We Need To Change The Way We Deal With Sepsis In The U.S.

The good news: Sepsis awareness is rising in the U.S. The bad news: There’s no way to know if it’s going to help.

We actually have no accurate way of knowing how many people die of sepsis in the U.S. That needs to change. 

Anna Almendrala-04/12/2016

Americans are more concerned about sepsis than ever before in the Internet age.
Some of that heightened awareness came recently, after Patty Duke’s family went public about the fact that she died from the condition. The day the news broke, Google searches for the word “sepsis” spiked 827 percent. Recent spikes in search terms like “sepsis symptoms” and “what is sepsis” clearly indicate an interest in the condition and how people can protect themselves.

This dovetails with the ongoing efforts of medical professionals and policy makers to reduce cases of sepsis in hospitals. For instance, the Centers for Medicaid and Medicare Services issued new criteria for how to diagnose and treat sepsis last year in an effort to save lives and money, as severe sepsis is an extremely expensive condition to treat. The Centers for Disease Control and Prevention is also being more proactive about sepsis awareness messaging, especially after the highly publicized death of 12-year-old Rory Staunton in 2012. The boy had cut his arm playing sports, and the infection led to sepsis that went unnoticed at the hospital.

New public interest in the condition is a boon to the sepsis awareness movement and will certainly save lives. But the U.S. has no reliable way to track if awareness or prevention programs are actually making a significant dent in sepsis deaths. That’s because we don’t have an  accurate way of tracking sepsis deaths, period, according to a new report from the CDC. Unlike cancer, diabetes or other diseases with national surveillance programs, health officials and researchers are currently unable to track national sepsis trends or tell whether or not new efforts to combat the syndrome are making a difference.

Because the U.S. has no way of accurately tracking sepsis deaths, there’s no way to tell what needs to change in order to better fight against the condition. Establishing a national surveillance system could play a huge role in reducing sepsis cases, either by alerting doctors to clinical signs they may miss during diagnosis or counting sepsis deaths to track the progress of awareness campaigns. 

Unlike cancer, diabetes or other diseases with national surveillance programs, health officials and researchers can’t track national sepsis trends.

What is sepsis? 

Sepsis happens when your body has an overwhelming response to an infection. This overreaction can cause life-threatening organ dysfunction, and can kill in a matter of days or even hours. The sooner a health care provider can spot sepsis, the higher a patient’s chances for survival.

There is no diagnostic test for sepsis. Healthcare providers make what’s called a “clinical diagnosis” based on a constellation of symptoms that may include fever, elevated heart rate, abnormal white blood cell count and other factors. The problem is that sepsis symptoms like fever, difficulty breathing and pain are easily confused with other diseases or infections that could clear up on their own. Physicians andhealth authorities also disagree on when sepsis actually starts, making it even more difficult to diagnose and list as a cause of death on a certificate.

We don’t know how much sepsis there really is

In the new report, the CDC analyzed sepsis deaths in the U.S. and found that yearly estimates vary wildly depending on how the data is collected. For instance, if the CDC uses administrative hospital codes to make an estimate, the mortality rate ranges from 168,000 to 381,000 deaths per year. But if they use death certificate data, the numbers range from 146,000 to 159,000 deaths per year. That means the hospital code estimate for sepsis-related deaths is 15 to 140 percent higher than the data drawn from death certificates, and there’s no way to tell if this data is an over- or underestimate of true sepsis deaths.

“This study highlights the need for a more reliable definition of sepsis, based on objective clinical data that can provide an accurate estimate of sepsis cases and deaths and whether there are changes in these estimates over time,” the report’s lead author, Dr. Lauren Epstein, told HuffPost.

We don’t treat sepsis like a ‘real’ disease

Currently, the main ways to treat sepsis include antibiotics to address the infection the body is trying to fight, vasopressors to increase blood pressure, and other supportive care to help maintain blood sugar levels, modify the immune system, and keep the body hydrated and oxygenated.

A nationwide surveillance system could have the added bonus of elevating sepsis to a disease level that has its own targeted therapies, much like the way doctors and scientists approach cancer and heart disease, notes Dr. Paul Walker, president and CEO of the Canadian company Spectral Medical. Spectral is developing an experimental sepsis therapy, and the company plans to publish the results of their six-year U.S. clinical trial later in the year.

A national sepsis surveillance system could change everything

The best way to get an accurate count of sepsis deaths would be to create a national sepsis surveillance system that draws data directly from medical records, so that it isn’t up to individual healthcare providers to interpret patient records and come to a conclusion on their own, Epstein explained. Then researchers could use this data in an algorithm that predicts or diagnoses sepsis, and the outcomes could feed into national trend reports.

For a surveillance system to work, physicians, hospitals and healthcare authorities first have to agree on a definition of sepsis, its symptoms and when the syndrome starts. Is it the 2001 definition put forth by an international coalition of sepsis groups, which has been characterized by critics not sensitive enough? Is it their most recent 2016 definition, published in a February issue of the journal JAMA, which discards an emphasis on inflammation and focuses more on organ dysregulation? Is it something in between?

That’s been the challenge for Dr. Stephen Claypool, the Minnesota-based medical director of the health division of the global IT and software firm Wolters Kluwer.

For the past four years, Claypool and his team have been experimenting with a surveillance system based on a computer algorithm that takes into account things like heart rate, body temperature, white blood cell count and other lab results in a patient’s electronic health records to spit out real-time sepsis diagnoses before doctors can even identify it.

The system is in place in two hospitals in Alabama and Florida, and sepsis mortality rates at both locations have gone down. But deploying the system on a national scale presents several hurdles, Claypool explained.

“A surveillance system is a great idea, but there are challenges,” he said. “Everybody agrees [sepsis] exists, but some people don’t want to call it sepsis until it gets really severe, and some want to call it sepsis earlier.”

If an agreement was reached on when sepsis starts, the American healthcare system could then create an infrastructure for a sepsis surveillance system. But the groundwork could only be laid once the following two questions are taken care of, Claypool said: Do hospitals have the ability to let agreed-upon sepsis algorithms access electronic health records to compute underlying data? And will everyone agree to adopt the program, so that the nation’s hospitals can all be on the same page and begin counting cases of sepsis and sepsis-related death in the same way?

How to spot sepsis

Sepsis is difficult to spot, but the CDC uses a “SEPSIS” acronym to outline the basic symptoms of the condition for patients.

CDC

The CDC’s sepsis graphic both describes and illustrates symptoms.

For now, the CDC has to keep aggregating big data on sepsis in piecemeal ways, which prevents health authorities and researchers from tackling the problem head on. And until a surveillance system is in place, it’s up to awareness campaigns among healthcare providers and the general public to not only prevent deaths by sepsis, but to spur more research in the field.

“More awareness of sepsis in the public could lead to earlier detection and more prompt treatment of sepsis,” said Epstein. “More public interest could also lead to more research into understanding the biological complexity of sepsis and identify biomarkers that can reliably identify sepsis and track clinical improvement.”

CORRECTION: A previous version of this story referred to Wolters Kluwer as Minnesota-based. While the firm’s medical director, Dr. Stephen Claypool, works in Minnesota, the company is headquartered in the Netherlands.  

LIVE-STREAMAccounttability and Justice for International Crime”Challenges and Achievements” Dr.NAVI Pillay

Sri Lanka’s Ability To Deliver Transitional Justice Grim

By Usha S Sri-Skanda-Rajah –April 12, 2016

Usha S Sri-Skanda-Rajah

Sri Lanka’s Ability To Deliver Transitional Justice Grim – Without Fundamental Change

Experts in the field, expect fundamental change on the ground plus in the state apparatus, systems and laws if Sri Lanka is to move towards delivering transitional justice to adhere to and implement the resolution on, ‘Promoting Reconciliation, Accountability and Human Rights in Sri Lanka’ – one that it co-sponsored last October 2015. And more specifically, according to the member of the Sri Lanka Monitoring and Accountability Panel MAP this would also entail creating “an independent and impartial victim centered accountability mechanism.”

Invited to speak at the annual human rights conference on transitional justice convened by the Transnational Government of Tamil Eelam (TGTE) on Sunday April 3rd, 2016 at the Delta Toronto East Hotel, Canada, an esteemed panel of lawyers expressed serious concerns at the “environment that currently exists in the North and East” and the lack of progress made thus far in implementing the resolution passed at UNHRC’s 30th session – given the High Commissioner for Human Rights is scheduled “to present an oral update to the Human Rights Council at its 32nd session” on June 2016, and “a comprehensive report followed by discussion on its implementation at its thirty-fourth session” on March 2017.

The striking parallels that could be drawn from the discourse that transpired was the need for fundamental, meaningful, substantial, significant and far reaching changes on a range of issues pertaining to the delivery of transitional justice in Sri Lanka.

Among the concerns identified in this in-depth, high calibre panel discussion, which made transitional justice impossible now in Sri Lanka are:

• The Sri Lankan military’s fierce grip on the Tamil people of the North and East in the island of Sri Lanka including its civilian and “institutionalised extortion” activities – akin to a “sophisticated” form of control over them
• The Sinhala Buddhist nationalist nature of the state
• The ways in which the Sri Lankan government has obfuscated the issue of accountability both internationally and domestically when speaking to the Sinhala population
• The large discrepancy between what the Sri Lankan government is telling the international community it’s doing on accountability and rule of law initiatives and what is actually taking place on the ground
• Government’s lack of transparency and sincerity to enact reforms – to enable trust and build confidence
• The still ongoing human rights violations and surveillance operations in the North East
• The absence of necessary measures for genuine reconciliation vis-a-vis the Sri Lankan government’s failure to return private lands, abolish the Prevention of Terrorism Act, review the Victims and Witness Protection Act and honour its promise to release political prisoners still languishing without charge
• The fact that torture and sexual violence against Tamils still continue
• The absence of answers for the families of the disappeared
• The occupation of public land and the army’s involvement in civilian activities, such as running shops, farms, hotels and even pre-schools
• The military’s continued distribution of goods to school children and other civilians widely regarded as its attempt to normalise its presence in the North East
• The continued harassment and intimidation of civil society and human rights activists, of families of the disappeared and former members of the LTTE as well as other Tamils
• The fact that testifying before any judicial mechanism would be difficult when the security forces are living next door
• The Sri Lankan government’s lack of honesty as evidenced by its statements post resolution, inconsistent with its obligations it was committed to carry out -for international involvement in any ‘credible judicial process’
• The fact that the Sri Lankan government has so far not demonstrated the political will to ensure an independent, impartial, victim centred accountability mechanism
• That many people in Sri Lanka have been victimised horribly – and if impunity for those crimes continue they’re going to be victimised further

Participants at the panel discussion were, Ms. Barbara Jackman – a Canadian lawyer specialising in immigration and refugee law and US lawyers – Ms. Tasha Manoranjan, an associate in the Litigation practice in the Washington D.C. Office, Prof. Ali Beydoun, Director, UNROW Human Rights Impact Litigation Clinic at the Washington College of Law and Ms. Heather Ryan, currently member of the Sri Lanka Monitoring and Accountability Panel (MAP) and also special consultant for the Open Society Justice Initiative monitoring the Extra-ordinary Chambers of the Courts in Cambodia (ECCC).

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Lack of fiscal discipline has plagued Lankan governments over the years: economist

2016-04-11
Mirror Business conducted an email interview with Dr. Arusha Cooray, the Lankan born Professor of Economics at the Nottingham University Business School (Malaysia), over the current economic situation of Sri Lanka. Dr. Cooray’s work is widely published and she is one of the leading academics in the field 
 of economics Sri Lanka has produced.  Sri Lanka’s economy is currently undergoing extremely testing times amid depleting foreign reserves, an unsustainable debt pile and a looming balance of payment (BoP) crunch. The bad economic policies of successive governments are at fault for the current predicament the country is in, but the present global economic developments  also haven’t been in favour of the US $ 82 billion economy. Following are the excerpts of the interview. 

   What is your opinion of the current status of the Sri Lankan economy? 

Sri Lanka has recorded an impressive growth rate averaging 7 percent over the 2010-2014 period. This has been accompanied by a stable unemployment rate of 4.2 percent. Inflation has in general been trending down. If Sri Lanka maintains the current growth rate of 7 percent, at current prices, it can attain the minimum gross national income  
(GNI) threshold (as defined by the World Bank) required for high-middle-income status  by 2019.  

However, a number of challenges remain. In order to maintain the current growth rate, investment would have to increase from the existing rate of 29.7 percent (CBSL 2014). Strong aggregate growth has not contributed to greater equality in income distribution. 
 The richest 20 percent of households receive 52.9 percent of the total household income of Sri Lanka, while the poorest 20 percent receive only 4.5 percent (Department of Census and Statistics 2012/13). 

Sri Lanka’s public debt currently stands at 75.5 percent of gross development product (GDP) (CBSL 2014), which has given rise to increasing concerns about fiscal sustainability. The commitment of successive governments to social welfare spending has led to a gross primary enrolment rate of 98 percent (World Bank 2016), which is commendable. Now however, it is necessary to take measures to increase the tertiary enrolment rate, which currently stands at 19 percent (World Bank 2016), to add value to economic activity. 

The remarkable growth rate exhibited at the aggregate level further masks a number of provincial and regional level disparities. To mention a few, the mean monthly household income in the Western Province as of 2012/13 was Rs.64,152, while in the Eastern Province it was Rs.30,676. Poverty measures indicate further imbalances.The number of poor households in the Mullaitivu District stood at 24.7 percent compared to 1.1 percent for the Colombo District (Department of Census and Statistics 2012/13).  
Although growth at the aggregate level is driven by the service sector, agriculture accounts for as much as 29.2 percent of average monthly income in the Uva Province, signifying the importance of the agricultural sector for some provinces. 

This regional heterogeneity highlights the need for provincial and district level policy initiatives to create greater equity in income, employment and productivity.Greater cohesion across districts and provinces will ensure that growth is sustainable. Success in achieving high-middle-income status will further depend on the government’s ability to attain and sustain macroeconomic stability. Specifically, curtail large and persistent budget deficits, strengthen and restructure the higher education 
 system and maintain its commitment to increasing investment.   

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Kumar Gunaratnam was not in the JVP

By Dilanka Gunatilaka-2016-04-12

General Secretary of the JVP Tilvin Silva says some of those who broke off from the Janatha Vimukthi Peramuna (JVP) are now in Mahinda Rajapaksa's lap. "Another group has become a very small faction without a vote base".
Excerpts:

?What is the objective of holding the April Heroes Commemoration?
A: The April Heroes Commemoration is being held for the 45th occasion, this time. Forty five years ago on 5 April 1971, the first generation of comrades who laid the foundation of our party took up arms against the oppressive administration that existed in the country then. About ten thousand members of our party sacrificed their lives in that endeavour. What we commemorate on 5 April is that uprising which our party launched on behalf of freedom and social justice, as well as the future of our party. We hold this commemoration under the theme, "Let us commemorate our comrades forever," every year.

?What has the JVP done on behalf of heroes beyond commemorative functions?
A: The objective of those who sacrificed their lives in April of 1971 was building up socialism in this country, to build up a party for that purpose. As a party we did not give up that objective and we brought forward the party they created. We have been able to provide victories for the people during that journey. Where democracy is concerned, we have achieved great things on behalf of the people. Therefore, we are travelling a certain political trajectory towards political objectives in order to fulfil the wishes of April heroes. We believe that it is what we have done on their behalf.

?What were the special objectives of this year's April Heroes Commemoration?
A: Today the capitalist system has run into a serious crisis. Our Prime Minister even had to state in Parliament that since there was a massive economic crisis, the people would have to get ready to take bitter medicine. What they are trying to do is get people to drink bitter medicine and for them to remain on a side. At the same time, their capitalist government is in crisis. They are finding it hard to administer the country. The hopes people had about the government have collapsed. People are being weighed down with economic burdens. People are raising their voices against this situation. Therefore, there should be a solution for that crisis.
The solution for that is not to bring back the defeated Mahinda Rajapaksa gang. We have to defeat everyone of those groups and build a new society within our country. This time we commemorated April Heroes with the objective of mobilizing people's power for that aim.

?Isn't socialism as well as capitalism facing a crisis right now?
A: Capitalism does not allow socialism to exist within capitalism. The fact that capitalism has been unable to fulfil the basic needs of the people of this country has been amply demonstrated by our politics that have brought to power the same two parties alternately for 68 years. Therefore, there is only one alternative before us today. As a political option, which people have not tried out, the JVP should be given an opportunity. We are also using this Heroes Commemoration function as one of the stepping stones to that opportunity.

?Various forces which were with the JVP previously have broken off from the party and are engaged in separate journeys. Did that happen because of a fault of the JVP or due to a fault of the groups that broke off?
A: History has proved who is right and who is wrong. When you look back it is possible to see where those who broke off from the JVP are now. A faction is in Mahinda Rajapaksa's lap. Another group has become a very small faction without any vote base. However, the JVP having won the people's trust is in the process of moving forward. When working as a party of the left, there are difficulties. There are no privileges. As a result some people give up. But the JVP is moving forward amidst many hardships. History has vindicated us.

?Kumar Gunaratnam who was engaged in leftist and JVP politics has been imprisoned today. What are you doing for him on the April Heroes Commemoration?
A: We do not hold the Heroes Commemoration to commemorate those who are alive. It is held to commemorate those who died within the '71 struggle. So, what people who are alive should do is to work towards achieving their own political goals. We too were in prison. We engaged in politics from within the prison. So, if those who represent a revolutionary political movement fall in the face of adversity they cannot carry on with their task.

?I am asking you about something else. He was a powerful figure during a certain era of the JVP. I am asking what the JVP is doing for him?
A: That is not our problem, our fight. It is the members of his party who have to do something for him. He as well others say that he was a powerful figure in the JVP. However, there was no such person in the JVP. His problem is before Court.

?You are saying that a faction that broke off from the JVP has fallen into Mahinda's lap. However, the present leader of the JVP is called the 'Red Baby Elephant' Why are such labels around?
A: Everyone who became pets of capitalists in our country stood up for those capitalists and insulted us. They threw mud at us. Prior to 1971, the 'Eththa' newspaper said we were engaged in a CIA agenda to bait youth in order to attack the Samagi Peramuna. At that time we were called CIA recruits by the Sama Samaja and Communist Parties.
Then after 1977 we were attacked saying we were the tail of the UNP. However, it was the UNP that banned our party and suppressed us. Even today when we are working strongly on behalf of the country two factions are attacking us. One is the capitalists, the other, their pets. We do not take any notice of their reproaches. Our conscience is clear that we are not the pawns of anyone.

?Even though you say that the JVP is going forward strongly, during the last General Election the JVP received very few seats. Doesn't that mean that the JVP too has been rejected by the people?
A: Everyone has the freedom to define it in various ways. However, the success of the JVP cannot be measured only through votes. We have a massive strength which goes beyond votes. Even today we have the largest trade union movement. We are the people who provide leadership to agrarian and youth campaigns. The JVP who has such massive power cannot be evaluated through elections alone. It is difficult to engage in an election campaign without lying to the people, without giving bribes and without distributing Sil cloths. We have policy based votes. It is difficult to obtain policy based votes amidst fraud and corruption. But that does not mean that the JVP has been rejected by the people. Our responsibility is to bring the JVP to power. We are carrying out the necessary tasks to achieve that.

?What will the journey of the JVP be after the April Heroes Commemoration?
A: After the Heroes Commemoration comes the May Day. After May Day we will mobilize to map out our forward journey, to achieve our objectives. That is, we will chase away the existing administration in the country and work towards building a massive, new social force within the country. We will take all necessary steps to strengthen our organizations for that purpose.

?Why do the crowds which attend JVP rallies desert them later?
A: There is nothing like that. It is because they contribute actively that we receive votes. As of this moment the JVP is in a powerful position in politics of Sri Lanka. However, the strength of the Janatha Vimukthi Peramuna cannot be measured via the number of votes received in an election.

Medical error and negligence

By Prof. Susirith Mendis-April 12, 2016, 6:59 pm 

"Twelve-year-old boy died of a toothache on Sunday."

Washington Post Staff Writer

Wednesday, February 28, 2007

The above news item continues: "For want of a dentist ……boy dies after bacteria from tooth spread to his brain. A routine, $80 tooth extraction might have saved him. If his mother had been insured. If his family had not lost its Medicaid. If Medicaid dentists weren’t so hard to find. After two brain operations and more than six weeks of hospital care, the boy died."

The above anecdote tells us about the whole world of patient safety and its myriad implications in a nutshell. I am writing this piece today because I happened to read with avid interest, my good teacher Prof. Carlo Fonseka’s article on "Dangerous Doctoring" in the ‘Sunday Island’ today (10.04.2016). I thought it might be relevant to add a little bit to it since the subject has been brought up by him.

Since I was concerned for a long time about the lack of vigilance of our medical professionals and the Sri Lanka Medical Association (SLMC) - of which I was a member for 10 years, and found how ineffectual it is in ensuring patient safety and patent rights - I made a point of talking about this aspect of medical care among my professionals friends and colleagues. The result was that I was invited to make Chief Guest and Keynote addresses by several medical professional associations. These included Sri Lanka College of Surgeons (SLCOS) on "Surgical Practice, Ethics and the Law"; Sri Lanka College of Obstetricians & Gynaecologists (SLCOG) on "Obstetric Practice, Ethics and the Law" and Sri Lanka Dental Association (SLDA) on "Dental Negligence and Legal Implications".

Thereat, among other things, I said the following:

It is ironic that, the better the standard of healthcare with advanced technology in a modern hospital setting, the more likely a doctor would be found to be negligent. The reports on the incidence of medical error, negligence and misadventure are increasing throughout the world. It is still the tip of the proverbial iceberg. Let me ask a few questions at the outset. Is this increase in incidence because (i) standards have deteriorated? (ii) more doctors are now less skillful? (iii) they are now more careless? (iv) lawyers like to make more money from doctors? (v) patients are more litigious? (vi) medical insurance companies are paying greater compensation? (vii) Or, like in cricket, the technology is exposing inherent mistakes and human errors of doctors?

Let us look at some subtle differences. Negligence is an act of commission or omission by a healthcare provider in which care provided deviates from accepted standards of practice in the medical community and causes injury or death to the patient. For negligence to be legally supported, there is the burden of proof on the victim (or the prosecution) to establish ‘duty of care’. If a breach of ‘duty of care’ is not established, negligence cannot be imputed to the doctor. Furthermore, a causal relationship between the breach of the duty and the damage caused to the patient has also to be established. Negligence can be of two kinds. Criminal Negligence that could lead to sentencing and imprisonment; and Medical (clinical) negligence that leads to damages being awarded.

As against that, there is Medical Misadventure or error or unexpected outcome during medical intervention leading to serious deleterious effect on the patient. If this is within the scope of natural probability, there is no case for negligence. Errors and Mistakes are adverse events that could be prevented given the current state of medical knowledge. But again, within the scope of the expertise, experience and expected knowledge of the doctor, it is accepted with, perhaps, an administrative and/or professional admonition or warning. An Adverse Event is defined as undesirable and unintentional, though not necessarily unexpected, results of medical treatment. An example of an adverse event is discomfort in an artificial joint that continues after the expected recovery period, or a chronic headache following a spinal tap. Adverse events should be reported in hospital audits. But it hardly ever happens in Sri Lanka. This is unfortunate because it’s the collection of such adverse events occurring worldwide that will ensure new evidence-based care in such situations.

To err is human

Here are some interesting statistics:

An average of 195,000 people in the USA died due to potentially preventable, in-hospital medical errors in each of the years 2000, 2001 and 2002, according to a study of 37 million patient records. (The Health Grades Patient Safety in American Hospitals study 2000-02).

According to Dr. Lucien Leape, the author of a Harvard study, the number of deaths from medical errors in hospitals in the US alone, account for the equivalent to the death toll from three jumbo jet crashes every two days. (Public Health Reports, 1999; 114: 302-317 July / August, 1999).

One in every 10 patients admitted to a hospital is the victim of at least one medical mistake. (National Public Radio (NPR) November 21, 2000)

More people die each year in the United States from medical errors than from highway accidents, breast cancer or AIDS, a federal advisory panel reported in 2010.

The report from the National Academy of Sciences’ Institute of Medicine cited studies showing between 44,000 and 98,000 people die each year because of mistakes by medical professionals. "That’s probably an underestimate for two reasons. One is, there are many different kinds oferrors we never learn about - even in retrospective studies - because they are never written down. Second, these studies did not include other areas of care like home care, nursing homes and ambulatory care centers." (Dr. Donald Berwick,in the famous "To Err Is Human" Reportof the Institute of Medicine, Washington DC, 1999).

In a later study, the authors claim that the numbers may be much higher –"between 210,000 and 440,000 patients each year who go to the hospital for care suffer some type of preventable harm that contributes to their death." (Journal of Patient Safety:September 2013 - Volume 9 - Issue 3 - p 122–128)

European data, mostly from European Union Member States, consistently show that medical errors and health-care related adverse events occur in 8% to 12% of hospitalizations. For example, the United Kingdom Department of Health, in its 2000 report - ‘An Organisation with a Memory’ - estimated about 850 000 adverse events a year - 10% of hospital admissions (WHO).

Doctor errors occur more frequently than patients realise.Most instances of doctor errors are not the result of intentional recklessness, but most doctor errors are easily preventable.Doctors are not infallible, no matter how much patients would like them to be.While doctors’ mistakes are not usually intentional, they typically occur when doctors fail to exercise the proper level of care and skill.

The situation developing in the UK with young doctors out on the streets protesting the Tory government’s new healthcare policy to reduce NHS expenditure by insisting on longer working hours for less pay, thanks to the ‘tax avoiding’ Cameron and his government, will inevitably increase ‘human error’ in doctor ‘decision-making’ as well as due to poorer ‘attention to duty’ by fatigued young doctors. Unfortunately, when doctors’ mistakes do happen, the consequences can be disastrous – even fatal. Also, unfortunately, the disaster and fatalities are not affecting the politicians making those anti-people decisions, but affects usually the poor and the unempowered.

What about the situation in Sri Lanka? There is a large body of ‘knowledge’ acquired from anecdotal narratives from patients, their relatives and also doctors (many of my students who are ethical doctors who suffer from pangs of conscience) who speak with us in strict confidence and anonymity on incidents of gross medical negligence in the Sri Lankan medical/healthcare settings. Some are horrendous stories that are clearly in the category of criminal negligence. These occur both in the State and private sectors. But there are no statistics available even on ‘Medical Errors in Sri Lanka’. The Annual Health Bulletin published by the Ministry of Health does not have a category under ‘Indoor morbidity and Mortality Reports’ on patient safety or medical errors. They are unlikely to have such a category for the foreseeable future.

Don’t misunderstand me. I pay tribute to the many doctors who serve their patients with due diligence, dedication and sacrifice. They are the strength and the backbone of our remarkable healthcare system that we have every right to be proud of. Nevertheless, we have much to put our house in order.

There is a veil of professional secrecy that shrouds these ‘dark medical phenomena’ in Sri Lanka. I believe that until such time, that we have the strength of our convictions and are able to rent this shroud asunder, and in spite of all our enviable health statistics, we will remain backward and in the backwoods within the comity of (to coin a term) truly ‘medically responsible’ nations of the world.

‘Expel Arjuna and Dhammika from the Port’ all trade unions demand right in front of Arjuna:P.M. promises to inquire – Arjuna in panic

(Lanka-e-News -12.April.2016, 12.15PM)  Representatives of all  the trade unions of the Ports authority  in one voice requested  the prime minister to remove Minister Arjuna Ranatunge from his ministerial post as well as Arjuna’s brother Dhammika Ranatunge (unsuitable and unqualified) who was appointed to the post of chairman of Ports authority by Arjuna . And owing to the siblings  giving  appointments to   rogues and rascals the Ports authority is fast heading towards disaster, it was alleged. 

During the discussions held at the Temple Trees yesterday (11), with the participation of Arjuna Ranatunge, all the trade union representatives in unison made the above request to the P.M. right before  Arjuna .This is the first time in Sri Lanka ‘s history such a request to expel was made right before the  minister in charge . It is specially noteworthy that it were the SLFP unions also  which made this request to expel Arjuna and his brother.

This meeting that was convened by the P.M. was attended by representatives of all trade unions of the Port . Ministers Arjuna and John Seneviratne were also present with the P.M. Discussions centered on issues concerning  the Port and the employees’ trade unions.At the end , the representatives of the unions said , the manner in which the Port is being run by Arjuna along with his relatives is courting  disaster for the Institution -Ports authority.

Accusations were levelled by the trade union representatives against the minister and his relatives that they are maintaining a ‘dictatorship’ within the Port. The representatives charged that after opening a massage center within the Port , the mistresses and paramours of  Ranatunges are being appointed to high positions. Hence the representatives  were opposed to the administration of the Ranatunges within the Port. Therefore all the unions in unison  urged that the minister and his chairman be expelled forthwith.

The P.M. responded by asking them to be patient  until the Sinhala New year is over , to take a decision. 

Minister Arjuna who turned panicky and jittery following the discussions through his media secretary issued a totally false communique which stated, Nimal Siripala De Silva and Malik Samarawickrema participated in those discussions, which is a blatant and brazen lie. Both of them were not present at the discussions. 

Arjuna by using  most povoctaive  language in the conmmunique which is unbecoming to a responsible minister has described  the trade union leaders as snakes and mongooses , thereby once again demonstrating most clearly that he is not suitable at all to hold a ministerial portfolio , and that he deserves the punishment the trade union leaders are demanding. Moreover , it is against his own SLFP trade union leaders he has used that abusive language , which is  another reason that justifies the popular view that Arjuna as an unscrupulous and incompetent  minister.

The SLFP trade union of the Port was a powerful trade union that conducted a determined campaign in the past against the corrupt and the corruption within the Port during the ‘nefarious decade’ of the Rajapakse brigand. Owing to their resistance and protests gaianst corruption  a large group of them  were dismissed from their posts during the Rajapakse brigand era.It is only after Maithripala Sirisena became the president  injustice meted out to them by the previous regime was remedied.  Now,  strangely self serving Arjuna Ranatunge in his dementia is mounting criticism against the same trade union leaders . 

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by     (2016-04-12 08:31:16)

US Embassy launches interview waiver program for Lankan visa applicants

Apr 12, 2016

The U.S. Embassy in Colombo today launched the Interview Waiver Program (IWP) for eligible visa applicants. The program allows eligible applicants to renew their visas without appearing for a personal interview. IWP may be used only by applicants who have previously traveled to the United States and are renewing B1/B2 visitor visas issued after April 2008. First-time applicants are not eligible. The U.S. Embassy in Colombo will accept applications only from Sri Lankans and Maldivians resident in the Consular District.

“This new program will streamline visa processing while enhancing our customer service to Sri Lankan and Maldivian visa applicants,” U.S. Ambassador Atul Keshap said. “The program is meant to help facilitate travel to the United States.”

All visa applicants will be automatically considered for the program after completing the DS160 online application form and paying the regular processing fees. Previous travel history will determine eligibility for IWP. The online program will prompt those not meeting program requirements to schedule a regular visa appointment.

Eligibility for IWP does not guarantee visa issuance. Approved applications will be ready for pick-up within two weeks of document submission to the U.S. Embassy. Applicants that have already scheduled appointments with the Embassy are not eligible for the program.
- http://www.sundaytimes.lk -

President’s Fund: Right to know

Tuesday, 12 April 2016

As famously said, sunlight is the best disinfectant. Where bright light shines, disease cannot thrive. Good systems go hand in hand with transparency and openness. The right to information, which is now being debated, is not just good, it is absolutely essential.

Every citizen, rich or poor, contributes towards the public sector. It is their taxes that fund the entire State structure, President’s office, ministries, departments and the millions of public servants. When governments negotiate loans, the ensuing debt sooner or later becomes payable by the people. By the time that debt becomes payable, persons who negotiated the loan, politician or bureaucrat, may not be among the living. But the liability is carried by the country and its people, until it is finally paid.

People have a right to know

Given the primacy of the people, it is unnecessary for there to be a long-drawn-out debate about the right to information. The people have a right to know what is happening in public institutions and what is being done with their money, save for a few special areas such as national security , sensitive matters pertaining to the integrity of the State and perhaps certain aspects fundamental to the country’s economic stability. While the need for confidentiality in such (restricted) areas is obvious, here too, the cloak of confidentiality is not a permanent cover. After a reasonable period the cover is removed and access to once confidential information is provided.

The right to information is not limited to activities of the government. What goes on in other places, tax havens, off-shore accounts, real estate deals in foreign lands could hold the clue to the integrity of systems and transactions thousands of miles away. If anything, the global scandal blown up by the Panama Papers bring to attention the unwholesome nexus between power and money, two things that are rarely apart.

According to the information divulged by the leaks, several heads of government have had undeclared accounts there. In one Latin American country, even the head of their anti-corruption body had betrayed the people’s trust, holding large sums of undeclared money in these secretive arrangements.

"Like many institutions associated with this office, there is a common perception that the Presidential Fund too may have been misused, or applied in manners not quite envisaged in the law or in the spirit of its creation. These funds were never meant to be a slush fund to be utilised to help friends and associates of the holder of the office of the President. Nor can such funds be applied in a manner calculated to enhance the political position or the bargaining power of the President. The purpose was more serious and noble"

Abuse of power

A central criticism of the Rajapaksa regime by the Yahapalanaya alliance was that all power was concentrated in the hands of a clique around the President, decisions being made by a small cabal of family members, aided by a staff of sycophants and careerists in the lowest sense. Decision making at the highest levels became ad-hoc, self-serving and opaque.

From the very inception, the office of the Presidency has been seen as unsuitable for a clime and culture such as ours. It lends itself too easily to the abuse of power, perpetuation thereof, and of course, corruption. Even for those who saw some good in the idea of an executive presidency, the Rajapaksa years provided the proof that this office poses far more dangers to the ideals of good governance than any potential for good it may carry in concept.  To abolish the presidency was the one demand that the entire movement against the Rajapaksa regime rallied on.

While we wait for the promised constitutional changes, there are other institutional aspects of the office of the President which could be made more transparent right away, if not dismantled altogether.

Presidential Fund 

The so-called Presidential Fund was created as a discretionary fund to draw on in order to assist those in dire need or deserving of help. Just because the word President is added to the title, the fund does not become holy. All the money for the President’s Fund comes from public sources, including proceeds of lotteries. For contingencies, the usual sources of funding available to a government are slow in coming and usually involve long bureaucratic processes. In such cases, a ready fall back source such as the President’s Fund could be useful. The Act envisages the funds being applied for health, education and other basic needs of those deserving.

Although the image of a benevolent ruler giving and a grateful people receiving is an anachronism in the modern era, we have no issue with the President having discretion in deciding who ought to receive the benefit, and to what extent.  Somebody has to make the decision, and it is assumed that such decisions are made bona fide. However a fundamental fact never to be ignored here is that these are funds collected from the public, for the public.

But like many institutions associated with this office, there is a common perception that the Presidential Fund too may have been misused, or applied in manners not quite envisaged in the law or in the spirit of its creation. These funds were never meant to be a slush fund to be utilised to help friends and associates of the holder of the office of the President. Nor can such funds be applied in a manner calculated to enhance the political position or the bargaining power of the President. The purpose was more serious and noble.

Questionable endowments

Some of the alleged endowments from these funds left the people scratching their heads trying to figure out the sense behind the payment, from what is after all their money. It was once said that the funds were used to meet the medical expenses of a son of a Minister who had met with an accident while living overseas.

More recently it was speculated that several well-heeled professionals, artists and even businessmen have had their medical expenses met through these funds. The criteria surely cannot be fame; this is not a fund for the rich and famous. It is even alleged that some officials in high positions compromised their independence, becoming obliged to the President, by obtaining benefits for their children from it.

Given that the workings of the President’s Fund are not in the public domain, we do not know the truth of any of the speculation about beneficiaries thereof. But this is a public fund, created with public money, and as to who had benefited from it is a matter of relevance to the public. Where the sun shines there is visibility.

The people have a right to know where their funds went.

DEW Gunasekera Cries Foul Over Latest Treasury Bond Issuance

April 12, 2016

Amidst allegations of yet another bond scam at the Central Bank, former chairman of the Committee on Public Enterprises (COPE) and leader of the Communist Party DEW Gunasekera has demanded as to why the Central Bank did not utilize the EPF Fund, or state banks such as People’s Bank or the National Savings Bank to obtain a short term loan facility instead of selling treasury bonds to ‘private capital owners’ at a high interest of 14%.

DEW

Gunasekera charged that even though the Central Bank had initially announced that it was going to issue treasury bonds to the tune of Rs. 40 billion in March 2016, the bank had instead issued bonds to the tune of Rs. 80 billion.

“This is the second biggest financial scam within a year,” he told a news conference on Monday.

Gunasekera also demanded Central Bank governor Arjuna Mahendran to reveal the names of the dealers to whom the treasury bonds were issued.

“This is suspicious because of the manner in which the treasury bonds were doubled even though the original announcement said that bonds will be issued to the value of Rs. 40 billion,” Gunasekera added.

Meanwhile former Deputy Governor of the Central Bank Dr. W. A. Wijewardena has also levelled allegations of the same in a column that was published recently. In his column under the subheading “Another Bond scandal?” Dr Wijewardena wrote; “In the recent past, the central bank, presumably with the approval of the Monetary Board, tried to suppress the interest rates in the market by rejecting all the bids at successive Treasury bill and bond auctions. But this is not a strategy which the bank can follow continuously since it requires the bank to compromise its monetary policy by financing the government through newly printed money. Hence, on occasions, it has to allow the auctions to determine the rates as well as the quantum of funds to be raised.

Dr W.A Wijewardena

“In those auctions, rates invariably go up forcing the bank to sell bonds below their face value causing a loss to the government. In a recent such auction, as reported by the financial website ‘EconomyNext’, a 15-year bond carrying a fixed rate of 11% and maturing in 2030 has been sold at a rate of 14.23% or below its face value. Within three days, the yield rates pertaining to these bonds, according to the web, have plunged by about 2%, increasing their market prices significantly.

“It has allowed the original bond investors to earn a massive capital gain which could have been earned by the Treasury had the bonds in question been issued at the prevailing secondary market yields.”

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