Monday, 24 September

Tonsillectomy Gone Horribly Wrong: Ministry of Health Absolves Physicians of Medical Malpractice



A special investigative committee looking into a possible medical malpractice case that left six year old Hasmik Martisrosyan with brain damage after a simple tonsillectomy has concluded that physicians weren’t at fault.

The committee was convened at the behest of Armenia’s Ministry of Health after press reports covered the case involving the young girl, a resident of the Shirak Province village of Bayandour.

Last November 28, Hasmik was taken to the Mother and Child Austrian Hospital in Gyumri to have her tonsils removed. Hasmik was then transferred to the Sourb Astvatzamayr Medical Center in Yerevan where she sunk into a coma for six days. The diagnosis on the medical chart accompanying Hasmik to Yerevan read that the patient had brain ischemia (is a restriction in blood supply to tissues, causing a shortage of oxygen and glucose needed for cellular metabolism)

The Ministry of Health has concluded that Hasmik had experienced a unique complication caused by pneumothorax; i.e. a collapsed lung.

A primary pneumothorax is one that occurs without an apparent cause and in the absence of significant lung disease, while a secondary pneumothorax occurs in the presence of existing lung pathology.

Spontaneous pneumothoraces are divided into two types: primary, which occurs in the absence of known lung disease, and secondary, which occurs in someone with underlying lung disease.

In children, additional causes include measles, echinococcosis, inhalation of a foreign body, and certain congenital malformations (congenital cystic adenomatoid malformation and congenital lobar emphysema)

Primary to the operation Hasmik had no breathing or lung-related problems. But the health ministry is avoiding getting into details as to why the young child experienced pneumothorax during the operation.

On the day of the operation, when Hasmik was transferred to the Sourb Astvatzamayr Medical Center in Yerevan, the resuscitation unit’s head, Anna Chobanyan, told the child’s relatives that her lung was punctured to allow for the removal of excess anesthetic.

Hasmik’s mother, Lianna Rafayelyan, says that a copy of the lung x-ray   proves that her daughter’s lung had been punctured. On February 23, Lianna asked the medical center to provide her with a medical history and x-rays of Hasmik. The center told her that x-rays could only be granted with permission from the health minister.  

That mistakes were made during the operation is proven by the comments made by the surgeon and otolaryngologist Yeranouhie Varagyan.   When confronted by Hetq, she shifted all responsibility to the anesthesiologist Ashik Dalibaldyan.

“The examination committee from Yerevan found that my surgery to remove the tonsils went without problem. You should direct your questions to the anesthesiologist because the equipment had broken down. I am amazed you even telephoned me because I operated without a drop of blood being spilled,” Varagyan told Hetq.

A few days after the operation, Dalibaldyan called the girl’s relatives, asking that they not make a fuss and offered to pay for her medications. After shelling out 220,000 AMD for medications, Dalibaldyan and his wife started to complain, arguing that they weren’t willing to take care of Hasmik forever.

We should point out that the special investigative committee’s report does not mention that the anesthetic equipment used during Hasmik’s operation was faulty.

The statement released by the health ministry merely says “The type of anesthetic was correctly chosen. During its application, a very rare complication unique to artificial respiration was experienced.”

The health ministry also failed to note that Hasmik was transferred to Yerevan in a coma which lasted for six days.

In fact, the ministry, in its statement, applauds the surgeon and anesthesiologist for quickly reacting to the crisis and saving Hasmik’s life.

On February 24, Hayk Martirosyan, an investigator with the Shirak Provincial Department of Investigations, requested that Hasmik’s mother and grandmother come to his office for a discussion about the case.

Lianna Rafayelyan, the little girl’s mother, explained to Martirosyan in detail what had happened. The investigator took three pages of notes. Afterwards, he gave Lianna another 3-4 pages of blank paper and asked her to sign her name at the bottom.

Martirosyan explained to Lianna that he had to rush off to see Hasmik and that he would interview her later by phone and that he would fill in the blank pages.

Two days later, Martirosyan telephoned Lianna Rafayelyan and asked her if she ever experienced pregnancy complications. The child’s mother repeated that she hadn’t and that she had brought Hasmik to the hospital merely for a tonsillectomy.

Thus, Armenia’s investigative agencies seem to be in cahoots with the physicians involved to quash an apparent case of medical malpractice.

Everyone wants to wash their hands of any responsibility regarding what happened to little 6 year-old Hasmik.

Photos: Narek Aleksanyan

 


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Comments (1)
1. Hayk20:37 - 26 February, 2015
Միգուցե երեխան ունեցել է Malignant hyperthermia (MH) կոչվող ժառանգական հիվանդություն: Եթե այդպես է, բժիշկներին մեղադրել պետք չէ: Malignant hyperthermia (MH) is a potentially fatal, inherited disorder usually associated with the administration of certain general anesthetics and/or the drug succinylcholine. The disorder is due to an acceleration of metabolism in skeletal muscle. The signs of MH include muscle rigidity, rapid heart rate, high body temperature, muscle breakdown and increased acid content. Immediate treatment with the drug dantrolene usually reverses the signs of MH. The underlying defect is abnormally increased levels of cell calcium in the skeletal muscle.
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