Search This Blog

28 July, 2017

Graduate Could Have Been Save : Says diagnosis Experts





Some medical experts in Lagos, Nigeria, and a public health specialist in the United States of America, have reviewed the medical file of a 29-year-old graduate, Kolawole Idowu, who died after alleged wrong diagnosis in a Lagos hospital.

The experts said although the victim received good medical attention, his life could have been saved if he had the right tests and handled by specialists.

A reporter had reported that Kolawole took ill and went to a private hospital, Ikeja Medical Centre, where he was treated for malaria and after reacting negatively to it, he was admitted for mental illness.

His mother and brothers had alleged that he was not properly tested before the private hospital came to the conclusion that he had psychosis.

After spending about two weeks at the hospital, he was transferred to the Lagos State University Teaching Hospital, Ikeja.

He was admitted to the psychiatric ward and later went into a coma.Our correspondent reported that he was taken to the Intensive Care Unit of LASUTH.

He died after spending about two months in the ICU.

Doctors at LASUTH had said he was received as a psychiatric patient, but further checks showed that his ailment was not purely a psychiatric issue, adding that he had meningoencephalitis infection.

However, medical experts, who studied Kolawole’s medical file, said his death was avoidable. 

An electronic copy of the medical file was obtained starting from when his treatment started at the Ikeja Medical Centre.

The file, signed by one Dr Fakoya, stated that the deceased had complained of tingling sensation and bitter taste in the mouth on May 8, 2017, adding that further questioning revealed he occasionally took alcohol and recreational drugs.

On May 11, 2017, it was noted in the file that the patient had sudden onset of irrational talk and violent behaviour.

Later that day, it was noted in the file that the patient had become calm and stable, “although he was unable to sleep.”

Another note in the file, dated May 12, 2017, stated that late Kolawole “was admitted yesterday (May 11), with a “sudden onset of irrational talk and violent behaviour. He is being managed as a case of acute psychosis 20 to drug abuse. Nil complaints today.”

By 12pm on May 13, the record said Kolawole discharged himself against medical advice the previous day and had been re-admitted.

On May 15, the hospital brought in a psychiatrist, who reviewed his case.

He was later referred to LASUTH.

An electronic copy of the referral letter, obtained showed that he was transferred to LASUTH on May 19, 2017.

The letter, signed by one Dr G.O. Omidiji, the medical officer of the hospital, said, “The above named presented to our facility with history of sudden irrational talk and violent behaviour. He was being managed as a case of psychosis 20 to drug abuse.

“An evaluation by a specialist was done and an assessment of delirium was conducted. The treatment included I.M. Diazepam 30mg stat and I.M. Chlorpromazine 150mg stat. The reason for the referral is for further review and proper follow-up in a specialist centre.”

The patient later died at LASUTH.

One of the medical experts, Dr Victor Chukwu, a Public Health Specialist and Biostatitian, based in the US, bemoaned the death, saying it could have been prevented.

Chukwu said, “The medical centre managed the case based on the information they got. The only issue, however, is that they should have taken a better history; get more information about the symptoms presented. They got confused when he manifested symptoms of psychosis. No proper history was taken. They should have asked more questions.

“The centre did a good job by transferring him to a tertiary institution. It took some time for the tertiary institution to also decipher what was going on because the presentation and history were confusing.”

He added that certain diagnoses were also supposed to have been done  on Kolawole, adding that the bacteria that allegedly affected his brain would have been ongoing for sometime before it manifested in full.

“They were supposed to do both physical and medical tests. But we don’t really have consultants in private hospitals, except the very big ones. It was easy for the tertiary hospital to detect the problem because they work in teams and they have specialists.

“I doubt if the private hospital has the equipment to do the tests that should have been done. Moreover, no doctor would think of a brain problem when presented with body heat and teary eyes (as the patient claimed),” Chukwu said.

Chukwu said Nigerian doctors, especially those in private institutions, needed continuous training, adding that the government should work on the health insurance system to make medical costs cheap.

The Chairman of the Nigerian Medical Association, Lagos State chapter, Dr Omojowolo Olubunmi, a consultant neurologist at the General Hospital, Marina, said Kolawole was admitted to Ikeja Medical Centre on suspicion of alcohol dependence or use of illicit drugs which was not corroborated by any history or test.

He said, “Ideally, with such suspicion, a drug screening test would have been ordered for the urine and blood. There may be limitations here because only a few labs do that and it is expensive.

“The Ikeja Medical Centre did well by calling a specialist, a psychiatrist, to review the patient. However, this should have been done earlier.

“So, in essence, the diagnosis was uncertain when he was referred to LASUTH. From the medical file, the patient was attended to promptly and regularly; it was not a case of negligence. The matter here was a diagnostic dilemma as the real cause of his sickness remained obscured even after the best effort. He should have been referred earlier to the general hospital.”

Olubunmi said LASUTH doctors did their best by giving the victim the attention of their specialists, expressing surprise that it took time before the government hospital discovered the supposed real problem with the patient.

“LASUTH tried and it is a plus that he was managed in the ICU because that is the best place for patients who are comatose or critically ill.

“But up till now, the cause of death is not definite. The only thing that can solve the puzzle is a forensic pathology expert, who will examine his brain and other tissues. I believe we should strive to get to the cause of his death because this will be useful in preventing a similar occurrence in the future,” he added.

A consultant at a neuropsychiatric hospital, Dr Adedapo, said the presenting symptoms made the illness to look like a psychiatric illness.

“But with the constant fever (he had), it is likely that a brain infection was ongoing; possibly tuberculosis meningitis or an autoimmune encephalitis. Autopsy will provide the answer,” he added.

Adedapo said Ikeja Medical Centre should have considered other non-psychiatric diagnoses, instead of fixating only on psychosis.

He explained that investigations were also vital, especially CT scan or MRI, adding that they cost a lot of money.

The consultant said Haloperidol did not cause Kolawle’s death as suggested by the family.

A general practitioner, who did not want to be identified, said, “From the way he was presented at LASUTH, he could have had meningitis, encephalitis or even neuroleptic malignant syndrome. Kolawole could have truly reacted to the medication he was given. At the same time, the encephalitis might just be evolving as of the time they saw him at the private hospital such that by the time LASUTH started treating him, the symptoms had become pronounced.”






No comments:

Post a Comment