Friday, February 5, 2010

Omani couple successfully sue Muscat Private for negligence over tragic death of newborn

I was recently forwarded a tragic story about Muscat Private Hospital.

Photo: Muscat Private Hospital in Bousher, Muscat, Oman. A family's child died due to negligence, according to the recent finding of the Oman Ministry of Health

A year and a half ago, an Omani couple gave birth to their child at Muscat Private Hospital, one of the 'top' private hospitals in Oman. The birth proved difficult and a C section was performed. The child was born OK though, and scored a 9 and 10 on the Apgar scale (a standard way to evaluate the health of a newborn, scored out of 10).

However, later that night there was a problem. The baby was having difficulty breathing, and had vomited some of the baby formula they had given it. Despite efforts to treat the problem, within a few hours the baby died.

The couple were convinced that the death would have been preventable if proper treatment had been given, and proceeded to seek to uncover the cause of the death through the courts and the Ministry of Health. In December last year they finally got confirmation that they had been correct, when the court appointed expert and the Ministry of Health officially found that Muscat Private Hospital and the paediatrician involved were negligent in their treatment, that the Dr. was not qualified for his role as a Senior Paediatritian, and that MPH had inadequate procedures (see document of the translated findings below).

Excerpt from the email sent by the mother following the report from the experts:

... As you are aware, we have taken up the matter with the Court and the Ministry of Health in order to ensure justice to our beloved baby and to prevent such incidents of dereliction of duty by medical professionals in Oman. Today, I’m writing to inform you that the Higher Medical Committee has finally given its verdict in our favour and found the doctor responsible for providing inadequate postnatal paediatric care and the MPH has inadequate protocols in case of an emergency which lead to the untimely demise of our beautiful baby [name removed by UD]. While their judgment won’t bring our baby back to our arms and there is no material that can compensate for him, it offers us some consolation that our fight for him and other innocent Babies did not go in vain, and hope that our efforts will prevent recurrence of avoidable paediatric catastrophes in future.



I've been sent a lot of the documentation, but here is certified translation of the key investigation findings from the Ministry of Health:




Medical errors and mistakes occur across the world everyday, unfortunately. No-one is perfect, and when imperfection meets critical health situations bad things happen. But this case highlights a few things that are more specific to the Oman healthcare environment.

For a start, it shows that ordinary people can successfully take such matters through the Omani legal process and win. This is really good, and not easy to achieve anywhere in the world. The court is due to rule on compensation and penalties for MPH this month. I understand the Dr. concerned has left MPH, but has anything changed at the hospital itself?

Second, the finding that MPH had inadequate protocols and systematically failed to execute accepted medical standard responses to what is a infrequent but very common and normal post-birth complication (generally 1-2% of births), calls into question the regulation and inspection of our many private clinics and hospitals, especially those that claim to be capable of offering advanced care. MPH's response to a neo-natal Pneumothorax - given that they are in the business of offering expensive maternity services, should have been slick, professional and effective, not dependent on a Dr. called in to deal with an emergency in the middle of the night.

Third, although this case involved an Omani couple, it's concerning that Expats in Oman are effectively forced by the Government to give birth in private hospitals unless there is a clear medical reason to go to the big state hospitals like Royal or University Hospital. Around the world, small private hospitals are fantastic for elective procedures, with no waiting, private rooms and nice food. They are almost like hotels (as is Muscat Private). But they are also potentially very dangerous places when something goes badly wrong, as they do not usually have a 24/7 operating theatre, long lists of experienced and specialist resident Doctors on duty, and are inexperienced with dealing with things when the shit hits the fan (because they don't happen very often). The usual response is to rush the patient to a big hospital asap.

And lastly these clinics are run for profit. There are often anecdotal reports of patients in Oman being subjected to expensive and unnecessary tests, or not receiving very good treatment at all. Doctors' qualifications can be dodgy. Clinics advertising "24hr Emergency care" are sometimes totally unfit to offer these services for anything serious, such as a heart attack or stroke. They simply waste time transfering the patient to a real hospital and, as a result, risk people's lives.

That the investigation was conducted and came to a ruling against MPH is to be lauded. BUT, The Ministry of Health needs to look to itself after this case, and see how it can improve the regulation of Private Hospitals in Oman.

My condolences to the family in this case, and I thank them for persevering against MPH in what must have been a devastating time of grief and something they must have wanted to do their best to forget. I also thank them for choosing to make their story public.

I am waiting to see if MPH have any comment to make on this case.

27 comments:

  1. Looks as if it was moved through all the procedure quickly – very impressive and so much better for the parents.
    I thought that Dr’s had to be examined by the MOH as to their capability – point number 2 seems to refute that .
    Irrespective – the MOH works wonders using 4.6% of Oman Government Budget (not GDP) http://www.emro.who.int/emrinfo/index.asp?Ctry=oma compared to the UK 11.8% http://www.ukpublicspending.co.uk/uk_health_care_spending_10.html (even though the figures come from different sources – you get the picture )

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  2. What's the best hospital for expats ? Can we pay to go to the busy maternity hospital instead of one that has cheapo underqualified doctors, and consultants who don't consider it a duty to be on call ?

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  3. If it was negligence then hopefully something good will come from this and standards will rise. I've known of several complaints about care and after care during pregnancies but wasn't aware of this. One point I picked up on was ''the inexperience of the Physician''. This does not surprise me as salaries are low and can only attract Doctors mainly from India, who can't get jobs elsewhere.

    I had a medical last year for insurance. I was told only two Doctors were acceptable and this in the whole of Oman!

    When it comes to medical care more and more Omanis are going abroad, mainly to Thailand.

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  4. UD, thank you for posting about the ruling. I heard about the tragic death and my heart went out (and still does) for the parents, not least because I had a baby in the same hospital around the same time.

    I was aware of the issues, of course, like too many scans/tests and being pushed for an unnecessary C-section. As there is no choice for people like me, I had no reason to and tried not to worry. I was very lucky and grateful to have a healthy baby.

    Even then I left hospital just after 24 hours because I found the doctor's check-up inadequate and some of the nurses (not all!) unhelpful, inconsiderate or, in one case, lacking understanding of basic hygiene. Having said that, I have stayed in hotel rooms much worse than my private room at MPH and the food was excellent.

    What's troubling is that even I know of another baby with a lifethreatning condition that went unnoticed during the many ante- and postnatal checks at MPH but was luckily picked up by another pediatrician in Muscat. As you said, the Ministry needs to improve the regulations, and MPH has surely taken action to improve the quality of care.

    Thanks again for the post.

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  5. Very encouraging story... The legal system isn't as bad as I thought after all.

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  6. The loss is very tremendous and nothing in this world can bring the baby back.

    The couple could get the justice for the baby. Thers'a possibility that decision of c-section should have been taken earlier.

    Doctors are life savers. They need to be alert.

    Thanks for this post

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  7. DA: It is totally a wrong impression that if doctors are from India, then treatment will not be upto the mark. You are right that for the salary paid here only Indians will come to Gulf. But be aware of the fact that many UK people are preferring to come to India to get their surgeries including cosmetical one done in India, due to huge delays and costs of getting it done there. Medical Tourism especially to Chennai in India has grown up substantially in recent years. Most Omanis in fact prefer to go to india to get advanced treatment.
    There are many instances when rich indians had gone to US or UK for advanced treatment but ended up with botched surgeries. Due to the large population Indian doctors are highly experienced compared to any other nationality.

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  8. Muscat Private Hospital is not equipped to deal with any medical emergencies and most Omanis who go there go for elective treatment, never for emergencies. However, despite it not having a pediatric ICU, many Omani couples choose to have their babies delivered there. Maybe it's considered posh to have your kids at a private hospital instead of in the government hospital with the hoi polloi.

    My wife and I choose not to have either of our kids delivered there because we've heard nightmare stories of babies being transferred immediately after birth to Royal Hospital because MPH doesn't have the facilities to treat their conditions.

    I am aware of this particular case. The infant's death occurred in 2008 and the couple in question have since had another baby. The couple initially accused their OB/GYN for the death of their child. As you mentioned the child was OK after birth and later started to vomit the formula. From what I know, the hospital didn't have a senior pediatrician on duty in the hospital and he had to be called from his house. I am not sure who was at fault in the death of the baby, but the hospital should take part of the blame for not having proper protocols. It's inexcusable that the hospital doesn't have a senior specialist on duty 24/7. Then again, shouldn't MOH also take some blame for allowing this private hospital to operate this way? And if this doctor is inexperienced, that blame also should be shared with MOH since they approve the appointment of all doctors in Oman and tests them before licensing them to work in the country.

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  9. In defense of the Midwives at MPH, our experience was wonderful. They were capable, direct, and experienced.

    Our youngest was born at MPH, by C-Section. We did not have a choice to go to a government hospital, as everything seemed normal-ish. Muscat private was pretty much my only choice, barring going to the UK or US for delivery.

    I adored my OBGYN, but didn't feel I could trust the hospital if anything went wrong with the delivery. Everything, from the nurses to the way thephones were answered, to the way nobody could answer simple questions regarding SOPs and statistics... It just didn't inspire trust in me.

    I chose a scheduled, elective cesarean, against the advice of the doctors. When the kid was born, I had the Best OBGYN, and the Best Pediatrician an Expat can have, bright and early, fresh and prepped, in the room, knowing exactly what they were expecting.

    I'm really glad I followed my gut instincts on that. The kid was almost a kilo bigger than anticipated, and 4 inches longer. Even the all natural earth mother midwives said later that they were certain I would have wound up with a crash C-Section.

    I think MPH doctors and nurses try their best and really do a good job, but I suspect it's the hospital administrators and accountants who prevent these guys from doing the best job possible. Hospitals shouldn't be For-Profit.

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  10. I am glad someone actually sued MPH, my wife and i had similar experience,our child was born with a heart problem, which as per other doctors said that our doctor should have noted the deficient in our baby heart thru the numerous scans that she did, but she did not and six months latter our precious baby passed away.
    We unfrotunately did not sue MPH, being expatriate and all, but its about time.My advice to all is, for emergency deliveries please do not go to MPH and also note that if your wife wants to deliver and she is 36weeks or less(premature), as per MPH policy they do not accept such cases and will direct you to Royal Hosp., just bear that in mind.

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  11. DA: I am an expat living in Oman. I must agree that the healthcare system in Oman is not upto the mark. However, implying that Indian doctors are the reason is a serious misconception. I very grateful to the excellent medical care I received while at my stay at a hospital in Mumbai. I was rushed there after I was misdiagnosed in Oman. I must tell you that apart from the exceptional medical care I received there, I also came to change the way I view Indian doctors. Doctors in India affiliated to reputed healthcare organizations are among the most highly paid. Yes, I do agree that only those who dont make the cut in India will accept a job over seas but that does not imply that Indian doctors are to be blamed. The blame should be on the private hospitals who employ unqualified persons, irrespective of their nationality.

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  12. India has excellent doctors but the ones employed by private clinics are either failures in India or have come with a forged certificate. Good doctors are making 3 to 4 times the salary offerred by private clinics here in Oman.

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  13. Blaming Indian doctors? LoL! I find that hilarious considering most of british doctors are indian or indian origin, same goes for the US. Hmm.... must be a conspiracy that US/UK medical system isn't that bad.

    Anyone who knows their history of the british NHS, would know that if it wasn't for indian doctors tehre wouldnt even be healthcare in certain areas.

    Just because MPH doesnt have facilities, why blamme the doctors? Look at Royal hospital, Khoula hospital, all have indian doctors and have functioned well since.

    Funny thing is, all the big indian hospitals have indian educated, British specialist training.

    MOH have to enforce when hospitals are of poor quality, nothing to do with the doctors.

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  14. All,

    No one is or should be blaming "Indian Doctors".

    DA, its exactly this sort of crap that degenerates the level of the debate.

    Muscati,
    Always an honour. Thanks for the supportive comment - even more of an honour!

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  15. Where did I state that Doctors from India are not up to te mark or suggest they are all crap?

    Oman is a target for many countries, not just India with its vast popuation, to dump so-called professionals there who can't make it in India or elsewhere. Yes, the good one's go to UK and the NHS has some exellent Indian doctors!

    The point made in the report as the inexperience of the said Doctor and I know from my own experience and friends who work in senior positions in hospitals in Oman that things are far from rosy. One friend resogned last month and went back to UK because he ws so concerned about standards!

    Finally, Anonymous, stop stalking me and contribute something constructive instead of challenging facts because you find them uncomfortable.

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  16. Several interesting points have been brought out in this discussion,
    1) Health care in Oman is not up to the standards we want it to be,
    2) The MoH is doing a good job, considering the small budget that they receive,
    3) The lack of adequate care can be blamed on under-trained/ un-experienced health care professionals, but not on any particular nationality,
    4) it is possible to get 'justice' from the system.

    So what is the solution to he lack of adequate health care in Oman? Is it a problem we can just throw money at? I think the start to solving the problem is frank discussions just like this one, not ones where we just break our arms patting our selves on the back saying how 'rosey' everything is. The first step to solving any problem is to admit you have a problem.

    Thanks Dragon for starting the discussion.

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  17. I am not a doctor.Hence I am not venturing to express any opinion on technicalities.Any way your post had two effects
    1.We have an idea about the degree of care and attention that can be expected of a private hospital in Oman due to their inadequate facilities and staff.
    2.People are now aware that the courts in Oman give redress or at least consider issues of medical negligence.
    But having said this I am interested to know the criteria by which a paediatrician is considered a specialist.( experience and qualifications)
    I am interested to know about the judjement of the court.ie The liability of the parties concerned ( the doctor, the hospital and the ministry, if the ministry is in the party array)
    Yes,there should be serious concern about the standards here, about the education system which ultimately ensure standards.I would also like to point out that India has institutions imparting standard education in all fields and also institutions having dubious standards.It is not possible to get qualified people for the money the private hospitals give as salaries.
    I am not in any way implying that the doctor concerned is not up to the mark or any thing.

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  18. MPH never had the basic standard quality control. As far as P + P,(policy and procedures) you can forget it.

    Severe regrets and condolences on the lost of any life, most especially a healthy born baby but the Ministry should be all over this place, everyday each week for 5 years beofre you will get change.

    I suggest that MPH is a Pandoras box and if you knew the half of it you would not even have a cup of tea in it. Anon

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  19. A pandoras box, if you knew thet half of it you would enter the doors with caution!!!

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  20. I recently had a baby by c-section at MPH and was not impressed in the slightest. My doctor was fine and the midwives were also. However, the midwives were so understaffed that we barely saw them. The basic nursing care was absolutely terrible. And like someone previously stated, some of the nurses did not know the basics in personal hygene. Nor were they all proficient in English. We have so many examples of the poor standards towards both my baby and I that it is shocking. Needless to say, I will not be having another baby in Oman.

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  21. http://onlinemba.co.in/education-reforms-aicte-to-revamp-its-approval-system-press-trust-of-india/2010/01/07/comment-page-1/#comment-1210

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  22. i had 2 babies at MPH and am glad to have got away with it with 2 healthy babies and with me also intact. With 2nd baby I had an awful anaethsitist that used bad drugs and my spine as a target practice (4 holes later). Elective C section with spinal block had to go to a General and an awful 'birth' experience followed by PND... all down to the useless Anaethestist. My Dr (Rula) was wonderful and Paediatrician (Dr Hans)- brilliant. I am back in NZ , 8 weeks away from having baby number 3 and the service and care from the FREE maternity care here is like night and day when comparing it to MPH. On reflection i wish i had walked away from MPH and their cash registers... but like i said we got off lightly. I am SO sorry for families who ahve lost babies.. :(

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  23. It's Just scary to hear about a baby dying at Muscat Private.

    I had a son born there on the 26 October 2008. His Apgar was 9/10. Wheezing started and we immediately informed them for the 10'th time of previous complications with our older son demonstrating similar symptoms. He was diagnosed with "Wet Lung" I argued with the doctors that this was more serious due to the fact that our previous son being born in South Africa was born with Congenital Pneumonia, which he spent 3 weeks in neonatal ICU. My son's condition rapidly deteriorated, after fears of a repeat condition we begged the "Paediatrician" to do something, they insisted there was no neonatal unit and the hospital was not equipped to deal with this. Furthermore, they could not refer him to another institution unless conditions changed.

    So what does this mean? Wait for him to die first?

    After literally threatening the doctor, he mamaged to get a place at the Royal hospital Neo Natal ward at about 5AM, eventually after the baby's lung collapsed, a place was found at the royal. I feel that it should be mentioned that the only people at that hospital that were forward and honest were the staff nurses and midwife. They suggested we get the baby the hell out of muscat private and into a bigger hospital.

    Amazingly enough, on the ambulance trip there, the oxygen cylinder ran out of oxygen! the MRI's had to hand ventilate my boy.

    After that incident, and a bill of over RO 10 000 form the hospital, which was not covered by any Omani medical aid, the Royal Hospital saved his life. His Second Lung Collapsed a few days later, but thank GOD there were REAL Doctors and medical students who had the experience, equipment and knowledge to deal with it. Interestingly, including all Lab Tests, several weeks in the hospital, the bill was around RO 400.

    My Boy is alive, well and still living in Oman with us, but no thanks to Muscat Private.

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  24. sad incidence but i am sure the medical board who found the doctor guilty may not have seen all possibilities in such a case. and surprisingly most of the members of enquiry commission may be from a non related speciality with no adequate insight into the issue. of course severe aspiration of food contents is life threatening emergency and few people escapes from immediate death, and how this doctor be responsible?

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  25. There is a lot of ' bitching ' here about MPH . I work in UK in sone part of Ireland
    there are no obstetricians ( all sued) and most of obstetricians and paediatricians are from overseas ( India Pakistan Sudan etc )

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  26. How Indian Doctors are treated in Oman by India based hospitals
    Hi,

    To all those doctors who are thinking of coming to Oman.

    Before you accept that lucrative contract dangled in front of you by a big name hospital, to come & work in Oman, please do contact the Indian Embassy in Muscat : http://www.indemb-oman.org/, specifically the counsellors who are aware of all pending cases against the so called big name hospitals here in Oman.
    The following link will help you all get in touch with the concerned authorities: http://www.indemb-oman.org/information.asp

    Now after the imp. info, why am i writing this blog.

    BEWARE!!!!.

    Some of the big names from India run only a small nursing home here, but market it as if it were a big institution. I have been working here for the past 03 years and have come across so many cases with this big name hospitals, that it amazes me as to why do the big names like Apollo give their brand to small time nursing homes & risk getting the brand name sullied & slandered .

    The same goes for some of the other hospitals.

    In fact the medical sector here is divided into Public & Private.

    The private is further divided into Clinics, Polyclinics, Medical Centres & Hospitals.

    When ever you get any offer do check out which type of medical institution is it. Do try to get into an Hospital, since many hospitals are now coming up here & very soon the medical centres will have a very difficult time to keep the business going.

    The big private names are:

    Al-Raffah Hospital
    Starcare Hospital
    KIMS Oman Hospital
    Apollo Medical Centre
    Badr-Al-Samaa Polyclinic group.

    Out of these the first 3 are hospitals and do have a good reputation.

    Badr has a lot of issues going with. Even Apollo, although affiliated to the Indian Apollo group, does not have a very good reputation esp. in the Embassy.
    Both Apollo & Badr have issues going on with patients, doctors & nurses. Although it is rumoured that Badr group are good paymasters but not Apollo.

    Always, always check out with the Indian embassy before coming here.


    Till next time.

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  27. Top 10 Hospitals in India which has witnessed a lot of enlargement in the medical world. Not only Indian doctors are now leading practitioners in the field of medicine across the world, but also patients from unusual parts of the world are coming to India for treatment.

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