An independent inquiry into the Shellesha Woodstock case has found that errors by Health Services Authority staff led to the 19-year-old giving birth on a Cayman Airways flight 2 October.
At a press conference Tuesday Health Minister Anthony Eden vowed the hospital would learn from the mistakes made. He offered a personal apology to Ms Woodstock, adding that he had met with her boyfriend, Laflin Clarke, Tuesday morning to inform him of the outcome of the investigation.
Reading the findings of the clinical audit, co-author Dr. Santosh Kulkarni, a senior lecturer with the University of the West Indies in Jamaica, said it was an error of clinical judgment to allow Ms Woodstock to fly.
The audit found that inattention to Ms Woodstock by hospital staff meant that she was most likely in active labour when she left the hospital on 2 October to fly to Jamaica.
But health insurance did not play a direct role in the decision to send Ms Woodstock to Jamaica because staff at the hospital never checked whether her insurance policy was valid.
The audit found that Ms Woodstock was advised at the hospital that the baby’s best chance of surviving would be for her to deliver in Jamaica because respiratory support there is better and there would be a high cost delivering in the Cayman Islands, given her insurance benefit would not have been adequate.
Ms Woodstcok accepted this advice, he said, but gave birth en-route to Jamaica just one hour and 40 minutes after being discharged from the hospital.
Despite telling Ms Woodstock that respiratory facilities in Jamaica were better, the report found that the hospital did have the available resources to care for Ms Woodstock and her baby and has done so in the past with a good survival rate.
‘Staff concentrated on the financial aspects when counselling the patient and relatives rather than on the clinical consequences of the obstetrical condition that was presented before them,’ Mr. Kulkarni told the press conference.
‘There was not enough emphasis placed on the likelihood of her going into spontaneous preterm labour. As a consequence all the available help and safeguards were not in place for her to travel or to rectify her financial distress as the emphasis was on getting her transferred.
‘Indeed, she was not given a balanced view of the risks in order to make an informed choice as babies at the gestational age can be safely delivered at that hospital based on the available resources and have done so in the past with good survival rate.’
Mr. Kulkarni said the audit has recommended changes to the way similar case are handled in the future and has also issued a Corrective Action Report to prevent such a situation arising again.
He also called on the hospital to rethink its policy of transferring maternity cases to overseas facilities by collecting and analysing the outcome of previous cases that have been transferred.
Health Insurance Commission Superintendent Mervyn Conolly told the press conference a separate HIC investigation had found that Ms Woodstock’s employer had allowed her health insurance policy to lapse, but this was not directly relevant to the care she received because hospital staff never checked if her insurance policy was valid.
He said the HIC would now pursue legal action against the employer under the Health Insurance Law.
Mr. Eden told the press conference he had been saddened by what happened but said everyone would learn from the experience.
He also payed tribute to the contribution of Jamaicans hospitals and doctors to the Cayman Islands over the years.
Ms Woodstock’s story caused waves both here and in Jamaica when she gave birth aboard a Kingston, Jamaica. bound Cayman Airways flight on 2 October. The plane was forced to make an emergency landing in Montego Bay, where Ms Woodstock – only 29 and-a-half-weeks pregnant – was later admitted to Cornwall Regional Hospital.
Ms Woodstock told the Caymanian Compass 3 October that she went to the Cayman Islands Hospital early in the morning on 1 October after her water broke but a doctor and nurse at the hospital told her it would be too expensive for her to have her baby in Cayman.
‘When I got to the hospital, they told me they don’t want to take the baby, so what they going to do, they going to send me to Jamaica. What they tell me about it was that it was too expensive but I didn’t tell them anything about any money,’ she said at the time.
She was given a letter, signed by Obstetrician Dr. Gilbertha Alexander, stating she was fit to travel by air. The HSA later alleged Ms Woodstock had not travelled on the date agreed and specified on the medical certificate but the Caymanian Compass later revealed the letter did not stipulate a travel date or an expiration date.
Following an internal investigation, the Health Services Authority, which runs the Cayman Islands Hospital, claimed Ms Woodstock was not in active labour when she came to the hospital, adding that membrane rupture in early pregnancy is not a contraindication for air travel.
But this assessment drew scorn from obstetricians. One told the Caymanian Compass turning the woman away from the hospital, let alone letting her fly, was unthinkable.
The case prompted a flurry of investigations. Upon returning from Washington days later, Mr. Eden announced that he had briefed two PAHO affiliated doctors to conduct an independent investigation, telling them to leave no stone unturned. The Health Insurance Commission and Jamaican Consulate also announced investigations.
Honorary Jamaican Consul Robert Hamaty in turn passed documents from his consulate’s investigation on to the Ministry of Foreign Affairs in Kingston, Jamaica, the Cayman Islands Office of the Complaints Commissioner, the Cayman Islands Human Rights Committee and Governor Stuart Jack.
On Tuesday, Ms Woodstock, who remains in Jamaica, said baby Latiesha Julene Clarke was doing well but she was not sure if she would return to Cayman.