Nursing Association head: Port of Spain doctor sent on leave is ‘low-hanging fruit’

The content originally appeared on: Trinidad and Tobago Newsday

TTRN President Idi Stuart – File photo by Angelo Marcelle

HEAD of the Nursing Association Idi Stuart says the North West Regional Health Authority’s (NWRHA’s) decision to send head of the Infection Prevention and Control department Dr Darrel Jones on administrative leave over the deaths of several babies at the Port of Spain General Hospital (PoSGH) raises new questions.

The babies, all premature, died after an outbreak of bacterial infection at the hospital’s Neonatal Intensive Care Unit (NICU) between April 4 and 9.

Lawyers representing the affected families say the number of questionable deaths has now risen to 11.

Jones was sent on administrative leave by the NWRHA’s board of directors.

In a statement issued on April 18 the authority said, “As the investigation matures, the NWRHA may make further recommendations for suspension if deemed necessary to advance the investigation.”

But Stuart said Jones was being made a scapegoat, as there are other people who similarly have questions to answer in this situation.

He described Jones as competent, conscientious and meticulous and called the decision to send him on leave “unfortunate.

“He may be an expected fallout (sic). He would be a low-hanging fruit, which the RHA could point to that they are doing something.”

Stuart accused the higher-ups of making the junior staff “take the fall” in this scenario.

“We find it so ironic that when there’s praise to be accepted, the lower-level staff is never the ones to receive that praise. It is the seniors.

“Now, when there’s blame to give, it is the reverse taking place. The senior staff is not present and the junior staff is taking the fall.”

He identified understaffing as a long-standing issue within the hospital and said he believed the NICU was no different.

“Anytime you move from one nurse to one patient or one neonate and you, you place that nurse to see about an additional child, additional neonate, you are increasing the chances of cross-infection.”

Referring to the initial reports of seven babies dying between April 4 and 9, Stuart explained that seven babies in the NICU will need almost 35 nurses assigned to the unit.

“If there were seven babies, there should be seven registered nurses in the morning, seven in the evening and seven in the night. That’s a minimum of 21 nurses per day with just those seven babies.

“The nurses can’t work every day, and then you have nurses who will go on vacation and casual leave, so you need additional extra nurses.”

He said the NWRHA has questions to answer about staffing issues at the NICU and their possible contribution to the babies’ deaths.

“The RHA needs to say how many babies were admitted (between April 4 and 9), what is the bed capacity of the unit, if all the beds were occupied, and how many nurses they had rostered to the unit.”

Stuart also asked whether all the nurses assigned to NICU had undergone the 18-month training programme required to become a NICU specialist nurse.

“They need to say how many of them are specialised nurses. It is highly unlikely, because (in) no area, barring none, in the healthcare sector do we currently have all areas occupied with specialists (nurses).

“What you end up happening is a number of the registered nurses, but not specialised any particular field.”

Stuart said the PoSGH medical director, to whom Jones reports, should also have questions to answer in this scenario.

“Does Jones have the latitude to determine the bed capacity for the institution? Can (he) improve the poor patient-to-staff ratios within the NICU department. Can Jones refuse babies from the unit if it is overcrowded, or if the baby has an infectious disease which will compromise other babies?

“The answer to that is no, it’s the medical (director).”

He said Jones’s position is mainly an advisory one.

‘While his title may be ‘infection and prevention and control,’ he is there to advise the medical chief of staff and the other parties within the hospital.

“He cannot change the environment, he cannot change the human-resource capacity, he cannot do any of those things. He has to propose and advise how to implement, but he cannot mandate those things being done.”

He said the other person whom the public may believe has questions to answer because of their role at the NICU will not be sent on leave, as there is no one to replace them.

“There are very few neonatologists in the country – probably two who are qualified and internationally recognised as neonatologists.

“You may have a number of doctors working in your NICU department, but it doesn’t mean they are specialists in the field. And because of this one person operating in about three different hospitals currently, you would not even hear that person name mentioned.

“It’s highly unlikely any sanction whatsoever will be placed on that person. You know, in America, they say it have banks too big to fail. Well, this is an individual too big to be suspended.”

Newsday spoke with NWRHA CEO Anthony Blake, who asked for any questions to be sent to him via WhatsApp.

Newsday sent the following questions:

What is the current nurse-to-patient ratio at the NICU at PoSGH and does it meet industry benchmarks?

Can you say what the nurse-to-patient ratio was between April 4 and 9?

Are all the nurses assigned to NICU specialised in neonatal nursing?

Does the head of the Infection Prevention and Control department have the power to make staffing decisions regarding NICU nurses?

Can the head of the Infection Prevention and Control department refuse babies from the unit if it is overcrowded or if the baby has an infectious disease which will compromise other babies?

Blake said in response he could not answer the questions, as “this unfortunate event is the subject of multiple investigations and may also be the subject of legal proceedings.”

He said it would be “irresponsible of me to comment on any information that may form part of the investigation.”