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Lawyers representing the parents of babies who died in the neonatal intensive care unit (NICU) at the Port of Spain General Hospital (POSGH) have filed a Freedom of Information Act request seeking a copy of the North West Regional Health Authority (NWRHA) internal investigation report into the children’s deaths.

In a letter sent to NWRHA attorneys Pollonais, Blanc, de la Bastide & Jacelon on July 21, Freedom Law Chambers requested a copy of the report, along with six related documents. These are copies of all statements made in relation to the investigation, copies of letters of appointment given to investigators, a copy of the terms of reference of the investigation, copies of the terms of reference for the investigation, copies of the terms of reference for investigators, including the issue of remuneration, a copy of any disciplinary charges filed against any NWRHA staff member from POSGH as a result of the findings of the NWRHA and/or PAHO investigation and the deaths of these babies, whether any disciplinary action will be taken against any staff member and if so, what the procedure and timeframe is for this. The letter cited an April 14 Newsday article in which NWRHA CEO Anthony Blake said there would be full disclosure and transparency about the investigation. “After receiving such public assurances from the NWRHA CEO, our clients understandably expected the NWRHA to honor its promise of transparency and provide them with immediate access to the internal investigation report as promised.

“However, it said that the NWRHA’s lawyers refused to release the report in a letter dated June 5. The lawyers said this was due to the various pre-action protocol letters that had been sent to the RHA. “Following receipt of your pre-action protocol letters, the investigation is now being conducted solely for the purposes of litigation and to enable our client to respond to the allegations in your letters. Accordingly, the investigation report will on that basis be a privileged document which will not be disclosed to you.” However, Freedom Law Chambers criticised this move as absurd, saying that the NWRHA had retained a strong battery of lawyers who would undoubtedly have advised it on this matter from day one. “We must therefore assume that when the CEO, Mr Blake, gave these assurances that the investigation report would be made public, he did so, with appropriate legal advice.” It also argued that Blake’s statements, together with those of Health Minister Terrence Deyalsingh assuring transparency, created a legitimate expectation among her clients and the public that this investigation report would be made public upon completion. Apart from the CEO’s public statements, Freedom Law Chambers argued that the parents were entitled to the report, since the Pan American Health Organisation (PAHO) investigation concluded that the babies’ deaths were due to nosocomial infection (an infection acquired in hospital). This, it said, qualifies the deaths as an adverse event which, under NWRHA policy, entitles clients to a copy. It also said that, given PAHO’s findings, it was clear that there was “serious mismanagement and inefficiency at NWRHA.”

“The NWRHA therefore has no right to keep this report secret. The public has a right to full and candid disclosure of this. Our clients have the same right to ensure that the systemic failures and gross incompetence that led to the deaths of these babies are publicly/properly addressed and remedied to prevent recurrence.

“The letter reiterated that the clients were willing to settle the case, but only if the NWRHA admitted liability for negligence and misconduct. Seven babies died at the POSGH between April 2 and 9 due to bacterial infections, prompting the NWRHA to launch an internal investigation and the Minister of Health to commission an independent investigation by a team of PAHO investigators. The team included Professor of Pediatrics, Global Health and Epidemiology at George Washington University in Washington DC, Dr. Nalini Singh; Clinical Microbiologist and Chief of Microbiology at Centro de Asistencia Medica Soriano in Uruguay, Dr. Grisel Rodriguez; and Neonatal Intensive Care Specialist and Head of the Neonatal Care Intensive Unit at the Queen Elizabeth Hospital in Barbados, Dr. Gillian Birchwood.

The PAHO report, presented to the House of Representatives on June 28, concluded that the infant deaths were due to poor infection prevention and control in the NICU. Of the various deficiencies found, it rated the unit’s precautionary measures at only 29 percent.

PAHO’s recommendations included breastfeeding within 24 hours of birth, improved hand hygiene, active screening of bacterial cultures during outbreaks, improved nurse-patient relationships, policies and procedures for cleaning and high-quality disinfection, and external laboratory performance evaluation. Following the report, Deyalsingh raised several concerns about its content and wrote to PAHO seeking clarification.

“Did you know that the head of the NICU was not interviewed? Do you know that the chief of staff of the PoS General Hospital was not interviewed? And as I said in my statement (in parliament on June 28), many of the recommendations that they have for the medium and long term are already part of our standard operating procedures,” he told reporters at a health fair on June 29.