Lack of specialists main reason for GPHC referrals

-Linden Hospital CEO

Management of the Linden Hospital Complex (LHC) says that referrals of patients to the Georgetown Public Hospital Corporation (GPHC) is not high when compared with other hospitals and that they are necessary judgement calls by the medical staff.

The $1.8 billion facility, which was commissioned a year ago, has been coming in for heavy criticism for its inability to handle various levels of medical care. However, LHC Chief Executive Officer Gordon Gumbs says that the facility was not built to compete with the GPHC. “There was never the intention to duplicate the GPHC around the country. That is the highest hospital in the country and others like the LHC, which are level 4, have to do referrals because of how the system is set up,” Gumbs explained.

In an exclusive interview, Gumbs and LHC Administrator Trevor Vangendren highlighted that human resource is one of the main contributors to the referrals of patients from Linden to Georgetown. According to Gumbs, the LHC is a Level 4 facility and specialist doctors are limited.
He explained that in most cases when patients are referred it is usually a judgement call on the part of the doctor on duty.

“The decision to refer a patient is usually a judgement call by the clinical personnel on duty who take into consideration the available physical resources and medical capacity,” Gumbs said. He added that unlike the GPHC, which is a level 5 facility, the LHC has one specialist doctor for some areas and none in others.

On a fortnightly basis, an orthopaedic specialist would visit the LHC to hold clinics and perform surgeries. In his absence, orthopaedic cases have to be transferred to the GPHC. There is no neonatal specialist, one gynaecologist, no cardiac specialist and the others are basic medical practitioners. “When it comes to high risk cases, one specialist might not be sufficient to effectively deal with the case so they are transferred to Georgetown, where there is a team of specialists,” Gumbs noted.

Vangendren added that because the Chinese doctors attached to the LHC have the privilege of being off during the Guyanese and the numerous Chinese holidays—in addition to enjoying vacation and some weekends off duty—delivery of care is further complicated.

Speaking to the question of what seems to be a spiralling incidence of maternal deaths, Gumbs said that for 2009 the LHC had two maternal deaths and for 2010 there were two who died after being transferred to the GPHC.

He explained that while the two operating theatres are functional, in most cases high risk patients are transferred mainly because for post-operation care. He said that while the LHC has a well-equipped intensive care unit, human resources to manage it are a major challenge. He said that the modalities are being worked out to have at least 16 nurses trained to function in the department. “There are a lot of things that we have to straighten out for this because these nurses would have to be stationed in Georgetown for no less than three months,” he said.

Gumbs hastened to note that the most recent maternal death—Inga Nieuenkirk, who transferred to the GPHC—was unavoidable since the baby had died prior to the mother’s arrival at the LHC. He added that the mother had several complications in the past and was advised against becoming pregnant before a stipulated time.

He said that his staff did their best to get the woman to the GPHC at the earliest possible time and she was handled with every sense of urgency upon her arrival there.

Referring to the shortage of oxygen, which resulted in the death of an infant en-route to GPHC, Vangendren said that he was not aware of the case but noted that the ambulance is equipped with a 100% gas cylinder which when filled, is sufficient for any patient travelling from Linden to Georgetown. “It is stationary in the ambulance but they (nurses) complain that it is too big for the ambulance,” he said.

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