Doctors’ neglect killed Huma Wasim: Health Minister

[Naveed Yaseen]

LAHORE: It has been proven that the negligence of her doctors caused the death of Wasim Akram’s wife, Health Minister Dr Ijaz Jakhrani said on Wednesday. Talking to reporters in Islamabad, Jakhrani said a request would be made for action against the doctors. Huma Wasim died in a hospital in Chennai on October 25, following heart and kidney complications. She was admitted on October 20 in critical condition, as the air ambulance carrying her from Lahore to Singapore had stopped in Chennai for refuelling, where her condition worsened. daily times monitor

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The saga of Huma Akram’s demise



Thursday, November 26, 2009
Shahina Maqbool

Islamabad

Inordinate delay in diagnosis of infective endocarditis, with a bicuspid aortic valve as an underlying condition, coupled with probable introduction of infection from dental scaling and/or Botox injections, as well as medical negligence, collectively triggered a chain of events that led to the death of Huma Akram, reveals an inquiry report presenting an appraisal of the circumstances and treatment processes that contributed to the tragic death of cricketer Wasim Akram’s wife.

The inquiry was conducted by a three-member committee led by the head of the Department of Pathology at the Pakistan Institute of Medical Sciences (PIMS), Professor Dr. Anwar Ul Haque, with Department of Nephrology Head Dr. Ghiasuddin Butt and consultant radiologist Dr. Shahla Zameer as its members. The report has been submitted both to Prime Minister Yusuf Raza Gilani, who ordered the inquiry into the alleged misdiagnosis and maltreatment resulting in the death of Huma Akram, as well as to Secretary Health Khushnood Akhtar Lashari.

Interpreting the report in simple language for ‘The News,’ an eminent cardiologist explained that Huma had a bicustid valve, a condition in which a valve (gateway of the heart) has a congenital, inherent abnormality characterised by two, rather than three leaves.

“Such an abnormality can remain silent for the entire duration of one’s life and can only be detected by hearing a murmur (an abnormal heart sound). It is a very threatening condition in case of certain infections which spread through the blood stream. These infections can usually be contracted through innocuous means such as scaling of the teeth or an injection,” the cardiologist explained.

It so happened that Huma had both scaling of her teeth in Lahore as well as Botox injections in Karachi prior to the illness, with a bicustid aortic valve as an underlying condition. Botox has been implicated in several unexplained deaths in the US and it has been put on Black Box advisory by the Centres for Disease Control, Atlanta, meaning that its administration requires well-informed consent and most stringent precautionary measures.

“The infection contracted through either scaling or the injection, nested on the abnormal valve and led to a chain of events which is characteristic of a disease called infective endocarditis. In this disease, very small clots of infected blood form on the valve and wherefrom spread through the blood stream to the small blood vessels of the body. This can interfere with many bodily functions and systems. Since blood supply to the artery of the kidney is very vulnerable, renal disease leading to renal failure is a very common condition in infective endocarditis,” the doctor explained. This is what was observed in Huma, and has also been outlined in the inquiry report.

A chain of events leading to abnormalities of blood coagulation can also be explained based on this. Similarly, the gangrenous patches on the skin which Huma had developed towards the end of her illness are also a manifestation of this disease. The disease started with fever and abdominal pain — of course fever is a hallmark of infection, and the abdominal pain can be explained by the emboli that must have originated from the valve and gotten lodged in some arteries in the abdomen.

“Unfortunately, the infection contracted through the scaling-injection was of a rare fungal infection, where mortality is very high in any case. It is very odd that nobody picked up the murmur in the heart because if the underlying condition is picked up in people who have such murmurs, then doctors always advise antibiotic cover when before scaling. Huma was 42 years old and it is appalling that none of the doctors picked up the murmur,” the cardiologist commented.

The findings of the committee are based on interviews of numerous individuals including Waseem Akram and the brother-in-law of the deceased, and over a dozen doctors who attended the patient at the National Hospital and Doctors Hospitals, where she remained under treatment before being shifted to Chennai, India. The committee also obtained access to records of both hospitals in Pakistan, and partial records of Apollo Hospital, Chennai, India.

The inquiry’s findings are based on statements of Dr. Sarwar of National Hospital and Dr. Kamran Cheema of Doctors Hospital. The inquiry committee holds the National Hospital responsible for delay in suspecting infective endocarditis. The diagnosis was made on October 15, on the 9th day of Huma’s admission to the hospital.

The report also points towards doctors’ failure to suspect fungal infection despite zero response of the patient to several broad-spectrum antibiotics. Although LDH was found raised on October 6, pointing towards substantive multi-organ damage, it was not further investigated till October 14. “Even after being diagnosed with infective endocarditis and structural valvular heart disease, no antifungal coverage was provided at Doctors Hospital,” the report states. Furthermore, arterial blood gases done on October 17 showed hypoxia. “This is in addition to having pulmonary hypertension and infective enocarditis put her on at a high risk for air travel. No blood gas was repeated prior to airlift. The patient’s transportation in an airplane proved to be the triggering event for cardiac arrest,” it states.

According to Dr. Sarwar, the hospital not only consulted its own infectious disease specialists but also those working at Shaukat Khanum Memorial Hospital, as well as visiting doctors from the US and UK. According to him, “all cultures were negative despite disseminated sepsis.” The entire staff of the hospital pledged having left no stone unturned in providing best possible care the wife of cricketing hero Waseem Akram. According to the report, “When an echo showed that the patient had a congenital bicuspid valve with vegetations, with moderate pulmonary hypertension of which she was unaware, the patient was shifted to Doctors Hospital for valve replacement.”

Dr. Cheema too claims having provided due care to Huma. “While they were considering the option of valve replacement after seeing the transthoracic echo, they became somewhat reluctant after the second echo examination (TEE, a much superior method) the heart valve which did not show the vegetations,” the report states. Meanwhile, Waseem Akram arranged an air-ambulance for shifting his wife to Singapore. At that time, the patient was fully conscious and moving around.

According to the report, Huma developed distress and restlessness in the air ambulance when being shifted to Singapore. “For this, she was administered intravenous diazepam, which further aggravated her condition. She developed cardiac arrest for which cardiovascular pulmonary resuscitation was provided. She recovered her heartbeat but required ventilator support. This led to the decision of a stopover in Chennai, where she was admitted at Apollo Hospital,” the report states.

In Chennai, Huma was put on ventilator, along with antibiotics and antifungal treatment empirically, while being investigated for the etiology. “The investigations included pan-cultures, CT scans of head, chest, abdomen and pelvis. She was also put on continuous slow dialysis for renal failure. She developed gangrenous skin blisters all over on October 23, for which a deep skin biopsy was obtained. Her lactate increased markedly, pre-terminally. She had cardiac arrest on October 25, and was declared dead at 9:20. a.m., without firm diagnosis,” the report states.

The inquiry report also points a finger at inadequacy of laboratory facilities in both Pakistani hospitals, as well as ill-equipment of their pharmacies.

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