Further News (24 April 2001)
In our survey dated 12 July 2000, there
were 7 replies
|
|
Yes |
No |
Abstain |
|
1) We should hold a meeting to
discuss this |
2 |
4 |
1 |
|
2) The anaesthetist should decide on
the priority of the cases |
3 |
4 |
0 |
1.
As there were less than 5 asking for a meeting, there will not be a
meeting.
2.
The vote was in favour of the anaesthetists not
deciding on the priority of two or more urgent cases.
1.
Why should we be involved in this? Administration problem!
2.
Get more nurses & pay them suitably or reward them enough $ to do 2nd
team.
3.
Increase cost, charge to patients who need to rush into O. R.
4.
Suggest Obstetric patients charged higher O. T. charges at night and
extra $ to reward nurses.
1.
Medico-legal implications in case complication on the case that is not
given priority.
2.
Need clear-cut guidelines, e.g.
a.
Case must be in the hospital.
b.
Seen by surgeon and consented
c.
Surgeon should talk to each other. Only when they cannot agree should
this be activated.
d.
Only for second team dire emergencies.
e.
All notes fully documented by the surgeon on the reason for the second
team.
f.
A review committee on each incident and if abuse detected, the
individual should be severely reprimanded
1.
Another independent person e.g. another surgeon/physician should be
able to make that decision.
2.
Known fact => some surgeons are not as good with some as with other
anesthetists, therefore, conflict of interest.
1.
Nursing staff not qualified to make decision.
2.
Cost is not the issue here. The administration claims that the OT staff
prefers not to do the second call as they want to have the time off.
3.
The possible alternatives to make the decision are the anaesthetist,
Chairman of the OT Subcommittee, or the CEO (Dr. Jacob Thomas). As we have on
the spot knowledge, we can make the best decision.
4.
The MAB, Chairman of the OT Subcommittee (Dr. Charles David) and Dr.
Thomas have all agreed to fully back us up on any decision that we make.
5.
Legally,
a.
If we make a wrong decision based on erroneous information from the
surgeons, the surgeons would be responsible.
b.
If we make an honest mistake, it is an error
of judgement which is acceptable and not considered negligence.
c.
If we don’t make a decision we can be cited for negligence.
Anne
I strongly
believe we anaesthetists should not be involved in this "dirty
business" when we are dealing with little boys!
I have
enquired how Sunway Hosp handles such a situation. Apparently, Lee F. C. (must be in charge of the Dept.) and someone else or
the main Directors are often referred to and they will speak to the respective
doctors to defer/etc.
Therefore,
here in SJMC -> get either,
1.
OT Subcommittee chairperson, or
2.
Director of Services
Don't
get the anaesthetists or the poor DNA's because these stupid little boys who
play such truancy will never listen or compromise. Worse still, they
will harbour ill feelings against you. In other words - a waste of effort.
A. As
the vote was for the decision not to
be made by the anaesthetists, we will have to make our counter-proposal as to
the best person to make that decision.
From the comments returned, the choices
are,
1.
OT Subcommittee chairperson,
2.
The Director of the Medical Centre,
3.
Director of Nursing Services,
4.
Another surgeon, or
5.
A physician.
B. I
would also like to propose that we adopt Charlie's suggestions, i.e., 2 a to 2
f.
The above was circulated to all members and a reply sought by 7 August 2000.
The vote was that, the following should be contacted in the order that they are listed, in the event that a decision had to be made concerning the urgency and priority of emergency cases.
OT Subcommittee chairperson,
Chairman of the MAB, and
Dr.
Jacob Thomas, Director
of the Medical Centre.
Furthermore, we proposed that the following conditions as proposed by Dr. Charlie Chan should be met in such cases,
Case
must be in the hospital.
Case seen by surgeon and consented
Surgeon should talk to each other. Only when they cannot agree should this mechanism be activated.
Only for second team dire emergencies.
All notes fully documented by the surgeon on the reason for the second team.
A review committee on each incident and if abuse detected, the individual should be severely reprimanded.
The above decisions were communicated to the MAB at its meeting held on 9 August 2000. Datuk Dr. Anuar Masduki asked that condition 3 be removed. The MAB then decided that the best forum to further discuss this was at the OT Subcommittee.