PHO says Badian hospital followed referral protocols

CEBU, Philippines — The Cebu Provincial Health Office (PHO) has addressed allegations by the family of a road crash victim that personnel at Badian District Hospital failed to provide adequate emergency care and delayed his transfer to a higher-level medical facility.

The clarification came after the victim's family posted on social media detailing their experience after Philip Josh Velvestre, 18, figured in a vehicular accident in Badian at around 3 a.m. on July 26.

In the post, the family alleged that the patient was left without sufficient medical intervention and that his referral to another hospital was unnecessarily delayed.

"We then arrived around 7:00AM where we found our brother struggling with no any medical support in any sort. No neck braces, no bandages, nothing at all. We were informed by our relative that nurses and doctors administered PARACETAMOL. Only PARACETAMOL! My brother was obviously in pain, fighting for his life and in dire help of urgent care," a portion of the post read.

In a media interview, PHO Chief of Hospital I Dr. Jenina Canoy said the provincial government immediately conducted an investigation after the incident by gathering reports from all healthcare personnel involved in the patient's care.

"So, immediately after that, we conducted an investigation with the PHO as well as our chief of hospital in the Badian District," Canoy said.

She said incident reports were collected from everyone who attended to the patient, covering the period from his arrival at the emergency room until the decision was made to either admit or refer him.

"So, we gathered all the incident reports, meaning all of the healthcare personnel that encountered the patient from the moment the patient was brought to the emergency room up to the management and up to the point of the decision whether to admit or refer the patient," she said.

According to Canoy, the patit arrived at the hospital at around 4 a.m. and was brought in by local emergency responders.

Initial records showed that Velvestre sustained a lacerated wound on the left frontal area, vomiting of blood, a left frontal deformity, and weakness on the left side of his body.

She said the attending physician's initial assessment pointed to a traumatic brain injury (TBI), prompting immediate stabilization and a decision to transfer the patient because Badian District Hospital is only an infirmary hospital.

"Upon the assessment, the doctor tried to stabilize the patient. And there was already a decision to refer the patient to a tertiary hospital because our Badian District Hospital is an infirmary hospital," Canoy said.

Canoy disputed the family's allegation that the patient was given only paracetamol while waiting for transfer.

"So, he was given IV medication such as paracetamol and a certain medication called mannitol. This mannitol is somehow given to lower possible brain pressure," she said.

She added that the patient also received intravenous normal saline solution, oxygen support, continuous suctioning because of persistent vomiting, and tranexamic acid. She said these interventions were documented in the patient's medication records.

"There were other medications, and we can attest to that because these medications are recorded in our medication sheet by our healthcare personnel, our nurses, and the doctor who gave the order," Canoy said.

Canoy also said that when the patient first arrived, no immediate family member was present to provide consent or make medical decisions.

"At that time, there's no family member yet," she said.

She explained that, following protocol, the hospital initiated an online referral to a tertiary hospital in less than an hour after the patient's arrival, initially prioritizing the Vicente Sotto Memorial Medical Center (VSMMC) because it has neurosurgical capabilities.

Referrals were likewise sent to Cebu Provincial Hospital-Carcar and Cebu South Medical Center in Talisay City.

Public Health Consultant Dr. Nikki Catalan said referrals were later expanded to include private hospitals, namely Chong Hua Hospital and Perpetual Succour Hospital, after the family requested these facilities.

"So we referred him to three government hospitals—VSMMC, Cebu South, CPH-Carcar—and then two private hospitals, Chong Hua and Perpetual," Catalan said.

Addressing claims that the referral process was delayed because of an internet outage, Catalan said hospital personnel continued processing referrals using mobile phones and cellular data.

"Despite the loss of the internet during that time, our personnel had this initiative to use the cellphones because the referral system can be accessed through our phones, tablets and laptops even using data," she said.

"So even though there was a loss of connectivity, the referral continued," she added.

Canoy added that the patient was transported at around 8 a.m., even before formal acceptance from the receiving hospital had been completed.

"The patient was transported around 8 a.m., even prior to the acceptance of the patient, who already traveled via our ambulance," she said.

Catalan, meanwhile, said the family later decided while already en route to proceed instead to Sacred Heart Hospital, describing it as a decision made by the patient's relatives.

The patient arrived at the hospital at around 11 a.m. and died later that afternoon at approximately 4:30 p.m.

In their social media post, however, the victim's family maintained that the transfer took too long, claiming the patient remained at Badian District Hospital for several hours despite his condition.

They also alleged that hospital personnel discouraged them from speaking to the patient and claimed they were repeatedly told to wait for referral updates.

"We were then approached by this Nurse, might be the head nurse to stop talking. She said, quote and quote, word per word, 'Ayaw na ninyo storyahi kay di na na kadungog ninyo," a portion of the post read.

The PHO maintained that its healthcare workers followed established referral protocols and documented all medical interventions provided.

The Office of the Governor, meanwhile, said it has reached out to the victim's family, but, as of Wednesday, had yet to receive a response.

Catalan noted that discussions between Governor Pamela Baricuatro and the Philippine National Police are underway to strengthen the enforcement of laws against underage drinking, driving under the influence of alcohol, and riding motorcycles without helmets following the incident. — /MRM (FREEMAN)