Complaint regarding negligence in treatment at royal prince alfred hospital, leading to patient's death. requesting investigation and justice.
Dear RPA Administration
This is in relation to my father, Mr. Sanjay Malik who was brought in to the Royal Prince Alfred Hospital, Camperdown on 17.11.2023 with symptoms of low blood pressure and spits with patch of blood in it. He was already suffering from Liver Cirrhosis diagnosed around May 2023. I am writing for myself and on behalf of my family and I wish to point out the various fallacies, carelessness and negligence in treatment and care of my father and the facts are detailed herein-below:
1. When the paramedics arrived, my brother provided them with details about his symptoms and medical condition, as well as information about our father's current medication, including the administration of Midodrine 2.5mg to elevate his blood pressure. Subsequently, the paramedics instructed my brother to accompany them to the ambulance, and he assisted our father in descending two flights of stairs and traversing a distance of approximately 50-75 feet. Upon arriving at the emergency department, the paramedics had already informed us that they had administered a mild dosage of medication to raise our father's blood pressure during transport in the ambulance.
2. Additionally, my father was mobile and walked to the restroom in the emergency department. While in the emergency room, samples of his blood and urine were collected for testing. Later, he was transferred to the resuscitation room, using a toilet chair due to the unavailability of a wheelchair at the hospital. In the resuscitation room, he experienced significant pain while a cannula was being inserted, and both my mother and brother observed substantial bleeding from the site where the cannula was being inserted into his hand. Furthermore, he received another dose of medication to raise his blood pressure, without allowing adequate time for the previous doses to take effect. My brother was informed that this was a high dose intended to rapidly elevate his blood pressure. Several doctors attended to my father, and he requested permission to use the restroom. It is noteworthy that up to this point, there were no signs of blood either from his rectum or through his mouth. This was confirmed when the head of the ICU examined his stool to check for melena or blood, and indicated that there were no indications of melena. However, my mother had previously cautioned the nurses and doctors that during his hospitalization in India, he had spat blood only when his blood pressure became too high, causing the rings or bends in his esophagus to open due to the pressure.
Moreover, there was no toilet chair available at the hospital at that time, so my father was astonishingly provided with a small bowl for his bowel movement, placed on a chair previously occupied by my brother. My father was instructed to lean backward onto the bowl while passing his stool. It is important to note that a patient with significantly low blood pressure should not be required to stand for an extended period. When my father partially sat down, it was then that my brother observed fresh, raw blood during the bowel movement process. Immediately, my brother alerted the nurse nearby and asked to call for doctor. My father was then asked to lie down on the bed. After, few minutes he started puking and it was again fresh blood in his vomit. Until this time my father’s was talking like a normal person would in such circumstance with no significant signs of confusion.
3. The liver specialists notified us that our father would need to undergo an endoscopy, a procedure he had previously undergone three times since late May, each time without any anaesthesia or sedation and with successful outcomes. Subsequently, my father underwent the procedure, but a few hours later, my brother received a call from the doctor, who informed him that the procedure was unsuccessful due to bleeding and the doctor mistakenly dislodged an existing ring/ band which fell inside my father. This led to a lot of bleeding and my brother was advised that another session of endoscopy would be necessary, and currently, my father is in Green ICU and has been fitted with a chest balloon and is being supported by life support machinery, including a ventilator. It is quite noteworthy that subsequent to a simple procedure like endoscopy a patient who was walking a few hours earlier was now on life support. This clearly demonstrates negligence and/or lack of experienced staff at the RPA hospital.
4. We were informed that our father is required to undergo another session of endoscopy at the earliest however the same got postponed continuously due to unavailability of doctors and surgery room. To put it in context, my father had undergone his first endoscopy during evening on 17th November and it was not until early morning on the 20th November that he was taken for his second endoscopy. That around 3 AM on 20th November, we received a call from the doctor who performed the endoscopy that he was quite satisfied with our father’s bleeding condition and that there was bleeding only from the point where the ring/band fell off and that he has now successfully placed another ring/ band on that point.
5. Furthermore, while in the ICU, we were informed of our father's significantly low sodium levels, for which he would be treated. Additionally, our father was continuously receiving sedation, although the doctors seemed to expect him to miraculously awaken and follow their commands in the morning. It wasn't until the sixth day of his ICU admission that the ventilator and chest balloon were removed. However, it's important to note that our father's serum bilirubin levels were alarmingly high, and the doctors suggested that the only way to reduce them was through bowel movements. It's crucial to emphasize that a patient who has been sedated for over six days would find it challenging to have bowel movements without medical intervention. This delay resulted in his body being unable to expel bilirubin, allowing it to accumulate and affect his brain. The entire process of ventilator use and sedation appeared to prioritize the doctors' protection rather than the patient's health and well-being.
6. Moreover, my father remained bedridden and incapable of movement. During this time, various doctors, including the speech therapist, conducted what they termed a "speech test." This test involved taking a sip of water. It was conducted in the morning when our father was still asleep. The doctors would wake him abruptly and immediately ask him to drink water. It's evident that a person, especially a critically ill patient who had been intubated for over six days (with a ventilator and chest balloon), would struggle to drink water upon waking and might cough it out. This indeed occurred, and the doctor simply mentioned that they would return the following day as they were unavailable. It's surprising that one of the largest hospitals in Australia lacks sufficient staff to carry out such a straightforward task as speech testing. During this whole time our father was not talking normally and seemed to have confusion. Moreover, since he had failed the speech test, a feeding tube was inserted through his nose through to his stomach.
7. Furthermore, during our time in the ICU, we were informed about our father's astonishingly high AFP levels, which necessitated an MRI in addition to the already completed CT scan. However, it took approximately ten days from the moment my family decided to proceed with the MRI until the scan was actually conducted. It appeared as though they had resigned to letting him perish rather than making efforts to save him. After spending approximately ten days in the ICU, our father was transferred to a ward, specifically Ward; 9 West 2- room 13.
8. That during this time since the speech doctor was not satisfied with his speech test results, they did not allow any food or water to be given to him through his mouth. That it is worthwhile to mention that it had been over 10 days since he drank water and it was obvious that he was dehydrating. Nevertheless, due to his state of confusion he pulled out the feeding tube running through his nose. In the following morning we were told that he will have to take be administered with another feeding tube and we allowed the doctor to insert it after discussion. This discussion mainly pertained that doctor wanted our consent since the patient was resisting and was in state of confusion. It was on 29th November that Dr Siricha had inserted a WRONG FEEDING TUBE inside our father who was already resisting the insertion of same as it was painful and highly uncomfortable to him. That the nurse Steve had informed us, later in the day that a wrong feeding tube has been inserted and it is highly “irresponsible of the doctor”. That as soon as our mother informed us of the same, I rushed to the hospital and had a word with doctors and Dr Siricha was continuously apologising. That due to her mistake and gross negligence my father had to go through the trauma, pain and discomfort of getting the wrong pipe removed which was followed by another pipe being inserted. It must be worthwhile to note that the pipe which was wrongfully and negligently inserted had a large mouth as compared to the feeding tube. It is highly likely that the rings/ bands in his oesophagus had been disturbed or other areas had been affected in his throat due to such pipe negligent insertion and removal.
9. However, our father's daily blood tests revealed that his sodium levels had risen significantly, potentially contributing to his confusion. It's important to note that if his blood samples were being taken daily, why did the hospital allow his sodium levels to become elevated, and more importantly, why was he still being administered sodium when it was already too high? The doctors had informed us that excessively high sodium levels could result in permanent brain damage or even coma. Despite our objections and concerns, sodium was still being administered through IV drips and also after every injection of other medications or substances. Nevertheless, it also must be added that despite my father being anaemic, a lot of bloods were being taken from him.
Additionally, my father continuously expressed a desire to stand due to back pain from lying in bed for over 12 consecutive days. However, the doctors refused his request and it was only with support and encouragement of nurse Steve one day that he aided my father in getting up after around 17 days on bed.
10. Additionally, on one particular night, my father experienced intense pain, prompting my brother to summon the nurse to request a doctor's assistance. However, it took over two hours for the doctor to arrive. Upon her arrival, she mentioned that the attending doctors were unavailable and could only offer Panadol. Moreover, it required multiple requests to the nurse to call the doctor, as my father was persistently requesting medication. The nurse informed my brother that he would not be assigned any shifts involving caring for my father because he couldn't handle the pressure. While it's important to respect the mental health of every individual, especially during challenging times, it's concerning and inappropriate for someone entrusted with the care of our loved ones to behave in such a manner. Certain professions inherently involve stress, but if a nurse feels overwhelmed simply by receiving multiple requests to call for a doctor, it indicates a significant deficiency in their work efficiency.
11. Furthermore, it's crucial to highlight that throughout his hospitalization, our father required diapers, which were changed multiple times daily. Additionally, following the second insertion of a camera into his throat to assess his speech organs, the doctors informed us of significant mucosal buildup around his windpipe opening. Consequently, he needed nebulization therapy to help expel the mucosa through coughing. One observation we made during this time was that nurses refrained from tilting our father's head downward during coughing episodes, as it could exacerbate coughing or cause bleeding. Similarly, they were cautious not to tilt his head downward while changing his diaper, and they even recommended keeping his head slightly elevated to prevent coughing or bleeding. We observed this as one of the nurses mentioned that since he is coughing and spitting blood thus, it is dangerous for his head to tilted downwards as it might lead to him puking out everything in his throat or allowing blood to make its way through due to gravitational pull.
12. However, our father began experiencing significant swelling in his stomach and abdomen area due to water retention. On one occasion, a new doctor arrived and suggested reducing the medication that promotes the free flow of urine and helps eliminate excess water from the body. It's important to note that this doctor made changes to the medication regimen despite the prescriptions provided by the liver specialists treating our father. Despite our objections, she insisted that since he was becoming dehydrated, he should not receive such medication. We pointed out that it had been over 15 days since he last drank water, and even now he was not being given enough water. Additionally, we highlighted that he had previously undergone two sessions of dialysis due to his inability to urinate, resulting in similar swelling.
13. Furthermore, our father began coughing frequently, and we noticed blood in his cough. We informed the nurses, who advised against tilting his head downwards. This situation persisted for over three days until his passing.
14. The most distressing incident occurred on the morning of December 8th. Nurse Tracey arrived to change my father's diapers as part of the morning routine. To provide context, my father's mobility was limited due to excessive water retention in his stomach, which hindered his ability to move quickly. While Nurse Tracey was changing his diapers, she laid my father flat on the bed and then tilted the bed downwards from the side of his head, causing the flow of his body to move towards his head. This action contradicted the advice given by doctors and other nurses, who had cautioned against such tilting when changing his diapers. As a result of this tilt, blood from his stomach and/or esophagus rushed into his mouth and nasal cavity, causing his face to turn red, his mouth to fill with blood, and his eyes to bulge out. Nurse Tracey then tilted him upwards and summoned the doctors. This incident resulted in my father experiencing a cardiac arrest due to the gross negligence of Nurse Tracey. It's important to note that prior to being admitted to RPAH, my father had never experienced a cardiac arrest or any issues with his heart.
15. Following that, our father received CPR, and his pulse was restored. Nevertheless, the doctors informed us that he was in his final moments and would pass away imminently. We were stunned by this prognosis and pleaded with them to take action, but they already gave up, stating that nothing further could be done, and allowed our father to bleed to death. They actually let him bleed to death since until his demise about 10-11 hours later, he was continuously bleeding through his mouth and nose. Despite our protests for intervention, they declined to perform any additional procedures or take further action.
I would like to emphasize that these details not only suggest a lack of adequate service and care but also indicate improper handling and gross negligence in the treatment of my father. I am requesting a thorough investigation into this matter and urge that justice be served for our beloved father. We sincerely hope that decisive action will be taken against those responsible for any wrongdoing or negligence, particularly Doctor Siricha and Nurse Tracey. Furthermore, we implore the hospital to prioritize patient care above all else and ensure that doctors and nurses adhere to this principle.
We are writing this without prejudice to any of our rights, interests, claim, power or authority concerning or over the incident. We reserve our right to lodge criminal complaint or initiate proceedings for murder by negligence or manslaughter or any other provision or law applicable otherwise. We also reserve our right to initiate any civil action for liabilities or claim or otherwise any other action available under law. Additionally, we also reserve our powers and rights to spread awareness about our father’s matter and share our experiences with RPAH with others.