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Family Calls For Enquiry Into Death After Fertility Surgery   
 
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04-May-2015  
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The Late Victoria Elorm Asamoah-Frempong
 
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The family of a 34-year-old woman have called for an independent enquiry into circumstances leading to her death after a fertility surgery carried out on her at the Lister Hospital and Fertility Centre in Accra.

The laparoscopic endomtrioma surgery (surgery that increases the chances of spontaneous pregnancy) to enable Ms Victoria Elorm Asamoah-Frempong, a former lecturer of the University of Mines and Technology (UMaT) in Tarkwa, to conceive and have children ended tragically, following what family members described as the piercing of her intestines on February 8, 2015.

She was pronounced dead on February 10, 2015, two days after suffering severe complications related to the surgery, also known as keyhole surgery, leading to internal bleeding from the process performed by one Dr Gilbert Anyetei, a visiting specialist from South Africa.

Not even the prompt repair of the deceased’s bowel by colostomy (a surgical procedure in which an opening is formed by drawing the healthy end of the large intestine) could save her life, as she was reported to have bled to death when she was being transferred to the intensive care unit (ICU) of the 37 Military Hospital.

A brother of the deceased’s, Mr Seyram Kojo Asamoah, told the Daily Graphic that Lister Hospital officials had not been proactive in handling the condition after they had told the family there had been a perforation of an organ during the initial procedure.

“The Director of the hospital, Dr Edem Hiadzi, approached the deceased’s husband, Mr Kwesi Frempong, and apologised that there had been an error in the earlier procedure, leading to a perforation of her organs and they would, therefore, need to carry out an open surgery to correct it," Mr Asamoah told the Daily Graphic.

“The hospital authorities have also failed to honour our request for an inquest into the incident. We have written to them; however, they have failed to even acknowledge receipt of our letter,” he alleged. 

Medical report
A medical report signed by Dr Hiadzi, a consultant obstetrician and gynaecologist at the facility, indicated that Ms Asamoah-Frempong had been referred to the facility to be assisted to undergo reproductive in-vitro fertilisation, popularly referred to as “test tube baby”, after several attempts to conceive had failed.

The report, addressed to the deceased’s family and copied to the immediate past Moderator of the EP Church, the Rt Rev Francis Amenu, a copy of which is available to the Daily Graphic, stated that the hospital had taken a decision to perform an endometriotic cyst removal surgery on Ms Asamoah-Frempong after a scan on her revealed that there was a collection of blood in her left ovary.

That was to be done to precede the fertility procedure.

Endometriotic cyst
An endometriotic cyst blocks the flow of menstrual fluid produced by cycling endometriosis, which then collects and causes the ovarian cortex to invaginate (become enclosed).

Endometriotic cyst is often removed through the performance of a keyhole surgery.

Post-surgery
The report explained that the following day, a review of the procedure revealed that Ms Asamoah-Frempong was suffering from  excruciating pain and looked pale.

“I, therefore, performed a scan of the abdomen on her but saw no fluid collection in the abdomen. That necessitated the need for a blood test, which indicated a massive drop in her blood level,” the report indicated.

"The low blood level necessitated the need to transfuse her and we further carried out an open surgery on her, while an exploratory laparotomy to find out where the bleeding could occur later revealed the abdomen wall where the endometriotic cyst was removed was conjoined to the bowel before its removal, causing a perforation (piercing) of the bowel,” it explained.

It elaborated that the bowel content leaked badly into her abdomen, therefore necessitating a critical monitoring when it was realised her condition was unstable.

The report said attempts to transfer her to the ICU of the Korle Bu Teaching Hospital or the 37 Military Hospital for resuscitation were unsuccessful, as she gave up the ghost on arrival at the hospital.

Family members
Family members who were displeased with events filed a complaint with the Homicide Unit of the Ghana Police Service, which ordered an autopsy, the result of which is yet to be made public.

They have further accused the hospital of adopting a domineering posture in relation to the incident.

“We are not asking for any form of monetary compensation. The hospital officials took the entire situation for granted and only experimented with the entire process and this is what we want the public to be made aware of,” Mr Asamoah told the Daily Graphic.

“It is very sad to say that a facility of that kind could experiment with the life of the very people it sought to assist in its operations,” he bemoaned.

Hospital management
 Dr Hiadzi, however, told the Daily Graphic that while they were sad at developments, there was no evidence of medical negligence in the processes that took place.

"The process was done with as much expertise and care," he intimated.

He admitted that there were times when the bowels of patients might open during the performance of keyhole surgeries, but they were quickly fixed and patients made full discovery, conceived and delivered safely.

 "The doctor who performed the surgery on Elorm is an experienced specialist. However, keyhole surgery can sometimes come with accompanying complications.

"There are times when bowels of some patients open during the processes, and when this happens, it is opened and fixed," he explained.

Dr Hiadzi said the family's case of negligence was misconstrued, noting that many critical lives had been saved in line of duty.

Complications
According to him, the facility never anticipated any complications when the process was being carried out, and so when the deceased, who was among five others who had undergone the same procedure, showed signs of not being well, "I investigated personally and even got a physician specialist to further carry out another review on her and thereafter recommended that the deceased be open in the abdomen". 

"Initially, I expected some minimal internal bleeding; however, upon opening, we realised that there was a bowel damage other than the minimal bleeding we had thought initially. 

“Thus, the surgeon who reviewed her immediately advised for a colostomy, which was immediately performed," he pointed out. 

Dr Hiadzi discounted claims that the hospital failed to do due diligence during the performance of the colostomy.

According to him, colostomy could only be said to be successful if bowels became well after days of surgery.

"The leakage of the bowel into the abdomen made us suspect an infection, so during the performance of the colostomy, additional amounts of antibiotics were applied to keep things under control," he explained.

The deceased's condition, he said, was stable thereafter, but since it was not a common happening of getting bowel leakage, a decision was taken that she be monitored properly at the emergency ward, after which she was to be transferred to the recovery ward for a reversal of the colostomy.

The reversal of the procedure, he said, would have allowed for the fertility treatment to be continued should she have recovered.

"However, in the night, her condition changed and the surgeon on duty made frantic efforts to secure an ICU bed at Korle Bu to transfer the deceased there for further attention. 

“But when the efforts were not successful, I was called personally to contact colleague doctors at the 37 Military Hospital, but my efforts were also unsuccessful, as I was informed there was no ICU doctor available to receive the patient," Dr Hiadzi said.

ICU system
He emphasised that the ICU system was such that there ought to be an intensive care doctor on duty to receive patients in such condition and stabilise them before further treatment could be advanced.

"In the case of Elorm, you don't just pick her and send her to the next facility. Her case was such that she had difficulty in breathing, hence the need to maintain her on an anaesthetic machine with a specialised doctor on board to monitor her progress in the transit process," he stressed.

That, he said, would have ensured that the patient did not die in transit.

"Our inability to secure an ICU bed was a major contributor to Elorm's death. If we had been able to secure an ICU bed, we wouldn't have lost her. There have been critical times when we were able to save the lives of a few patients who equally had complications because we were successful in securing beds. It is just sheer misfortune that Elorm's case couldn't stand the test of time," Dr Hiadzi recounted.

He said the facility had successfully performed keyhole surgery on many patients in the last eight years without any such incident since it introduced the service at the facility.

The deceased, a product of Mawuli School in Ho, who recently completed her Ph.D at the Western University in Canada, was a lecturer in Environment and Safety Engineering at UMaT.

She also served as Ghana's national consultant for the United Nations Economic Commission for Africa (UNECA) Gender and Mining in Africa Project.
 
 
Source: Daily Graphic
 
 

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