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Durban - Clinical notes taken by the Durban doctor of a patient who collapsed and died hours after he had been discharged from hospital have been described as “scanty”.
Expert medical witness, Dr Ravinkumar Ramdass, testified at a Health Professions Council of South Africa (HPCSA) inquiry yesterday where Dr Sujatha Hariparsad has pleaded not guilty to four counts: failure to correctly diagnose a patient, failure to take a full and complete history, failure to admit the patient for further observation, and failure to keep adequate clinical notes.
During examination by pro forma prosecutor, advocate Meshack Mapholisa, Ramdass said the notes did not indicate that the patient was an Indian male and neglected to include detail about the chest pains the patient, Ravine Parmanand, 40, was experiencing.
The inquiry had heard how Parmanand woke his wife on the night of November 4, to take him to Netcare Umhlanga Hospital because he was in pain.
Pamela Parmanand had testified that her husband was still in a fair amount of pain when he was sent home. The couple got home at 11.30pm, and at 8.10am the next day, after he had dropped his children at school and arrived at work, her husband collapsed and died.
She argued that her husband’s complaints were taken lightly and that Hariparsad’s notes were vague.
Parmanand is also suing Hariparsad and the hospital for R3.5 million in a separate claim for damages.
Yesterday, Dr Ramdass, who practised medicine for 23 years before becoming an advocate four years ago, said detailed information regarding Parmanand’s medical history and clinical examination was not recorded.
“In this case all we have is chest pain. The nature of the pain, where it radiated, etc hasn’t been recorded,” he said.
The clinical findings, Ramdass said, did not sustain Hariparsad’s diagnosis of Costochondritis – an inflammation of the junctions where the upper ribs join with the cartilage that holds them to the breastbone.
“Upon clinical examination, the patient would be in pain if you touched the costochondral joints (joints between the ribs and its costal cartilage). Proper notes were not taken,” he said.
Ramdass said Parmanand displayed a classic presentation of angina (pain or discomfort that occurs if an area of the heart muscle does not get enough oxygen-rich blood) which has intermittent symptoms and can be properly diagnosed once a series of tests are conducted.
“The management of the patient after the ECG (electrocardiogram) and the cardiac enzymes were done was not reasonable. The patient should have been admitted,” he said.
Hariparsad’s attorney, Altus Janse van Rensburg, asked Ramdass if his opinion would have changed had Pamela Parmanand included in her statement that her husband was well enough to drive his children to school, and himself to work the next day.
“I wouldn't have changed my opinion. Intermittent pain is a symptom of angina. You can have totally well periods in-between with angina. He was in a stage where he was clinically well,” Ramdass said.
Cross-examination was expected to continue today.