Prisoner’s death: PHC report contradicts CMIT findings

LAHORE: Punjab Healthcare Commission’s inquiry to fix responsibility over negligence in the death of an under-trial female prisoner at Kot Lakhpat Jail due to cardiac ailment has gone off-track as it prima facie tended to save the responsible from Punjab Institute of Cardiology – earlier charged with negligence by a high-powered committee constituted under Chief Minister’s Inspection team.

The PHC, in its decision dated March 7, 2017, held medical staff of Kot Lakhpat Jail, including a woman medical officer, earlier praised in the report of CMIT’s inquiry committee, completely responsible for the death of under-trial female prisoner after failing to fix responsibility for medical negligence committed at the PIC despite referral by the jail’s medical staff twice, which led to patient’s death due to acute myocardial infarction.

Following the order of Punjab Chief Minister Mian Shahbaz Sharif to hold an inquiry into the death of female prisoner Ulfat Bibi alias Baybi, w/o Muhammad Iqbal, a resident of Faisalabad, on November 8, 2014, CMIT’s inquiry committee comprising Kokab Nadeem Warraich, Member General-V, CMIT, as convener and Prof Dr Faisal Masood, the then vice-chancellor of King Edward Medical University, as member conducted a detail inquiry on November 12, 2014 and came to the conclusion that the patient died of acute myocardial infarction with or without arrhythmia and left heart failure.

It held WMO Jail Dr Nusrat Naz, in-charge of the morning clinic, responsible for not recording the patient’s vital information and past history of hypertension, diabetes mellitus and ischemic heart disease and, as a result, her treatment in jail (though appropriate) remained symptomatic and of emergency nature and making a routine request instead of an emergency call to PIC.

On the other hand, it said, the on-call Emergency WMO Jail, Dr Tooba Ashraf, did a good job of diagnosing the condition correctly as a heart ailment and started all the appropriate medical on both her visits in addition to the emergency referrals to PIC. On the third occasion, Dr Tooba, upon finding the patient BP-less and pulse-less, referred her to Jinnah Hospital for expert management but, unfortunately, she died on the way.

With regard to negligence on part of the PIC, the committee noted that, in the context of repeated attacks and suggestive history, the patient’s condition warranted an evaluation by a senior person before discharging from the hospital.

Based on these findings, the committee recommended proceedings under PEEDA Act/relevant laws be initiated against WMO Kot Lakhpat Jail Dr Nusrat Naz for her act of negligence and inefficiency and she be immediately replaced by a competent WMO. It further recommended that the decisions taken, regarding the management of Ulfat Bibi at PIC, may be referred to Punjab Healthcare Commission with cardiologists on board to fix and apportion the responsibility as to why the patient was discharged twice without realising severity of her ailment in the context of her suggestive history.

Furthermore, the CMIT chairman also gave his comment saying, “As per inquiry conducted under Mr. Jiwan Khan, the deficiencies of PIC emergency were identified and included lack of consultant supervision and back-up.”

The inquiry was forwarded to Punjab Healthcare Commission on June 09, 2015 and later in its report based on inquiry titled “Government of the Punjab Vs Punjab Institute of Cardiology” dated March 7, 2017, the Board of Commissioners decided, “The healthcare establishment i.e. Punjab Institute of Cardiology is exonerated from the charges of medical negligence. However, the Board of Management of PIC is directed to develop and implement the SOPs for recognition, registration and management of medico-legal patients."

The recommendations of Chief Minister’s Inspection Team for proceedings against Dr Nusrat Naz under PEEDA Act, 2006 is endorsed and her case is referred to PMDC for not performing her duties diligently and not sending the patients to OPD of PIC, as was advised by the specialty hospital and, thus, wasted the crucial time for the treatment and management of the patient.

It also directed the authorities concerned to initiate proceedings against Dr Tooba Ashraf for failing to diagnose the disease of the patient and referring her second time to PIC instead of a medical care facility where it had been declared by the specialty hospital that the patient did not have an acute cardiac issue and she had been aware of the co-morbidities of the patient.

The PHC’s report contradicted the findings of the CMIT’s committee having the services of one of the country’s top physicians Prof Dr Faisal Masood, currently serving as acting VC of University of Health Sciences, and exonerated PIC of the charges of negligence and recommended proceedings against Dr Tooba Ashraf instead. The PHC’s act of shying away from fixing responsibility in matters of patients’ welfare on a mega hospitals such as PIC is only helping in deterioration in healthcare services in public sector hospitals, which eventually prompted Chief Justice of Pakistan to take suo motu of the below par state of healthcare delivery in public sector in the province.

“PHC’s report, however, falls short of recommending proceedings against Prof Faisal Masood for praising me for performing my role in thoroughly professional manner and holding PIC responsible for negligence, which impeded efforts to save life of the female prisoner,” it was observed in an application to PHC by Dr Tooba Ashraf, who went on to say that it meant to ridicule the judgment of Prof Faisal Masood and by extension of the CMIT committee and showed mala fide in making her a scapegoat just to save skin of the responsible from the PIC.

She took another plea that she had been held responsible without an autopsy report of the deceased conducted before or after exhumation of the body as per the rules and regulations of the PHC. She believed that there seemed to be a mala fide in PHC’s remark about disparity in echo, especially when it says the attending doctor is not being available in the country for discussion. She said that, in violation of the PHC law, she had not been informed before the decision to allow her to take another cardiac expert’s opinion in the case.

She mentioned that the circumstances prompted her to file an appeal before the district and sessions judge, but Legal & Complaint Management departments had been using delaying tactics to prolong the case on technical grounds i.e. taking leaves, pointing the matter as time-barred, creating legal hindrance. PHC’s counsel is avoiding defending its case through arguments on merit.

When contacted, PHC Director (Complaints) Prof Dr Riaz Tasneem said that PHC’s Board of Commissioners had given a collective decision and it didn’t have powers to review its decision, which can only be reviewed in the court of law, he told this correspondent.

When asked about the contradiction in the findings of CMIT and PHC’s reports in the case, he said that PHC conducted an inquiry much like in a judicial manner and, hence, the findings could differ. When asked about the aggrieved party’s accusation against PHC’s of mala fide in exonerating the responsible from PIC especially when CMIT’s complaint was against PIC and not her, he said that it was the petitioner’s version.