A cancer patient from south Kashmir’s Kulgam district had a close shave with death after department of surgical oncology at SKIMS took a decision to perform his surgery at a district hospital though he had been admitted for treatment at the institute.
On November 14, the patient (name withheld) underwent surgery for mouth cancer (squamous cell carcinoma in buccal mucosa) at district hospital Anantnag (Islamabad), which lasted for almost four hours. But over two hours after his surgery the patient was rushed back to the SKIMS for “further management” after his condition had deteriorated. On Friday, 12 days after his first surgery for removal of the tumor in the mouth, the patient had to be again operated upon at the SKIMS for five hours as he had developed “necrosis in the flap” following the first surgery.
The case has once again brought to the fore the danger of performing complicated surgeries out of the institute equipped with the facilities as well as the expertise. As per official records the patient was admitted to SKIMS on October 20 (under MRD No 942346), but he was shifted to the district hospital, which doesn’t have an ICU for the surgery which lasted from 12:30 pm to 4:15 pm.
“At 6:25 (2:10 hours after the surgery) patient has not gained consciousness and there are no motor/sensory response except breathing which also is not adequate…therefore he is referred to SKIMS for further treatment,” reads a referral note, written by the authorities concerned at the district hospital before he was rushed to the SKIMS. GK is in the possession of the medical records of the patient as well as the referral note.
The doctors are now questioning the “illogical decision” of the institutes’ surgical oncology department to conduct such critical surgeries out of the SKIMS. “What is the necessity for carrying out advanced procedures in peripheries when we have all the facilities available at SKIMS?” asked a doctor. “Aren’t we risking lives of patients?”
The SKIMS in collaboration with directorate of health Kashmir has been carrying out surgeries of cancer patients in different districts, “in an effort to reach out to the patients at the doorsteps.” Under the program, termed by many health experts as ‘ill conceived’, the department of surgical oncology, SKIMS sends doctors to the districts for carrying out surgeries.
A senior doctor said though there was a practice of reaching out to patients for primary and secondary healthcare and for early diagnosis of the diseases, the authorities shouldn’t risk lives of patients by carrying out their critical surgeries out of tertiary care institutes.
“Look at this particular case…the patient could have died,” said the doctor. In absence of the life support system and critical care ambulance, when the patient was shifted back to SKIMS his breathing system had to be supported for around 70 kilometer journey on “ambu-bag”, a hand operated ventilator, and that too by the attendants.
An official in SKIMS administration said the fact that the patients was brought back to the institute put a question mark on the “needles and risky decision” of moving out the patients from SKIMS for surgical procedures.
The patient, who is undergoing treatment at the SKIMS, was on Friday rushed to emergency theater for second surgery for removal of the “necrosed flap”.
“That the patient developed the necrosis shows how badly the procedure had been conducted. The doctors had to carry out tracheostomy of the patient yesterday as he was suffering from breathing problem,” said the SKIMS official.
While the case has brought to fore the risk involved in performing the critical surgeries out of the SKIMS, the authorities at the institute, it seems, weren’t ready to learn from the mistakes. As per the sources a 19-year old girl from Eidgah here, suffering from mouth cancer (ca hard palate), was also shifted from SKIMS to district hospital Anantnag earlier this month for conducting his surgery there.
“Such illogical initiatives are putting lives of patients in danger and putting stress on already exhausted system in the district hospitals,” said a doctor of directorate of health services.”The government should immediately step in and order complete halt to such practices.”
Sources said during the SKIMS’ last governing body meeting, chaired by chief minister Mehbooba Mufti, the director SKIMS Dr AG Ahangar had pitched for funding of Rs 20 crore for developing “mobile SKIMS” program for carrying out advanced medical procedures in districts. However the sources said the proposal was objected to by most of the members of the governing body who insisted that that the funding should be instead pumped for augmenting the present infrastructure at the SKIMS.
Minister of State for Health Asiea Naqash said the case had come to the notice of the government. “It is bizarre to conduct such critical surgeries in peripheries and the SKIMS authorities should stop this practice forthwith
“They (SKIMS authorities) have no mandate to carry such procedures out of the SKIMS. How can the doctors leave the institute and why are they being permitted to do so,” asked the minister.
She said the SKIMS authorities should fix the responsibility regarding the case of Kulgam patient. The minister also confirmed about the governing bodies opposition to the proposal for allotting of Rs 20 crore to the institute for purchase of hi-tech and life saving ambulances for carrying out surgeries in the peripheries.
“The proposal was outright rejected by the Chief Minister who told the meeting that there was need to upgrade healthcare facility in SKIMS,” said Asiea, adding the chief minister had also issued the directions that there was no need for SKIMS doctors to move out of the institute for conducting surgeries.
