Doctors clash

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Doctors clash

Mandeville Regional Hospital SMO denies interns' claims, but consultant physicians say he's talking rubbish

By Kimberley Hibbert Senior Staff Reporter
hibbertk@jamaicaobserver.com

Tuesday, February 23, 2021

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MANDEVILLE Regional Hospital (MRH) yesterday denied claims of operational inefficiencies and exposure of medical interns to health hazards, saying that the hospital places great emphasis on the safety of its staff, patients and visitors.

“That goes doubly for the interns as we are cognisant of our responsibility for nurturing them and helping to guide them into realising their potential as great physicians,” Senior Medical Officer (SMO) Dr Everton McIntosh said in a news release.

Dr McIntosh was responding to this week's Sunday Observer lead story which reported a number of concerns aired by interns. But his retort was swiftly rubbished by two consultant physicians, one of whom described the SMO's explanations as absurd and odd.

Responding to the interns' complaint that they were scheduled to conduct COVID-19 swabs without being fit-tested for adequate personal protective equipment (PPE), Dr McIntosh said: “I went to great pains to explain to the interns that fit-testing is the ideal, but that fit-testing is not currently available. Virtually all staff at the MRH and at other hospitals around the island are using N95 masks which were not fit-tested because of the global shortage of specific sizes to fit all faces, and we just have to do the best with what we have until the matter can be addressed. So they are by no means unique in this matter, and all of us as doctors and nurses are in the same situation, and there is no evidence to suggest that anyone has contracted COVID-19 due to the use of non-fit-tested N95 masks.”

However, one of the consultant physicians, who requested anonymity, said he and all his colleagues were fit-tested in May last year, so he could not understand why MRH was saying it is not available.

“At the hospital where I work, we have N95 masks available. No one operates on patients if they were not fit-tested, so what Dr McIntosh is saying about all doctors and nurses being in the same situation is rubbish,” the senior doctor told the Observer.

Meanwhile, Dr McIntosh also said the interns' claims that they were the only ones involved in COVID-19 swabbing was not entirely true.

“There are more than 80 staff members at the MRH currently conducting swabbing and the 34 interns are a small fraction of more than 400 team members across the Southern Regional Health Authority who are conducting swabbing,” he said, adding that interns, medical residents, senior house officers and nurses are also involved in the general swabbing of patients.

“The medical interns were asked to participate in swabbing in-patients to facilitate increased testing required to fulfil the mandatory testing for all patients in hospital. It is public knowledge that there has been an upsurge in COVID-19 cases in Manchester and all hands are needed on deck,” Dr McIntosh said.

But the second consultant physician, a Jamaican who is now working in the United States, weighed in on the discussion, saying nobody should be put at risk if they are not given adequate supplies, and fit-testing, which is a quick, simple and cheap skill that anyone can learn, and it can easily be done.

“Swabbing a patient is manual labour and is not a required competency to be a good physician,” he said. “Learning to swab without appropriate PPE is even more inane than that idea. Any member of the workforce can do it, and it is a waste of human resources having the interns only swab. Besides, swabbing is just one problem. Why are interns doing CPR without being appropriately fit-tested? Bagging a patient is aerosolising.”

The local consultant also said it was interesting that staff at other hospitals have been fit-tested but MRH has not, and maintained that preservation of the workforce should be the ultimate priority of a hospital administrator.

The Sunday Observer story had also reported the interns saying that the SMO had told them they did not need to be fit-tested because their risk of contracting the novel coronavirus on the wards was equal to them contracting the virus from swabbing a patient. He also insisted, they said, that it was not possible for them to contract the novel coronavirus twice.

But Dr McIntosh, in his response, said his comments were misrepresented.

“My response to that query was to say that there have been isolated cases reported on which the jury was still out as to whether these were genuine re-infections versus persons who developed another respiratory illness while still shedding non-viable COVID viral particles, a situation which can cause a person to continue testing positive for COVID-19 for months even though they are no longer having an infection. I stand corrected if this is not so,” he said.

Regarding claims that the interns were threatened and told they are venturing down an insidiously dangerous path in this early point in their career by defying orders from the consultants and the SMO, Dr McIntosh said: “I did say to them that it was unfortunate that they had chosen this dangerous path at such an early point in their careers, in the context that poor attitudes and bad habits, if fostered, will become hard to break and will likely follow them throughout their careers with adverse impacts on their career development.”

“Recruiters from abroad, for instance, place great emphasis on things like work ethic, reliability, integrity, respect for others and being a good team player. Sadly, these qualities are not very evident at this time,” Dr McIntosdh added.

But the US-based consultant countered: “It is not nurturing to expose the unfitted interns to COVID patients under the guise of building character and work ethic. This is a poor excuse and should not be debatable.”

Dr McIntosh also insisted that the interns were the logical choice to facilitate the increased testing required to fulfil the mandatory testing for all patients in hospital, due to their large numbers and the fact that rostering two of them per day, between 8:00 am and 4:00 pm, would not significantly impact their other functions.

“This works out to each intern being assigned to swabbing twice per month. Interns are not utilised on the COVID isolation ward for any reason,” he said.

In relation to the duty roster, a copy of which was obtained by the Sunday Observer, and which showed that only interns were being assigned to do the swabs, Dr McIntosh said it, was “just a mechanism to facilitate the smooth assignment of the interns on a daily basis, and does not represent the sum total of swabbing in the hospital, as other doctors and nurses on the wards and in the Accident and Emergency Department will and do swab patients”.

However, the US-based physician challenged this explanation, saying, “If the interns are the logical choice for the manual, unskilled task of a nasopharyngeal swab, then the logical thing to do would be to ensure they are appropriately fit-tested for their N95 and provided with the appropriate size masks.”

In relation to the interns' claim that a number of them had contracted COVID-19 when performing cardiopulmonary resuscitation (CPR) due to the lack of PPE, he said that only one intern had contracted COVID-19 and this pertains to a 2020 incident in which a child with a heart problem had cardiac arrest and an intern attempted resuscitation.

“At the time, the child was not considered COVID-19-positive, and this was only subsequently discovered when the results of the routine surveillance came back. There has been no such incident since the interns have been asked to perform COVID-19 swabbing,” he insisted.

Dr McIntosh went on to say all staff, including medical interns, may be exposed to COVID-19 patients on general wards prior to such patients being confirmed and relocated to the isolation ward.

He added that all staff members are required to take precautions when seeing all patients by wearing the provided PPE.

But the US-based physician said if the assumption is that every patient is COVID-19-positive, until otherwise proven, then each CPR is placing them at risk.

“If the decision is not to fit-test, then CPR should not be attempted and the patient pronounced dead without further exposure. I'm sure Dr McIntosh, being an anaesthetist, is fit-tested, so why not his junior staff? The entire thing should not be debatable. The interns start on July of each year. It's now February – eight months into their internship and over a year into a pandemic. It's shameful we're putting the interns at risk and expecting them to do it without complaining, and having them be afraid and ashamed to do so. Certainly we do not send the JDF [army] and JCF [police] to fight crime with water pistols and paper guns. I am appalled we are asking the doctors to do exactly the opposite,” the doctor said.


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