Mukdahan Hospital has admitted that staff reassessed a 65 year old emergency patient about an hour apart, when its own protocol sets 30 minutes.
The man died hours after he arrived with severe abdominal pain. A CT scan found an aneurysm and dissection of his abdominal aorta. His family has asked the hospital to explain the delay. They say they will not take legal action.
Khaosod reported the case on August 14. Its reporters interviewed the man’s wife and daughter at the family home, then put the family’s questions to the hospital’s director and deputy director.
Ohn Si, 54, took her husband Cham, 65, to the emergency department at about 7pm on August 12. Khaosod withheld the family’s surname.
During history taking, Cham told a nurse he felt an abnormal hard lump in his abdomen. A doctor asked about his symptoms and carried out a preliminary ultrasound. The doctor then said staff would give him a painkilling injection and he could go home.
Thai hospitals have faced similar complaints this year. In July, a Ratchaburi hospital suspended a doctor who refused an ECG for a 31 year old man with chest pain and sent him home, where he died hours later.
The family says Cham waited about two hours after the doctor spoke to them. He never received the injection. He had no CT scan during that period. His pain continued throughout.
By about 10pm his condition worsened. His daughter Thanyarat, 28, went to the emergency room counter and asked how much longer they would wait. She told staff her father could not cope, and she feared he was going into shock.
Cham developed muscle rigidity shortly afterwards. He vomited, turned pale and sweated heavily. He then lost consciousness. The family called for help. Staff moved him to the resuscitation room, gave him oxygen and checked his vital signs. Relatives say his blood pressure read about 200 mmHg at that point.
The medical team sent him for an urgent CT scan. Doctors then told the family they had found an abnormality in a blood vessel in his abdomen.
They said he needed surgery immediately, or he might not survive. The family signed consent for treatment. Staff intubated him and contacted a vascular specialist. His pulse weakened and his heart stopped. The team attempted resuscitation but could not save him.
The CT scan showed an aneurysm and dissection of the abdominal aorta.
Thanyarat later posted on Facebook and questioned the care her father received. She asked why he had no CT scan while he was still conscious and able to describe what he felt in his abdomen. She also asked why he waited so long before his condition collapsed. The family then asked Mukdahan Hospital for an explanation.
Reporters visited the family home in Tambon Phon Sai in Mueang district, Mukdahan, where the funeral was under way. Ohn Si and Thanyarat gave matching accounts. Both said they did not want to press charges against anyone.
They said they wanted the hospital to explain why diagnosis and treatment took so long, and why the family lost its main provider inside a medical facility. Both believe Cham might have survived with a thorough examination and faster treatment. They asked the hospital to review the case so other families do not suffer the same loss.
Reporters then went to the hospital. The director, the deputy director for medical affairs and other staff answered questions.
The director offered her condolences to the family. She said staff triaged Cham as an emergency level 2 patient, or pink.
That is the second most urgent category, behind level 1, or red, which covers the most critical cases. Under the guideline, staff should reassess pink patients every 30 minutes. In this case the gap ran to about an hour. The director accepted that this fell outside the set timeframe.
Two red level patients arrived at the same time. A cobra had bitten one of them, and his symptoms were severe enough to need intubation. The other was in cardiac arrest from sepsis. Staff had to treat the life threatening cases first.
Timing in emergency care has caused public anger before. In October last year, a blocked ambulance in Krabi held up the transfer of a critically ill heart patient, who died soon afterwards.
The hospital said the situation with the two red level patients was not an excuse. It accepted the delay in reassessment. Once staff saw Cham deteriorating, the team contacted a vascular specialist and sent him for the CT scan.
The result showed an aneurysm and dissection of the abdominal aorta. Medicine treats that as the most critical form of the condition. His vital signs then weakened and he died.
The deputy director for medical affairs said the hospital would put the case through a review. He said the review would strengthen the patient care system, with attention to continuous monitoring, patient safety and survival chances. He said the hospital would treat its shortcomings as a lesson, develop its practice guidelines and prevent a repeat.
Foreign families in Thailand have raised comparable concerns. Relatives of a British man who died after a Thai hospital discharged him in July said they were later told his care had been inadequate, though nobody has independently verified that claim.
The view that earlier examination and treatment might have saved Cham belongs to the family. Whether the length of the wait relates to his death is a separate question. Answering it requires a full review of his medical records, the sequence of care and expert medical opinion, so that the outcome is clear and fair to everyone involved.
Patients with concerns about their universal health coverage rights can call the National Health Security Office hotline on 1330. They can also contact a provincial public health office complaint centre.
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