Baby Kimora Leslie died on Saturday, April 29?two weeks short of her second birthday?after she was unable to get surgery to replace a shunt in her brain, to aid her in her fight against hydrocephalus (an illness known locally as ?water head?), a condition with which she was born.
Now the KHMH, where the girl had been hospitalized just prior to her death, and two neurosurgeons who could have saved the girl?s life, are at the center of the controversy.
Firstly, the neurosurgeons, Dr. Giovanni Lara, a Guatemalan, and Dr. Joel Cervantes, a Belizean, were not on duty at the hospital to give the child the specialized care she needed when she arrived for surgery, and when one of them finally showed up at the hospital, KHMH did not have the shunt that was needed.
A shunt is a tube implanted in the cranium to divert the flow of cerebrospinal fluid to the abdomen. It is used in the treatment of hydrocephalus.
On Tuesday, April 25, Baby Kimora?s mother, Kereen Leslie, and grandmother, Shaun Lemoth, took her to the KHMH after observing that the girl was crying in pain and her body was beginning to stiffen. When they went to the KHMH, they were told that the baby was in urgent need of surgery, but no neurologist was at the hospital.
Surgery cost at private hospital prohibitive
Since the surgery could not be done at the KHMH, the family was referred to Belize Medical Associates (BMA), where the operation would have cost the family $10,153.33. We understand that the family had to make a down payment of $3,500, which they were unable to do.
According to the family, they only had a pledge of $1,000 from the Ministry of Health, which they got on Wednesday.
On Thursday, April 27, when they got the estimate for the surgery, they went to Channel 5 to launch a public appeal via the media, requesting donations to pay for the child?s medical expenses. On Friday morning, they called the WUB Morning Vibes morning show on KREM, and they also went to Channel 7. On Friday night, the child?s story aired on both television stations. Hours later, however, she died.
The family did not have enough money to pay for the surgery at BMA, even though there was a shunt available there, which was to have been used on another child, who, instead, was going to be taken to Melchor for surgery.
Clinging to hope
On Friday, Baby Kimora was admitted to ward at the KHMH after another bout of pain struck her. Doctors there advised that she had to urgently undergo surgery to replace the shunt implanted in her in November 2004, when she was six months old.
Later that day, Dr. Lara, who inserted the first shunt, saw Baby Kimora at the KHMH.
Lara only appeared for work, said KHMH?s CEO, Dr. Alvaro Rosado, after a Government Minister pleaded with him to go to the hospital.
Sister Nzinga Barkley-Waite of Friends of Pediatrics said that they were willing to pay for the surgery at the KHMH, and pleaded with former Health Minister, Hon. Vildo Marin, for help. He, in turn, appealed to Lara to return to work and assist the child.
Dr. Egbert Grinage of Friends of Pediatrics, who works out of Universal Health Services, another private hospital in Belize City, was unable to help; he, himself, was on sick leave at the time, Sister Nzinga informed.
The baby reportedly went into cardiac arrest at the KHMH, but Dr. Lara revived her and put her on a respirator, with the intention of stabilizing her and getting her into surgery. But when he checked for supplies, he found out that the hospital did not have the shunt necessary for the surgery. His alternative was to use a syringe to temporarily drain the cerebrospinal fluid that was collecting in the girl?s brain, said Dr. Lara.
According to Cervantes, he and Lara were unaware that a shunt was available at Medical Associates, and so this is why Lara did not obtain it.
Regrettably, Baby Kimora went into cardiac arrest again early Saturday morning, and died at about 3:45 a.m. at the KHMH. A post-mortem examination was conducted on Tuesday, May 2.
The results, relatives say, indicate that Baby Kimora died due to five complications: broncho-aspiration, as a consequence of upper gastro intestinal hemorrhage, raised intra-cranial pressure, hemorrhagic gastritis, and the malfunctioning of the shunt.
KHMH management deflects blame to doctors
Yesterday, Tuesday, May 2, the hospital held a press conference to discuss why they believe that Baby Kimora died.
Present at the press conference were Baby Kimora?s relatives, KHMH?s management, including chief executive officer (CEO) Dr. Alvaro Rosado; medical chief of staff Curtis Samuels; KHMH board chairman Israel Marin; and Gary Ayuso (public relations officer); media representatives and Barkley-Waite, among others.
The hospital?s administration maintains that the baby?s death was not their fault and laid the blame squarely at the feet of Dr. Lara and the other neurosurgeon, Dr. Joel Cervantes.
Rosado claimed that the KHMH offered everything it could to aid Baby Kimora, even offering to pay for a shunt if one could be located elsewhere.
He, furthermore, claimed that even after Lara reported to the hospital on Friday, April 28, he refused to do the surgery at KHMH.
KHMH?s chairman, Marin, maintained at the press conference that the hospital is not to blame for Baby Kimora?s death. He claimed that if the neurosurgeons were at the hospital, she would not have died.
When he was asked what would have made the difference, since the KHMH did not have the shunt which was needed for the surgery, Marin said that if the neurosurgeons were on duty, they would have known that the hospital did not have the shunt in stock.
For his part, Dr. Lara said that the hospital should avoid any such incidents from recurring. He said that having the basic materials for staff to work with and being able to dialogue with the nurses, technicians and all the others who make up the health care system, would help the situation a lot.
Dispute over employment contracts complicates matters
Dr. Lara has been on contract with the KHMH, but had not reported for work since his vacation leave ended on March 31, 2006, said Rosado. Cervantes, the other neurosurgeon, was supposed to be on call while Lara was out, said Samuels. However, he had not signed his contract, and refused to return to the KHMH unless the new terms were settled, said Rosado.
Based on the various accounts from hospital authorities, it appears that Cervantes was not called in to attend to Baby Kimora.
The contracts of both Cervantes and Lara had expired last December. Lara renewed his, but was unhappy with the terms and wanted to renegotiate.
The doctors claim that they were being underpaid and they were not being adequately equipped to do their jobs.
So far, Cervantes and Lara have been unable to reach an agreement with the hospital over their contracts, but Amandala sources say that the negotiations are ongoing.
Marin recounted that the first conflict the hospital had with the neurosurgeons was in November last year. The board pleaded with them not to stop neurosurgical services and told them that the board of directors was willing to sit down with them and negotiate the points which the men brought up in their proposals for new contracts.
Marin claimed that the neurosurgeons placed the board?s backs against the wall, giving the ultimatum that either the contract that they proposed be signed, or they would stop working.
?Their oath to save lives was not important; what was important was the contract, so this is what we have here today,? said Marin.
Family says ?childish? dispute cost the baby its life
The child?s grandmother, Shaun Lemoth, now thinks that Baby Kimora is dead because of an ongoing ?childish? dispute between the KHMH?s management and the neurosurgeons.
At the end of the press conference, Lemoth stood up and said that she was not happy with the fact that her granddaughter had to die because of a dispute between the board of the hospital and the neurosurgeons.
She said that as far as she is concerned, the hospital did not have what they needed to do the surgery?not to mention a surgeon. She also opined that the doctors had made an oath to save lives and they were not truthful to their oaths, which is why her granddaughter died.
Doctors accused of ?taking money under table?
When a reporter questioned whether the doctors are owed money, CEO Rosado said, on record, that they were not owed anything, and further charged that the two doctors were ?taking money under the table? for surgeries done at the KHMH, especially for surgeries done in the private ward.
According to Rosado, they had overstated the cost of a surgery, giving an estimate for a private hospital to Social Security when in fact the surgery was done for less at the KHMH.
Rosado was questioned why the matter was never reported before the press conference, and why even after all that, they are trying to sign new contracts with them. He did not answer the question.
After the press conference, Cervantes denied allegations that they were taking money under the table. Cervantes said that Rosado should prove his allegations, while Lara challenged Rosado to share what he has found in his investigations.
Dr. Lara says ?sayonara,? but doctors willing to talk
Shortly after the press conference, Dr. Lara tendered his resignation, but said that even though Rosado has accused them of this hideous act, he is still ready and willing to meet with him and try to iron out what he considers a very difficult situation.
Cervantes also said that he is willing to sit with the KHMH, and if necessary, Ministry of Health officials. He said that they have never been listened to in the past, and hopefully they will be able to reach a reasonable solution so he and Lara can return to the hospital as soon as possible to render neurological services.
Investigations launched ? who will be held accountable?
According to GOB?s release, the Minister expects that the report on the internal investigations and the recommendations based on the findings will be forthcoming within a week.
The team of investigators, headed by Dr. Polanco, includes Marjorie Parks, deputy director of health services; Dr. Peter Allen, director of the policy analysis and planning unit, Ministry of Health; Dr. Martha Habet, president of the Belize Medical and Dental Association; and a Crown Counsel from the Solicitor General?s Office.
When asked at the press conference if anyone would be held criminally liable for Baby Kimora?s death, Rosado said that the KHMH board has documented the hospital?s findings and has handed over the files to the Belize Medical Council, which is the licensing body that will make the final decision on whether the doctors would be allowed to continue their practices.
Family grieves loss
Relatives say that they do not intend to take legal action against the doctors or the hospital. They said that they want Baby Kimora?s case to be a lesson to Belizeans, that they cannot depend on KHMH for medical treatment, and should store away money for emergency health care.
With tears in her eyes, Lemoth said that her granddaughter?s suffering and crying were actually a plea to the public to assist her the day before she died, but her pleas seem to have gone unheard.
She said that she is also grateful that Lara took time out and went to see her granddaughter at KHMH, and thinks that the doctor did the best he could under the circumstances when he took the syringe and drained the fluid from around Kimora?s brain.
Baby Kimora will be laid to rest today, Wednesday, following funeral services at 3:00 p.m. at Port Loyola Baptist Church.
She leaves behind her mother, Kereen Leslie; her grandmother, Shaun Lemoth; and her grandfather, Anthony Leslie; as well as aunts, uncles, and a host of other relatives and friends.