After nearly a month the Karl Heusner Memorial Hospital's investigation into the death of 3-year-old Graciela Perez is complete and there's no surprise there the hospital found that no one is at fault. The hospital report on baby Graciela's death says it was not the hospital or a doctor at fault but rather a breakdown in the system.
For some background, Graciela is the little girl who had ingested an earring, which was lodged on of her lungs. A endoscopy successfully removed the earring and Graciela's prognosis for recovery was excellent. But the 3-year-old took a deadly turn for the worse when she woke up and she began to gag on the tube. Sadly little Graciela died on May 12th and after her grieving father Carlos Lara said the death was due to negligence.
The KHMH launched an internal investigation and yesterday, the finding was released: the KHMH's Chief of Staff Dr. Fernando Cuellar says it was a breakdown in the system and there is no blame to throw around. Rather Cuellar says Graciela's death was unfortunate but for the most part unavoidable.
Dr. Fernando Cuellar, KHMH Medical Chief of Staff
"It was a breakdown in the system and not attributable to any one person or action taken by anybody that led to the demise of Graciela Perez."
Q:_In the end, could her death have been prevented?
Dr. Fernando Cuellar,
"I am not sure. I am not sure quite honestly. It was a difficult case because of the complication that developed unfortunately. (and) Very precise expertise would have to be involved at a very high level to have said totally that it was preventable. I would like to think that any case to a certain extent that comes into the hospital could be guaranteed as such (that we have good outcome) but unfortunately these situations do arise that we cannot take care of."
"I don't think it is a situation where we need to say whose fault it is. A system includes different players and different processes and that's where the focus is on. When we have these cases and we co-manage patients, I think it is in everybody's interest for us to come and work together."
Q: Did negligence play a part in her death?
Dr. Fernando Cuellar,
"I think the word negligence sometimes gets toss around too quickly. It's a overused word and I definitely don't want to suggest that negligence was a factor here."
Representatives from the private sector and Ministry of Health conducted the investigation. It was an investigation that took close a month but one which the still grieving father told us today it is unsatisfactory and incomplete.
Carlos Lara, Graciela's Father
"Well according to this report, certain persons or whoever made some mistakes down the line which led to the death of my daughter but they still are not claiming the negligence as I was saying. They could put out anything to the public to read. But whatever transpired in the room that night I am the only one that knows about it besides the nurses and the doctors. I am still not satisfied with the report that they have concluded their investigations. I mean I just came to know about it through you all and I thought that I would have been informed before this thing goes out to the media. My plans is that I am still feeling it was a part of negligence that caused the death of my daughter and I plan to have it look into further which is I plan to do a lawsuit against the hospital."
Lara says he will be exploring those legal options as early as next week.