Home' Trinidad and Tobago Guardian : May 15th 2013 Contents A5
Wednesday, May 15, 2013 www.guardian.co.tt Guardian
The bed shortage at the San Fer-
nando General Hospital has taken
a new twist with doctors accusing
medical director, Dr Anand Cha-
toorgoon, of sending critically ill
patients home to die in order to
free up bed space.
Some doctors have objected to the
proposal outlined by Chatoorgoon
in a letter to Health Minister Dr Fuad
Khan to stop housing patients await-
Chatoorgoon's colleagues say his
letter, advocating the need to reserve
hospital beds for patients "with
reversible, salvageable pathology," is
tantamount to playing God.
"He is making a decision who
should live and who should die. Peo-
ple would do all they can to ensure
the survival of their loved ones," one
They are also upset that Khan has
agreed to the "practical suggestion."
But Khan and Chatoorgoon see a
need to free up scarce beds for new
patients who have a chance of recov-
ery.In the e-mail exchanges about the
patients requiring haemodialysis,
Chatoorgoon wrote: "I do not mean
to sound uncompassionate but in
my respectful view they should be
sent home and not be kept here at
the SFGH at expense cost to the
SWRHA while waiting haemodial-
He said "beds are at a premium
here at the SFGH where overcrowd-
ing haunts us night and day."
So, he suggested, until arrange-
ments were made for such patients
with the social worker, "we send
"Some of them may well be able
to afford one or two haemodialyses
on their own per month," he said,
pointing out those who can't do so
can return to the SFGH which would
then find a slot to haemodialyse
them and send them home.
What some other doctors are
frowning upon is Chatoorgoon's
written suggestion that "death is a
graduation, a promotion, says my
Lord, Fuad, and there comes a time
when we have to allow patients to
die, for death is inevitable.
" And so, I seek your blessings
and permission to send home those
patients who require haemodialysis
as opposed to keeping them here at
the SFGH and awaiting an available
slot to fit them in.
"Some of these patients have been
here with us for weeks and I want
to put a stop to that. I am not being
uncaring and uncompassionate but
we need the beds for patients with
reversible, salvageable pathology until
some such time that we can have
more beds to accommodate the end-
In another letter to Khan, Cha-
toorgoon pointed out, "Ethical issues,
such as this one is, have become the
order of the day for medical insti-
tutions across the world.
"Life is about choices and bearing
in mind how expensive the practice
of medicine has become and bearing
in mind the global economic reces-
sion, medical practitioners and
administrators are now forced to
make ethical decisions and choices,
no matter how painful that may be."
What Fuad said
In an e-mail response to questions
from the T&T Guardian, yesterday,
Khan, who is out of the country,
agreed that while there was a great
need to treat acutely ill patients, "the
chronic dialysis patients can be dial-
ysed as outpatients. They can come
into the hospital and have their dial-
ysis on their days or otherwise.
"Keeping them there just to hold
them and deny new patients who
are ill a bed seems unfair to the new
Khan said: " Dr Chatoorgoon has
indicated a practical approach. This
will allow more patients to be treated.
Those who complain against this
may be the ones responsible for hav-
ing the patients who are ill and new
admissions sit on corridor chairs and
trolley or go to private institutions
where they benefit. Dr Chatoorgoon
is trying to avoid that happening."
Responding to the criticisms of
his colleagues, Chatoorgoon said the
approach had to do with solving the
overcrowding problem at the hospital
rather than have patients waiting on
benches, trolleys and chairs for an
"For many years now, overcrowd-
ing has been and continues to be a
great challenge at the SFGH, which
has only approximately 650 beds
and which serves a catchment area
of 600,000 people.
"It is hoped that with the avail-
ability of the San Fernando Teaching
Hospital at Chancery Lane in the
not-too-distant future, more beds
will become available for those
patients who seek medical care at
"In the meantime, the South-West
Regional Health Authority (SWRHA)
has embarked on a series of initia-
tives with the intention of making
beds available for patients who gen-
uinely need hospital admission."
He said those initiatives included
accommodating patients at the Point
Fortin Area Hospital, fast-tracking
radiological and haematological
investigations to minimise the stay
of patients at the SFGH and making
alternative arrangements for patients
with irreversible pathology to be
looked after at home with assistance
from the district health nurses and
doctors attached to the nearest health
The challenge, however, Chatoor-
goon specified, was that "many of
our patients with end-stage kidney
disease or with terminal cancer but
who are fully conscious do not want
to leave the hospital for fear of dying
"All of these patients have what
we call comorbidities which means
other life-threatening conditions,
such as severe heart disease or severe
diabetes or severe hypertension, and
so they want to stay at the SFGH
where they can be treated in the
event that any complication sets in.
"With the development of inten-
sive care units, high dependency
units, modern drugs and equipment
to prolong life, families, relatives and
friends too are reluctant to take these
"If we are not careful and wise,
the hospital could soon be filled up
with cases such as these, thereby
denying beds for patients with treat-
able and reversible illnesses who can
benefit from being in the hospital."
What the CEO said
CEO of the South West Regional
Health Authority Anil Gosine said
even though the hospital had 11 dial-
ysis chairs and operated six days a
week, it still lacked the capacity to
deal with the number of patients
Gosine said there was a steady
intake of patients with approximately
60 new patients being treated every
six months and 25-30 patients being
treated at home. The hospital pro-
vides both haemodialysis (renal) as
well as peritoneal dialysis treatment.
The Nephrology Unit is to be relo-
cated to a dedicated, bigger space
to accommodate more dialysis
machines so that more patients can
be treated daily. There are also plans
to equip the Penal hospital with 20
additional dialysis chairs when that
comes on stream.
Construction of the $7.2 billion highway
extension to Point Fortin has again stopped
after disgruntled workers walked off the job
yesterday, over a decision by Brazilian firm
OAS Constructora not to increase wages.
The shutdown occurred after the Oilfields
Workers' Trade Union (OWTU) met with
OAS representatives --- Leonardo Luna, Nadera
Eccles, Gibran Ferreira and IR consultant
Newton George --- at 5 pm on Monday.
During the meeting, OAS presented a survey
of compensation packages offered within the
construction sector, conducted by the Employ-
ers' Consultative Association (ECA).
However, addressing hundreds of OAS
workers at the construction site in Golconda
yesterday, OWTU's labour relations officer
Aaron Moyne said the survey was flawed.
"We were not afforded any opportunity to
peruse the said document. The reliability and
validity of the data is in serious question,
given that we are unaware of the time period
the survey examined," Moyne said.
He also pointed out that the companies
surveyed were all local and never undertook
a project of that magnitude.
"The survey said that OAS salaries are ade-
quate and superior to some of the companies
assessed. However, these companies which
were surveyed are paying their workers sub-
standard wages so we will not be surprised
if those workers also protest," Moyne said.
He added the rates of a foreign contractor
on a major local construction project were
not factored into the report.
"The bonuses and fringe benefits, including
cost of living allowance (COLA) added to the
basic rates of workers at some of these com-
panies, were never mentioned," Moyne said.
He pointed out that a labourer employed
at the Ministry of Labour worked for more
than a labourer at OAS. He told workers OAS
was willing to offer a safety and attendance
bonus of $3,000 annually once there were
no loss-time injuries, no fatalities, no disci-
plinary action lodged against the worker and
no unjustified absence.
"They are also committed to do the per-
formance appraisal system which says we will
get increases based on performance," he said.
Highway work stops again
Company refuses to increase wages
OAS workers assemble under a tent at Golconda after walking off the job yesterday. PHOTO: TONY HOWELL
'Chatoorgoon playing God'
Doctors object to sending home critically ill
Contacted via text message
yesterday, Suruj Rambachan,
Minister of Works and Infrastruc-
ture, said he was concerned about
the highway shutdown.
He said he was in Uganda
attending a Commonwealth local
"I am concerned that the
issues which existed two weeks
ago have not been resolved. I will
be in contact with Ganga Singh
to get an update from Nidco. If
required, we will also seek the
assistance of Minister McLeod,"
When told of the protest at 1
pm yesterday, McLeod said: "I
don't know that any group of
workers can shut down an oper-
ation and then demand to have
a meeting with me.
"I don't like to engage in this
kind of journalism. I would need
to see what comes from them
(OWTU) before I make any kind
He denied speaking to any
member of the OWTU. However,
Moyne said he spoke directly with
McLeod at 10.15 am yesterday.
Dr Anand Chatoorgoon
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