Doctor declared alive woman dead without examination!

The woman who was declared dead even though she was alive at Bangladesh’s largest state-run health facility, the Dhaka Medical College Hospital, was a case of sheer negligence by a duty doctor, it has emerged in a bdnews24.com investigation.

This blatant disregard for human life at the biggest academic institution in Bangladesh has shocked and alarmed many.

It had raised questions about whether the protocol following which a doctor declares a person dead is working properly or needs to be changed.

bdnews24.com tried to find the answer speaking to a number of senior physicians and staff of female ward 802 where the woman in her mid-40s finally died barely a day after her Phoenix-like rise.

The female doctor did not examine the patient before giving the death certificate – was the clear answer coming from them.

In fact, this was the talk on Saturday in the medicine department of the busiest hospital where, at any given time, patients at least twice the number of allocated beds receive treatment.

Deputy Director of the hospital Dr Mushfiqur Rahman told bdnews24.com that they launched investigations and a report was due by Monday.

The identity of the woman could not be known.

The hospital director admitted her after he found her unconscious near the hospital during a drive to evict illegal structures.

She had been treated for weakness and malnutrition.

On Thursday noon she was declared dead, only to be found alive after four hours when a boy from mortuary arrived in the ward to take the body for autopsy.

Finally she died on Friday afternoon.

Personal negligence

The incident triggered a barrage of criticism against doctors and the patient management system at the largest public hospital.

“It was a very personal negligence,” another senior doctor who knows details of the incident told bdnews24.com.

The female doctor who wrote the death certificate was an honourary medical officer (HMO), who works without payment for the training of her post-graduate degree.

HMOs are one of the core groups of the DMCH patient management.

She declared her dead soon after arriving at work last Thursday noon.

During the change of duty, the previous duty doctor passed a verbal note saying that the patient lying on the floor was in critical condition.

But the word spread that she was dead. Being severely malnourished, the woman was unconscious from the first day of treatment.

The ward body, who prepares paper for doctors to write death certificates, asked the new doctor for a certificate for the woman.

She issued the certificate without examining the patient herself.

“This was a big mistake,” said a doctor of the ward, who did not want to be named.

How doctors declare dead?

Associate Professor of Medicine at DMCH Titu Miah said they examine vital signs – pulse, blood pressure, respiration, and brain activities – before declaring someone dead.

“When we are sure that everything become non-functional then we pronounce someone dead,” he told bdnews24.com when asked.

But he said they suggest an ECG – where electrical activity, or lack thereof, of heart is recorded – should there be confusions.

“We examine the eye to see if the pupil is dilated and body reflexes to confirm that heart and brain activities have stopped.”

But Dr Miah said in some cases a patient’s vital signs may be back after stopping for a while.

“And that’s exactly why we ideally suggest an ECG.”

The associate professor would not comment on this particular case with investigation pending, but said “this incident is new to us”.

“It’s a learning opportunity. Now we can prepare a check-list that a doctor at the hospital must tick before declaring someone dead.”

He said they always advised their doctors to take time, at least 30 minutes, before declaring someone dead.

“Junior doctors if confused can consult a senior doctor,” the associate professor said explaining how DMCH doctors declare a patient dead at general wards.

But in the case of brain death at the ICU, a committee comprising doctors of different disciplines including neurology takes the decision.