The two health ministers were taken to task by their colleagues at the recent cabinet meeting over the upsurge in maternal deaths and it was recommended that there be more stringent recordkeeping in the health sector to allow for the identification of what is wrong.
Cabinet Secretary Dr Roger Luncheon at his weekly press briefing yesterday told reporters that the ministers, Dr Leslie Ramsammy and Dr Bheri Ramsarran, were also roundly criticized for poor recordkeeping.
He said Cabinet “rejected the reasons” given by the ministers for the delays by the ministry in providing detailed records of the “those 21-odd cases” of maternal deaths.
Ramsammy on Sunday had said that there were 18 maternal deaths for the year and had indicated that there was a spike compared to recent years, pointing to the 13 recent cases.
He said the spike began in September, the month when some eight women lost their lives while giving birth in the various public hospitals. It is not clear whether the figures given by Dr Ramsammy and Dr Luncheon included any deaths that may have occurred at private institutions.
According to Dr Luncheon, the Cabinet review process could only have “pronounced on completely submitted records” but disclosed that “there were prevalent lapses in record keeping and supervision at the administrative and professional levels.
“These were two main considerations Cabinet felt contributed to the deaths and definitely in those cases when reviews were not possible the lack of records completely paralysed those reviews.”
As a result, Luncheon said Cabinet recommended that it statutorily monitor all maternal deaths while adding that its monitoring of newborn deaths is related and has been included.
The Health Ministry would also have to keep Cabinet up to speed with its implementation of the Health Facilities Licensing Act.
“In essence, the bodies set up under the Act having their work programme and their periodic reports addressing the accreditation of health institutions being also reported to Cabinet,” the cabinet secretary said.
Further, Cabinet mandated the Health Ministry to ensure that the initiative that deals with the service contracts between it and the public hospitals is implemented and the results publicised.
“The service contract initiative essentially models itself on social contracts where the hospital undertakes to provide a service, indicators are selected and targets are decided on,” Dr Luncheon explained.
He said the length of time to get attention in the emergency room; the length of time it takes to be seen on the ward; how long one has to wait before elective surgery is done are some of the indicators in the service contracts that have been executed between the Ministry of Health and the public hospitals. Targets have been set and they would report on these publicly.
Meanwhile, when asked whether there was any mechanism to monitor the competence of the medical staff, Luncheon said it is only records that could recreate and allow a good review. “So the issue of competence… In a couple instances clear cut evidence exists that the standards and the clinical skills weren’t adequate, but those were a couple of instances,” he said.
He reiterated that it is the record keeping, consummate attention to detail and recording of details, operative on the wards and labour room that allow for quality comment on clinical competence.
“You have to document properly and if you’re committed to documenting properly it follows that all of the other things will be done properly…,” he said.
While he acknowledged that no one is going to document that they did something wrong, he opined that the mere act of documenting, making adequate and correct records and the knowledge that one is making those records would force the average practitioner – whether at the medical or administrator level – and all who are involved in healthcare “to conform and do what is right.
“What the lack of recordkeeping does is essentially cover all sorts of inadequacies that cannot be penetrated as readily as if records were available,” he further said.