Formal Letter of Complaint by Dr. Gap Legaspi
GERARDO D. LEGASPI, M.D.
10 April 2010
Dr. Ramon Arcadio, MD
University of the Philippines Manila
Dear Dr. Arcadio:
I would like to bring to your attention an incident that happened last Tuesday, April 8, 2010, at the RCB OR complex. It was during a particularly difficult procedure, on a 27 year old female, excising a Malignant Glioma of the right thalamus. At the start of the tumor dissection, around 9:30am, I noted that the tumor was very vascular and bled more than usual. I then asked my anaesthesiologist, Dr. Geraldine Jose, to secure the blood, 1 unit if PRBC, we have prepared pre-op. Thirty minutes later she informed me that our blood loss was already nearing 1 liter and patient was tachycardic. I immediately instructed one of the residents assisting me, Dr. Roel Domingo, to scrub out and facilitate procurement of 2 more units of PRBC and fresh frozen plasma, emphasizing on the urgency of having it at the soonest possible time.
At 10:15 am, Dr. Jose started transfusing the 1st unit of PRBC, prepared at pre-op. However, at that time, bleeding from the tumor, deep inside the brain, was still brisk and estimated loss was 1.5 liters. I was informed that the BP was then starting to go down and went as low as 70/50 mmHG. We got in touch with Dr. Domingo and followed up the request, stating also to waive complete crossmatching due to the need to transfuse right away. At 10:47 am, a text message was received in the phone of my assist, our senior resident, Dr. Kenny Seng. It was from Dr. Domingo and it read, “Ok. Paakyat lang po. Nagkaproblema sa ADHO Bout d Mass leave kaya natagalan.” I asked the charge nurse to verify what happened and after talking to Dr. Domingo he said that only 1 unit of PRBC, of the 2 that we requested was approved, as well as 2 FFP. He also informed us that, on verification with the blood bank, there were 24 units of PRBC, type AB, on stock. I could not comprehend what was happening, nor verify it because I had my hands full with a bleeding tumor in front of me, in a potentially life threatening situation as blood loss was at that time almost 2 liters. At this point, Dr. Jose was able to maintain BP with IV fluids and inotropes, but I noticed the blood pouring out in the field to be diluted already.
At 11 am a 2nd unit of PRBC arrived (1st of 2 units initially requested), helping us stabilize the patient temporarily. At 11:30 am, the BP again started to decrease and we were frantically following up the 2nd unit. (I recall, out of frustration, relaying a message to our circulating nurse that I will make anyone in the ADHO answerable in court if anything happens to my patient). We also instructed Dr. Domingo to secure more blood and FFP.
At 12 noon we were able to hook up the 3rd unit of PRBC and FFP. It was the 2nd unit of the 2 we initially requested, coming a full 2 hours after we requested for it.
Tumor bleeding was unrelenting. At this point however, for some unexplained reason, the procurement and availability of blood became more expedient, making management of 1 more episode of hypotension less difficult. (Apparently, some other official was approving the request at this point). The patient received a total of 6 units of PRBC and 6 units of FFP. After completion of tumor excision the patient remained intubated due to massive blood loss and transfusion.
After the surgery I appraised the family of the situation and the events that happened during the conduct of the operation. I then called Dr. Roel Domingo to personally narrate to me what happened at the ADHO’s office when we requested for the first 2 units of blood.
He said that when he presented our request at the office there were 3 women inside and one of them asked him what he needed. He relayed our request for blood and the urgency of the situation. The woman he was directly talking with asked whose patient it was, and he said it was mine. Her comment then was “Bakit siya nagoopera ng elective na private case? Di ba naka mass leave siya? O sige 1 unit lang.” She also had other comments which I would rather not add anymore.
I am submitting this report just to put on record this unfortunate event which I believe should not happen in a center of excellence and professionalism like the PGH. I have deliberately omitted the names of the officials involved so as not to be unfairly judged by anyone who might read this report, without verification of the facts or getting their side of the story.
Gerardo D. Legaspi M.D.
Associate Professor I
Section of Neurosurgery
Department of Neurosciences
University of the Philippines-Philippine General Hospital
Dr. Benjamin Sablan
Dr. Rodney Dofitas