BY IRWIN ANGIKI
Misdiagnosis which is costing lives and causing much suffering is a real problem at the Emergency unit of the national referral hospital (NRH), an Island Sun investigation has shown.
The NRH has an Accidents and Emergency (AE) unit along with a general outpatient service which receives emergency cases and referrals, and give general medical attention.
But, just as drugs and accessories are a usual rogue for the hospital, making wrong diagnoses is apparently becoming all too common for comfort at the Emergency.
Reports are increasing of near-death experiences, prolonged suffering as doctors at the emergency unit struggle to diagnose what ills a patient, and death after being left too long at the unit awaiting right diagnosis and treatment, or after being sent home under a wrong diagnosis.
Island Sun’s two-month investigation has uncovered a cocktail behind this sub-standard service at the Emergency unit – ranging from hurdlesome internal protocols, poor communication system, internal competition, some incompetent ‘cowboy’ doctors and politics.
This has spited the hard work put in by few dedicated doctors who have given a lot towards improving the Emergency department over the years.
NRH authorities told Island Sun it was looking into allegations of misdiagnoses. Four NRH doctors spoke to Island Sun under condition of anonymity, and two former NRH doctors now running their own private practices gave insight, also under condition of anonymity.
Day at the Emergency
Wednesday October 9, Honiara businessman Craig Day was rushed to the NRH Emergency with severe abdominal pain at 4am. He waited 30 minutes before being given attention.
A blood test was taken. Results came back 24 hours later – only to be found that it had been the wrong blood test.
Ultrasound scan results said his appendix was alright, according to the Emergency doctors. Hindsight views from doctors say Mr Day should have undergone a CT scan.
By Thursday the pain had worsened – but Emergency doctors nevertheless began preparing papers to discharge Day.
Upon Day’s protest, doctors said he would get a surgical review at 10am the next day.
However, there was no surgical review by lunchtime Friday – and Day decided he was not going to wait to die.
He arranged for a med-evac to Brisbane, Australia, where Emergency doctors immediately diagnosed his appendicitis and removed his engorged appendix.
Day had a gangrenous ruptured appendix. He had had a brush with death.
Day’s experience not unique
One prominent member of parliament shared on social media his experience in 2018 when his child suffered for a week from appendicitis before x-ray results detected it since it had already calcified.
Ten other people shared with Island Sun similar experiences at the NRH Emergency under condition of anonymity.
Their stories outline three types of experiences at the NRH Emergency – premature discharge with doctors unable to diagnose, suffering while doctors apply trial-and-error to get at the right diagnosis, and death either at the hospital or after being sent home under wrong diagnosis.
A 60-year-old mother said her eldest daughter passed away in 2021 after being discharged prematurely from the Emergency ward when doctors said they could not find anything wrong with her.
“This was despite my daughter having a swollen belly, rash on her body and severe abdominal pain on her right side,” she said.
“Two days after being admitted at the emergency outpatient ward we were told to leave by the doctors saying they could not find anything wrong with her and gave us Panadol and antibiotics, telling us if it persisted after four days to return.
“We were discharged and two days later my daughter died,” the mother sobbed.
A 54-year-old mother said her son died while admitted at the Emergency last year after spending one night and day there, with the same symptoms.
“We arrived at night and spent hours sitting outside until admitted near dawn. Later that morning the doctor said my son would be x-rayed. We waited and waited, all the while my son was crying in pain. Later afternoon he passed away,” she said.
In September this year a young man was rushed into the AE with a ruptured stomach and his chest x-ray results clearly showed fluid levels consistent with ruptured bowels. He was misdiagnosed and went through seven days of suffering before doctors finally decided to operate.
On the operating table, the young man went to severe sepsis and could not withstand the exploratory laparotomy – he died on the operating table.
A man, 35, said his father had spent a month in 2022 admitted at the outpatient ward under Emergency doctors who could not find anything wrong with him and later sent him home. His father died a month later in their village.
A father, 50, said he brought his son in earlier this year and had his head x-rayed. “The young doctor at the Emergency said he’d read my son’s x-ray results. When he came out of the room he handed us my son’s medical book saying everything was clear. The doctor had not written anything on my son’s medical card, which was weird.”
His son has since been suffering from chronic migraine and nose bleeds, and they have been in and out of private doctors.
Former NRH doctors – ‘misdiagnosis at Emergency is real’
The two former NRH doctors who spoke with Island Sun said misdiagnosis is a common occurrence at the Emergency department.
They said misdiagnosis has been a bug at the Emergency department for decades, but has recently worsened with the influx of Cuba-trained doctors.
Two groups of doctors man the Emergency department – qualified, experienced PNG/Fiji-trained and underqualified, ill-experienced Cuba-trained, the two former NRH workers said.
Yet, misdiagnosis is committed by both sets of doctors, they add.
“Just recently, a very senior doctor at the Emergency sent home a girl with fluid in her lungs,” one of the two doctors said.
This coupled with lack of resources, ongoing internal politics and nepotism results in the sub-standard service at the NRH Emergency, they said.
Authorities within NRH and the MHMS are aware of this and deeply involved, they said.
NRH doctors – ‘best medical service Solomon Islands has to offer’
Enquiries sent to the Ministry of Health and CEO of NRH, Dr George Malefoasi, went unanswered.
NRH Medical Superintendent Dr Janella Solomon responded to enquiries saying they are investigating Mr Day’s case using a process she called ‘clinical audit’, which she adds is ‘a very technical audit’.
She said a result to their investigation could be made available in the last week of November.
The four NRH doctors who spoke to Island Sun on condition of anonymity said doctors at the Emergency are working hard against odds stacked against them such as poor resources, lack of drugs and accessories, unavailability of needed devices and equipment, and protocols which often slow down or deny access to resources.
“Let me be clear that this is the best medical service at the NRH Emergency that the Solomon Islands can offer given our situation,” one of the NRH doctors said.
“You cannot compare medical care in Australia which is a resourceful country to Solomon Islands, because we are developing and our doctors at the Emergency are trying their best.
“The aim is to identify life threats, manage and get them quickly to the next level of care. The AE doctors have all the knowledge needed but are without the needed equipment and resources,” the doctor said.
Reasons for Day’s nightmare
Another doctor said that with Mr Day’s case, the ultrasound images produced by the machine at the NRH are not of quality which could explain why doctors at AE did not spot his appendicitis.
“It is unfair to blame our AE doctors because the images produced by our ultrasound scan is of low quality which even the well-trained and experienced eye can miss such things as engorged or ruptured appendix.”
The four NRH doctors agree that Day should have received a CT scan, which would have picked up his appendicitis.
One doctor said NRH protocol had delayed Mr Day from getting a CT scan.
“There is protocol in place where radiologists established for consultant at the Emergency to discuss and justify why a CT scan must take place before the patient is scanned.
“So, Day needed a scan but did not get one because he was under the surgical team and there was no surgical consultant available because government had not sorted out the person’s contract,” the doctor said.
Blood tests at the NRH are done at the hospital laboratory.
At the Emergency ward Mr Day underwent a blood test, which took 24 hours before results came – and it turned out to be the wrong blood test.
One of the NRH doctors said the NRH lab is manned by highly experienced and qualified technicians, and they carry out the specific blood tests instructed by the doctors.
“Day’s blood sample came with the instructions to carry out renal function test, which our lab techs did. So, it is unfair to blame our lab techs. The wrong instructions were given,” the doctor said.
“This happens sometimes and it is wrong to say it was a mistake or misdiagnosis because the doctor on-call decides which blood test to run based on his/her observations and we follow their instructions,” the doctor adds.
‘We’re trying our best’ – despite growing complaints
Only two of the NRH doctors inclined when asked to comment on the testimonies of the 10 other people who shared their harrowing experiences at the AE.
“Although we try our best, mistakes do happen. Our main aim is to preserve the life of our patient. If it’s a straight-up injury we address it. If it’s an illness then we investigate using limited resources we have to identify the cause and treat it.
“And, yes, this involves trial and error because illnesses share a lot of common symptoms and often when we arrive at two possibilities we have to rule out one by treating for the most likely cause. If it results differently then we’ll know it is the other, and further treatment.
“And, it is sad that few patients die during the course of searching for their illness, but given our circumstances it cannot be avoided. However, our efforts minimise such deaths,” the doctor said.
The second doctor sympathises with the reports but encourages public to report their complaints to the NRH authorities.
“Unless there is an official report, we cannot address problems public face with our services, especially at the Emergency department.
“Public can report to the Medical and Dental Board (MDB), or the Medical Superintendent of NRH, or the CEO of NRH. Then we can investigate and address the complaints.
“If we at NRH do not address or respond to the complaint reports then public can go to the media,” the doctor said.
NRH complaint channel
Deputy Secretary Health Care Dr Gregory Loko Jilini, a member of MDB, explains to Island Sun the MDB’s function.
“The Medical and Dental Board only responds to complaints that are formally submitted to the Board in writing. When a complaint is received, the Board will then carry out its own independent investigation
“If a patient or relative feels that a doctor’s action is not right, inappropriate or unsafe then they must address their complaint to the Board. The following information are important to include when making a complaint:
1. The name of the doctor about whom the complaint is made.
2. Describe in detail what happens, including the time, place, patient affected any other person that may be involved or who else witnessed the incident.
3. The name, address and contact details of the person who submits the complaint. The letter of complaint must be signed and dated.
“By law, the complaint must be submitted within three months of when the incident occurred, so it is important to submit complaints while they are fresh,” Mr Jilini said.
