‘Baby, when is the oxygen coming?’

The number of deaths being blamed on last weekend’s shortage of oxygen in some public hospitals has risen to eight, including a pregnant woman, a Gleaner investigation has found, as pressure mounts on the Holness administration for an independent investigation into the issue.

It is “clear and evident” that such a probe is needed, argued Public Defender Arlene Harrison Henry, who is backed by the Medical Association of Jamaica and the Association of Government Medical Consultants.

Questions asked of Health Minister Dr Christopher Tufton were not answered up to press time.

The death of Diagrea (pronounced DEI-DRE’) Cunningham, 37, who was a nurse at the Savanna-la-Mar Public General Hospital in Westmoreland, captured national attention after the Western Regional Health Authority denied claims that the woman’s condition deteriorated after oxygen ran low at her workplace and then at Cornwall Regional Hospital (CRH) in St James, where she later died.

Doctors at both hospitals have insisted that the nurse’s death was preventable, a view held by her husband, Rayon Cunningham, who said he “noticed that … she was getting worse” and struggling to breathe after she was removed from high-flow nasal oxygen on Sunday because the pressure was too low.

He said she asked, “Baby, when is the bulk (oxygen) coming?”

“When I tell her that ‘Baby, they said that it’s coming’, she shook her head, and I see a sign of hopelessness on her face,” he said, repeating some of the last words of his wife of over 14 years, who died hours later.

The bulk oxygen needed to support the oxygen machines did not come in time.

“The system failed miserably,” Cunningham insisted, adding that his wife, whose positive COVID-19 result came on Monday, had hypertension but had it under control.

The husband said they intended to be vaccinated.

At least seven other cases related to the oxygen shortage have emerged, five of which reportedly took place at the Kingston Public Hospital (KPH), the country’s main trauma centre. Tufton had confirmed that Savanna-la-Mar and Spanish Town were among four hospitals hit hardest. KPH and CRH are believed to be the others.

At CRH, doctors and nurses have been quietly angry over the situation which they claimed hampered treatment to between 10 and 15 patients in the intensive care unit (ICU).

The death of a 30-week-old pregnant woman has been particularly upsetting.

“She should not have died,” said a clinician who is alarmed that the authorities have not given the issue “greater attention”.

“What keeps you alive is the oxygen and we just had to watch patients deteriorate,” said the doctor, who alleged that some of the deaths from the group that was in ICU over the weekend were hastened because of low oxygen saturation.

The ICU patients were on high flow and when the oxygen supply dropped, the cylinders could hardly maintain the pressure, a senior official said.

“The cylinders give about 60-70 per cent of what the high-flow machines give. That means people are sure to die and we got supplies too late on Monday to save some of them,” he said.

DEATHS COULD HAVE BEEN PREVENTED

The health ministry has not confirmed any deaths linked to last weekend’s crisis, the Permanent Secretary, Dunstan Bryan, said on Tuesday, days after some of the country’s major hospitals ran out or got dangerously low on the life-saving commodity.

But several medical doctors are “convinced” that some of the deaths could have been prevented had there been adequate supplies of oxygen, which globally is in short supply in major economies such as the United States.

Three of the five deaths at KPH were over the weekend and involved elderly women, with the two other cases occurring on Thursday when another shortage gripped the hospital, claimed two doctors who spoke to The Gleaner.

Like their Westmoreland colleagues, they spoke on condition of anonymity for fear of victimisation and because they were not authorised to talk with the media.

“For some persons, it (oxygen machine) had to be turned off to accommodate other persons, and for some, it was basically done,” said a doctor on the situation at KPH on Thursday. “Some persons were short of breath and were not able to really tolerate the low oxygen levels. There were other patients who had other illnesses but required high rates of oxygen who were also essentially dying.”

“One was very sick from events but did require oxygen, but the other one definitely was directly related to oxygen,” the doctor said of the two persons - an elderly woman and a “young” man – who died on Thursday.

The three women who died over the weekend were on high-flow oxygen but struggled with the low pressure. The physicians believed that they could have been kept alive longer had they been able to get adequate oxygen.

“It’s very dismal. Nurses and doctors were very disheartened just watching. There’s not really much that could be done from a medical perspective,” a doctor said.

“Usually, when somebody’s oxygen level falls low, you would take them to ICU or try to put them on a high level of oxygen with the high-flow devices. Those, however, wouldn’t be an option.”

CONTRADICTORY REPORTS

Chief executive officer of KPH Burcknell Stewart contradicted the health minister on the situation at the hospital on Thursday.

Tufton, speaking on Radio Jamaica’s Beyond the Headlines on Thursday evening, said that based on checks with the permanent secretary, there was “nothing at KPH that is concerning” and the hospital was “adequately supplied in terms of oxygen and, therefore, the alarm is a false alarm”.

On the same programme, some minutes later, the hospital CEO said the situation was dire and forced the suspension of surgical operations, which confirmed developments The Gleaner was also tracking.

“The (oxygen) levels were much too low,” said Stewart of the main and reserve facilities.

He said IGL Limited, the sole supplier of medical oxygen on the island, was scheduled to make a delivery at 3:00 p.m. but had to be asked to make an emergency provision earlier.

Stewart explained that patients did not entirely lose the oxygen, but the pressure “fell significantly” and could have resulted in distress for the patients although he could not say whether any deaths occurred as a result.

“I do hope that some measures can be put in place where we don’t end up here again,” he said because “if one life is lost as a result of oxygen deprivation, it’s one life too many”.

KPH’s main oxygen storage facility has a capacity of 6,000 inches of water columns, and its reserve offers 2,000 more.

With the recent spike in COVID-19 cases and increased hospitalisations, approximately 1,000 inches of water columns of oxygen are used per day to treat patients with the respiratory illness as well as those with non-COVID illnesses, the CEO said.

INVESTIGATION WILL TAKE TIME

A related death is alleged to have taken place at the Princess Margaret Hospital in St Thomas, as relatives are contending that the oxygen shortage played a role.

Errol Greene, acting regional director for the South East Regional Health Authority, which covers hospitals in Kingston, St Andrew, St Thomas, and St Catherine, said there has been no report of persons dying because of the crisis.

The health ministry said it was “looking at” the deaths that occurred over the period August 26-29 but that it will take more time to determine whether they had been caused by the oxygen crisis, the second such situation since March.

“The investigations in terms of the cause of death will take a little while before we arrive at causation,” said Permanent Secretary Bryan.

But the public defender said that the ministry should not be leading the probe.

“For some time, we have been asking for a review of all the steps taken in the management of COVID, all the steps and all the missteps. And that assessment has to be conducted by an independent body and not the Ministry of Health,” said Harrison Henry.

President of the Medical Association of Jamaica Dr Andrew Manning and Dr Konrad Lawson, head of the Association of Government Medical Consultants, which represents the country’s most senior doctors, agree that there should be a probe independent of the ministry.

“It would be a wise thing to have such an exercise led by and involving independent entities in addition to all the stakeholders in the field,” said Manning, because “it’s clear that moving forward, we have to prevent such an occurrence occurring again.”

Lawson said a formal probe is needed given that just months ago, there was a similar oxygen problem. “If we do get yet another surge and we have this happening again, we can only expect the same result,” he stated.

Although saying that an overseas supplier ran into problems that affected oxygen imports that contributed to the shortage, IGL publicly claimed that the Government had not provided it with a forecast of needs for the country should a third surge take place, and additionally, that it had no contracts in place with three of the regional health authorities.

The health ministry hit back, arguing that a framework agreement has been in place and that negotiation takes place on the rates IGL wants to charge. It also said that additional oxygen needs were discussed at a May meeting where IGL reportedly said it would be able to provide oxygen for a 30 per cent increase in bed capacity nationally.

Further public feuding between IGL and the health ministry was stamped out with the reported intervention of senior government officials to get cancelled a press conference that had been called by Tufton, whose resignation the Opposition People’s National Party has demanded for the oxygen debacle.

Permanent Secretary Bryan said contracting specific oxygen amounts would not be prudent given the swings in hospitalisations and other demands. In a Gleaner intervew, he likened the situation to electricity provision.

“It’s just like electricity at your home. What you negotiate with JPS is a rate, and month on month, they apply the rate to the quantity of electricity that you use, and you then get a bill. So you don’t have a cap on it,” Bryan said.

jovan.johnson@gleanerjm.com