Mercy killing -Doctor to be probed in brain-dead patient case

An investigation has been ordered into the circumstances surrounding the removal yesterday of a patient from a ventilator at the San Fernando General Hospital which was said to be in breach of the established protocol for the diagnosis of brain stem death.

Imtiaz Ahamad, chairman of the Southwest Regional Health Authority, which is responsible for the San Fernando General Hospital, has called for written reports from doctors in the Accident and Emergency Department as well as the anaesthetist who took the patient off the ventilator and other medical personnel connected to the incident.

Abraham Knut, 56, of Princes Town, was removed from a ventilator at the Accident and Emergency Department which had kept him alive for 48 hours.

His wife Seeta and her four children were present when he was removed from the ventilator.

Hospital authorities are concerned that although Knut appeared to be brain dead, the doctors did not follow the established protocol to deal with brain stem death which was set by the Ministry of Health in January 1999.

Dr Anand Chatoorgoon, the anaesthetist who removed the patient from the ventilator said yesterday: "Ever since the patient came to the Accident and Emergency Department on Saturday we tried unsuccessfully to get the opinion or presence of a registrar in the department of medicine but we failed."

Chatoorgoon said he did not know if Knut's relatives were aware of the established procedure in dealing with brain stem death.

Knut was taken off the ventilator around 4.40 p.m. yesterday and declared dead.

Knut went to the hospital on Saturday afternoon with intra-cerebral bleeding (a burst blood vessel in his head) and was placed on a ventilator in the Accident and Emergency Department.

Two doctors diagnosed him as brain dead and later removed him from the ventilator without the opinion of a specialist trained in internal medicine.

The protocol for the diagnosis of brain stem death as approved by the Ministry of Health calls for "two doctors to perform the clinical tests. One of (them) must have no part in the clinical management of the case," states the protocol.

The doctor will be chosen from a list maintained by the Medical Chief of Staff.

Four sets of tests have to be conducted by each doctor and testing should not commence until at least 24 hours after the onset of coma.

The second set of tests is carried out 24 hours after the first and the time of death is recorded as that at the completion of the second set of tests.

The protocol also calls for dialogue with the relatives.

"At all times the patient's condition must be discussed with the relatives."

The protocol came into force following the "pulling of the plug" by an anaesthetist in 1998 at the San Fernando General Hospital involving a patient, Joseph Dwarika, of Siparia.

C Pallis writing on Brain stem death - The evolution of a Concept defined the condition as "when the brain as a whole cannot function and if the brain has permanently lost the ability to function, the individual is dead".

The Express learnt that a meeting between the Medical Director attached to the Southwest Regional Health Authority, Dr Albert Persad, and the heads of department will take place on Wednesday regarding the adherence to established protocols by the Ministry of Health.

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