THE Health Ministry (MOH) must launch an immediate inquiry and investigation into the serious allegations of medical negligence in the case of a doctor who accused the Ipoh general hospital’s ambulance service of allowing his brother to die from a heart attack by failing to perform cardiopulmonary resuscitation (CPR), said Bandar Kuching MP Dr Kelvin Yii.
This came after news reports that the Raja Permaisuri Bainun Hospital’s (HRPB) paramedic team did not even remove Dr Thiru Terpari @ Thirupathy’s brother Kumaraveloo from the latter’s vehicle, where Kumaraveloo collapsed, to try to revive the 43-year-old man with CPR or by using an available AED device from the ambulance.
AEDs are portable, lifesaving devices designed to treat sudden cardiac arrest, a medical condition in which one’s heart suddenly and unexpectedly stops beating.
Dr Thiru, who works in the medical department at HRPB and is a training specialist in internal medicine, said he would still be able to accept his brother’s death if the paramedic did CPR for half an hour but was still unable to revive him.
“But my brother was left to die in his car, he wasn’t even brought to the ambulance,” Dr Thiru told CodeBlue last Saturday (June 18).
Kumaraveloo, a government school teacher at SMK St Michael in Ipoh, Perak, clocked out from work at about 5:40pm on April 13 this year and was driving alone through Jalan Sultan Nazrin Shah in the capital city when he suffered breathing difficulties and collapsed near the BHP petrol station.
According to Dr Yii, such an issue must not be swept under the rug or even handled internally as it is important to restore public confidence, not just in this particular hospital’s emergency health response, but in all government hospitals, while also bringing justice to the aggrieved family members.
“Life-saving interventions [like CPR and AED], while not guaranteed, can increase the chances of the patient [surviving],” he noted.
An eyewitness in Kumaraveloo’s case noted that the HRPB paramedic did not perform CPR or used the AED device to attempt to revive the victim, claiming that the victim was “already gone”.
This was confirmed in the Pre-Hospital and Ambulance Service (No Sign of Life) report that the HRPB medical assistant had signed on April 13, 2022 claiming that algor mortis – a stage of death when a human body’s temperature drops to the external temperature – had set in, indicating a “clear sign of death” which was why he did not perform CPR or used the AED device.
According to CodeBlue, the HRPB paramedic’s also stated that Kumaraveloo showed no pulse, no breathing, and no cardiac activity, with his pupils fixed and dilated, while his blood pressure was unrecordable. On underlying disease, only diabetes mellitus (DM) was marked.
Clear signs of medical negligence
Dr Yii, who is a medical doctor by training, said that algor mortis generally begins two hours at the earliest after the heart stops and is established at around 18 hours after death.
“If we were to look at the timeline and witness statements, assuming that the victim collapsed around 6:10pm – as stated by an eyewitness – this means that the paramedic pronounced the victim’s death in just 30 minutes at 6:40pm and even claimed that the body had turned cold within that short period of time,” Dr Yii pointed out.
“This is why, based on evidence, there are definitely clear signs of medical negligence and possible criminal elements present. On top of that, based on news reports, it is not an isolated case as a similar case had occurred before in May of this year.”
The HRPB medical assistant who attended to Kumaraveloo had similarly claimed algor mortis in a second emergency case that he handled last May 11 and did not perform CPR on the patient, an 85-year-old male motorcyclist on the roadside in front of OYO Hotel at Jalan Kuala Kangsar, Batu 9, Chemor, following an accident.
The purported algor mortis and lack of CPR intervention were documented in the Pre-Hospital and Ambulance Service (No Sign of Life) report, as sighted by CodeBlue, that the medical assistant signed at 1:16pm, just 11 minutes after his stated arrival at the scene at 1:05pm. He departed from HRPB 15 minutes earlier at 12:50pm, according to the document.
When questioned by a HRPB medical officer (MO) on why he did not perform CPR on the patient, the MO was told that it was “too late: because it took the medical assistant 20 minutes to arrive at the scene from the hospital.
The MO further told CodeBlue that she observed an exposed wound on the motorcyclist’s leg as the only obvious physical injury without any bleeding or bruises all over the body. The man passed away.
MOH must launch investigation into entire chain of events
In the effort to resolve this matter, Dr Yii said that MOH must not sweep this issue under the carpet as it involves people’s lives and public confidence in our hospitals’ emergency response.
As such, the Ministry must launch an investigation on the entire chain of events from the time the emergency call was placed to when the ambulance response team had left the scene of the incident.
On top of this, MOH must also conduct a nationwide review to ensure that cases like these are isolated and are not happening in other areas around the country, he added.
“All medical assistants involved in such emergency situations must be given the necessary support and even continuous training for proper management of patients who collapse on roadsides to ensure that they are competent and have the right attitude when dealing with such situations,” Dr Yii remarked.
“MOH must also conduct an audit on all equipment and medications on all ambulances to ensure that they are adequate and properly maintained to ensure that they can be used effectively and swiftly when needed.”
Dr Yii further called for the Government to increase public awareness and training on life-saving maneuvers such as CPR and the use of AEDs.
“With the announcement by Health Minister Khairy Jamaluddin in March that the installation of AEDs would be made mandatory in public areas by 2025, the public must be trained to use them during emergencies while waiting for the arrival of first responders.
“Lastly, the Government must not take any disciplinary action against any public health workers or whistle-blowers of negligent practices. Instead, they should review and improve on any shortcomings to ensure that the quality of care to our people continues to improve.” – June 22, 2022
