Daly Bread: Chronic evasion of accountability

The report of the investigating team of the Pan American Health Organisation (PAHO) into the death in April this year of seven babies in less than a week in the Neo-Natal Intensive Care Unit (NICU) of the Port of Spain General Hospital (POSGH) has been delivered.

In clear terms it exposes deficiencies in the management procedures of the NICU. PAHO gave the NICU a failed grade of 29 per cent.

A baby receives treatment in a Neonatal Intensive Care Unit.

Notwithstanding the PAHO report, the Minister of Health is at it again, once more attempting chronically to evade accountability and consequences.

Even though editorials in the daily newspapers deplored the Minister’s approach to the PAHO report in strong language—for example, the Newsday on 2 July 2024 as “nonsense” and “deeply unedifying”—it is important to emphasise why it is not open to the Minister of Health to attempt to dumb down the NICU’s failed grade of 29 per cent.

As reported in the Trinidad Express newspaper on 23 April 2024, Dr Marlon Timothy, head of the NICU admitted that the deaths were “caused by the bacterial outbreak between 4 and 9 April” at the NICU.

Minister of Health Terrence Deyalsingh.
Photo: Ministry of Health

Immediate critical observations of commentators about a bacterial outbreak that seemed preventable were subject to personal attacks and insinuations. In addition to the usual suspects, other persons trotted up to the deflection line to make reference to “sensationalism” on the part of commentators.

The public was told that it must not jump to conclusions and to await the result of an “independent enquiry” into the fatal incidents. However, it was plain that conditions at the NICU at the material times would be a principal focus of the PAHO investigation—specifically what caused or contributed to the admitted bacterial outbreak.

Alongside its publication of the PAHO report, particularly the NICU’s failing grade of 29 per cent, the Express listed in bold type 12 deficiencies specific to the NICU.

There were some basic, jaw-dropping omissions related to the spread of infection such as:

  • NICU unit dose medications not prepared in sterile conditions by the pharmacists;
  • limited hands-free alcohol-based hand rub dispensers in NICU;
  • breaches in personal protective equipment (PPE) protocols;
  • a persistently inadequate ratio of nursing professionals to patients;
  • lack of implementation of timely contact precautions for patients affected by MDROs.
A baby in a neonatal intensive care unit at a hospital.

(The acronym MDRO, I am advised, means in simple terms bacteria resistant to antibiotics.)

In these circumstances it was rationally impossible to dispute the Express newspaper’s headline of last Sunday that said Failing Grade On Babies or to claim misrepresentation by the media.

The Minister of Health claims that PAHO did not interview the head of NICU and the chief of staff of the POSGH. This is a curious claim.

Minister of Health Terrence Deyalsingh (centre) poses with health workers at the Freeport Health Centre.
(via MoH)

The POSGH falls under the remit of the NWRHA. Subsequent to the deaths, the Ministry and its satellites, when trying to hush us up, pushed the importance of having PAHO investigate and kept us informed of PAHO’s arrival.

The CEO of the North West Regional Health Authority (NWRHA), Anthony Blake, reported on the interaction with the PAHO team at a media conference on 22 April 2024. He was reported in the Newsday as stating that PAHO met with the NWRHA management on the morning of 22 April.

The purpose of the meeting was “to look at firstly the terms of reference for that investigation and to request from the NWRHA relevant documents and to schedule interviews and so on”.

 

The Port of Spain General Hospital.

The NWRHA was reported to be committed to providing PAHO with all of the information they needed and access to all of the relevant persons in terms of interviews moving forward.

It was later reported in the Trinidad Guardian on 28 April 2024 that the PAHO team met with Ministry officials at the NWRHA “for a de-briefing following the five-day investigative period”.

Were the subjects of PAHO’s access to the two heads and its failure to interview them raised at these meetings, as they obviously should have been?

Minister of Health Terrence Deyalsingh.

The Minister brought PAHO to investigate the NICU deaths. Now that it has reported unfavourably on the NICU, his attempt to dilute the PAHO’s findings brings to mind a child who brings the football and takes it back when a goal is scored against his side.

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