On behalf of Nandan and Bhakta,  I am setting out the events of the past year,

so that those who have been following the progress on the legal front or who are wondering where things are up to can have clarity and accurate information.

So, on the 12 month anniversary of Disha's death, after consultation with both Bhakta and Nandan, and with their permission,  in order to clarify the situation, I have put together a brief outline of the events and the legal procedure that has been happening during this past year.

The motivation for taking the action of lodging a complaint is so that emergency hospital procedure should be followed and that this should not happen again to someone else.

We are now aware that other women who have contacted Nandan from this area, had previously had ruptured ectopic pregnancies and had been misdiagnosed, fortunately they are still alive.  Most people don’t bother to make a complaint as it is can be labourious, but the hope is that Mullum will obtain an Ultra sound Scanner, or that staff will be more diligent and this situation will not reoccur, and lives will not be lost.

Sept. 05

Disha and Bhakta were eight weeks pregnant, and they attended after hours Mullumbimby Hospital Accident and Emergency Dept, as they suspected she may be having an ectopic pregnancy and it could burst.

She was seen by nursing staff and Dr Suresh, a very experienced local GP.

According to the written Hospital records they were informed of her sterilisation and reversal, and that she was at eight weeks gestation.  They noted that Disha had abdominal pains and  cramps, nausea and vomiting. Dr Suresh diagnosed acute viral gastroenteritis, treated her accordingly and sent them home.

According to Rural Emergency Clinical Guidelines the first and highest risk to be excluded is the possibility ofa ruptured ectopic pregnancy.

Later that night, Bhakta made a phone call to the Mullum Hospital requesting an ambulance, this request was declined.  Some hours later Disha left her body, paramedics were called and attended and she was rushed by helicopter to Lismore Base and was placed on Life Support. After consultation with Bhakta, the support was discontinued.

Lismore Hospital staff were concerned at the situation and informed the Coroner that there may have been a misdiagnosis.

Oct. 05

Nandan and I  went to the Coroner to make a personal connection and to express her concern and distress at the situation.  She made it clear that her motivation was to avoid this situation happening again and more loss of life.

After consultation with a legal advisor, we lodged a complaint with several local Health bodies to make them aware of our concerns. We also lodged a complaint with the NSW Health Care Complaints Commission ( HCCC).  The body that has the power to make recommendations for disciplinary action should there be a case proven of negligence.

The Coroner accepted Nandan's concerns and assured us he would investigate thoroughly within his powers.

Over the next eight months, I called the Coroner regularly to enquire into the progress that he was making in his investigations.  It was quite a slow process, and he seemed unable to chase up the statements that he required from the medical staff involved.

I expressed our concerns that Dr Suresh had left the country and needed to be pressured into giving a statement.

Over those eight months I also had regular phone calls to the HCCC and informed them of our concerns and that progress was slow.

In June 06 the Coroner signed off on the case, and recommended that the HCCC investigate Disha's death.  However he would not be holding a Coroners Inquest as he was satisfied with his findings and his jurisdiction in the matter.

The HCCC then received all his written evidence, statements and findings.  As their investigation was already underway this has expedited the matter somewhat.

Below is a copy of the letter dated 07 Sept 06 from the HCCC sent to me.

Zenith Virago

HCCC Investigation Progress Report

As discussed this morning, please find below an update regarding the HCCC's investigation.  This investigation concerns the medical care and treatment your friend, Tatjana 'Disha' Schluter, was provided by Mullumbimby Hospital in September 2005. 

I understand that you will be forwarding this e-mail onto Mrs Schluter and Mr Bhakta Huerkens.

I can confirm that all of the information requested by the HCCC has now been received.  The HCCC has received a response from Dr Rananavare (a.k.a Dr Suresh) in addition to statements from all of the other relevant medical staff who were working in the emergency department at the time of Disha's admission to hospital.  Relevant documents have also been obtained from the NSW Coroner in Lismore and the NSW Police.

Following the receipt of the above information, the Commission sought an independent opinion into the medical treatment Disha received at Mullumbimby Hospital from an expert reviewer, who is an emergency doctor in a rural hospital.  The Commission seeks the opinion of an expert reviewer to review and comment on the conduct of the respondents (Dr Rananavare and Mullumbimby Hospital).  The role of the expert reviewer is to advise regarding the accepted standards, whether a departure from that standard occurred, and, if so, the degree of that departure.  The opinion of the reviewer is taken into consideration when the Commission determines its findings. 

A clarifying report from the expert reviewer is expected to be received tomorrow. 

Whilst this report will require some further analysis, the Commission will be looking to determine its findings and consulting with the NSW Medical Board by mid-November 2006.   I am aware that the time factors associated with investigations can be very frustrating, but please let me reassure you that the investigation continues.

8 SEPT 06.

The investigation by the NSW HCCC is still underway, and they have yet  to make a finding
We expect them to have made a judgement on the medical assistance and staff by mid November.