June 26, 2017

Tags Posts tagged with "procedures"


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by Bertha Henson

NOW, here’s the thing. You can expect a stiff response to a civil society activist who complains about being incarcerated. But you don’t expect the same response to a 74-year old woman who lives alone.

It seems that Police and Prisons Department believe in meting out the same treatment to everyone, regardless of age or type of crime. The sanctity of their Standard Operating Procedures (SOP) is critical. Officers should leave their brains behind and refer to the book.

So Madam Gertrude Simon wrote to the ST Forum Page to say that elderly people should be treated better by the police and recounted what her mother went through over the weekend of March 4. Madam Josephine Savarimuthu went to Ang Mo Kio South Neighbourhood Police Centre to presumably report a missing pawn ticket. That is, she went to seek help.

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Because we are a smart nation, the police officer could immediately see that there was an outstanding warrant of arrest for her in 2016 for a town council-related matter. She was taken, handcuffed her daughter claimed, to Ang Mo Kio police station and then to the State Courts and then to Changi Women’s Prison.

What did the agencies say? They made an issue of her declining to contact anyone, not even for someone to bail her out. “If she had accepted the bail offer, she would have been released that day, and attended court another day,” it added.

In other words, it was her fault. She need not have spent time in jail; she chose to.

Obviously, police officers are not very good at dealing with old people who can become flustered and forgetful when they are stressed. Then you have to reckon with this stubborn streak that they have about not “bothering’’ their children; that they are able to take care of themselves.

You would have thought some officer would have the initiative to ask to see her belongings to find traces of her next-of-kin, or go down to the house, which must be in the neighbourhood, to gather some clues. This, presumably, would not be SOP. And of course, the police don’t want to seen as favouring someone with (gasp!) an outstanding warrant of arrest.

The agencies, probably in anticipation of arguments that the old lady was traumatised, made it clear that she “did not show any sign of being traumatised, and was alert when in police custody.” At the same time though, they also said that she was restrained at the hands and legs as part of Prison’s SOP, “which include preventing persons in custody from harming themselves.” But she wasn’t traumatised, was she? So why would she harm herself? Ahhh….that SOP again.

The saving grace was that the old lady was put in a medical ward and given her medicines. She stayed the weekend at the G’s expense. When her daughter finally knew what happen, she tried to see her mother on Sunday but couldn’t because it wasn’t visitation day. I don’t know about you, but if it was my mother, I would have barged through the prison gates and raised an almighty stink. Hey, this is an elderly person we are talking about, not an able-bodied pai kia.

MP Louis Ng would probably have cited this as an example of the public service without a heart. Should rules and SOPs be adhered to strictly even though a little empathy and common sense would serve better? It boggles the mind that the police could have forgotten that their strict adherence to SOPs was a factor that accounted for their late response to the Little India riot in December 2013.

Consider also what her summons was about. According to the old lady, it involved the wrongful placement of potted plants outside her flat, which amounted to an offence involving a $400 fine. Hardly a hardened criminal.

The agencies’ response is really, to put it bluntly, horrible. If the purpose was to maintain an image of immoveability because of a “duty to uphold the law”, it succeeded.

I wish the response would have been this instead:

We learnt with much regret what Madam Josephine Savarimuthu had to go through over the weekend when she was remanded at Changi. In hindsight, we could have done more to track down her next-of-kin and spared her the ordeal of incarceration. Law enforcement officers must uphold the law but they should also be sensitive in their one-on-one dealings with members of the public. While abiding by SOPs is important, this does not mean that no discretion is afforded to officers handling individual cases.

We will be looking for her missing pawn ticket.

Read part 1 here.

Featured image by Sean Chong.

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SGH's Renal Health clinic.

by Bertha Henson

NOW that the review of the Hep C outbreak in Singapore General Hospital is out, is any one sparing a thought for the staff who worked in the Wards 64A and 67? The past few months must have been a trying time for them and it’s not going to ease given that a disciplinary panel has been convened to look at their work processes.

There were 24 staff members, including three renal doctors and two medical officers, who worked in the two wards during the time of the outbreak in the middle of the year. All were interviewed by the Independent Review Committee’s quality assurance team. (Presumably, they were included in the 319 SGH staff members who were also screened for the virus.)

You sort of wonder how they felt when the team, which included four foreign experts, came on site visits, or rather, inspection tours. It made 18 visits in all from Oct 15 to Nov 11. It didn’t just visit the two wards but also other areas where the infected patients might have visited, like the radiology and urology centres, or where their medications and blood products were handled. It even called at the pharmacy.

You can sort of empathise with the 10 selected nursing and medical staff who were asked to demonstrate clinical procedures, such as administering intravenous medications and glucose monitoring. One housekeeper was even asked to demonstrate cleaning procedures. It was during such demonstrations that the team spotted a wrong procedure being used. A staff member opened the cap of a patient’s intravenous tube instead of a side port when injecting medication into it.

What’s the big deal? “Such a practice poses a risk of the patient’s blood flowing out through the Intravenous (IV) cannula, leading to environmental contamination and transmission of infection, as well as exposure of the patient to contaminants entering his or her bloodstream,’’ said the committee.

You think about what they said to the team who asked them about the blood stains on a wall and on medical carts and trolleys. These carts and trolleys were supposed to be cleaned and disinfected before they were pushed into preparation rooms; they weren’t. And when asked to demonstrate the cleaning process, the committee found that they were “not adequately cleaned’’. In fact, there was “inadequate hand hygiene observed among some staff when they were performing procedures’’.

What’s the big deal? The Hep C virus is very resilient and tests have shown that it can be detected in dried blood spots on surfaces in the environment for up to a year. That stain on the preparation room wall, for example, still contained the virus months after the outbreak.

The committee said that items used during invasive procedures should not be brought into clean areas where IV medications are prepared. Nor should common medical carts for storing clean supplies for intravenous procedures, such as needles and syringes, should not be moved from patient.

You wonder if there were procedures in place at all (yes there were). Given this, you wonder whether the staff members complied strictly or whether they were monitored in some way.

Lay-out of Ward 67, Image from IRC report.
Lay-out of Ward 67, Image from IRC report.

Some of the blame went to the lay-out of Ward 67 which has a long corridor of single rooms with the preparation room for medications at a far end. The patients had been moved from Ward 64A which had the preparation room in the centre. Although three patients were believed to have been infected in Ward 64A, the rest of them had stayed in Ward 67 and some rooms had multiple cases of the patients staying in them at different points of time.

Lay-out of Ward 64A, Image from IRC report.
Lay-out of Ward 64A, Image from IRC report.

The committee, as well as the Criminal Investigation Department, think that staff members “modified their practices in order to complete their tasks’’.

What’s the big deal? “The computerised medical carts and procedure trolleys can be possible sources of infection as they are moved from patient to patient,’’ said the committee.

Now the report on the staff’s work isn’t all bad. The committee cited several “commendable practices’’ such as the way they consistently checked the patients’ identity before procedures. SGH was also praised for the way it had a clear structure for skills development and training, with nurses taking a significant share of duties normally performed by junior doctors, like giving the first dose of IV medications.

Now did you do a double-take on that? The nurses are probably wishing they didn’t do those jobs.

It seems that these nurses aren’t your young rookies fresh out of polytechnic. Renal patients require a great deal of care and nursing expertise. It is also likely that the patients, most of whom had kidney transplants, would have known the doctors for some time.

The medical and nursing staff must be beating themselves up for what happened. May they get over this painful period, suck up the consequences – and move on to fulfill their noble calling.


Featured image by Najeer Yusof.

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