Mishka’s death: A tragic consequence of multiple instances of negligence

The case review of the death of Maldives’ youngest COVID-19 victim shows multiple instances where established protocols were disregarded.

Health Ministry released the findings of its review into the death of Fathimath Mishka Mohamed, 10, Laajahaage, HDh. Kulhudhuffushi, on Friday night.

Health Ministry reviewed the response of Health Emergency Operations Center (HEOC)’s clusters – the Call Center, Medical Response Team (DMRT), Clinical Management and Advisory Team (CMAT), and Emergency Medical Services (EMS), and adherence to set protocols.

The timeline starts from when Mishka was tested after she began exhibiting COVID-19 symptoms.

DOCTOR’S CONSULT WASN’T PROVIDED, NO CALL TO CHECK CONDITION

Mishka was tested after she began exhibiting symptoms consistent with COVID-19 on May 28. The parents were informed she tested positive for COVID-19 on May 30.

The findings show Mishka’s parent was asked if they wished for a doctor’s consultation in accordance with procedure, and that the parent asked for a consultation. Though the parent’s wish for a consultation was noted on the sheet, no consultation was provided.

The standard protocol requires for all information on the sheet to be computed into the Outbreak (OB) system. However, the information wasn’t updated on the system.

The standard protocol also requires for the Care Cluster to call and check the condition of children under the age of 15 years. However, no call to check Mishka’s condition was made within the two days.

WHAT HAPPENED THAT NIGHT?

According to the findings of the review, Miskha’s parent contacted the Call Center at 14:20 hours to inform that Mishka had high-fever, wasn’t able to eat, was fatigued, and had a cough.

Based on the information, a doctor from DMRT called for a general consultation at 15:53 hours. The doctor advised that Mishka continue to be administered her current medication, and call again if there are any further complications.

Mishka’s parent contacted the Call Center again at 21:06 hours, after Mishka’s condition continues to worsen. The parent said Mishka was in respiratory distress, was thrashing her hands in discomfort, and needed to see a doctor as soon as possible.

According to the findings, a doctor from DMRT tried, but failed to contact the parent at 21:53 hours. Though unable to contact the parent, it was signed off on the sheet as “attended”.

Upon missing the doctor’s call, the parent called back the Call Center at 22:06 hours and informed them again that Mishka was in respiratory distress.

The information was immediately inputted into the system, and a doctor from DMRT called the parent at 22:33 hours. The parent told the doctor that Mishka was positive for COVID-19, that she had been having trouble breathing for a day, had been having a dry cough for two days, and had been having high fever for six days.

The parent also told the doctor that Mishka was a special needs child, and that though she had no underlying medical issues, she has trouble communicating all her condition.

The doctor forwarded the information to CMAT in accordance with protocol.

AMBULANCE SENT AFTER PEOPLE SENT TO HEOC HQ

“It has been noted that though the information was provided to the two clusters assigned to activate ambulance – DMRT and CMAT, neither instructed for an ambulance to be sent,” reads the report.

The findings show Mishka’s parent called the Call Center five times between 23:16 hours and 23:33 hours. In one call, the parent said Mishka’s condition was deteriorating, that she had fainted, and that she was bleeding from her nose and mouth.

The parent also said that the ambulance hadn’t come as promised.

“And though the Call Center said an ambulance had been sent, an ambulance want activated,” reads the report.

Following the delay in the arrival of an ambulance, the parent sent someone to the HEOC headquarters in Dharubaaruge. HEOC’s Facility Management Cluster informed EMS of the need for an ambulance after that, at 23:32 hours. And EMS called the parent at 23:33 hours, and informed that an ambulance had been sent.

An ambulance arrived five minutes later, at 23:38 hours. However, Mishka was unresponsive by the time the ambulance arrived. According to the findings, Mishka was immediately given CPR, and the ambulance arrived at Indhira Gandhi Memorial Hospital’s ER at 23:42 hours.

She was declared dead at 00:10 hours.

CASE WASN’T TREATED AS AN EMERGENCY

According to the findings, the situation wasn’t considered as an emergency, and emergency healthcare protocols weren’t activated.

Furthermore, the ambulance wasn’t triaged in the appropriate time, and two hours and 26 minutes passed before an ambulance was activated after Mishka’s condition was reported as an emergency.

The review uncovered that though it had been an emergency situation, and though both DMRT and CMAT had been informed of the fact, an ambulance wasn’t dispatched as was required under standard protocol.

The review also uncovered that based on the call log, the Call Center failed to asses the seriousness of Mishka’s condition and the need for immediate medical intervention.

The report states that once EMS was informed of the case, an ambulance was immediately dispatched and Mishka was taken to the hospital within 10 minutes.

Health Ministry has provided assurance they will take necessary action in response to the findings of the review.