Questions surround death of new mom
The husband of a young mother who was diagnosed with terminal cancer days after her son was born claims doctors should have spotted the disease before or during her pregnancy.
Latifa Maybury had just turned 30 when she died of colorectal cancer at King Edward VII Memorial Hospital in November last year — and her son Khaleel was barely six months old.
Mrs Maybury’s widower Kemar is threatening to sue Bermuda Hospitals Board over what he claims was a failure by emergency room medics to spot “many red flags” before and during her pregnancy and a breakdown in communication between doctors.
He has also complained to the Ombudsman, who is investigating the case.
His wife, who was originally from Morocco, visited the emergency room at KEMH with abdominal pain and rectal bleeding on August 17, 2012, before she ever conceived.
But a “discharge sheet” from the doctor there, which advised that she see a specialist and have a screening exam for colon cancer, apparently never made it to her family doctor. BHB says it faxed the sheet to physician Shaina Kelly but Dr Kelly says it didn’t arrive — and she insists she did not receive discharge sheets from two later ER visits made by Mrs Maybury during her pregnancy.
A BHB spokeswoman said: “Discharge sheets are always faxed to a patient’s doctor’s office, although patients also receive the same information.”
In relation to the August 17 discharge sheet, she said: “The information was successfully sent, according to the BHB fax machine, although the GP (General Practitioner) has said the fax was not received.”
The hospital admits it did not fax discharge sheets to Mrs Maybury’s obstetrician after the two later ER visits, on January 18 and April 21, 2013, as it wasn’t policy to do so at the time.
But the spokeswoman said that had now changed, in light of Mrs Maybury’s “tragic case”.
According to hospital records, on Mrs Maybury’s ER visit of April 21, her “long history of constipation” and rectal bleeding was noted again.
Yet the BHB spokeswoman claimed that when Mrs Maybury visited ER during her pregnancy she “did not discuss the ongoing symptoms she was experiencing”.
Mr Maybury, 33, told The Royal Gazette his wife was completely let down by Bermuda’s medical system, claiming she suffered a “torturous” and painful pregnancy while being told by Dr Kelly, her obstetrician Wendy Woods and ER doctors that she simply had haemorrhoids and constipation.
Only after Khaleel was born via a Caesarean section on May 9 last year, was a massive malignant tumour discovered on Mrs Maybury’s colon, along with growths all over her liver.
By then, she had stage four cancer and nothing could save her. Her husband said: “If there is something that big, at that time, it’s been there for some time. She would have stood a chance [if it was detected earlier]. She was a very strong person.”
His wife died six months later, leaving behind a heartbreaking video message for her newborn son, in which she tells him she has waited for him all her life, loves him more than words can describe and will always watch over him.
Mr Maybury said: “I feel that she got cheated. She got cheated out of being able to have the opportunity of not putting Khaleel in that predicament.
“There was time for them to detect what was under the surface, if they had just done their jobs.”
Mr Maybury has shared his late wife’s medical records with this newspaper and her chart from KEMH records her August 17, 2012 visit to ER, noting that she had been suffering from constipation for three months and that day had “passed large amounts of blood per rectum which was dripping in toilet”.
The chart states: “The rectal exam showed haemorrhoids, internal, with pain without bleeding and a few external superficial fissures.”
Mrs Maybury was given suppositories, according to the chart, which states: “Follow-up was written with Dr Shaina Kelly to arrange referral with a specialist for investigation of per rectal bleed: colonoscopy.”
It does not mention the patient being advised to follow up with her doctor but Mr Maybury insists his wife did make an appointment with her GP after the visit, seeing a locum standing in for Dr Kelly.
He said neither he nor his wife knew what a colonoscopy was and the locum was “very vague” on the need for further tests. “She said it was haemorrhoids,” he said.
Had they known she had cancer, Mr Maybury added, they would never have tried for a baby. He said his wife next saw Dr Kelly when she was already pregnant and was told again that she had haemorrhoids.
Dr Kelly disputes that Mrs Maybury saw the locum after the August 17 ER visit.
Her records show the patient visited the surgery only on July 20 and September 26, 2012 and April 29, 2013.
“I can confirm that Latifa Maybury did see my locum in July but not in August as a follow up after the ER visit,” the GP said, speaking with the permission of Mr Maybury, who agreed to waive patient confidentiality for his late wife.
“The patient did not follow up with my locum doctor in August 2012 after that ER visit, therefore no diagnostic tests were ordered. “Mrs Maybury did not see me for visits after August 2012 specifically regarding symptoms related to her illness.”
She said Mrs Maybury did not complain of rectal bleeding to her and she never diagnosed her with haemorrhoids.
Dr Kelly added that she received no discharge sheet or any other information from the hospital after August 17, nor after the patient’s ER visits of January 18 and April 21, 2013.
“My locum and myself did not receive the ER sheet recommending a colonoscopy.”
BHB insists that while “this is a tragic case” and it is “truly sorry that Mrs Maybury died”, the care it gave her was “appropriate”.
The spokeswoman said: “We certainly have and continue to apologise where our care has proven to be lacking and will always strive to learn from events and improve.
“In this case, however, it is not related to the care and advice that was provided by BHB’s emergency department. The appropriate advice was provided.”
She said: “During the period of time after August 2012, Mrs Maybury did not discuss her symptoms, either with her GP or her obstetrician.”
The spokeswoman added: “When Mrs Maybury saw an emergency physician while she was pregnant, she did not discuss the ongoing symptoms she was experiencing.”
Dr Woods told this newspaper she provided Mrs Maybury with the “normal prenatal care” and “there was nothing reported or noted during her visits that would have led me to suspect or do an investigation for colon cancer”.
“Constipation is common during pregnancy,” she added.
Mr Maybury insists his wife told her obstetrician about her rectal bleeding and about the constant stomach pain she suffered and was told the latter was “nerve compression” — claims that Dr Woods denies.
“Latifa never reported any of that to me,” she said.
She stressed that Mrs Maybury did not complain to her of abdominal pain, only constipation, and didn’t mention rectal bleeding until a week before her delivery. The doctor said she never told her patient she had haemorrhoids.
Dr Woods said Mr Maybury’s reference to nerve compression was likely a reference to her diagnosing round ligament syndrome, which causes pain during pregnancy.
Mr Maybury and his mother Keetha Lowe — who considered Latifa to be her daughter — say they want to share her story with the public, in the hope that it will lead to better patient care and improved oversight of the Island’s only hospital.
Ms Lowe, who is helping to bring up her grandson, said: “I can’t even put into words, when this type of thing happens and an entire family’s life collapses and falls apart inside of 24 hours, what amount of damage that does.”
Her son added: “I’ll never be the same. You can’t go through something like that and be the same person that you were before. Never. I’m still in shock.”
He said his complaint was not about money — though he believes the doctors who allegedly failed his wife should return their fees — but about accountability within the medical profession.
“Everybody who does not want to take responsibility, who had some involvement ... should be exposed.”
The BHB spokeswoman said the board extended its “heartfelt sympathy” to Mrs Maybury’s family. She added: “We would stress the importance of patients following the instructions given on discharge from emergency.”
Ombudsman Victoria Pearman said she could not comment as she was bound in law to maintain secrecy.
Statement from Bermuda Hospitals Board on Latifah Maybury.
“Bermuda Hospitals Board extends its heartfelt sympathy to Latifa Maybury’s family. This is a tragic case.
“We are limited by how much we can say as this is an active investigation by the Ombudsman of Bermuda and BHB is only allowed to release detailed medical information about an individual’s medical care to the patient and family, through a legal process or Ombudsman investigation.
“However, we can confirm that our own review indicates the care and advice that was provided to Mrs Maybury from the KEMH emergency department was appropriate.
“Only once in her four visits to the emergency department did she inform an emergency physician about the symptoms directly related to her final illness and, at that visit, she was discharged with verbal and written instructions to follow up with her GP as further diagnostic tests were recommended.
“Emergency doctors do not replace a patient’s primary care physician, who coordinates and manages that individual’s care day to day.
“We cannot disclose the medical details of her other visits, but they have been provided to the family.
“We can confirm that one of the visits she decided to leave before seeing a physician.
“During the period of time after August 2012, Mrs Maybury did not discuss her symptoms either with her GP or her obstetrician.
“When BHB received the complaint from Mrs Maybury and her family, BHB recognised that it was an integrated health matter, so coordinated a meeting for the family to meet with both KEMH and community healthcare providers involved in the case.
“BHB wanted the family to have the opportunity to hear from all providers in an open forum. This meeting was arranged rather than starting with a root cause analysis in the interests of transparency, as root cause analysis documentation is usually only fully disclosed in a court of law as part of a legal case.
“A written summary of that meeting was sent to Mrs Maybury and her family and all requested medical notes have been provided.
“Subsequently, the family requested the Ombudsman of Bermuda carry out an investigation and full disclosure has been provided to the Ombudsman as part of that legislated process.
“BHB agreed with the Ombudsman’s office that, before having further dialogue with the family, BHB would allow the Ombudsman to complete her investigation.
“This is to ensure that the Ombudsman’s investigation is in no way compromised.
“We are truly sorry that Mrs Maybury has died. We certainly have and continue to apologise where our care has proven to be lacking and will always strive to learn from events and improve.
“In this case, however, it is not related to the care and advice that was provided by BHB’s emergency department. The appropriate advice was provided.
“As we have informed the family from our review, we are aware that the GP’s office did not have the discharge sheet from emergency for Mrs Maybury’s first visit.
“Discharge sheets are always faxed to a patient’s doctor’s office, although patients also receive the same information.
“The information was successfully sent according to the BHB fax machine, although the GP has said the fax was not received.
“Additionally, we also felt that for pregnant patients, discharge sheets could also be sent to the individual’s obstetrician.
“However, it should be noted that when Mrs Maybury saw an emergency physician while she was pregnant she did not discuss the ongoing symptoms she was experiencing. Finally, we would stress the importance of patients following the instructions given on discharge from emergency.”
In response to a follow-up question about discharge sheets, the spokeswoman added: “It is BHB policy to send GPs faxes of discharge sheets for every emergency visit.
“It has never been policy for BHB to forward emergency department discharge sheets to specialists, including obstetricians. The expectation would be for the patient to raise this with the obstetrician and provide the discharge sheet if required.
“In the meeting with the family, BHB felt this was an opportunity to improve the coordination of care.
“Although Mrs Maybury did not mention her ongoing symptoms during these emergency visits, BHB does feel that there is value in obstetricians receiving ER discharge sheets going forward.”
