Dubai-based heart surgeon suspended for mismanagement

Posted On:   05 December 2016

Dubai – 6th November, 2016: The Dubai Healthcare City Authority – Regulatory (DHCR), a part of the Government of Dubai, who operates independently to ensure compliance and enforcement of clinical governance investigated this case, and after a thorough review, decided to suspend the licence of Dr Uwe Klima for three months.

Dr Uwe Klima, a well-respected surgeon with over 20 years of international experience, was in charge of the patient, Mohammad Imran Hussain, as the primary treating cardiac surgeon for his Heart Bypass surgery.

The family of Mohammad Imran Hussain initially filed the complaint against Dr Klima for allegations of “professional misconduct”, after he was left brain damaged, suffering permanent disability which will leave him with lifelong dependency on others for his care and support.

On August 3rd, 2016, Mohammad Imran Hussain was taken to Mediclinic City Hospital in Healthcare City, Dubai, to have heart surgery. According to the medical report, seen and verified by our editor, Malik Al ash-Shaykh, the initial operation went well, the recovery process was underway and the patient was due to be discharged seven days later.

One of the last procedures a patient must undergo after such heart surgery is the removal of the “pacer wires” that are left externally in an area next to the heart and are connected to a bedside device. The removal of these pacer wires can sometimes be complicated, and even lead to death unless certain precautions are taken to prevent any avoidable complications.

One of the most feared and known complications after removal of the “pacer wires” is called “cardiac tamponade.”

This can occur if there is bleeding around the heart when they are removed. When such bleeding does occur, the blood accumulates between the sac that surrounds the heart and the heart itself. If there is continued bleeding within this sac, the heart becomes compressed and cannot properly fill, so the heart’s function to pump blood begins to fail.

Well-documented research shows that one of the common symptoms of cardiac tamponade is shortness of breath, low blood pressure, and elevated heart rate.

On August 10th, 2016, seven days after the initial heart surgery, at 0810 am, the pacer wires were removed by Dr Uwe Klima.

There is no documentation that there was any order for the patient to have additional monitoring by the nurses. There is no documentation that there was a discussion held between the doctors and nurses of what signs to watch out for to enable early detection of cardiac tamponade. Moreover, there is no documentation that there was any patient education about the symptoms of cardiac tamponade and the necessity of letting the hospital staff know at the earliest occurrence of such symptoms.

0930 AM: The patient’s first documented symptoms were noted, at which time the patient complained of shortness of breath and was noted to be excessively perspiring.

0945 AM: 15 minutes after these symptoms began, the patient was evaluated by the surgical intensivist who verified the continuing symptoms as recorded earlier, in addition to significant blood pressure lowering and elevated heart rate.

By this time, the diagnosis of cardiac tamponade was clear.

1000 AM: Another 15 minutes later, the patient was transferred to the Intensive Care Unit (ICU) with even further worsening symptoms and noted to be in considerably more distress. By that time, the reduction of Mr Hussain’s baseline blood pressure and escalation of his baseline heart rate was an emergency requiring immediate intervention to stabilise the patient and reverse the cause.

1050 AM: 50 minutes later, the cardiologist, Dr Zuhair Yousif arrived in response to the call about the patient’s deterioration, which actually began 1 hour and 20 minutes earlier.

1053 AM: 3 minutes after the arrival of Dr Yousif, the patient’s heart stopped, the patient “died”. This lead to Mohammad Imran Hussain requiring emergency resuscitation and removal of the blood around the heart.

1102 AM: Mr Hussain’s return of natural blood circulation was noted, 9 minutes after the heart stopped.

The brain is intolerant of any loss of blood flow and the brain damage that Mr Hussain suffered from the event was substantial. Reports, verified by the Independent.ae team confirm that two US-based doctors, each known to be experts in their respected fields, were either flown into Dubai to independently assess Mohammad Imran Hussain’s case or shown the full medical report provided by Mediclinic and signed by Dr Uwe Klima.

Dr David Jayakar, Director of Cardiac Surgery, of the Texas-based Diagnostic Clinic of Longview, confirmed the timeline of events as described above and said:“ Mr Hussain developed the classical symptoms of cardiac tamponade. The delay from onset of symptoms to intervention (1 hour and 23 minutes) was unnecessarily long. The treatment of cardiac tamponade is not overly complex and can be executed rapidly.”

“Had the team been well prepared, the first noted symptom of shortness of breath and excessive perspiration at 0930 am would have led to rapid recognition of its significance and bringing together the team who should already have been “on alert” to confirm the evolving cardiac tamponade and intervene without allowing progression to the extreme that occurred in this case. It is clear to me that the confluence of events led to a completely avoidable catastrophe,” he added

Dr J. I. Frank, a neurologist, also based in the United States of America, with 25 years experience, travelled to Dubai on August 19th, 2016, and again on September 19th, 2016.

He was asked by the patient’s family to help them understand his neurological situation, provide guidance on the pathway of recovery, and assist in strategically planning for Muhammad Imran Hussain’s future.

In his official report, provided to our journalists by the family of the patient, Dr Frank says: “Mr Hussain suffered a heart and breathing stoppage on August 10th, 2016, due to cardiac tamponade, as a complication after removal of pacer wires approximately two hours earlier. Severe low blood flow injuries to the brain as suffered by Mr Hussain are expected to cause variable degrees of permanent disability.”

Furthermore, he goes on to state: “Presently, Mr Hussain has sleep-wake cycles, but he cannot connect with his environment. He does not follow any instructions or provide eye contact when his eyes are open. He is unable to speak or swallow food on his own – requiring a hole in the neck for suctioning of the lungs to keep them clean and a hole in the stomach to provide nourishment. He has no willful control of his body at all. He is incontinent of urine and stool. He is fully dependent for all of his needs and care. He also has low-grade fevers and a healing bedsore.”

The Complaints Panel Chairman reviewed and took into consideration all relevant matters concerning the complaint and investigation. In accordance with his mandate under the Governing Regulation No. 1 of 2013, the respected Chairman appointed a “Fitness to Practice Panel” (FTPP) to further inquire into the allegations made by the patient’s family against Dr Uwe Klima and the hospital.

The FTPP came to the conclusions that:

there was a delay in recognising cardiac tamponade, and the possibility exists that an early intervention could have improved the outcome.

a cardiac surgeon was not available at the time and it is a “problem in the system”.

the hospital should have had another surgeon available for urgent situations.

there is no professional misconduct or negligence on Dr Uwe Klima’s part, however, there was clear mismanagement in dealing and recognising the main complications of cardiac tamponade.

Accordingly, the panel unanimously decided to:

suspend the license of Dr Uwe Klima for three months because of the mismanagement of this case and failure to give clear instructions to monitor the patient after removing the pacer wires and failing to manage the complications in a timely manner.

Send a warning letter to Mediclinic City Hospital in Dubai for the failure in their system of not having a replacement cardiac surgeon available whilst Dr Uwe Klima was in the operating theatre.

The family of Mohammad Imran Hussain have appealed the decision made by the regulatory body and are awaiting an answer.

We visited the patient who is currently still at Mediclinic City Hospital and met his brother, Amjad Hussain, who said:

“We cannot accept partial acceptance of the blame. We want the hospital and surgeon to take full responsibility for what has happened to my brother and we will continue to fight for justice. Mohammad Imran’s four children have been severely affected, both mentally, and physically by this tragic incident and are now unable to go to school. We also want the hospital to review and change its internal procedures so that a failure like this never happens again, to anyone.”

Arun, the spokesperson for Mediclinic City Hospital also confirmed to our reporter that the decision to issue the hospital with a warning letter was officially appealed.

According to the hospital management, there was, in fact, more than one surgeon available on duty at the time of the events, for which they have submitted proof to the Dubai Healthcare City Authority – Regulatory (DHCR). The spokesman also confirmed that Dr Uwe Klima is an external visiting doctor who is not directly employed by Mediclinic City Hospital.

Dr Uwe Klima has previously had his license suspended in Singapore by the ‘Singapore Medical Council’ and was found guilty on two counts of professional misconduct. The committee suspended him for six months for administering undiluted cardioplegia into a patient and further three months for delegating another doctor to carry out a follow-up emergency operation on the child when his condition deteriorated.

Heart surgery was performed on a two-year-old child in December 2007. During this operation, the surgeon assumed that the syringe handed to him by a nurse contained diluted “cardioplegia”.

Cardioplegia, a medication that slows down the heart so that operations can be carried out safely, can only be used after it is diluted; the undiluted form of this drug is potentially fatal.

The boy, now 10, suffered developmental disabilities as a result.

His suspension was later lifted in 2015 and the initial verdict of the disciplinary committee was overruled by high court judges in Singapore, who came to the conclusion that, although Dr Klima did make a mistake, the responsibility does not lie with him entirely. The question the judges asked themselves was whether Dr Uwe Klima was guilty of professional misconduct for these consequences – which the court found he was not.

Dr Klima himself was not immediately available to comment.

The case continues as all involved parties await DHCR’s responses to their appeals.

Source: http://independent.ae/3685/dubai-based-heart-surgeon-suspended-for-mismanagement/