Few Unanswered Questions:

Few Unanswered Questions:

1. Who signed the operation form?

2. Why it was falsified?

3. What was the motive?

4. Why signature on the BTL form signed only by the husband and not both husband and wife? When did they obtain this permission before labour or during and not during the prenatal visits?

5. Who did the artificial rupture of the membrane?

6. Why there was 2 incisions?

7. Why there was no monitoring of the fetal heart rate (FHR) between 10.30pm to 2am.

8. When the cervix has dilated to 9cm (as indicated) delivery could have been done through vaginal? Why choose C-Section?

9. Why delay Em LSCS for more than 3 hours?

10. Why caesarian was only done at 4.15am (no recordings of contraction and FHR since 12.30 on the PARTOGRAPH)?

11. Why there was no indication of what time oxytocin was administered on the (PARTOGRAPH)?

12. Intra operative notes on condition BP 90/50 case note 39. The excessive blood lost during the surgery up to 2 liter what were the remedial measures taken to control blood lost?

13. Case note 37 only shows the plan post operatively and the earlier portion the page is blank on the operative notes. We want to know whether Dr. Hasimah and Dr. Fazilah were competent enough to perform the surgery. Is she credentialed to do so?

14. We want to know the type of caesarian section done?

15. Why PARTOGRAPH and the Labour Chart (case note 33 and 34) only indicate the first hour 10.30pm on the 18th February 2002. We want to know why these two important documents are incomplete?

16. What caused the fetal distress? Even during surgery there was no abnormalities written except for TMSL. But the deceased lost 2 liters of blood?

17. IS THIS NOT COMPLICATION? Why she was not referred to a Gynecologist?

18. The excessive blood lost during the surgery up to 2 liter what were the remedial measures taken to control blood lost?

19. The excessive blood lost during the surgery up to 2 liter what were the remedial measures taken to control blood lost?

20. We want to know since Dr. Hashima and Dr. Fazilah not a Gynecologists she had a duty to refer the deceased to a Gynecologists when she encounter problems. Why this was not done? She had 30 days.

21. The management was, administration of Syntometrine in the hope that the hemorrhage will subside without further investigation and consultation with a proper Gynecologist: failure to diagnose the cause of the SEC PPH. Why she was not referred to a Gynecologist?

22. Hysterectomy was an option and why it was not referred or considered, when there was a serious complication SEC PPH up to a month. Why this was not considered?

23. The Date 1st March 2002 at the Clinic Kesihatan Long Semadoh the deceased was attended by JM Lily and Tia Tindin. According to them her wound was dirty and there was infection on her wound. The wound was still open and requires dressing and her uterus was bulky. They did not refer her to Lawas Hospital. Refer to case note 13 on the Plaintiffs’ Bundle of Documents (PBD). Appointment set on 8th March 2002 according to the records. Why she was not referred to a Gynecologist?

24. The Date 8th March 2002 Dr. Hasimah has gone to Long Semadoh to give talk to ladies in the village. On this day the deceased when for her appointment at the Klinik Kesihatan Long Semadoh, where she was checked by the Dr. Hasimah and she was treated for infections on her wound and JM Lily was a witness to it and JM Lily said that “Fundal height was still high”. She also said that Dr. Hashimah told the deceased that her uterus was still bulky because of her age. On what basis and finding is this? JM Lily claims that Dr. Hashimah treated her with antibiotics. There no appointments given.

25. Why she was not referred to a gynecologist?

26. The Date 14th March 2002 - Kam Agong suffers SPPH at her home. At Lawas Hospital she was received by Dr. Fazilah. The deceased was admitted and they placed a pad on her vaginal to see if she was still bleeding. According to the JM Lily there was very little bleeding but there are no records available to conform this. No records of her BP and HB after admission. The Discharge summary mentioned about ultrasound but no report in the case notes. According to witness there was no blood transfusion but given drips (IV) and blood request was send to the lab. There was no active management to monitor the deceased condition and the cause of her massive hemorrhage. She was merely kept under observation for less then 48 hours. No blood transfusion.

27. Why she was not referred to a gynecologist?

28. The Date 16th March 2002 What attempts made to consult a gynecologist? Who was the person made these attempts and which gynecologist did they consult at the material time? We have requested for her to be transferred to Miri Hospital but there was no reply on the part of the hospital staff. It is assumption that the condition will resolve and no need for further consultation.

29. Records (on the day of discharge, evidence to show that she has stopped bleeding, even her vitals was not given, was there any form of treatment administered on the wounds for infections).

30. What was the reason to discharge her in such a hurry without appropriate, adequate assessment and consultation with a gynecologist? She was admitted in the late afternoon on the 14th March 2002 and discharged in the early afternoon on the 16th March 2002. She was only observed less than for 48 hours.