I consented to a vascular bypass at the back of the knee and woke up to a whole leg amputation

Dear Editor,

In your March 28th edition you published a letter from Mr. Donald Ramotar, former President, who stated that the public was being exploited by the private medical establishment; and on March 30th a letter from Dr. Mark Devonish, MBBS. MSc, MRCP (UK), FRCP (Edin) on private hospitals.

Both of these letters addressed the practices by the private medical establishments in Georgetown whose practice is to extract the maximum cash from patients whilst providing the minimum medical support that the patient is paying for and expecting in return for the fees.

I empathize with these letters; as I have had a real experience of the practice in one of the private medical establishments. So, I will be able to put some ‘meat on the bone’ to the point they are making by giving a real life example. Of course, I cannot go into details of which hospital or of which medical practitioners were involved in my treatment in this letter as you will not be able to publish. Also of course, I am researching the option of litigation to expose what I will be alleging is medical malpractice by a specific hospital and specific identified medical practitioners. I can identify the medical practitioners involved as they are listed on the bill which has been paid; with their obscene fees.

Now the facts:  For two years I had a diagnosed aneurysm on the back of the knee joint.  An aneurysm is a growth in the vascular system which can impede the passage of blood to the lower leg. I was told by the vascular surgeon in England that this growth was benign and not a concern as it was small and was not impeding the blood flow to the foot. However I was informed that if it grew larger then a vascular bypass would be required.  It was explained that this was a relatively straightforward surgical procedure of taking out the section with the growth and replacing with a healthy section from my other leg or arms.  On January 29th on waking up, my leg was weak and losing its fleshy colour. I of course sought medical attention. I went firstly to a private hospital at the outpatients and was informed that a bypass was required to restore full blood flow. As this hospital did not have a vascular surgeon I then proceeded to another private hospital. A doctor examined the leg and explained that yes he could perform the necessary bypass operation. Accompanied by my wife I was taken to the operating theatre and this surgeon explained, in finite detail what he would do to achieve the bypass and restore full functionality to my leg.  He explained to me and my wife that as is standard bypass operating procedure, veins would be taken from my healthy leg, inserted as the bypass and full blood flow would be achieved.  I agreed to that, confirmed to the doctor that I had funds to cover any medical expenses and signed the appropriate medical consent form. I then was given a general anaesthetic and when I woke up in a hospital bed from the anaesthetic; I found that my leg had been amputated above the knee. What a devastating experience. I consented to a vascular bypass at the back of the knee and woke up to a whole leg amputation from the thigh.

My wife explained that whilst I was under the anaesthetic that the doctor spoke to her and stated that a vascular bypass was not appropriate and that amputation was essential to save my life.  My wife informed the surgeon that she could not make that decision as she had no medical knowledge.  She informed that I had daughters in England that were doctors and she arranged a call to my daughter to allow the surgeon to speak to her. Now two points; my daughter is not a surgeon or a medical doctor but a doctor in psychiatry.   Additionally my daughter was not present and could respond only to what the surgeon stated to her on the phone.  She subsequently informed me that the question put to her was rhetorical in that she was requested to give permission for the amputation as it was necessary as failure to amputate would lead to serious life threating complications. Of course, she was asked to make a decision on a medical situation that she had no experience on and had to accept the recommendation of the surgeon; without any information to evaluate the accuracy of the request being made. This was a rhetorical question:  We amputate or your father will die.  As I had agreed to a vascular bypass with not an iota of a suggestion made of a possible amputation, medical practice dictates that (as it was not a medical emergency) that I should have been brought out of the anaesthetic and asked to consider a whole leg amputation.  I would then have had the option of seeking a second opinion (from another medical establishment) on the need for the amputation.  A whole leg amputation has a major impact on your life; the quality of the rest of your life. I have been informed by other medical practitioners that (as it was not life threatening) that it would have been standard practice to bring me ‘back’ and explain and seek my specific and personal agreement to this major life changing operation.

 It is worth noting that the hospital fees included, of course, the fee for the operating theatre,   anaesthetist  and nursing staff; fees for the surgeon and also in this case two additional doctors. What role did these additional doctors play to entitle them to enormous fees?

The quality of life as an amputee for an active individual is devastating. As a lifesaving operation, of course, there is no question; but as elective surgery by the beneficiaries!!!

Final note: after I requested to be discharged, I was presented with a five-page itemized bill with every individual aspirin and sheet of toilet paper recorded (at a greatly inflated price).  Of course full settlement of the millions of dollars in payment was demanded before I was discharged. It is noted that this millions of dollars’ major operation, after a whole leg amputation did not supply any post care treatment, advice or rehabilitation advice. Not a single word.  No fact sheet as guidance.  It was “pay up and go away”. Can you imagine, after a major life changing operation that will take months before the wound is healed (not to mention the psychological adjustment) not a single fact sheet of guidance or rehab guidance?  Fortunately the internet is a wonderful source of information on how to exercise and physically adjust to this life shattering event. Of course psychological adjustment (particularly when you are convinced that the amputation was not necessary and not done in the patient’s interest) is a huge barrier to overcome. Also I requested to purchase a wheel chair and crutches.  I was told the hospital does not supply such items. I asked which establishment sold these items and was advised by the hospital administration to check the yellow pages.  So it is a matter of take your money and we do not want to know.  This is the standard of private and horrendously expensive health care in Guyana.

I have consulted other doctors and the consensus is that as an aneurysm is not life threatening; as the worst situation was amputation, the delay in bringing me back would not have had any impact on the amputation decision.  I should have been brought back to consciousness and the amputation discussed.  To get cover for the surgery, non-medical personnel were used (my wife and daughter) by putting life & death rhetorical questions – it was simply as I said – to provide cover for their actions.

I am exploring the option to litigate and thereby bring this individual example into the public forum through the civil court system; thereby allowing the public (through the media) to  have full reports on proceedings against the surgeon(s) that performed the operation and the hospital that provided the facilities to conduct this operation thereby making it a party to the alleged mal-practice.  My daughter is in contact in England with a prominent medical mal-practice law firm who can liaise with, and brief a local lawyer, in the court presentation and proceedings to provide expert advice.  Although one swallow does not indicate a summer; it may have the benefit of making the doctors and private hospitals a little less cavalier in their clandestine extortion practices.

This is what the Americans call a “double whammy”.  Plunder my finances to do an unnecessary operation that has a major and devastating effect on the quality of the rest of my life. With apologies to Shakespeare: ‘He who steals my purse steals trash; ‘tis something, nothing it was mine, it is his and been slave to thousands; but he that filches the quality of my life, robs me of that which not enriches him and makes me poor indeed’.

There is a moral dimension to this. What was taken in addition, was the quality of my life and a major impact on my family.  No longer a normal up and about life.  My wife now has a baby in the house and I need not expand on the present quality of my life – for the rest of my life.

Yours faithfully,

(Name and address supplied)

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