Secretary Duque explains

Why the DOH Report on Neonatal Sepsis at RMC is a Whitewash

We write in response to the letter of Department of Health (DOH) Secretary Francisco Duque III denying that their report on the neonatal sepsis deaths at the Rizal Medical Center (RMC) was an attempt to cover up the culpability of involved personnel and health agencies. This letter came out in several newspapers and was quoted by many members of media.

The letter of Sec. Duque vehemently denies any wrongdoing on their part, especially in interpreting the report of the DOH Fact-Finding Committee (FFC), as well as statements from the National Epidemiology Center (NEC). Unfortunately, it is the highlight of this particular report that has cast aspersion on its true intent and value.

The DOH report emphasized that, as per their investigation, the pathogens that caused the neonatal sepsis in RMC were “maternally-acquired” and “not from the hospital equipment or staff”. From there, the report also cited that the newborns already “showed signs of difficulty in breathing, poor suck, and fever within 90 hours of birth”, thereby seemingly corroborating their earlier assertion.

Why are these statements tantamount to a whitewash, as we have accused them of?

First, neither the NEC nor the DOH attempted to clarify exactly what neonatal sepsis is, which would have settled a lot of misinterpretations. Neonatal sepsis can either be maternally- or hospital-acquired. The difference is important mainly in terms of management, particularly in starting empirical antibiotic management, which is done even before culture testing can give an accurate picture of the pathogen and the effective antibiotic.

But regardless of whether the neonatal sepsis was maternally- or hospital-acquired, the role of the hospital and its aseptic conditions remains the same. In short, the information on where the pathogen was acquired has very little bearing in terms of clinical and medical responsibility! This is also the reason why all cases of neonatal sepsis are considered part of hospital morbidity and are included in their morbidity and mortality census. But neither the NEC nor the DOH mentioned this basic fact.

Second, there was a clear clustering of cases (11 out of 15 live births, where 9 died) in a single hospital in a very short period of time (since October 4, day of birth to October 6-7, when the neonates died). The most obvious common denominator in all of the cases is the hospital where the babies were born. There is a very clear pattern that has both epidemiologic and public health implications. Yet the NEC and the DOH were again silent on this very salient fact.

Third, what did the DOH report say about the aseptic conditions of the hospital, in the light of testimonies of the mothers that the delivery room was “dirty”, which was corroborated by the hospital director himself when he tried to attribute the poor conditions to typhoon Milenyo? Nothing. In fact, neither the NEC nor the DOH reprimanded the hospital for not immediately closing its delivery room (the standard operating procedure) even when the cases of neonatal sepsis became obvious and started to pile-up in their emergency room.

Lastly, the DOH report failed because its basic premise was that it was meant to investigate the medical circumstances of the neonatal deaths, rather than investigating how and where the health system failed. Frankly, what question did the DOH report settle in this issue? Nothing much of practical use to either the grieving mothers or the general public. Instead, it emphasized the aforementioned misleading statements. This DOH report did not even delve on the pathetic conditions of public hospitals, most of which are ill-equipped, undermanned, and poorly supplied with basic necessities because of overall gov’t neglect.

In sum, the DOH report only muddled the issue further instead of providing clarity. Hence, the calls of a whitewash remain valid.

The belated assurance of Sec. Duque that investigations will continue is unconvincing and is clearly meant to assuage fears of ningas cogon, or that nothing will come out of this whole issue. In this so-called initial investigation, the DOH has not shown that it can deal objectively with issues of public accountability. So it will not be surprising if subsequent investigations, if ever undertaken, will be more of the same exculpatory exercises.

The members of HEAD, doctors, nurses, and hospital workers alike are witnesses to the continued inability of our public health care delivery system to address the needs of our people, especially the poor. The infirmities that afflict our public health care delivery system have become pervasive and systemic because health policies and programs of the current dispensation are politically-motivated and profit-driven.

It is imperative for the health sector to maintain the public trust, not just by the service we provide but by the integrity by which we serve, even under the most difficult conditions. It is also important to show that our patients do have remedies for their complaints. Most importantly, we should continue to demand from the Arroyo administration the fulfillment of its Constitutional obligation: that of ensuring the health of the people.

Signed,

Gene Alzona Nisperos, MD

Secretary General

Health Alliance for Democracy (HEAD)

Mobile Phone: 0916 2145724