KUALA LUMPUR, March 10 – Since last December, public ambulance services in Perak stopped providing written documentation verifying the deaths of emergency cases to the deceased’s next-of-kin to avoid litigation.
In a circular dated December 7, 2022, as sighted by CodeBlue, the Perak state health department instructed all Ministry of Health (MOH) hospitals and district health offices (PKDs) statewide to immediately halt the provision of the Death Verification Form (Borang Pengesahan Kematian) by emergency ambulance services to next-of-kin at incident sites, “seeing that this can cause medicolegal and legal impact to the department”.
“This decision was made in the Perak state emergency service management meeting Bil 1/2022 on October 13, 2022, based on the Ambulance and Pre-Hospital Treatment Service Guideline,” Perak state health director Dr Sirajuddin Hashim said in his circular.
“In line with that, the call card on death cases will be immediately forwarded from the Medical Emergency Coordination Centre (MECC), Raja Permaisuri Bainun Hospital (HRPB) to the District Control Centre (DCC) of the Perak contingent of the Royal Malaysia Police through the Malaysian Emergency Response System (MERS) 999 for their further action.”
Dr Sirajuddin’s circular attached his earlier letter to the Perak state police chief, dated November 16, 2022, that informed the police that MOH’s ambulance services in the state would no longer use the death verification form.
“MOH workers will provide a verbal declaration of death for the next-of-kin at the incident site,” the Perak state health director wrote to the police.
“Providing that form to the next-of-kin or to anyone who presents as the deceased’s next-of-kin can create medicolegal and legal implications for this department.”
CodeBlue was unable to find a digital copy of MOH’s Ambulance and Pre-Hospital Treatment Service Guideline, as cited by the Perak state health department.
The Selangor state health department’s 2018 “Guideline and Policy: Ambulance and Pre-Hospital Treatment Service”, however, includes a “No Sign of Life” form in an ambulance response service record with space for the next-of-kin to sign their acknowledgement of medical staff’s explanation of the condition of the patient.
The form, providing a space for signatures by both the next-of-kin and the medical staff, states that it cannot be used for court cases and insurance claims.
The Perak state health director’s December circular was issued a few months after CodeBlue reported in June 2022 the case of school teacher Kumaraveloo Terpari @ Thirupathy, who died earlier on April 13 last year from a heart attack after collapsing in a public area in Ipoh, Perak. HRPB’s ambulance service had withheld cardiopulmonary resuscitation (CPR) intervention from the 43-year-old man.
The Pre-Hospital and Ambulance Service (No Sign of Life) form signed by an HRPB assistant medical officer for Kumaraveloo’s case – without any signature by the next-of-kin – stated that CPR was not provided and claimed that the patient showed algor mortis (body turned cold), a “clear sign of death”, even though HRPB’s ambulance arrived at the scene within just 10 to 15 minutes from the emergency call.
Both the post-mortem report and death certificate state the date and time of Kumaraveloo’s death as April 13, 2022, at 6.40pm – the same date and time when the HRPB medical assistant signed his Pre-Hospital and Ambulance Service (No Sign of Life) report.
Deputy Health Minister Lukanisman Awang Sauni told Parliament last February 27, in response to a question by Ipoh Timor MP Howard Lee Chuan How, that MOH is improving standard operating procedure (SOP) on CPR intervention by the public ambulance service.
Lee had asked whether MOH has a policy that allows for the withholding of CPR by emergency medical services in emergency cases where the ambulance arrives on site beyond 15 minutes from the emergency call, referencing Kumaraveloo’s case.
“In relation to what Ipoh Timor questioned about the provision of CPR intervention, the MOH is improving the SOP to the best to avoid a repeat of past incidents,” Lukanisman replied.
Health Minister Dr Zaliha Mustafa, in a written parliamentary reply to Lee last February 21, revealed that only between 28 per cent and 42 per cent of MOH ambulance arrivals from 2016 to 2022 nationwide met the target of 15 minutes or under for critical emergency cases.