AmbergrisCaye.com Home Forums Belize Life News KHMH: A Dozen Dead Babies

Families Wrestle with Grief, Rage

And that's what created the conditions for a devastating and rapid loss of a dozen newborns. And while the KHMH investigates what went wrong, the families are getting ready for funerals or trying to recover from them. We spoke to two grieving parents today.

Jules Vasquez reporting
Harrison Sutherland - Father of 8 day old baby died at KHMH
"I'm just sad for my baby, really sad because so much babies have died just like that, it's sad."

Harrison Sutherland and Kelcey Young are an 18 year old couple. Their baby Imari was born premature at 7 months on Mother's day but died 8 days later.

Harrison Sutherland
"Well in a way I'm angry yes because I blame the hospital for it."

This 16 year old mother feels the same:

Voice Of: 16 year old Mother Of Deceased Premature Newborn
"They killed my baby that I have to say that they killed my baby."

Her baby boy, Jordan was the last to die on the 20th, when he was just 15 days old.

Voice Of: 16 year old Mother Of Deceased Premature Newborn
"The first time the baby came in the Intensive Care the doctor told me that the only reason that the baby is in there is because he was premature and his lungs needed to develop and they would keep him in there for the full nine months. Now they called us two days after and they called in the morning again and told us the baby turned blue. My mom, sister and I came in and when I saw the baby all his face was purple and his feet were blue and everything was blue. The last time I could have seen my baby alive the doctor told me that my baby was getting better and the only thing happened was that the medicine was fighting the bacteria inside. When I reached home they called me and told me the baby passed away. My baby was going to live because he was one pound 8 ounces when he was born and within two weeks my baby gained 3lb and 14 ounces and he was only on feed, he wasn't on any antibiotic. Within this week they started telling me about my baby that it turned out that he had sepsis, I don't know what sepsis is because that is what they are telling all the parents that they have a bad infection."

Now they have nothing nice to say about the hospital.

Voice Of: 16 year old Mother Of Deceased Premature Newborn
"And the nurses that are in there are careless, I mean so careless. When I come in sometimes after 6 and I come in to check on my baby, they have some of them on their cell phones, computer and gossiping and talking about each other."

For this father, he knew the end was near:

Harrison Sutherland
"I think I blame I will blame the hospital - the ICU because they knew the ICU had an infection so they should have moved the baby from a long time ago but they waited until all the babies died then they took out the last three everytime I go there they tell me that another baby has died. That really is puzzling to hear that because I think this place should be better than that because it's all the young babies, they should have had that place well secure - wash their hands properly but sometimes I even see people from the morgue go into the ICU with there regular clothes. They would go into the ICU to take gowns, that isn't right."

Voice Of: 16 year old Mother Of Deceased Premature Newborn
"From the first baby died they should have checked the place and tell the parents what was happening. The nurses and the doctors didn't even come to tell us that the place was infected we had to hear it from other parents - they didn't tell us anything."

That lack of urgency in addressing the problem also sticks in the throat of the Chairman of the KHMH Board who learned about the deaths yesterday. She called in the KREM's WUB this morning:

PHONE INTERVIEW with KREM
Evan 'Mose' Hyde
"This was something that should have sent off an alarm bells before it reached a death count of 12."

Chandra Cansino - CHAIRMAN KHMH Board of Directors
"Unfortunately Mose - yes. Those are the answers we are trying to seek. Why was this information not forth coming before we reached this number? The answer to your question is yes; I am trying to compose yourself. Yes I am very disturbed of the fact that we only found out about this yesterday."

And while the administration looks for answers, the lives of these young parents have been shattered:

Voice Of: 16 year old Mother Of Deceased Premature Newborn
"I had big dreams that I wanted to acheieve with my baby and they just came and shattered it."

Harrison Sutherland
"Everyday I get up and I try to do something but it just hurts me because I have to remember it. It's my first baby and we had to bury the baby, it hurts - I cried."

PHONE INTERVIEW with KREM
Chandra Cansino
"I just wanted the general public to know that the board is just as mortified by the numbers as the general public is. There's nothing I can say that can change the reality for the moms and the families of these babies but we just want the general public to know that we are addressing the problem as an emergency."

Harrison Sutherland
"We just want to talk about it and something to come out of it, we want all the parents to come together and talk about it and have something come out of it because it isn't right for babies to just die and nothing comes out of it."

There are no pictures of Baby Imari because on Monday, someone broke into their relatives' Belize City home off Faber's Road and stole the IPAD, with the only pictures of the child.

But, back to the KHMH. First, a team has been doing a rapid investigation all of today. The findings of that - however preliminary - will be presented to the KHMH Board at an emergency meeting tomorrow. The critical determination will be whether it was a failure of reporting, or a failure to respond appropriately.

The Ministry of Health has sent in the Director of Maternal and Child Health, the National Epidemiologist and an Infection Control Expert. Additionally, PAHO, the Pan American Health Organization has offered technical support.

The Opposition PUP also issued a statement today calling for the quote, "immediate resignation of the Minister of Health and of the Board of Directors of the hospital."

The release adds that quote, "The fact that any bacterial or other infection could have been allowed to take so many lives before any response was made, demonstrates that there must have been gross negligence by the hospital authorities."

Channel 7

Enterobacter cloacae killed 7 of 12 infants at K.H.M.H.

The biggest scandal to hit the Karl Heusner Memorial Hospital is unraveling. Words cannot describe how the collective conscience of parents, particularly mothers, received the news that twelve newborns died in less than one week at the Karl Heusner Memorial Hospital. Alarm bells were sounded last Friday by grieving parent who spoke to News Five about the death of his innocent twenty-seven day old baby. Two other parents gave gripping testimony on Monday of the deaths of their premature babies�and even more reports are coming from other parents with similar experiences. On Monday, the K.H.M.H. reported that twelve babies had died in the first twenty days of May. The killer of seven of these infants is called enterobacter cloacae. After a meeting with three of the mothers who lost their babies to the bacteria, the Chair of the K.H.M.H. Board of Governors, Chandra Cansino, joined by the hospital's C.E.O., Francis Gary Longsworth, and Director of Medical Services, Adrian Coye for a media briefing. Would the bacteria wreak havoc in the other units of the hospitals were amongst the first questions asked of Doctor Coye.

Dr. Adrian Coye, Director of Medical Services, K.H.M.H.

Adrian Coye

"We have seen an outbreak of a particular organism, enterobacter cloacae and this organism is not only selecting our Belizean babies, but it is an organism that is responsible for major outbreaks in NICU's all over the world. In that light, this is part of why we see that even PAHO Washington is sending us assistance; to see and help us analyze the outbreak that we have because it is matching a global trend. We had initially released there were twelve deaths this month which is unusual because the month is not yet done. And twelve deaths that happened were the majority were happening precipitously in the last week. And so this form of outbreak raised alarm bells; adjustments were being made clinically and within the unit, some procedural changes. But in spite of that, we had the high number of tragic loss as alarming as it is and as unfortunate for all because it is very sad for us to see and witness that amount of loss. However of the twelve deaths, only seven have been shown in our analysis to be positive for this organism out of the twelve. So in fact, the initial impression was that all of them had this organism but in fact only seven of them. And so the other deaths happened as a result of prematurity-related issues and not related to this infection. This is not a superbug. The profile of the resistance pattern within the organism we have found is sensitive to antibiotics that we do have in the hospital and made available through the Ministry of Health. So it is not a superbug. But the problem with this type of organism is it's very fastidious, difficult to clear and there is transmission by direct contact and also by indirect contact. So it can be on the skin of any of us right now in this room, on your clothing material, on stethoscopes, on IV drip stands, the surfaces in the clinical area, etc. And that is again to show you how ubiquitous; all over the place the bugs can be a source. We are implementing an aggressive approach to determining if there is actually an environmental source. So we've actually brought in a specialist for the purpose of studying all aspects of our ventilation and all other areas within the unit that can be a source for continued colonization because that is exactly what this organism behaves as-it is an opportunistic infection."

Neonatal Unit closed for a month while upgrades being installed

Doctor Coye said that the bug could have come from another section of the hospital or from an incoming patient. There were questions regarding whether or not air condition problems in clinics one through four were a part of the problem, but he said it was not. Inside the special care nursery, terminal cleanings were carried out three weeks ago. Now, the K.H.M.H. has specialized areas that are Hepa-filtered, a specialized air filtering system and the water is tested every month for bacteria. So there are factors in place to keep the hospital sterile. But that didn't help within the Neonatal Intensive Care Unit. The hospital says it has to carry out specific procedures to find out what is causing the deaths and that includes lab tests. The question was also asked if someone had flagged that the twelve infants had died in twenty days?

Dr. Adrian Coye, Director of Medical Services, K.H.M.H.

"It can be anywhere, but the susceptible population is the premature babies who are in the intensive care unit as they are. Whether it was brought from other parts of the hospital, I cannot say, but I know from an epidemiological point of view, when you look for an outbreak, you try to identify an index case. An index case was identified in February; the first infection of this nature. However, that baby was treated and went home. It could be then from that original infection, colonization had happened and that's how when you talk about how things could spread and so that may be one source. But like you rightly suggest, there may be an environmental aspect to it. This number of twelve is unusually high for us. We are more used to seeing rates of five or six neonatal deaths per month. So this rate of twelve and as we've explained, it was in a very short period of time that it went above what we recognized as a baseline because we receive babies from everywhere in this country-all the way down south, P.G. and from private hospitals as well that have operated on them and send them here for ventilation and those babies go home alive. But other babies have come to us very septic and in a position where we cannot recover them."

Jose Sanchez

Adrian Coye

"When the infant dies of sepsis, is it normal procedure then to have that body tested for a particular bacteria?"

Dr. Adrian Coye

"Well that is a very good question because you don't want to diagnosing when they have died; you want to be able to know. And so from when the baby is not well, we will be sending samples. However, if that opportunity didn't happen for whatever reason and sepsis is something that we have been very sensitized to. In CMEs we have done here, Dr. Grinage has presented a global picture on continuous medical education. And so we have been talking about pediatric sepsis and all of these things already. It is not that there is not the awareness but yes, for some babies that died from sepsis, we don't know why they die, we take samples to confirm and that is how we confirmed some of the cases as having this same organism. Adjustments were being made when recognition that some septic events were happening. We do have a log when we were able to confirm. And the log is confirmed positive cultures because we rely on the central pathology services by sending specimens there for them to incubate it over two three days, analyze it and then do testing of the bug or the organism that they grow to see what antibiotics they are sensitive too. And so that is a process. But then what do you do in the meantime? You adjust."

Chandra Nisbet-Cansino

Chandra Nisbet-Cansino, Chairlady, Board of Governors, K.H.M.H.

"The definitive information that we got today were the epidemiological reports and the reports from the infection control. We still have a lot of information that we are gathering regarding that specific question that Jose and Miss Amaya are asking. What was the process of communication? That is important to us. We do not have that answer today, but we are definitely working on getting hat answer because we know that that is one of the biggest questions that the public has. And we feel an obligation to answer the public on that question."

K.H.M.H. Board wants answers as to why alarm not sounded quickly

Francis Gary Longsworth

Today, the Board of Governors held an emergency session to find out what happened. And the initial results were shared with the media. But there is still the question of safety and when the NICU will be reopened. According to K.H.M.H. C.E.O., Francis Gary Longsworth that may take some weeks while improvements are being made. But the Board Chairlady says there are other reports that the board is awaiting to see if anyone is to be held culpable for not sounding the alarm.

Francis Gary Longsworth, C.E.O., K.H.M.H.

"Well we want to do some major reorganization and renovations to it. And one of the goals is to expand the clinical area in the NICU immediately�if we can. We anticipate a period of about within a month, hopefully less than that; a matter of two weeks would be appropriate for that to happen. Generally we see between four hundred and fifty to five hundred and fifty patients per year in the NICU. Our annual mortality rate for that unit vary between five percent to fifteen percent with the median being around ten percent. So that's what we are looking at in terms of survival. We are looking at between eighty-five to ninety-five percent survival rates."

Chandra Nisbet-Cansino

Chandra Nisbet-Cansino, Chairlady, Board of Governors, K.H.M.H.

"This press conference is basically to update to you on the epidemiological findings, the preliminary findings that they did yesterday and they presented to us this morning. We still have a process ongoing and we need to get reports from the pediatricians from the ward, from the nurses, from the head of that department to determine if there were any weaknesses in raising alarms and raising flags. We are still in the process of gathering that information and as soon as we have that information available then we will be passing it on. But that information has not been finalized yet. My first instinct was to come here and find the person that is to blame and deal with that person. There are so many more technical issues to that. We got an explanation of the system of the culture; the blood cultures take a week. That is not something that is a deficiency of the lab. A blood culture takes five days to grow and there is no way around that and there is no other way of determining the sensitivity of an organism except by doing a blood culture. And while you are waiting five days for a blood culture result, babies were passing away. And that little cluster of time is where we lost some of the babies without knowing that it was because of this particular bacteria."

Doctor speaks about infection at K.H.M.H.

Marco Tulio Mendez

As parents grieve the painful deaths of their loved ones, the public is outraged that the growing number of deaths could have gone unnoticed at the national referral hospital. This afternoon, COLA issued a very strong statement on the neonatal deaths, while the office of the Special Envoy, Kim Simplis Barrow said that it will be spearheading the construction of a suitable Paediatric and Neonatal Intensive Unit at the K.H.M.H.� But the lingering question is who should be held responsible for the death of the babies? This afternoon, Pediatrician Doctor Marco-Tulio Mendez who has been flagging hospital malpractices up north called out the Minister of Health, Pablo Marin, asking for his resignation.

Via Phone: Dr. Marco Tulio Mendez, Pediatrician

"I'm pretty sure that the ministry of health knew about it and if they knew about it, they are the ones that are supposed to be held accountable; they are the ones that supposed to be guiding and establishing and implementing the guidelines for the hospital. I mean the Karl Heusner Hospital is our referral hospital, it is the flagship of our entire health system and it should be well protected and all the measures to decrease this type of nosocomial infections supposed to be done. Now, there is something that is very important is that this problem is a complex problem. It is not solely at the hospital level.� It is a very repulsive situation that has occurred and the Minister of Health�to me the Minister of Health needs to resign. Not only this problem we have been facing, but also the problem up here in the north; at the northern regional hospital. They said that they would do an investigation. Up to now we don't know what went on. They didn't went in depth of the problem that our pregnant mothers and women went through just about six month ago. I am pretty sure that I do not know if this investigation will help."

Dr. Mendez also says that the number of premature babies has increased in the past four years.

Channel 5

KHMH Isolates Bacteria Bug That Caused Baby's Deaths

Dr. F. Gary Longsworth - CEO, KHMH
"Over a very short period of time beginning last week we had a cluster of deaths in our Neonatal Intensive Care Unit and it went out to the media. One of the parents went to the media, I believe, that actually prompted the investigation because up to that point we were not aware that the situation was developing."

Dr. Adrian Coye - Medical Chief Of Staff, KHMH
"We have seen an outbreak of a particular organism it's called enterobacter cloacae and this organism is not only selecting our Belizean babies but it's an organism that is responsible for major outbreaks in ICU's all over the world. Now we issued a release that there were 12 deaths this month which was unusual because the month is not yet done and 12 deaths that happened where the majority were happening precipitously in the last week and so this form of outbreak does raise alarm bells, adjustments are being made clinically and within the unit, some procedural changes. In despite of that we had the high number of tragic loss. However of the twelve deaths only seven has been shown in our analysis to be positive for this organism. The other deaths happened as a result of prematurity related issues and not related to this infection. This is not a super bug - the profile of the resistance pattern within the organism that we have found is sensitive to antibiotics that we do have in the hospital and made available through the Ministry of Health so it is not a super bug. The problem with this kind of organism it it's very fastidious, difficult to care and there is transmission by direct contact and also indirect contact. This is an opportunistic infection that can be anywhere. The susceptible population is the premature and babies who are in the intensive care unit as they are. Whether is was brought by different parts of the hospital, I cannot say but I know from an epidemiological point of view when you look for an outbreak you try to identify an index case and an index case was identified in February, the first infection of that nature - however that baby was treated and went home. It could be then that from that original infection, colonization had happened and that's how you talk about how things are spread that may be one source."

Dr. F. Gary Longsworth
"Generally we see between 450 to 550 patients per year in our NICU. Our annual mortality rate for that unit vary between 5% - 15% with the median being around 10%. That is what we're looking at in terms of survival rates. We're looking at between 85% to 95% survival rates."

Dr. Adrian Coye
"This number of 12 is unusually high for us. We are more used to seeing rates of 5 or 6 neonatal deaths per month. This rate of 12 and as we've explained it was in a very short period of time that it went above what we recognize as a baseline."

Jules Vasquez
"Is it a failure in reporting and responding in your opinion?"

Dr. F. Gary Longsworth
"I wouldn't refer to it as a failure. As Dr. Coye tried to explain earlier what the time log that is unavoidable between culturing a baby that is getting sick and receiving the report is out of the control of the physicians managing the case."

Chandra Nisbet Cansino - Chairman, KHMH Board Of Governors
"Because my first instinct was to come here and to find the person that was to blame and deal with that person - there are so many more technical issues to that, we got an explanation to the system of the blood culture that takes a week. That is not something that is a deficiency of the lab, a blood culture takes five days to grow and there's no way around that and there was no other way of determining the sensitivity of an organism except by doing a blood culture. While you're waiting five days for a blood culture - babies were passing away. That little cluster of time was where we lost some of the babies without knowing because it was because of this particular bacteria. The second purpose of our meetings is still to have a discussion with staff, we still have not gotten a lot of reports to determine if anybody is culpable, we have not established that at this time and that is a process that is still under investigation. The most important purpose for us being here today was for us to sit-down and have a discussion with some of the parents of the deceased children. Unfortunately they went to the media before coming to us - that is totally understandable, we have no problem with that but we needed to hear from them about their experiences. They shared a lot of information with us - they had suggestions and recommendations for us. We haven't met all of them and we're hoping to meet with all of them but that was basically the most important part of the day for me because we really needed to hear from them."

Reporter
"Accusations being made that there were two deaths in two days would have caused that the NICU be closed."

Chandra Nisbet Cansino
"What was the process of communication? That is important to us - we do not have that answer today but we are definitely working on that answer because we kow that one of the biggest questions the public has and we have an obligation to answer on that."

Reporter
"At this point is the infection under control?"

Chandra Nisbet Cansino
"Yes"

Dr. Adrian Coye
"The answer is yes but there is always a risk. As I said we are always under threat and in this particular case we believe we have it under control. We are making plans and changes that allow us to safely take care of our Belizean babies in the near future."

It is important to note that while the media has been alerted about newborn deaths from infection dating back to December of last year, the administration says those were likely unrelated. The pediatric intensive care unit was built 16 years ago and has a capacity for ten newborns; in May, as in many months prior, it was operating well above that capacity.

A release from the office of the Special Envoy for Women and Children stresses that it is spearheading the construction of a Pediatric and Neonatal Intensive Unit - which will be in a new wing at the KHMH.

Channel 7

Former KHMH CEO Criticizes Successor

Dr. Alvaro Rosado - Former CEO, KHMH
"Well first of all I must state that the media had approached me before asking me for comments and I had refused because I said it was unfair to the administration for me to comment before they did their investigation. Now that the investigation has started although with all fairness to the Chairlady she said that it would continue. I get the impression that this is the beginning of the end and that this is almost the begin of the end of the investigation and it bothers me because I don't think that the answers and the information that was given was really information that is pertinent. I think the first thing that needs to be answered is - How did the bug get into that Neonatal unit? NICU is supposed to be most secure, sterile area of the hospital. It's cleaned twice a day, should be cleaned, swabbed, they take cultures regularly so how did that germ/bug get into the hospital. It can be traced there is no big secret about how these things happen. The second and the most disturbing to me is to hear the CEO and the Chairlady say that they were not aware of the situation until they heard it on the media. It's unbelievable that you have the bosses at a hospital not aware of what is happening in there for three weeks.

In 2004, specifically, the Neonatal Intensive Care Unit was the pride and joy of KHMH - that was our show case, when anybody came from abroad that's where we went. In the region it was considered the best Neonatal Intensive Care Unit, people marveled at how the doctors and nurses there were able to keep 90% of Neonates alive - that's a very high percentage. It's not a question iof is there the medical knowledge or expertise - it's not a question if there is a nursing expertise, the nursing staff and medical staff of KHMH are the highest trained medical personnel in this country. There's no shortage of medical knowledge and expertise - there was a breakdown somewhere and I think what needs to be done is for an investigation to be carried out to find out how it happened and why it happened so it doesn't happen again."

Rosado says that the hospital should not focus on who is to blame, but on what went wrong because the Neonatal Intensive Care Unit will need to be reactivated. He also believes that energy expended on damage control due to the legal issues which may arise is wasted at this critical time.

We should note that the babies who were in the unit when it was shut down have been relocated to what is described as a safe place within the hospital.

Channel 7

Help coming for Belize hospital where 12 babies died

Prime Minister Dean Barrow says the government will assist in sending neonatal cases to private hospitals following the death of 12 babies at the Karl Heusner Memorial Hospital (KHMH) that had been linked to the outbreak of enterobacter cloacae - an organism that is said to be responsible for major outbreaks in Neonatal Intensive Care Units (NICU) all over the world.

In a statement after he was briefed on the situation at the KHMH, Prime Minister Barrow has "agreed to assist with any interim arrangements needed to outsource urgent neonatal cases to private hospitals while the KHMH unit is being made completely safe by re-modelling".

Director of Medical Services at the hospital, Dr Adrian Coye, said that the enterobacter cloacae organism is not a superbug.

"The problem lies in the fact that it is very fastidious, difficult to clear and there is transmission by direct contact and also by indirect contact. So it can be on the skin of any of us right now in this room, on your clothing material, on stethoscopes, on IV drip stands, the surfaces in the clinical area, etc," he said.

"The profile of the resistance pattern within the organism we have found is sensitive to antibiotics that we do have in the hospital and made available through the Ministry of Health."

He said due to the nature of the outbreak, help will be coming from the Washington-based Pan American Health Organisation (PAHO).

In the aftermath of the deaths, the hospital's NICU has been closed and an independent contractor has ordered an assessment of the air quality in the unit. This will be followed by the removal and disinfection of all equipment and terminal cleaning of the entire unit.

The Ministry of Health said it is making all of its resources available to the KHMH to investigate and deal promptly with "this alarming situation" at the country's only referral hospital.

A news conference will be held on May 30 to disclose the preliminary findings of the investigation.

Source

A Plea From the Medical Chief Of Staff

Dr. Adrian Coye - Medical Chief of Staff, KHMH
"It is easy to see the wrong, it is easy to say, well 'they don't have this, they don't have that' and I am challenging you as a country to see the other side. If they don't have this, where can I fit in? How can I fix that? We see that this is a small unit; we're asked to do so much, four hundred and fifty, five hundred babies a year with a capacity that should be for ten babies, but we do twenty sometimes and I see and have seen miracles, I've seen excellent work and when all those successes are happening, no one says anything. But I just want to say, in defense, of all those I see work without praise, that I am proud to be working in such a great group."

And in a question that got mis-inserted into an earlier story, some of the families who've lost babies want to know if they'll be compensated - since at least seven lives were lost due to bacterial infections. The Chairman of the board made no commitment on compensation.

Reporter
"Aside from the apology to the families, are you in a position to offer them anything else?"

Chandra Nisbet-Cansino - Chairman, KHMH
"I'm not sure exactly what compensation, because it was basically a brief admission and discharge and the only thing that they would probably be given would be a hospital bill."

Channel 7

KHMH: Who's Responsible?

Jules Vasquez
"What you said at the Press Conference was that it was really a failure of management protocols, a failure of reporting protocols so am I to determine then that no one is to blame? No human is to blame? No one is accountable?"

Chandra Nisbet Cansino - Chairman, KHMH
"If you are asking specifically about the deaths of the newborns - at this time we cannot hold any one person accountable. We have had detailed discussions with the head of the Pediatric Unit and there response was really timely, they did what they were suppose to do and when they were supposed to do it. I think as Dr. Coye explained, he was aware of what was going on - unfortunately the CEO was not. We would have liked that the CEO knew about these events as they were unfolding and so we as a board plan to have a conversation with him probably to strengthen that area because as a board as well if there is a crisis in the hospital, we also feel that we should know. We definitely will have that conversation but our first concern was to ensure that the situation was handled correctly and that there was no negligence on the part of the medical professionals."

Jules Vasquez
"But just from a visceral prospective, when you hear the stabbing statistics of 12 deaths in 21 days even if they are premature and are high risk patients. As the Prime Minister likes to say 'heads have to roll'. You mean out of all of this nobody's 'head will roll'?"

Chandra Nisbet Cansino
"I'm not saying nobody's 'head will roll' but nobody's head is rolling at this time, today - so far."

That interview was conducted after the press conference which detailed the sequence of the deaths and the medical response. As the Medical Chief of staff explained, the tragedy started unfolding on May 10th: The explanation is a little lengthy, but it's important, so bear with us.

Dr. Adrian Coye - Medical Chief of Staff, KHMH
"The clinical course essentially happened where around the tenth of May it was recognized that a baby became unwell and this baby was screened and cultures did not show any positivity for any organism and the baby died as a result of sepsis, as presumed sepsis - thought no cultures were grown. It was recognized by the clinical team that babies were becoming septic and becoming unwell very quickly. So sepsis meaning that they stopped, they weren't feeding well, febrile, short of breath and it was recognized. All these babies that come to our unit were sick babies and they didn't just go into the unit for not being sick. The week before we had our first press conference, essentially was when more babies were becoming quite septic and dying. There was a lag in terms of us being able to identify an organism but on the ground, I was alerted that babies were becoming very septic. We went down to the unit with the head of Pediatrics and we looked at the area and talked about the cases with the head of infection control in our hospital as well and we analyzed the situation and we decided to do what we were doing in terms of adjusting the antibiotics, emphasizing the hand washing and making other measures in that area - including wearing gloves and other restrictions. Restrictions meaning moving out some of the equipment that we had in that area. Despite these measures they came the way that I described before and we made a continued antibiotic changes and the peak of it all happened on the weekend of last weekend when the majority of those babies who had the severe infection succumbed."

Reporter
"Even before the press conference was held - even before the first Press Released was sent out you had already agreed that babies were entering septic shock. Dr. Longsworth was not - he admitted in the last press conference that he learned about this by way of the media. What failed there? Shouldn't the hospital's CEO become aware that this was happening?"

Dr. Adrian Coye
"I'll start first. Yes I was aware and my pediatric team and the nursing staff, we were all aware that something unpleasant was happening and we made adjustments on clinical grounds. You may recognize something is happening but you have to make changes and also need supporting evidence so in the end we didn't have supporting evidence - it was a delay in some respects and we're able to say that it's that organism. I think Dr. Longsworth trusts me enough to make the kind of decisions on the ground at that time and I made the reporting as I could having dealt with this situation in the best way that all of us could have done in a team."

Reporter
"So the first death by Cloacae was on May 10th. In reading about it I have read that this bacteria is very deadly and recognizing that shouldn't have the NICU be closed then on May 10th?"

Dr. Adrian Coye
"If I closed the unit that has sick babies in a cluster that were most likely having the same problem - most likely."

Dr. Ricardo Bustamante - Infectologist, Ministry of Health Chile/PAHO
"Outbreaks are unfortunate events that happen not as maybe more often as we would like in any hospitals around the world. I come from Chile and in Chile we also have outbreaks. I think that the measures that were taken of the awareness of the authorities from the hospital and the Ministry of Health, from the country itself were done in a timely manner. Sometimes it isn't easy to identify an outbreak and here you had an outbreak that started in a very short span of time, we're talking about ten days where 6 or 7 newborns got infected and died. It's not always easy to be aware that this is an outbreak - most of the time it happens that doctors start treating them and giving them medications but none of them are aware that this would turn out to a certain common source of infection that they did. So I think that the approach that they did here was in a timely manner, unfortunately it created several deaths."

Chandra Nisbet Cansino
"That was our main concern as a board that the measures taken to address the situation was taken timely and with the interest of the patients first. Up to now we are convinced that that has been done and so far we don't have any reason to believe that anything was breached in the management of the cases that were with the present bacteria. We don't want to sit here and say that everything is fine - there are areas that can be strengthened, those have come out as the preliminary findings. There were issues that came up when we spoke to some of the mothers - perhaps the way they were spoken to in some of the wards, things nurses and doctors may have said or any other person may have said. We want the staff to know that we appreciate what they do but every single patient and family that walks into KHMH deserves the compassion and the respect and the courtesy and dignity that every human being deserves and we want to put them a notice that kind of behavior will not be tolerated; we need them to treat the people with the dignity that they deserve."

It was clipped out of the story, but after May 10th, no new babies were admitted to the Unit - as the medical staff tried to manage the cases that it had. For the time being, government is paying all costs to restore and re-fit the existing unit and the four newborns that were taken out of the unit are being cared for in a private room in the maternity ward. It will be another one to two months before the Pediatric Intensive care unit is re-opened. But, even then, it will only be temporary, as Government has committed to provide start-up funding for the new wings with a pediatric intensive care unit. The PM explained.

Dr. F. Gary Longsworth - CEO, KHMH
"This we anticipate will take approximately 18 months to two years to be fully completed. The new NICU - PICU will be fully completed and equipped and ready for occupancy for staff and patients."

Hon. Dean Barrow - Prime Minister of Belize
"What Government will now do is to find the first half a million dollars so that construction can commence immediately - I believe we have disbursed some of the money already Dr. Allen. That should see the project within the next few months while the promised donations are being unlocked and the entirety of the 3 million or so is gotten together to complete what will be the KHMH state of the art facilities for our babies and children."

As a closing detail, it is important to note that 13 deaths were recorded at the unit in May - and only 7 are being ruled as sepsis, or resulting from bacterial infection. The other six were due to prematurity and related conditions. On average, the unit records five deaths per month.

We'll have a little more from the press conference later on in the news as the Medical Chief of Staff makes a heartfelt plea for his hospital.

Channel 7

COLA Protests; The Little Ones Not Forgotten

Daniel Ortiz was out there, and he found out that, as with everything COLA, it was done in dramatic fashion. Here's his report.

Daniel Ortiz reporting
At the head of their procession, the supporters of COLA had a coffin, which could neatly fit one of 12 dead neonates who passed away inside Intensive Care Unit at the KHMH.

There weren't any actually bodies inside it, unless you counted them speaking as one body about the loss of confidence which they continuously hefted along. All through the streets, in a circumference around the hospital grounds, they gave a loud lamentation of their dissatisfaction, closely monitored by wary police officers.

But those officers weren't really threatened by this peaceful group, either physically or by numbers.

Geovanni Brackett - President, COLA
"COLA has staged this protest and demonstration to state three or four things on the record. 1 - we need an independent investigative team to audit this entire situation at the KHMH. This is not the first major incident we had; I think about 9 mothers who had issues up north, parents down south and so we need to put a health check. We need to do a reform of our health system and these grieving mothers and fathers need to get professional counseling and the government should pay for it. 2 - somebody must be held accountable, somebody needs to be held responsible for what happened."

Brackett also asserted that the importance of this issue should not be determined by a numbers game.

Geovanni Brackett
"Of course you would want to have more people but that's not an issue for us. To me the government doesn't need a protest to respond to the thirteen deaths of children who died in 20 days. If they don't respond adequately that just shows the kind of heart the government has. You would have to be a cold hearted person not to even have an impact just by the deaths of the children, much less you need a protest to have a heart? That should not be the case. So we do not need a protest for hearts to be touched, you just have to have the heart to see that 13 kids died and somebody not be held responsible. If nobody wants to hold responsibility then it tells you that not only do we have a breakdown in the health system, a breakdown in morality but a breakdown in this entire country."

These citizens believe that the any meaningful response from the hospital authorities and the Government is too late, but that the people deserve it anyway.

Geovanni Brackett
"I would hope they respond by tonight or by the next hour. If they don't it just shows that it's really what people think of the hospital."

You should remember Marissa Cruz; she is the mother who gave powerful testimony at the COLA press Conference on Tuesday describing the pain and grief she's been forced to go through. Finally, after days of suffering, she has a minor reason to smile.

Marissa Cruz - Lost Her Baby In ICU
"I'm really glad with Ms. Shakron, with the COLA and Mr. Menzies that are behind us here that are supporting us, giving us their full support. I really think it's necessary that they give us support because with oly us, the families, we might not be heard. But with their support it gives us more of a backbone to this whole issue. I think for me to be here today, it does not only make me feel proud of myself but of all the other families that are here because since everybody is here right now it makes me feel like they want to do something about this and bring justice not to only my baby but to everyone else's."

And there were Belizeans this morning who were offering a voice in support.

Keith Yearwood - Concerned Citizen
"I'm here to support the grieving mothers and at the same time I'm a father. At any given time my children could end up in the hospital and I would hope that this tragedy would not happen to one of them."

Daniel Ortiz
"Sir, do you have any confidence in the KHMH to provide care to anyone of your family?"

Keith Yearwood
"No, Sir."

Daniel Ortiz
"Why is that?"

Keith Yearwood
"Because they have unproved themselves too many times."

Phillip 'Fawda' Henry - Concerned Citizen
"I have life and I was one of them who was born out of a hospital in this country. As a citizen of this country, we must know what is going on in our health system. Health is one of the biggest role and issue in our nation and we all have a time when we choose people to govern our country. We have failure for the past 30 years with our health system and Belizean citizens need to learn to stand up when it pertains to health. There are so many things that happen within our health care system and nobody stands up and ask why it is happening."

Carlee Orosco - Concerned Parent
"My baby could have been one of them and I thank God that He saved my baby that's why I'm here to support them."

But how did we ever arrive here? A former minister of health says that it is due to a breakdown in Leadership that ministry.

Jose Coye - Former Minister of Health
"So I think what we see here is syntomatic of a leadership crisis in the Public sector, that is precisely what I think it is."

If you ask COLA, they don't need any accolades for organizing this protest. All they want is that the grieving families get some form of a release from the emotional toll.

Marissa Cruz
"I didn't have any courage, I was devastated that my child died. I didn't even want to speak to anyone about the issue, I just ignored the issue at thatpoint but now I feel good."

Steven Panton - Lost His Baby In The ICU
"What I think is that everybody is listening to the situation but not everyone understands or are trying to realize the situation because first of all basically most of my family members are taking it badly. My girlfriend is taking it the hardest, it is just to say, everyone knows if you have a girlfriend or a wife that has been pregnant before, everyone knows all the hardship and troubles especially if the person had been having a complicated pregnancy. There's a lot of things that you go through just before the time the kid is born and while your kid is in the womb, you have been having a relationship with that kid as well so just because my kid was seven days old doesn't mean that I didn't know or love my child because I had a relationship with my child before my kid came out of the womb. Everyone that has had a baby before could attest to that and everyone knows what we have to go through to even make the baby come to existence. So a matter like this is very serious and people are not understanding how serious this matter and the same people that are not understanding will be the same people that they will want to run over when something happens to them."

Channel 7

PAHO Reports On Neonatal Deaths; KHMH Has Much To Explain

4 weeks ago, 7News showed you the comments of Prime Minister Dean Barrow, as he responded to the protest held by COLA about the 12 neonates who died inside the Pediatric Intensive Care Unit.

One of the major public concerns was the perception that KHMH Administration was investigating itself, and so, the issue was that if the hospital was investigating itself, they could doctor the results to hide any major mistakes and forms of negligence.

PM Barrow allayed that fear somewhat when he announced that the Pan-American Health Organization (PAHO) would be the leading organization inquiring into the mass premature deaths.

Well, it's been about a month since that protest, and yesterday, KHMH finally announced that the full PAHO report is finally complete. They only just released today it on their website, but the date on the document suggests that it was available since last week Monday.

Our newsroom has only been able to peruse the 25 page document, but there are several findings which are of significant note.

The first is that KHMH has an oversight mechanism which is supposed to work to prevent the bacteria outbreak which ran amok in the Neonatal Intensive Care Unit. It is called the Infection Control Committee ICC, and this committee advises the hospital on its Infection Prevention and Control program, ICP. According to PAHO, the ICC as an advisory committee has not been working on a regular basis. The report does not define what "regular" is, and leave a lot of room for interpretation about the time gaps which the ICC is not active.

According to PAHO, the ICP is led by trained personnel, but it lacks direction and evaluation by the ICC, which is significant because, essentially, the report is saying that there is lack of assessment to see if the program is working.

The report adds that the hospital is equipped with a microbiology laboratory, which is able to carry out its functions; it is handicapped by a constrained and reduced space, supplies capacity, quality control measures, and training for the staff members.

Finally, the PAHO report says quote,

"Standard precautions for hospital infection control and prevention and National Infection Prevention Guidelines lack of monitoring and of a supportive environment." End Quote. Expanding on this finding, the PAHO investigators have discovered there is not enough hand washing sinks and hand hygiene solution. Additionally, the walls and ceiling tiles show signs of exposure to water leak, mold growth, rusty furniture, and porous surfaces in critical care areas. The report lists quite a number of recommendations for improvements, which we plan to explore with the KHMH Administration, who has scheduled a press conference for tomorrow to address the report.

Channel 7

KHMH Addresses the Damning PAHO Report
Last night, 7News told you about the now-ready report from the Pan-American Health Organization, which shows that there were a number of irregularities at the KHMH which could have contributed to the deaths of the 12 neonatal patients in May. And even if they don't, it shows that the hospital is not up to international standards in trying to insulate its patients from contamination as best as possible. Well this afternoon, the hospital's Administration and the Minister of Health hosted a press conference to address the concerns raised by the PAHO investigators. The media was there in full force, and the head table was grilled on this report. We'll get to that, but first� 2 members of the head table accused the media of twisting the facts to further their own sinister agenda. So for transparency, we'll start with start with a few parts of the report which KHMH CEO chose to address. The first was that the report points to the fact that hospital has an Infection Control Committee ICC, and this committee advises the hospital on its Infection Prevention and Control program, ICP. As we've reported, the PAHO investigators found that this program was not functioning as well as it should, or the bacterial outbreak which caused the death of the neonates would not have been as catastrophic.

KHMH Admin Answers To All Charges
And so, when the media got an opportunity, they zeroed several important aspects of the report which are damning. We looked first on the fact that it took a great tragedy for the hospital to get its act together. Here's how that conversation went: Daniel Ortiz "How do you respond to the criticism that all of these improvements have come too late, days have passed away and if you look at the deaths - it's 13, it's too late. These things should have been in place before, the hospital is suppose to give the utmost best care possible." Dr. Francis Gary Longsworth - CEO, KHMH "My response would be is that we've been dealing with these issues - I have been dealing with them from the first day I stepped into this hospital, we have made incremental changes in many areas. Perhaps the changes have not come fast enough but there are different reasons for that, some of them financial, some of them human resource issues but it is not that we have not been doing anything for all of these years." Reporter "It's intro venous the way the bacteria infected these neonates?" Dr. Peter Allen - CEO, Ministry of Health

KHMH Board To Discuss The PAHO Report
So if you've listened to the response from KHMH to this PAHO report, and you still have questions, we did too. So we asked the chairlady of the Board to comment on her impression as one of the bosses of the hospital who is now forced to answer to an upset public who believes that this is a major failure. Here's what she told us after seeing the report, and hearing the explanation from the CEO: Daniel Ortiz "Ms. Cansino as the chairlady of the board, after seeing the report and hearing the responses from the authority, the CEO of KHMH - are you pleased or satisfied with the responses they have given. In my opinion, the public deserves a little bit more of explanation, something else to encourage them that the KHMH is taking this matter seriously." Chandra Nisbet Cansino - Chairlady, KHMH Board "When I speak, I speak on behalf of a board - I don't act alone. We just received the report on Monday and we've had one meeting since then and of course the reports/findings are not the best findings that you would want from a report which is the one that PAHO did. The board is looking very seriously in the timeline of the recommendations and we will be looking to see that the recommendations are followed based on the timeline from PAHO because I think they categorized it as a one month then a three month deadline and we will be ensuring that those are adhered to.

KHMH Refuses To Accept Fault In The Face Of PAHO Report

He also looked at the very clear picture presented by the PAHO investigators about what caused the bacterial breakout, which claimed the lives of its neonatal patients:

Daniel Ortiz reporting
The PAHO Report also points to very little training in infection control. It says,

Page 9
"There is evidence that the hospital staff in its different areas has been trained in basic principles for infection control and prevention since 2008, at a beginning as a very short introduction with a few hours of information and currently as a two days course. This training has been given to personnel on duty and to the newly hired entrants. There is no assessment of knowledge acquired in this training."

And the PAHO investigators made significant observations about the Hospital's Microbiology laboratory. This important unit is like the eyes of the Hospital, keeping a look out on infection breakouts. The investigators seemed to suggest that the hospital is blind, or something very close to it.

They say,

Page 11
"The laboratory within the hospital does not have capability for culture and susceptibility microbiological tests, therefore the samples are processed in the Central Medical Lab (CML).

The CML has the capacity to use automated identification systems or commercial manual methods, but lacks the supplies to run those tests in a routine basis.

Due to the lack of supplies, since February, 2013 the lab has been using home-made manual methods for the identification of gram negative bacteria. Manual methods also limited the susceptibility reports to a few antibiotics. The manual methods for culture and sensitivity lacked quality control measures."

Well, the Ministry is taking steps to the upgrade the CML:

Hon. Pablo Marin - Minister of Health
"The government through my ministry is making available three hundred thousand for the renovation of the middle floor of the central medical laboratory. The government through the ministry and the UNDP is making available eighty thousand for renovation to the ground floor of the cetral medical laboratory."

The Minister didn't get into any details about what that upgrading process is, but the PAHO report notes that highly specialized equipment is needed for lab to do its work properly. But, the families of the dead neonates won't enjoy these upgrades, and they won't know exactly happened to cause the deaths because the lab technicians discarded the evidence.

According to Investigators:

Page 11
"The original specimens from the recent outbreak of E. cloacae were discarded due to the constrained space. Further testing and finger printing by pulse field gel electrophoresis that could have confirmed cross-transmission in the hospital environment could not be performed."

So, further testing that could have assisted them in finding out exactly what happened, cannot take place. The CEO says that it was not done for any sinister motive, or due to the staff trying to hide anything.

Dr. Francis Gary Longsworth - CEO, KHMH
"I do not think they were aware of that, that's the lab and the lab technicians that work in a particular area of the lab. The technicians at the lab were not aware that those particular samples were related to an outbreak. They just did their work and they followed their routine. It's not that somebody went in said 'bway throw away those samples', I don't think it happened like that at all and it is not that that the samples were not tested. The samples were subjected to testing at the lab. When the experts came in to investigate the outbreak they would have liked to have sent the samples abroad for much more advance testing which we do not have available in Belize. Gel field electroscopic is not available in Belize."

We'll have to take his word for it because he is the authority on such medical matters. But following along the report, the PAHO observers found a procedure by hospital staff which concerned them very greatly.

Page 12

The report says:
"It is a regular practice seen in pediatrics and neonatology to prepare intravenous medications left in syringes for up to 48 hours. These syringes are piled up in a small container and are to be used for several patients up until their expiry date, which is labeled in a tape surrounding each syringe. This practice was already seen in the assessment done in august 2011, and was observed as a high risk practice. The only change observed since the first report was in shortening the expiry date from 7 days to 48 hours. Being a high risk practice for patients (contamination) and for personnel (needle puncture) it should be eliminated."

When questioned about it, the CEO says that a change was made, just not the change which was initially recommended of discarding it completely.

Dr. Francis Gary Longsworth
"In the context of the report, a change was made from several days of storage to a maximum of 48 hours of storage - so we did comply."

But they didn't comply fully with what was suggested in 2011. The report shows clearly what the PAHO investigators think probably happened. They did so by explaining the nature of the bacteria E. cloacae, and the possible mode of transmission.

Page 14
"Since this bacterium was isolated in blood samples and its transmission is via the oral-fecal route, the most plausible explanation for this infection is through contamination of any device for intravenous puncture or intravenous medication used in these patients. Their prematurity implies management with intravenous therapies permanently since their admission. The regular practice of using multi-dose syringes shared for many patients and kept in use for at least 48 hours confers a high risk of contamination by any handler."

That seems to explain as best as possible what caused the outbreak, but the CEO wasn't convinced.

Dr. Francis Gary Longsworth

"We accept that the outbreak occurred, you know, but specifically we do not know the source of the outbreak and that is contained in the report"

And the only technical personality at the head table who was willing to deal with that concern directly was the CEO of the Ministry of Health.

Reporter
"It's intravenous the way these bacteria infected the neonates?"

Dr. Peter Allen - CEO Ministry of Health
" Yes, that is exactly what the PAHO report says and it says that the most likely route of the infection is from transmissions through introvenal therapies."

Reporter
"So would you accept that it occurred in the Neonatal Intensive Care Unit."

Dr. Peter Allen
"Well I would accept exactly what the report suggests that, that is the most likely route of the infection."

The Ministry of Health and the KHMH Authority has pledged to activate all the improvements which have been recommended by the PAHO investigating team.

Channel 7