Snake bite victim's family criticises hospital

Official medical report says RAK snakebite victim did not respond to antivenin treatment.

The brother of a Ras al Khaimah man who died in hospital four days after apparently being bitten by a snake says he has filed a malpractice complaint with the Ministry of Health.

The RAK health authority yesterday released a medical report to The National, detailing the events leading up to the July 16 death of Prabhakaran Thazhathupurakkal (TP), a carpenter from India.

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"We filed a complaint with the ministry blaming both the hospitals for failing to give timely treatment," said Velayuthan TP, the victim's brother. "If the hospitals had treated him on time we believe he would still be with us."

Dr Yasser Al Nuaimi, the head of the RAK medical district, said the hospitals took the right steps.

"Our doctors did the appropriate management," Dr Al Nuaimi said. "It is the severity of the toxin and the specificity of the antivenin that makes the difference, if any."

The deputy manager of the Saif Bin Ghobash Hospital, Nawal Al Awadi, said Mr TP's report had been sent out but declined to comment further.

The report said Mr TP arrived at Saif Hospital at 5.13am on July 12, complaining of a painful bite to his right foot. His brother said he had two fang-like puncture wounds.

Snakebite patients are normally admitted at Saif Hospital but the report from last Monday said Mr TP was not confirmed as such a case. The report was requested by the RAK Medical District, the emirate's section of the Ministry of Health.

The doctor who examined him "did not notice any significant external symptoms", the report said.

After having a blood test and taking a painkiller and tetanus shot to defend against infection from the creature's mouth, Mr TP left.

But within two hours the hospital's laboratory tests found his blood to be "highly thin" and he was recalled.

By then his foot had begun to swell and he was given antivenin. Over the next two days in hospital he received additional doses and "other required medicine".

But Mr TP began to have trouble breathing and was transferred to the intensive care unit (ICU). After another day he was sent to the ICU at Saqr Hospital, also in Ras Khaimah, to use its ventilator.

A few hours later he died in the middle of the night.

"His health deteriorated and there was no improvement in his blood thinness," the report said.

In the case of a poisonous bite, antivenin specific to the type of animal must be administered as soon as possible.

Mr TP had not seen what creature had bitten his foot but another brother and then-roommate Raju TP said they lived in an area known to have snakes, and saw two bite marks that matched snake fangs.

"When we approached Saif, they took some blood and sent him home," said Velayuthan TP.

"They called him back after they detected poison in his blood but by this time the poison had spread through his body."

He said his brother told both hospitals he strongly suspected a snakebite.

"The ministry has promised to investigate the issue. We approached them so this does not happen to another person," Velayuthan TP said.

There is one type of antivenin that should counter all three varieties of poisonous snake in the UAE, said Dr Yasser Sharif, the head of medication and medical product safety at the Health Authority-Abu Dhabi.

But Dr Sharif added the antivenin might not work for a bite from a snake brought in from overseas.

He declined to comment on Mr TP's case, saying he did not know the details, but said snakebite patients should be monitored closely for between eight and 12 hours to determine whether they needed antivenin.

Physicians should check for swelling every 15 minutes, as well as other indicators such as blood coagulation, vomiting and nausea, Dr Sharif said.

Anyone attacked by a snake should head straight to the hospital for a professional assessment, he said.

They should draw a circle around the bite, watch for swelling and, if possible, bring the snake with them.

To prevent venom from spreading, they should not raise the bitten area above the rest of their body, especially the heart.

If possible, they should avoid walking and remove watches, belts or other restrictive items that could cause pain if there is any swelling.

Two poisonous snakes common to Ras al Khaimah are the saw-scaled viper, which normally stays in the desert, and the Omani carpet viper that prefers mountainous areas and rocks, said Ajmal Hasan, who studies snakes in the emirate.

Mr TP's body has been sent home to India.