Hospital warned after man lapses into vegetative state

Dubai Healthcare City Authority suspends licence of cardiac surgeon after inquiry finds mismanagement

The family of a 48-year-old man who lapsed into a vegetative state following post-operative complications is fighting for justice. Imran Hussain was the breadwinner of his family

Dubai: Dubai Healthcare City Authority (DHCA) has warned a hospital and suspended the licence of a cardiac surgeon after a Dubai resident lapsed into a vegetative state following cardiac surgery.

Mohammad Imran Hussain, a 48-year-old business development manager in a chemical firm, lapsed into a vegetative state after developing post-operative complications, his family said.

Hussain underwent a Coronary Bypass Artery Graft (CABG) on August 3 at Mediclinic City Hospital and was expected to be discharged on August 10.

An inquiry conducted by the DHCA’s regulatory arm examined the case and described it as mismanagement by the hospital.

It also suspended the medical licence of cardiac surgeon, Dr Uwe Klima, for three months.

Pakistani expatriate Hussain’s family and the hospital have now appealed to the authority’s board. The family is seeking further action.

Dr Ramadan Al Beloushi, CEO, DHCA – Regulatory, told Gulf News: “Patient safety is our top priority and as a regulatory body we make every effort to ensure fair, transparent and equitable complaints process for both patients and health-care professionals.

“The decision in this particular case was based on evidence from cardiology interventionists and they have given their detailed unbiased clinical opinion after carrying out in-depth reviews, including a detailed clinical review that found that the cardiac surgeon mismanaged the case as he failed to give clear instructions to monitor the patient after removing the pacing wire and managing the complications in a proper timely manner. DHCR can also confirm an appeal to this decision is in process.”

The Customer Protection Unit (CPU) of the DHCA carried out its investigation and referred the case to the Fitness to Practice Panel (FTPP) for an impartial review.

The panel said there was a delay in recognising the symptoms of cardiac tamponade and timely intervention could have changed the outcome.

However, it described the non-availability of another cardiac surgeon in the hospital as a “problem in the system”.

In its final conclusion, the panel described it as “mismanagement” and suspended the licence of Dr Klima for three months.

It also issued a warning letter to the hospital for the “system failure”.

A spokesman of the Mediclinic City Hospital told Gulf News: “Mohammad Imran Hussain remains a patient at our hospital following complications that unfortunately arose after his heart surgery." 

The spokesperson added: "The hospital is currently in the process of lodging an appeal against the findings of the regulatory body. As such, it would be inappropriate to comment further whilst the issue is still subject to the process of investigation and appeal.”

Following a request from Hussain’s family, two US-based cardiac surgeons reviewed the case and submitted their report to the DHCA board.

According to that report, during a CABG procedure, pace-maker wires are left outside the heart in the epicardial space and exit from the chest wall to be connected to a bedside device.

It is a standard procedure to remove these either 24 hours after surgery or 24-48 hours before discharge.

Complications

It said one of the rare yet well-documented and most feared complications of removal of these wires is cardiac tamponade, or bleeding that results in the collection of fluid outside the heart, resulting in loss of blood pressure, breathlessness and compression of the heart owing to the pressure of fluid outside the heart.

While this happens rarely, nurses attending on a post-operative patient are trained to look out for symptoms and immediate intervention is advised as the patient can go into cardiac arrest resulting in loss of blood to the brain.

The report further said, that in this case, Hussain’s wires were removed at 8.10am on August 10.

He displayed all the classic symptoms of a tamponade but there is no documentation of any medical intervention until 9.30am.

Hussain was rushed to ICU at 10am and Dr Zuhair Yousuf, a cardiac surgeon, arrived at 10.50am after a full 1-hour-and-50-minute time lapse.

At 10.52am, Hussain suffered a cardiac arrest and was resuscitated.

His brain did not receive oxygen for nine minutes, resulting in irreparable damage to his brain tissue, the US doctors’ report added.

Amjad Hussain, the patient’s brother, told Gulf News: “My brother was recovering perfectly. Had the nurses recognised the symptoms and acted immediately, this would not have happened. His life is ruined. His children and wife are in shock and our entire family cannot come to terms with this.”

The family’s legal consultant Tameem Hashmi said there is prima facie evidence of gross negligence.