Would they have been so careless if he were a young Maltese man?
timesofmalta.com, 12.49pm today
Doctor admitted giving valium to asthmatic migrant, court told
Experts appointed by a court said today that a doctor had admitted that she administered 5mg Valium to an asthmatic illegal immigrant, despite fearing for his condition, saying she had done so on advice from her superior.
The female doctors, aged 28 and 31 and whose names cannot be published by court order, were working at St Luke’s Hospital on the night of February 6, 2005 when Eritrean national Sagid Iisraquay Tegualde died a few hours after being administered the tranquilliser. It was given to him because he was being violent and refusing treatment.
Court experts Dr Mario Scerri and Prof Joseph Caciatolo said the doctor had initially considered giving the migrant only half the dose, but then opted for the full dose as instructed by the senior doctor.
The migrant had been taken to hospital after filling ill while at Hal Far detention centre.
I’m among the first to stick up for doctors and nurses working in the high-pressure conditions of the Accident and Emergency department at the state general hospital. I’ve had to use their services many times over the years.
On those occasions when people asked me why I don’t go to a private hospital instead, my reply was always the same: that when it’s an accident or an emergency, the state general hospital is the safest and most reliable place to go, even if it’s far from being the most comfortable and you might have to wait for hours. This is because its A & E department has seen it all and dealt with it all, and all systems are in place to cope with anything at any time – after all, there’s an entire general hospital attached.
This is why I am so deeply upset by this latest migrant story. The young doctor knew that she shouldn’t administer diazepam to an asthmatic, and yet she went against her better judgment, saying that she was just following orders from her superior. As a doctor, as a human being, she should have refused to follow those orders if she knew it would put her patient’s life at risk.
We still don’t know why her superior gave that order. Did s/he know that the patient was asthmatic? More pertinently, perhaps, did s/he know he was an African from the camps?
I find it really difficult to reconcile this careless attitude with the meticulous attention to detail which I have always observed at the A & E department during my visits there over the years.
There are two issues here. The first is establishing whether there was negligence that resulted in the death of a patient. This is what the inquiry appears to be concentrating on. The second is to establish whether this negligence, if such it was, was specifically related to the fact that the patient came from a minority group that is the target of hatred, resentment and racism. Is this being looked at?
There is a third issue, and though some might suggest it is going too far, I still think it has to be looked at closely. This is the possibility that the order to administer diazepam to this man was not negligently given, but wilfully so. Though it appears to be too horrible to be considered, considered it must be. The idea that racists who are prepared to kill those they consider less than human lurk only within the lower orders of society is entirely a mistaken one.They might baulk at actually stabbing somebody, but might think little or nothing of taking a huge (and pointless) risk with diazepam.
54 Comments Comment
Leave a Comment
Daphne – Try to be violent in a British hospital. Security will throw you out in the street. All the medical staff at A & E work under immense pressure – ingratitude and even violence be it from some unruly Maltese patients or foreigners
[Daphne – David, this is not about whether the patient was unruly or violent. It is about whether he was given diazepam when it was known there was a high probability that it would kill him. Surely you are not suggesting that the lethal dose of diazepam was administered in self-defence, or that it was justifiable. Whatever next?]
The British National Formulary 58 (quite the bible of prescribing) does not describe asthma as a contraindication to the prescription of diazepam. What it talks about is using it with caution in respiratory disease and as contra-indicated in respiratory depression.
In light of this, unless you can prove respiratory depression, it’s certainly not fair to say it was a stupid idea. It’s certainly less fair to say 5mg is a big dose – it’s not, and calling it “the lethal dose” is overly dramatic. It’s true that the agitation exhibited by the patient may have been caused by respiratory depression, but aggressive and agitated patients can make assessment difficult as they’re not usually terribly cooperative. From here the situation can get very complicated very quickly and I don’t really know enough to say how important it was to sedate the guy (how unwell was he? how violent was he, if at all?).
An issue that surprised my when reading the article was that it was the junior doctor who found the patient dead. I was under the impression that the nurses should monitor unwell patients in their ward, yet this patient seems to have died without anyone noticing his deterioration.
So in summary:
1. Unless you have blood results showing respiratory depression, you can’t say “it was known there was a high probability that it would kill him”. Because it wasn’t known.
2. As per BNF58, Diazepam can be given to asthmatics with caution (i.e. adequate monitoring).
The fact that the patient was violent and unruly is relevant to the story. It is more relevant than him being an irregular migrant. I am convinced that the same would have happened had the person been a Maltese inmate who was brought in and was being unruly.
I am in no way saying that it is a justification but only that the fact is relevant to the story. It helps put the story in context. I think mistakes were made and if any are discovered those responsible should be held accountable, however this time I think the fact that the patient was an illegal immigrant has nothing to do with it.
Why do you ask ‘Did S/HE know that the patient was asthmatic?’ (s/he referring to the superior) when the article clearly states ‘The female doctors, aged 28 and 31…’
It was a ‘she’, quite clearly.
Yes, not one but two women made a grave error of judgement (just as men frequently do). Live with it, Daphne.
[Daphne – My reference was to their superiors. I know that the young doctors are women. But do you know what their superior is? I don’t.]
I believe the superior is the 31 year old. But what’s sex got to do with it?
Daphne, unless the superior is not under investigation, we have to assume it is one of the two (female) doctors and in all probability the older of the two, as John says. On second reading though there is a slight bit of ambiguity in the article.
John, Daphne often pushes a subtle (sometimes not so subtle) feminist agenda which I take occasional pot shots at. Above she refers to the superior as ‘s/he’ (as opposed to ‘she’) and I thought she was trying to blur the fact that two women were involved when in fact it is a genuine case of the author of the article not being crystal clear on this point.
Get your facts right.
1. The incident did not happen at A and E. It happened at the M8 ward at Saint Luke’s.
2. The patient died of a collapsed lung and water in the chest (it does not specify whether the water was within the lung (pulmonary oedema) or outside the lung (pulmonary effusion). Diazepam causes NONE of the above.
3. 5 mg of Diazepam is the MINIMUM RECOMMENDED dose for severe anxiety. The maximum recommended dose is 10 mg every 4 hours.
4. Diazepam cannot be given in Respiratory failure not in asthma. If the patient was in respiratory failure why was he admitted to a neurology ward (M8) and not to a respiratory, or high dependency unit / ITU? Why is the admission of a patient to an INAPPROPRIATE ward not even worthy of a mention in all this tirade against these two doctors? Also, asthma apart, why wasn’t a patient with Tuberculosis admitted to the old Sir. Temi Zammit ward, which is the infectious diseases ward. No one mentions the fact that this patient was a health hazard to the rest of the patients and health carers in the Neurology ward, and that no one (read administration) is being taken to task for the two massive shortcomings mentioned above. Sir Temi ward was well equipped with positive pressure single rooms to take better care of this patient, and protect those receiving treatment in the same ward.
5. The young doctor did what was expected of her in difficult cases; contact her senior. Whats the use of contacting a senior if then her advice is not heeded? Senior doctors have more experience than junior ones, and so it is natural to put your doubts to the side and
6. The senior doctor was unable to visit the patient herself since she was stuck with another difficult case in another ward. Had more doctors been available (and this being the Maltese system, doctors are hard to come by), the situation might have been treated with a calmer attitude, but most of the time, no sorry, every day junior doctors are expected to handle on their own, 4 medical wards each, resuscitations, and stay at work for 36 hours at a stretch, making best use of their medical knowledge, no matter the amount of pressure and tiredness they are faced with. At the end of the month they receive peanuts in return.
7. The junior doctor did not need to admit in court that she prescribed Diazepam. She would have written it in the file and signed with her name and registration number. Thats a responsibility no other person at that age is able to take.
Quite logical and quite correct.
Ordered by a superior? The Nuremberg defence.
“The fact that a person acted pursuant to order of his Government or of a superior does not relieve him from responsibility under international law, provided a moral choice was in fact possible to him.”
I think a moral choice was available, so they’ll have to think up another defensce.
Having said that, that’s why you have senior doctors. Should junior doctors ignore the advice of older, more experienced doctors? What happens when a junior doctor ignores a senior doctor, and somebody dies? Perhaps this has nothing to do with the Nuremberg defence.
I doesn’t have anything to do with Nuremberg. A junior doctor sees a patient, may have an idea what to do, but if they’re not sure, they call their senior for ADVICE (and not orders).
The senior doctor is often much more experienced and knowledgeable, their advice is solid. Junior are free to ignore it if it’s nonsense, and can justify it.
What would’ve happened if this doc had ignored her seniors advice and the guy died anyway? If the diazepam contributed to his death and he in the middle of an asthma exacerbation, he was probably in respiratory depression already. This means that the patient was probably very unwell and would’ve possible died anyway without significant changes to his treatment (i.e. using Non-Invasive Ventilation, which is usually poorly tolerated by agitated patients). To prove this, you’d need to get an arterial blood gas (this one’s trickier than the usual venous bloods) … off an agitated, aggressive and non-compliant patient … not an easy task to say the least!
** I’m drawing these conclusions from a couple of articles I read, I may not be right on the circumstances, but I can’t see any other likely way diazepam can be implicated.
As far as I know, Diazepam is not contraindicated in Asthmatic patients, it just needs to be “Used with caution”.
I think the answer to your questions is a simple ‘yes’. I have heard of so many idiotic mistakes made by staff, ranging from incompatible blood transfusions to wrong infusions (remember the infant’s death a few years back?).
A few Christmases ago my father was taken to Casualty after a bad fall. He was throwing up and displaying all signs of concussion. After having been left alone for nearly five hours he had a scan taken and a skull fracture was discovered. He died a couple of hours later. He wasn’t Maltese but that had nothing to do with the crass incompetence of that evening’s staff.
[Daphne – I am so sorry to hear that. The problems are all in triage, which is why it is crucial to be very, very well informed and to then drive the point home as politely as possible that urgent attention is required. This happened to me when one of my sons suddenly began exhibiting all signs of anaphylactic shock after eating pancakes (turns out the flour was a year past its sell-by date and that flour mites trigger anaphylactic shock in rare cases). The triage nurse decided that it wasn’t anaphylactic shock because he was still upright and breathing and dispatched us to the waiting-room. Before long he was barely able to breathe at all, so I bypassed triage and cornered a passing young doctor, who recognised the problem immediately, and whose reaction was a little – um – inappropriate (“Oh my god, this is what we learned about but I never saw a real case…how exciting”). Once past triage, the treatment was beyond perfect. It was just the most blessed coincidence that only a week or so before I had watched an episode of Doctors on BBC Prime, and the story-line dealt with anaphylactic shock, only it was due to the more common cause – a bee-sting. Then again, when I went in with a smashed wrist I didn’t mind waiting for four hours because I knew it would make no difference. I’ve also noticed that small children are rushed through immediately but the middle-aged can be brushed aside. When another of my sons was around five years old, I carried him into A & E with obvious concussion. He was literally snatched from my arms the minute I walked through those doors and taken straight in while I was dispatched to give his details.]
I don’t know why but I was expecting some piece about the deep parliamentary crises of Monday?
[Daphne – There wasn’t even one deep parliamentary crisis, let alone more. Don’t get too excited – or your parliamentary procedures in a twist.]
re Dr Franco Debono – let’s not play down the problem. Dr Primadonna Debono wants to show the prime minister that he is the one vote majority and will not tolerate Louis Galea being brought back into government.
Have you forgotten his post election success? He sent a correction to The Times report that “He even ousted a minister”. It’s now a real possibility that Dr Franco Primadonna Debono will be the Achilles heel of this government.
Perhaps a good dressing down from Brussels will cut this twerp to size.
[Daphne – I think that next time round, we all have to be ultra-careful who to vote for. Any signs of psychological instability or a huge and fragile ego, and the answer is a 10 or nothing at all – and that should apply whichever party we vote for.]
Daphne, you got the best explanation from Jon.
May I point out that it is highly important that patients co-operate with the hospital staff. Doctors are prone to make mistakes especially when they are working under pressure, the least they would need is someone causing them unnecessary problems, this applies to everyone.
I can tell from experience that hospital staff appreciate a lot that ‘thank you’ from their patients, it lifts their spirits.
Chapeau!
More than anything, this smacks of a decision taken by the harried doctors when dealing with a load of work that is not sustainable. Working in an environment where one has multiple pending calls, anyone of which potentially being a life threatening situation, it becomes more and more easy to take decisions that one would reconsider given the luxury of hindsight and adequate time to assess the situation.
I feel that the implication of racism is dastardly, to say the least.
[Daphne – Not when you know just how many doctors play an active role on Malta-based racist internet sites. I even had one or two on this blog – both women, incidentally. One of them used the nick Sybil. They used to pop in to make racist comments and describe Africans and Muslims as sub-human. Nice.]
Truth is that the general hospital is manned by junior doctors, who despite the much acclaimed agreement, remain poorly paid and working inhumane hours. And yet this does not dishearten most doctors, who give the best of themselves every single day. The situation will only become safer for doctors and patients when the management will do its utmost to retain the more experienced doctors, offering adequate remuneration for decent hours. And it will cost way way less then just the maintenance for our new lovely hospital.
Hi Daphne. Unfortunately there are doctors AND doctors. Not all are good – same as with football players or musicians. Some suck. It’s reality and we have to face it. I don’t know all the details of the case. All I can say is that doctors at hospital are overworked and seniors are nowhere to be seen.
There were serious administrative shortcomings that are not even being investigated. This is sad. I don’t see why the young doctor should take all the blame. And yes, this was a difficult case. Doctors don’t do miracles.
The problem with Mater Dei’s A & E is that the waiting-room is too small. Shame after all those millions spent and all those empty corridors to have such a small waiting room. Otherwise the service is top notch considering it is free. Obviously there is always room for improvement, as with anything.
Franco Debono should invest in an alarm. David Agius should stop taking us for a ride.
He suffered the consequences of his own actions. If he didn’t go ape shit, none of this would have happened.
[Daphne – We live in a civilised country, but judging by some people’s reasoning, I think they’d be more comfortable with the shariah law they purport to despise.]
The point isn’t that he’s black so out of racial hatred they killed him.
In being violent, he most likely confused them (unless doctors are expected to be robots without emotion) and maybe the superior made a mistake. Now whether that mistake was on purpose out of her personal hatred towards black people, that’s all speculation and rumors as far as I am concerned.
[Daphne – How can a mistake be ‘on purpose’? It’s either a mistake or it’s deliberate.]
Once again you’ve failed to see the points in my argument. I will try to word it better.
1.In being violent, he most likely confused them.
2.Confusion causes mistakes or errors of judgment.
3.Accusations of racism are speculation
Regarding your previous answer: we’re so backward that any moment now somebody might come out and say “women in the workplace are dangerous, because their minds are feeble, they cannot make good decisions and they get easily confused”.
Which brings me to another point: if sexist comments were passed by anybody important, you would have stood up for the women and said the same thing I did about the man.
On the other hand, if the courts find that the superior doctor deliberately did it out of malice, then it is another story. I just find it unlikely.
Of course there was no problem for the PN in parliament on Monday. Its all SuperWan twists and shakes, right? I mean, we all know that Prime Ministers have the habit of visiting backbenchers in their home every so often. Yes, right.
[Daphne – Nobody’s saying that there isn’t a problem. What I am saying is something quite different: that it is not the government which is unstable, but the psychology of certain MPs. In David Landes’s The Wealth and Poverty of Nations, one chapter begins with a telling quotation about the fragility of the male ego in the Arab world. I think this is what we are dealing with here in Malta: the problems in both parties are caused by the fragile male egos of the Arab world. There are two cultures in Malta: Arab culture (some like to say southern Mediterranean, but it is really Arab) and Anglo-Saxon culture. And that’s why the country is split down the middle culturally, rather than along partisan political lines, in its response to sulking, stamping ‘honour’ tantrums. Half the country thinks they are right and backs them, and the other half thinks they are disgraceful, behaving more like menstruating teenage girls than grown-up men.]
An acquaintance of mine once defined the Maltese male as having the social ineptitude of the English and the “macho-ness” of an Italian. In other words, a hopeless case. It may be a sweeping statement, but I think it covers about 99.9% of the (male) population with the ratio between the different mixes varying according to the individual.
Unfortunately, judging from what I hear from exasperated single female friends of mine, the situation gets worse as the typical single Maltese male gets older. I guess going around in circles on a small windy island is not too good.
@Steve
Assuming you’re male, which highly-evolved country are you from?
Dear Daphne, give us your comments about the case of Franco Debono vs GonziPN.
[Daphne – You have them in my article in The Malta Independent today. It was written before the Franco Debono incident, but the same reasoning applies to him. Also, I think we are dealing with the usual clash of cultures in Malta: the clash between Arab culture and Anglo-Saxon culture. We tend to forget that there is a cultural split which underpins and even overrides our political split. To me, it is culturally – as opposed to politically – unacceptable for grown men (or women) to behave like that. To others, it is not just culturally acceptable but entirely justified. The two cultures can never meet. Malta is very complex: Anglo-Saxon culture imposed for almost 200 years on what was essentially Arab culture. You have people who absorbed Anglo-Saxon culture completely, others who absorbed some of it, and the vast majority who absorbed none at all. It makes for some very serious communication problems, because Maltese society is really not as homogeneous as it seems to be at first.]
Yes, triage IS a problem; I cannot fault Mater Dei on anything except this. I have had such mixed experiences. From the security guards who made me park a mile away after my 81-year-old mother got an angina attack in the car and my own sugar count plunged with the shock of driving her to hospital with one hand as the other was holding her in the passenger seat. When I got to Emergency I asked for a glucose sweet only to be told that there weren’t any so a nurse took me to the staff canteen and gave me some sugared water from her personal supply which I found charming of her but not saying much for an Emergency Department in a country which is 60% diabetic.
We then waited and waited and every one-and-a-half hours my mother was taken in for yet another test etc. Doctors seem to make it a point not to make eye contact and tell you nothing. The frustration keeps mounting. The angina happened at around 11am and by 3pm I was famished and my sugar count plunging again. Then an orderly brought me a ham and cheese sandwich made by him, entirely unprompted and unasked. That man is an angel.
Mummy was finally admitted at 5pm and after all the formalities were complete and she was settled in, trying to make head or tail of how to use the PC, it was 6.30pm. I was shattered, alone and worried sick. I really felt as if I should have been admitted myself. Need it take so long?
Can the system not become more streamlined? It is not a question of medical incompetence; far from it, but of cockeyed administration. Can this not be addressed? Maybe the incoming minister of social policy can do something about this lacuna which necessitates the presence of a plethora of security guards in Emergency. Can one be surprised when even someone of my temperament and background can be pushed to a point of no return?
Have you ever thought about always having some kind of sweets in your pockets?
Some more facts.
The primary absolute contraindication is an allergy to Diazepam.
There are relative contraindications, which require more careful monitoring of patients after receiving diazepam, however the primary contradiction is an allergy to Diazepam.
In conditions such as Chronic obstructive respiratory disease (COPD) a stronger consideration of alternative drug therapy is required and the initial dose should be decreased. Patients common symptoms of COPD is shortness of breathing described as “breathing requires effort” and is not associated with TB. In this case the patient had TB he might had difficulty in breathing but don’t think it’s the case.
Diazepem can cause depression of respiration and consiousness however there is no dose associated with death. In the few documented fatal cases, doses have not been known with certainty and other factors complicated the clinical presentation. A 28 year old man ingested 2,000 mg diazepam approximately 10 hours before presentation. He was responsive to verbal stimuli, and oriented to person, place and time. He was observed, and fully alert 2 days after admission (Greenblatt et al., 1978).
Daphne is this case ‘Sub judice”? I guess we should consult Dr Anglu.
quote:”Patients common symptoms of COPD is shortness of breathing described as “breathing requires effort” and is not associated with TB. In this case the patient had TB he might had difficulty in breathing but don’t think it’s the case”.
In what way/s could tuberculosis change the anatomical structure of the lung?
What “case” would you wish to think of, and why?
If I am the other woman doctor you are refering to, who supposedly posted racist remarks on this blog, think again. I invite you to re-read all my posts and see if you can come up with one racist comment. The facts I posted (such as the high incidence of HIV infection in urban areas of sub-Saharan Africa) are taken from black-on-white statistics and not the result of racist fantasies.
[Daphne – You’re not. Don’t jump to conclusions.]
Maybe they’re whites’ statistics on blacks??
Most probably the doctors were trying to calm him down with valium befored treating asthma. Breathing problems should be treated at once, without losing time, and they usually take priority over all the other problems with the patient if there are any others. But dealing with a violent patient could be very difficult. They tried to do what they could instead of kicking him out of the clinic.
That’s good. So there was another lady doctor around here, apart from Sybil and myself? Interesting. Never noticed, and I can usually detect other doctors immediately when they write. Anyway, an unusually high percentage of lady doctors on this blog. Cannot be a bad thing – not bad at all!
The “superior” in question is one of the accused. The 31 year old is the senior house officer (SHO)…the one who advised the house officer (HO) to give the valium.
I can assure you 100% that she (and I suppose even the HO, though I don’t know her personally) is an exellent doctor, and human beings…and it was totally an error of judgment.
It is advised (because it is just an opinion, and never been tested on human asthmatics) not to give valium. Because theoretically it may depress breathing. But what other option is there when someone is agressive and there is no way to give the poor guy treatment???
The proper thing was to get an anaesthetist to put the poor guy to sleep and intubate him. Anyone working in St Lukes would tell you that this would have been impossible to organise quickly for an SHO!! With experience it is possible. A Senior Registrar (2 rungs above an SHO) or consultant would call ITU, refuse any ifs and buts from the anaesthetist and tell him “get your f^&*in ass over here, I don’t give a f$%^ if you have a bed or not, I want him intubated NOW!”
My goodness, what is my daughter letting herself into. She is at university reading medicine.
Daphne, I’m afraid you are totally wrong suggesting that any doctor would deliberately harm an immigrant.
You haven’t got the faintest idea what incredible (and unbelievable, given the nasty comments one hears) help, empathy and support, immigrants get from staff at Mater Dei.
It astounds me every day, honestly!
The nurse and the receptionist who fostered two orphaned Somalis after they met them on a visit to the hospital. The cleaners who emptied their lockers of anything consumable for a patient to take back to the open centre. The nurse calling every Somali she can find to convince a fellow Somali to accept open heart surgery. The consultant threatening to cut-off a minister’s balls if he refuses to pay for a black child to go to the UK for surgery…..the list is endless.
And of all doctors, the SHO involved is one of those obsessed in helping the most unfortunate.
Don’t you know, Daphne, that it is demeaning for a Muslim man to be examined by a lady doctor, and this was why the man was agitated? It is instilled in Muslim boys at an early age and this also goes for lady teachers: they are told by their parents (read father) not to take any notice of what a lady teacher says: this what Europe has to face.
[Daphne – In that case, his wishes should have been respected and he should have been examined by a man. Unlike you, I don’t find this extraordinary. It has nothing to do with lack of respect for women’s judgement: Muslim women prefer to be examined by women doctors. The veto is on examination by a member of the opposite sex. I can understand this, which is why my gynaecologist is a woman.]
What if there were no male doctors available at that moment? It’s hardly as though she was going to perform a prostate exam or some intimate sort of thing… which is why the comparison to a woman wanting a female gynaecologist falls somewhat flat. For any other purpose, I’d consider a doctor to be pretty much genderless when it comes to the physician/patient relationship, and show more concern over their abilities rather than their sex.
[Daphne – If it’s a cultural problem, it’s a cultural problem, and it has to be dealt with. End of story. You live in a country which does not have divorce or abortion because of cultural reasons, and then you wonder at the fact that some people come from a society which vetoes the examination of people by doctors of the opposite sex? Come on.]
Actually divorce and abortion are excluded on moral grounds, which find expression in the culture. If the idea that a female doctor might somehow pollute a male patient is part of their culture, integration is going to be a *really* bumpy ride.
[Daphne – It’s got nothing to do with pollution, and everything to do with embarrassment.]
I can’t really agree with you there. Isn’t refusing to be seen by a doctor because of his (or her) sex on par with refusing to be seen by a doctor because he’s black (for instance)? Both views are discriminatory and cultural values or beliefs cannot be used to justify this.
[Daphne – Not at all. There are reasons why a man might not wish to be examined by a woman, nor a woman by a man, that have nothing to do with prejudice against the opposite gender. Women have to confront this issue on a very intimate level when deciding whether they would prefer to have a woman gynaecologist or a man. Discomfort at having your private parts examined by a man with whom you are not in a relationship (or woman, for that matter) is just the extreme end of the same argument: the discomfort some men from a more conservative culture might feel at having an unfamiliar woman touch other parts of their body in a non-sexual scenario. Let’s put it this way, if you have a problem with, say, erectile dysfunction or urination, or even just a strange mark on your genitals, would you be more comfortable talking to another man or are you one of those who would get some sort of thrill from having it prodded about and discussed by a woman in a white coat, as long as she’s attractive?]
Wrong… apart from the white coat bit. Well, it doesn’t even have to be white as long as it’s woollen and whoever it belongs to bleats and baas…. you know my surname and origins.
But seriously, I was referring to those people who refuse to be touched by doctors of the opposite sex even when the part of the body needed to be examined is not private. I can understand your issues with a male gynaecologist but I can’t imagine you feeling uncomfortable with a male dentist or optician.
My point is that the unfortunate man you refer to objected to having a female doctor not (to the best of my knowledge) to having a female doctor fiddle with his private parts.
[Daphne – This is exasperating. The cultural veto on doctors of the opposite sex is not because of a prejudice against women, but because of discomfort at being touched by unfamiliar members of the opposite sex, whether on one’s private parts or not. I brought up the example of private parts because in our society, that is what most people are uncomfortable with. We’re trained not to make a scene about it, but we still don’t like it.]
I’m with Daphne on this one. I’d rather be examined by a woman doctor. Any day.
@DCG:
I do agree with you that when gynaecology is involved it should be as you say, but this was no gynaecology case and the teacher case you chose to ignore: you find one exception and this is enough for you to deny that there is a clash between what we Europeans are used to and what Muslims want, and that we should just say yes to their demands in our home countries: you should have your head examined!
[Daphne – Your distinction between Europeans and Muslims is flawed. Millions of Europeans are Muslims. If it doesn’t break the law, then accommodate a person’s religion or cultural differences. That’s what being civilised is about. I imagine you would be one of the first to object if a chest-beating Maltese ‘Catholic’ doctor were to be forced to perform abortions. Same difference.]
What a load of rubbish! He wasn’t even Muslim.
I am in complete disagreement with you on this one. Though there are (as you state) certain doctors that do post racist remarks, by far the majority of us in hospital treat all patients equally and with due diligence.
In this case I can see only two possible scenarios.
1. Either the Valium has no direct consequence to the death of the patient as contrary to what a lot seem to believe, Valium can be given in asthma, especially where anxiety and agitation are playing a part.
2. These doctors missed the possible physiological effects of hypoxia (lack of oxygen) and hypercapnia (excess of carbon dioxide) in causing agitation. If this was so (and they would have required to take blood gases to determine them) then giving Valium is a contraindication.
As I do not have any data on the actual condition and as it would have been impossible to get the original blood gases from the autopsy, then I think that the is no case against these two,
My personal belief is that this case was instigated in a sort of reverse racist case – basically the authorities did not want to be accused of not taking any action because the patient was a coloured immigrant.
One should not complicate matters unnecessarily, especially when one does not have tangible evidence.
@Chris II
You are right in having no doubt that these doctors acted in good faith.
Re 1. You are completely wrong, Valium is strictly contraindicated in acute asthma attacks, more so if there is anxiety and agitation. After the patient calmed down the doctors then managed to get blood gases. They couldn’t before.
I had a similar young patient who died while I was trying to organise ITU admission, even though I didn’t give him Valium. So one can never prove that Valium killed him, because he was obviously in a very bad shape.
This is not reverse racism. His consultant had written to the authorities asking them not to make him sleep in a tent in Hal Far after several bad asthma admissions. When he finally died, he refused to issue a death certificate, so the police got into it and they found a mistake to blame – not blaming the authorities, of course.
Sorry, Jason, to disagree with the Valium part. There are hardly any research papers in the literature on the use of benzodiazepine and asthma. I could only identify five or six and in none was diazepam shown to have any serious side effects when given in asthmatic patients.
In fact, the most recent one (2008) was a French study that found that almost 26% of asthmatics were also prescribed anxiolytics. The authors though showing concern, did not directly identifying any serious side effects. In another two studies concerning children, the use of anxiolytics during an attack was in fact found to be beneficial, as it reduced the anxiety (which can be made worse through the use of adrenergic stimulants that are common asthma treatment).
In addition, anxiolytics can be administered with caution during an asthma attack, and are only contra-indicated in a case of respiratory depression (at least in accordance with the recommendations of the British National Formulary – 2008).
I have a feeling that this might be another medical fallacy that has been perpetuated and almost turned into dogma. In my 25-year career as an MD, I have met a number of these that disappear once scientifically challenged.
quote: “There are hardly any research papers in the literature on the use of benzodiazepine and asthma. I could only identify five or six and in none was diazepam shown to have any serious side effects when given in asthmatic patients”.
EXACTLY!
It was racist to assume that the doctor had racist sentiments simply because that doctor was white and the patient black.
I am a medical specialist and agree fully with the comments made by Jon on 16/12/09. I spoke to nurses working on the night of the incident – the patient concerned was being aggressive and was a danger to himself and others. This may not have been his fault- hypoxia can cause confusion.
Most clinical mishaps/incidents/fatalities are not the result of a single human error. More often it’s a series of errors: one after the other, in a system with little overlap to minimise these unfortunate events-in other words system malfunction. I am afraid all too often a scape-goat is the most convenient solution. Enter the junior doctor. A scape-goat getting all the blame diverts attention from a closer look at the system. Factors such as nurse-to-patient ratios, overcrowding, doctor-to-patient ratios, no beds in monitored areas etc are not examined. Top management comes out clean; small guy takes a fall.
Totally with James on this. It’s very rare that the system accepts responsibility.
It is normal practice to administer respiratory suppressants in certain instances of respiratory distress, I’ve seen morphine help lots of patients who have had trouble breathing.
Lastly, from reading a few of this journalists articles it seems obvious she is nothing more than a trouble maker looking for glory. Her suggestion that the patient was given the wrong treatment because he was African is highly insulting to the doctors involved. These damaging accusations aren’t based on evidence but on an imagination fuelled by avaricious needs. With that in mind she should also be made accountable and sued.
As a gay man I really don’t care who examines any part of me, male or female. But then gay men are not known for promising a night of love provided a ring is put on a finger, and promising eternal fidelity. Our take on matters sexual are somewhat liberal, not so hung up, not so neurotic.