Ex-I.C.U. director says hospital mortality rising

The former Director of the Intensive Care Unit (I.C.U.) at the national hospital says mortality rates have risen since it changed its approach to intensive care medicine. 

In previously unreported remarks, the former Head of the Intensive Care (I.C.U.) at Moto'otua Hospital, Maapupula Dina Tuitama, revealed that mortality rates at the hospital have been increasing since she resigned from the hospital in April, when the hospital reverted to treating intensive care patients in an open (generalist) setting.  

Before she became its director, Maapupula was among a team to establish the hospital’s first closed (specialist) I.C.U. unit in 2015, catering for babies to geriatric patients with a team of six medical professionals.

Prior to its establishment, an audit in 2012 found a mortality rate of 82 per cent among ventilated patients in the I.C.U. (a study a year prior put mortality rates at 56 per cent), she said at the World Congress of Intensive Care 2019 Congress in Melbourne last month. 

In its first year of establishment of the I.C.U., the hospital recorded a dramatic decrease in I.C.U. mortality rates to 19.7 per cent, Maapupula said.

The six-bed unit handled a variety of cases focusing on patients with severe and acute reversible diseases.

Maapupula resigned from the hospital in April this year, at which time the I.C.U. had been reverted back to treatment in an open setting. 

Maapupula said after the abandonment of the specialist I.C.U. model, mortality rates at the hospital dramatically rose once again. 

"It comes as no surprise that the immediate rise in mortality rates over the following three months," she said.

In May, she claimed, the I.C.U.'s mortality rate rose to 33 percent, dropped to 31 per cent in June and then rose again to 47 per cent in July.

During her presentation she told of the challenges they faced in the unit.

"Working in isolation it is very easy to become complacent, with no one keeping you accountable or justify and explain your decisions to," she said.

"Perhaps the biggest challenge to me was the human resource constraint, having limited man power and a system that didn’t offer much support for intensive care services development.

"As a head of unit, you fought for equipment, you fought for staff, you for medications that were lifesaving but management couldn’t see."

"So for health reasons and for my own sanity from an unsustainable and unsupportive workforce, I left the service." 

She praised Dr. David Galler for leading the creation of the I.C.U. team 

"Samoa does not know what you have done for it, but you and all the other wonder intensivists we’ve come to know, thank you for all your hard work in developing I.C.U. in Samoa," she said. 

Maapupula said a sense of guilt had been eating at her since her resignation from the hospital seven months ago as she wondered what she could have done better. 

She questioned if there was even a point in setting up an I.C.U. in the first place, until she remembered all the patients they healed.

"[The] I.C.U. did not fall apart because of something we did wrong or what did not do it right, it happened because of factors that were beyond our control, beyond what we could affect and one day Samoa will realise its potential to do more than what we’ve limited ourselves to," said Ma'apupula.

The Assistant C.E.O. of the Ministry of Health did not immediately respond to a telephone call and text message seeking comment. Written questions to the Ministry of Health did not respond to written questions on Friday. 

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