Frequent reports of patient safety issues from both private and State hospitals have raised the question of whether Sri Lanka is doing enough to create a culture of safety and care that places patient rights front and centre in the healthcare system.
In February, the dialysis unit at the Kurunegala Hospital temporarily shut down following a series of patient deaths in January. Committees have since been appointed by the Ministry of Health (MOH) to determine the cause of the deaths. Last year, a number of deaths and complications occurred due to the administration of low-quality medicines to patients in State hospitals. This was attributed to the forex crisis leading to the import of lower-quality drugs.
Just last week, parents of a stillborn baby alleged that officials at the Matara New District Hospital had initially refused to show the body of the baby to the father and had later told the parents that the Public Health Inspector (PHI) had cremated the body – without obtaining the consent of the parents.
Patient safety culture
Incidents such as the above raise urgent questions about the culture of patient safety in State hospitals. Health Ministry Deputy Director General of Health Services (DDGHS) – Planning Dr. S. Sridharan told The Sunday Morning that patient safety “could definitely improve in Sri Lanka”.
He recommended that the involvement of the public, incident reporting, and a safe working environment for health professionals be enhanced in order to improve patient safety.
“We can’t develop patient safety with rules and regulations; we have to develop the culture. This includes proper training, reporting, learning, and fostering an open culture where even minor staff can speak on patient safety. Continual improvement over breakthrough improvement is needed to create confidence in the system,” said Dr. Sridharan.
He pointed out that although in the early 2000s the concept of patient safety was not properly understood by health professionals, the situation had since improved.
“In 2019, Sri Lanka co-sponsored a resolution on patient safety as well for the World Health Organization (WHO). We established the Directorate of Healthcare Quality and Safety in 2012, which triggered a wider understanding of the subject. We have conducted several training programmes throughout the country and incorporated the subject into the medical administration curriculum as well,” he said, noting that they were moving in a systematic manner to address the issue.
“Throughout the world, 85-95% of patient safety issues are due to systemic failures and only 10-15% are due to individual failures. If we address the system failures first, individual failures will automatically diminish. Thus, we are after the root cause.”
Systemic shortcomings
Dr. Sridharan said that although the MOH had introduced incident reporting forms, they had observed a reluctance by people to report incidents due to fear of potential penalties. “Our objective is not to penalise anyone but to correct the system.”
He further said that a grievance handling mechanism had been established with the 1907 hotline while suggestion boxes were being kept in hospitals. “We have also started using patient experience surveys – this is better than a patient satisfaction survey.”
Furthermore, commenting on the work of the Directorate of Healthcare Quality and Safety, Dr. Sridharan noted that the institution had initially had issues such as inadequate training, turnover of key personnel, and a lack of financial allocations.
“We are fixing these issues at the moment. We didn’t have much data on patient safety. We also found that there was a lack of focal points inside the hospitals so we have created Quality Management Units (QMUs). The Directorate now does a performance review meeting quarterly for hospitals – not as a fault-finding mechanism but as a learning exercise for all.”
Dr. Sridharan added that the MOH was currently planning to introduce patient safety to primary care institutions as well.
Meanwhile, parliamentary sub committees are also currently working on a long-awaited patients’ safety charter.
Incident in Matara
Chathura told The Sunday Morning that his wife, Kavindya Madushani, had admitted herself to the Matara New District Hospital at around 11.30 p.m. on 22 May as the doctor she had channelled for a check-up earlier during the day had told her that her baby’s heart was not functioning.
“I was working a night shift when I got the call and only made it to the hospital at around 12.30 a.m. on the morning of 23 May. They had already scanned her by the time I went and the ward doctor told me to give up hope as they couldn’t hear a sound from the child’s heart.”
Thus, medicines had been administered to Kavindya on 23 May to induce birth. The delivery had only occurred during the early hours of the following day (24 May) when Kavindya’s husband and family members were unable to stay beside her.
“She called me when she was being taken to the labour room, but I couldn’t go from Weligama in the middle of the night. At 2.40 a.m., the child had been delivered and she had asked to see the baby. However, the nurses had said there was no need to see the child.
“Since she had insisted, they had kept the child at her feet and let her see the child for only about two minutes before wrapping the body up in a cloth. They had taken a signature on a document afterwards saying she had seen the body and was aware of the death,” he said, adding that the nurses had also refused her permission to contact him by phone.
According to Chathura, Kavindya had requested the hospital staff to keep the child until daytime, when he was expected to visit. However, when he had arrived at the hospital early in the morning, the nurses had questioned him as to why he would want to see the body.
“They said I would get upset, but I repeated my request so they directed me to an office. The officials there instructed me to obtain a stillborn certificate from the ward, which I did. But afterwards, the officials told me to first finalise the details of the last rites with the Municipal Council and come back.
“I completed all of these procedures on 24 May itself and came back to the office, asking to see my child. But they refused and told me they could not be unwrapping the body on that day. They told me to come back the next day to perform the last rites, during which I could see the body. I accepted this and told them that I would be back the next day to conduct the last rites.”
However, on 25 May, after he had gone back to the hospital for the body of his child, the officials had informed him that the body was not there as it had been taken by the Public Health Inspector (PHI) to be cremated. “I asked how they could do that without telling me, but the officers only said that I should focus on doing the religious rites. I told them to at least dig the body back up and give it to me,” said Chathura, pointing out that they had refused to let him see the body of his child even the previous day.
“An argument followed and the Police were called in. The Police asked us to file a complaint and I wanted to do so only against these officials who had lied to me so I went back to get their names. It was then that they requested me not to file a complaint as the body of my child was being brought back from Colombo.”
On the evening of 25 May, an ambulance had come into the hospital and Chathura had been called to view the body of his child. “I don’t know where the ambulance came from. There was a body of a baby wrapped in a cloth and two name tags with the same name – one stained with blood and the other clean. The officials told me that the issue was now resolved as I had seen the body. I got angry at this point and yelled at them, questioning how they could show me a body now after they themselves had told me that it had been cremated.”
Thereafter, Chathura had requested a DNA test. The next day, towever, the Director of the hospital had informed him that they could not do the DNA test as they lacked the resources for it. Despite a court order later mandating a DNA test, Chathura and Kavindya remain uncertain about the mechanism.
Hospital Director’s response
Speaking to The Sunday Morning, Matara New District Hospital Director Dr. Upali Karunarathna claimed that the issue had arisen due to a “breakdown in communication”.
“Usually, parents don’t request to take the body for final rites, but we do give it if they make such a request. At the time of the delivery, they hadn’t requested it and therefore it had gone to the third party that disposes of bodies on our behalf. There was a communication problem there – it had been decided to dispose of the body on the idea that they had not requested it at the time.
“Those who transport the bodies for disposal had taken the body, but when the issue arose, it had been immediately retrieved and given back to the parents. Afterwards, the parents said they could not accept it.”
Dr. Karunarathna said that the body had not been taken to Colombo but had only been on the vehicle being transported to Colombo for disposal purposes. “We are doing a departmental investigation on the communication breakdown and penalties will be issued based on the findings,” he added.
Meanwhile, Directorate of Healthcare Quality and Safety Director Dr. Upuli Wijemanne told The Sunday Morning that they were the authority to which complaints and reports of such incidents could be directed to but declined to comment further on the matter.
Multiple attempts to contact Health Ministry Secretary Dr. Palitha Mahipala and Director General of Health Services Dr. Asela Gunawardena proved futile.