child’s death also remained unanswered. When the parents attempted to secure a copy of their baby’s hospital file, this was also refused as it was deemed to be under the auspices of the magisterial inquiry. All of this caused the parents deep distress and none of these points were conducive to closure.
The Ombudsman made several sensible recommendations that Mater Dei, and the health authorities, would do well to heed. These include a suggestion for the hospital to initiate an internal inquiry whenever circumstances such as these warrant that this be done in the interest of patients, their relatives or of the hospital, naturally unless debarred by an inquiring magistrate.
The hospital should also have a protocol guiding staff when communication to relatives and/or friends of sick, dying or deceased individuals is particularly crucial in order to avoid misunderstandings. This should include explanations on the clinical and administrative aspects of treatment and should be followed by adequate and appropriate and, if necessary, repeated professional counselling as may be required. This should be organised mindful of the fact there is an existing complaints policy that may need to be upgraded. A customer care department manned by clerks is simply insufficient! There should also be a parallel, support mechanism to help staff members to handle difficult situations or complaints and also to allay unjustified fears and unfounded suspicions that inadequate communication could lead to.
In view of the right of patients to see their medical records, a protocol should be established with urgency with clear and written instructions to hospital staff as to how to deal with requests for the medical records of patients. Failure to do so will further increase mistrust and suspicion in the system.
The Ombudsman also recognised the sterling work carried out by voluntary organisations dedicated to palliative care and it was suggested such organisation could readily be used to provide ancillary (and not primary) support.