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(First in series of stories. Part 2.)

Commonwealth Health Center known as ‘butcher shop’

By Jude O. Marfil SAIPAN, CNMI (Saipan Tribune, Nov. 17, 2009) – In the Commonwealth of the Northern Mariana Islands, Saipan, Cheryl Indalecio buried her only son seven years ago. Yet the image of Christopher Ray Indalecio struggling for his life at the Commonwealth Health Center remains vivid in her mind.

"He was bleeding everywhere from the [tracheotomy tube], from his mouth, from his nose," she sobs. "He came in for a cold and he died bleeding to death."

Indalecio, a staff at Saipan Southern High School, was among the parents who sued CHC for negligence leading to a patient's wrongful demise. There are many complaints about the hospital's competence but not all end up in court. Even though very few, the medical malpractice and wrongful death court cases against CHC nonetheless mirror the government-run hospital's ability to provide proper health care to the community.

This article is a first of a series that takes a closer look at CHC, which marks its 23rd anniversary this month. Part 1 covers the medical treatments gone awry. Part 2 reveals the poor conditions and explains why CHC is "at the crossroads of a total breakdown." Part 3 walks the readers through the Emergency Room, the most talked about department in the hospital. Many agreed to be identified for this special report but others feared retaliation if they complained publicly.

Lawsuits tend to disrupt delivery of service at the hospital. Doctors would immediately leave Saipan the moment they are named defendants. Such was the case of Dr. Florian Braig, an ear, eyes, nose and throat specialist, who resigned along with his wife, Dr. Tutet Nguyen, a pediatrician. The resignations happened last month following news reports about Braig facing a couple of medical malpractice suits: one for allegedly burning the face of a patient; the other one was for the death of an 18-year-old following a botched tonsillectomy procedure.

Lawsuits against the hospital have also cost taxpayers money. For instance, records showed the CNMI paid Chimako R. Rauepi $50,000 in December 2002 for losing her dead child at the morgue. Ruby De Guzman got $75,000 in settlement money after she sued CHC when her baby, Marianne, died at birth. Unless the Supreme Court rules in CHC's favor, government will have to cough up $402,113 in damages to Eric David, his wife Tania and their son for a failed vasectomy.

On May 12, 2008, Superior Court Judge David A. Wiseman issued a final judgment awarding Indalecio $50,000, the maximum amount surviving relatives could get in a wrongful death case. The CNMI government has yet to pay Indalecio that amount.

"It's never been about the money. I wanted [the doctor] to admit that it was his fault," Indalecio says in an interview. "My son is the love of my life. I gave up everything to be with him. I quit my job just to stay home and make sure he got the care he needed."

Christopher Ray Indalecio was no ordinary teenager. At age 6, he was diagnosed with muscular dystrophy-a weakness and loss of muscle tissue. Although wheelchair-bound, he graduated from high school with honors in 2002.

On June 24 of that year, a day after her birthday, Indalecio took her 18-year-old son to the Commonwealth's only hospital. He had a cold and was very congested. The doctors decided to admit him.

On July 2, 2002, Christopher Ray underwent a tracheotomy, a surgical procedure that opens up the windpipe to allow air into the lungs. According to court records, he appeared to be doing well after the surgery and was planning on going home. It was decided that he would keep his tracheotomy tube open in the event he had trouble breathing again in the future, given his muscular dystrophy. But the nurse noticed the tube was protruding from the patient's neck and therefore should be adjusted.

On July 15, 2002, Dr. John Yarofalir, a surgeon, was called in to adjust the tube. "My son was crying in pain. He couldn't talk but you could see his mouth screaming," Indalecio says. She remembers confronting the surgeon. He apologized to her son.

But the following day, Christopher Ray began bleeding profusely. His mother continues between sobs, "I ran-to the ICU-and I called all the nurses 'Help me. Help me. Something's wrong with Chris'. They started doing CPR, trying to revive him. But he lost so much blood-there's nothing they can do." He died 20 minutes later.

Indalecio says that experience has made her doubt the hospital's capability to treat its patients. "We call [CHC] a butcher shop. You talk to anyone on this island and they are scared to death of CHC," she says. This is why she asked her husband and children that in case she has a stroke or a heart attack, "just let me die. Don't bother to call the ambulance. Don't send me there."

There are many allegations of medical malpractice and wrongful death incidents against CHC. But not all purportedly aggrieved patients or families of patients press charges.

One reason is Public Law 15-22, or the Government Employees Liability Reform and Tort Compensation Act of 2006. This limits government liability to $50,000 for wrongful death cases and $100,000 for personal injury awards. The cap discourages most lawyers from taking on these cases that entail the review of voluminous medical records, interviews with case witnesses and hiring of expert witnesses. This to-do list makes litigation expensive. Even if the plaintiff wins, there's no guarantee the government will pay, given its deficit.

Clarinda Celis Ngirausui explains that as part of their culture, the indigenous people in the CNMI-Chamorros and Carolinians-often just suffer in silence even though they believe their relatives wrongfully died in the hands of doctors at CHC.

"I don't think it's accepted yet that they can go and sue. Everything is just hush-hush leave it alone. A lot of people don't speak out," says Ngirausui, a Chamorro. "I can't. If I know something is wrong, I'm going to say something."

Ngirausui took her 10-year-old son Joshua Ike N. Celis to the hospital because "he started complaining that his leg was hurting," she says. Eighteen days later he died.

On Aug. 6, 2007 she sued CHC for her son's alleged wrongful death. The case is still pending with the Superior Court.

Ngirausui's son was admitted to CHC on Oct. 12, 2004 and remained there for two days, according to the complaint. He was diagnosed with rheumatic fever and given antibiotics and aspirin. Rheumatic fever, common in children aged 5 to 15, stems from an untreated or poorly treated strep throat.

"Four aspirins four times a day," claims Ngirausui, is what the doctor gave Celis. "Actually it helped him because it helped him walk. What we didn't know, it was slowly killing him," his mother says.

On Oct. 16, 2004, Ngirausui says an ambulance was called to rush her son to the Emergency Room. "He went into a coma and never woke up for 15 days until we decided to unplug the respiratory," she says.

While in the intensive care unit, Joshua Ike was diagnosed with Reye's syndrome. This condition, which primarily occurs in children, affects all organs of the body, mostly the brain and liver, according to the National Institute of Neurological Disorders and Stroke. Reye's syndrome can be acquired by taking aspirin or other medications that contain salicylate while one has a viral infection.

Ngirausui's complaint further alleged that her son was not closely monitored. He was not tested for aspirin toxicity, salicylate levels, and liver function.

"Everybody seemed to think it was okay. I thought everything was fine. We trust our doctors," Ngirausui says. "He was brain dead. You know you never get over the pain. He was my only son."

Ngirausui says she decided to "sue these people [at CHC] so they can learn." She also wants to encourage other parents to come out if they believe their child was a victim of wrongful death.

Public Health Secretary Joseph Kevin P. Villagomez admitted that there are "lawsuits that should have been prevented but because we don't have enough equipment to diagnose patients, medical malpractice happened. And we own up to it."

As long as CHC remained Saipan's primary health care facility, Villagomez said, "we will never avoid medical malpractice because we have no capability that other health care facilities in the mainland have. This is why we just send patients on medical referral."

While he commiserates with families of victims and understands their reason for suing, Deputy Secretary for Hospital Administration Pedro T. Untalan said, "Doctors are not gods. They are humans just like us."

It all boils down, he said, to doctors having to work 12 hours because there are not enough of them to cover the 24-hour shift. "It's not manual labor that [doctors] are doing; it's all mental. The likelihood of making a mistake on a 12-hour shift is very strong," Untalan said as he renewed his call to CNMI legislators to properly fund the hospital. He asked lawmakers to pass a budget that will increase the salary of doctors to attract U.S.-based specialist-physicians to practice on the island.

"Mistakes happen no matter what," said Dr. Gregory Kotheimer. "The doctors in this institution are good. They are conscientious." Before he began working at CHC, Kotheimer said, he was an expert witness for lawyers in medical malpractice cases in Texas for 15 years.

Anna Leah Castillon, 38, Filipino, has lived to tell her ordeal at the hospital when her swollen appendix ruptured. At first she refused to be identified for this article lest hospital staff refuse to treat her children if they get sick. But her husband, Patrick Castillon, believes she should not worry since their case had already been settled. Department of Finance records showed the Castillons got $17,500 from the government.

On Dec. 25, 2004, Anna Leah Castillon went to the ER with abdominal pain. Doctors diagnosed the patient with food poisoning, but failed to consider her negative urine, blood and stool cultures.

Anna Leah Castillon said doctors gave her a shot of morphine. When the pain subsided she was discharged. She went home thinking the crisis was over-until she peed. "I was screaming in pain. I couldn't stand anymore. My husband had to carry me to the car," she recalls.

Four days after her admission, she had a CT scan. The ultrasound technician mentioned that she might be having appendicitis. But the doctors didn't listen. So they gave the patient laxatives and painkillers and treated her with enemas, a procedure usually used for treating constipation by injecting liquids into the anus.

"But they couldn't explain why my stomach was getting bigger. I look like I am eight months pregnant when in fact I just gave birth three weeks ago," Anna Leah Castillon says. "They just gave me painkillers every four hours."

Over her doctors' objections, Patrick Castillon decided to take his wife to the Philippines.

At St. Luke's Medical Center in Quezon City, Philippines, several doctors gathered around her. The surgeon decided right away that she had ruptured appendicitis after reading her x-ray and CT scan results. Within three hours of landing in Manila, Anna Leah Castillon underwent operation.

"Gangrene was coming out of her appendix," Patrick Castillon says of the doctors' findings. Because her appendix had already ruptured, her intestines were stuck together. Doctors had to remove her entire intestines and put them back together.

"I was traumatized by this whole experience," says Anna Leah Castillon, "Especially every time I see my scar."

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