Peju Ugboma may have died from wrong medication and lack of adequate anticipatory care while at Premier Hospital, a US-based medical quality process and procedures assessment expert has told the Federal Competition and Consumer Protection (FCCPC) panel probing the deceased’s death.
Dr. Ayoade Akere, who testified at the second sitting of the panel on Wednesday, said the deceased’s medical record showed that she experienced low blood pressure after a surgery, and that physicians at the hospital gave her medications that would further reduce it.
“The blood pressure was 118/40 which the physician’s attention was drawn to. And the physician basically treated the heart rate. The heart rate was also elevated. It was over 120. And of course, to treat the heart rate, she gave … and now Furosemide,” the doctor said.
“However, these two interventions, when you really look at them — at that point in time, the diastolic blood pressure was in the 40s — the Furosemide and Labetalol, both of those are going to lower the blood pressure further. So, that is an intervention I would rather not have at that time.”
Akere said that although the physicians chose the medications to control the deceased’s heart rate, which had also increased, there were other ways to slow down the heart without lowering the blood pressure.
“You have to look at what’s going to harm the patient most and be able to find an appropriate balance. And at this point in time, ‘I’m I treating the heart rate, the blood pressure or …?'” He said.
“Because there are different ways to intervene, and you have a situation where you have a low blood pressure and you have a high heart rate. That, especially in a patient who is having …, that’s an indication to give fluid.
“The fluid will correct the heart rate; it will correct the blood pressure. So, it’s not that it is something that cannot correct the heart rate; it is just that it’s not the right medication for the heart rate at that point in time.”
Peju, a Lagos-based chef and CEO, had walked into Premier Hospital in Victoria Island, Lagos, on Thursday, April 22, for a fibroid surgery billed for the following day. She complained of abdominal pain and discomfort shortly after the surgery and her condition worsened as time went by.
On Sunday, April 25, Premier transferred her to nearby Evercare Hospital for possible dialysis, a procedure which helps remove wastes from the body when kidneys stop functioning properly; just few hours later, she was pronounced dead.
According to Akere, there were sufficient indications in the values of electrolytes in her body by evening of Saturday, April 24, to let the physicians know they had a very sick patient requiring prompt anticipatory care, which would have prevented her kidneys from getting damaged.
“The record shows that they were doing it (monitoring the electrolytes) twice a day. And it was appropriate for that time. But by evening when the bicarbonate went up, that should change immediately because that indicates that your data has gone out of the comfort zone, so to speak,” he said.
“So, the real action that I expected, it was on Saturday, that two to three hours later, they were checking the electrolytes again. Because the next time, it is not going to be bicarbonates alone, other electrolytes are going to be involved.
“The next time it was done was Sunday morning and that was when they saw that potassium was now 7.2. But if it was done three/four hours later, they would have seen when potassium was 5 and when it was 6, not when it had gone all the way from 4 to 7.”
Akere also said that although kidneys stand the chance of recovering from damages resulting from deranged electrolytes, the wrong administration of Furosemide and Labetalol by Premier physicians might have worsened the damage.
The panel sat for the first time on Tuesday, when Ijoma Ugboma, the deceased’s husband, blamed her death partly on the lack of adequate care by Premier Hospital physicians in the aftermath of the surgery.
Witnesses summoned from the hospital, however, refused to show up.
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