Open Letter from a Medical Doctor to the Health Minister at the Charles Amissah investigation – Life Pulse Daily

Introduction: A National Crisis in Emergency Care

The tragic death of Charles Amissah following an emergency medical incident has become a pivotal moment for Ghana’s healthcare system. This event is not merely a isolated incident but a stark revelation of deep-seated vulnerabilities within the nation’s emergency medical response framework. In response, Dr. Papa Kojo Mbroh, a concerned medical professional, has authored a pivotal open letter to the Honourable Minister for Health, Kwabena Mintah Akandoh, who has commendably committed to chairing an investigative committee. This letter transcends the specifics of one case; it is a urgent, evidence-based plea for a foundational review and strengthening of Ghana’s entire emergency care infrastructure. The nation now faces a critical choice: to treat this as a singular failure requiring only punitive measures, or to seize it as a catalyst for transformative, systemic reform that will safeguard all citizens in their moments of greatest vulnerability. The public’s trust, once eroded, is difficult to regain, and the outcome of this investigation will signal whether Ghana’s health institutions can learn, adapt, and emerge more resilient.

Key Points from the Medical Doctor’s Letter

Dr. Mbroh’s communication distills the complex situation into several core, non-negotiable demands for the investigation and subsequent action. These points form a blueprint for moving from crisis to constructive change.

1. The Primacy of Factual Clarity Over Premature Blame

The letter explicitly states it is not an exercise in assigning immediate individual culpability. Instead, it demands a meticulous, evidence-based reconstruction of the sequence of events. Key questions include: What specific clinical protocols were or were not followed? At what precise points did decision-making occur, and what information was available at those moments? What were the operational conditions of the facility at the time (e.g., staffing levels, equipment availability, bed capacity)? The investigation must establish a clear, unadorned timeline anchored in documented facts, not public speculation or rumor.

2. The Distinction Between Individual Error and Systemic Failure

A central thesis is that even highly competent, dedicated professionals can be set up to fail by a dysfunctional system. The letter urges the committee to examine the “conditions that make such decisions possible.” This means analyzing standard operating procedures, resource allocation, training adequacy, supervision mechanisms, and the culture within emergency departments. Was the staff overwhelmed? Were protocols unclear or contradictory? Did logistical bottlenecks (e.g., lack of ambulances, broken equipment, drug shortages) directly impede care? Identifying a “bad apple” is less valuable than diagnosing a “bad barrel.”

3. The Goal is Institutional Learning, Not Just Punishment

While accountability is essential, the letter argues that a purely punitive approach will not prevent recurrence. Sustainable safety is built on understanding system behavior under stress. Recommendations must therefore be framed as opportunities for structural improvement. This involves creating a “just culture” where staff can report errors and near-misses without fear of automatic dismissal, allowing the institution to learn and build safeguards. Punishment should be reserved for willful negligence or gross misconduct, not for failures born of systemic inadequacy.

4. The Need for Enforceable, Nationwide Standards

Recommendations cannot be vague aspirations. They must translate into specific, measurable, and enforceable standards for emergency care across all Ghanaian health facilities. This includes clear triage protocols, mandatory equipment checklists, defined staff-to-patient ratios for emergency units, and standardized transfer procedures. These standards must be supported by mandatory training, regular audits, and a robust oversight mechanism with the authority to enforce compliance.

5. Protecting Clinicians Acting in Good Faith

A resilient emergency system depends on professionals who can make rapid, decisive clinical judgments without paralyzing fear of legal or administrative reprisal when acting in the patient’s best interest. Reform must therefore include protocols and legal safeguards that support and protect clinicians who follow established procedures and demonstrate sound clinical reasoning, even when outcomes are poor. This encourages decisive action and reduces defensive medicine.

Background: The Charles Amissah Incident and Ghana’s Emergency Care Context

To understand the letter’s urgency, one must contextualize the Amissah case within the broader landscape of healthcare delivery in Ghana.

The Charles Amissah Case: Known Facts and Public Record

Charles Amissah presented at a healthcare facility with a medical emergency on the evening of February 6th. Reports and public documentation suggest delays or deficiencies in the emergency response, assessment, and stabilization processes, ultimately leading to his death. While the full, verified details are the precise subject of the Minister’s committee, the incident has resonated widely because it touches a universal fear: that the system meant to save us may fail when we need it most. The case has been widely covered by outlets like Life Pulse Daily, framing it as a symbol of systemic distress.

Overview of Ghana’s Pre-Hospital and Emergency Care System

Ghana’s emergency medical system is a hybrid of public and private providers, often operating under significant strain. The National Ambulance Service (NAS) is the primary public pre-hospital provider, but faces challenges including fleet availability, fuel constraints, and geographic coverage gaps, particularly in rural areas. Upon arrival at a hospital, patients enter an emergency care system whose capacity varies dramatically between major teaching hospitals and smaller regional or district facilities. Common systemic pressures include:

• Resource Constraints: Shortages of essential emergency drugs, functional ventilators, and diagnostic equipment.
• Human Resource Gaps: Understaffing of emergency units, with nurses and physicians often managing high patient volumes. Specialized training in emergency medicine is not uniformly available.
• Infrastructure Overload: Emergency departments frequently operate beyond capacity, leading to “hallway medicine” and compromised infection control.
• Fragmented Coordination: Communication and coordination gaps between ambulance services, different hospital departments (e.g., Emergency, ICU, Surgery), and between public and private facilities.

Historical Precedents and Prior Calls for Reform

The concerns raised are not new. Ghana’s health sector has long grappled with these issues. Previous reports from the Ghana Health Service (GHS), civil society organizations like the Ghana Medical Association (GMA), and media investigations have highlighted similar patterns: avoidable deaths linked to emergency care delays, equipment failures, and staff burnout. The Amissah tragedy has reignited these longstanding concerns, creating a palpable public demand for action that previous warnings may not have achieved.

Analysis: Deconstructing Systemic Vulnerabilities in Emergency Response

Moving beyond the specific case, Dr. Mbroh’s letter prompts a necessary analysis of the architectural flaws in the emergency care ecosystem.

System vs. Individual: A Root Cause Analysis Framework

Applying a systems-thinking approach reveals how multiple latent failures can align to produce an adverse event (the “Swiss Cheese Model”). For a case like Amissah’s, potential systemic holes include:

• Protocol Deficit: Lack of a universally adopted, simple triage and early goal-directed therapy protocol for common emergencies (e.g., sepsis, trauma, cardiac events).
• Supervision Gap: Inadequate real-time clinical oversight in emergency units, especially during night shifts or high-volume periods.
• Supply Chain Failure: Unreliable availability of critical emergency supplies, forcing clinicians to ration or spend time sourcing items.

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• Decision Support Absence: Lack of point-of-care diagnostic tools (e.g., ultrasound, rapid blood tests) to expedite diagnosis in unstable patients.
• Communication Breakdown: Poor handover procedures between ambulance crews and hospital staff, or between different hospital teams.

An individual clinician’s error (e.g., misdiagnosis, delayed intervention) is often the final active failure, but it is enabled by these pre-existing systemic weaknesses. The investigation must map this entire chain.

The “Pressure Cooker” Effect: How System Strain Erodes Safety

Emergency departments are inherently high-stress environments. When systemic resources (beds, staff, equipment) are chronically insufficient relative to patient demand, a “pressure cooker” effect occurs. Under such duress, normal safety margins erode. Clinicians resort to workarounds, shortcuts, and triage based on resource availability rather than pure clinical need. Cognitive overload increases, raising the likelihood of diagnostic and treatment errors. The Amissah incident may illustrate what happens when the pressure cooker explodes—a system operating beyond its designed capacity finally fails a patient.

Public Trust as a Public Health Asset

The letter correctly identifies public trust as a “foundational component of public health.” When trust in the emergency system wanes, catastrophic behavioral consequences follow: patients with true emergencies may delay or avoid seeking care due to fear of neglect or financial ruin, leading to worse outcomes from treatable conditions. Public cooperation during mass casualty events or disease outbreaks also depends on trust in the system’s capability and fairness. Restoring and maintaining this trust requires transparent accountability and demonstrable, sustained improvement.

Practical Advice: Pathways to a More Resilient Emergency Care System

Based on the analysis, what concrete steps can translate the letter’s urgings into action? The following framework addresses policy, operations, and culture.

1. Immediate Standardization and Protocol Implementation

The Ministry, in collaboration with the GHS and professional bodies like the GMA, must mandate the nationwide adoption of a simplified, evidence-based emergency care algorithm. This could be based on the WHO’s Emergency Care System Framework, adapted for Ghanaian context. Key components:

• Universal Triage: A standardized, color-coded triage system for all emergency units to prioritize patients by clinical urgency.
• Checklists: Mandatory “Sepsis Bundles,” “Trauma Checklists,” and “Stroke Protocols” with clear time-bound actions.
• Minimum Equipment Lists: A legally defined list of equipment and drugs that must be immediately available in every designated emergency facility, verified through quarterly audits.

2. Investment in Human Resources and Training

• Specialized Training: Scale up training programs in Emergency Medicine for physicians and nurses. In the interim, mandate short, intensive certification courses (e.g., Advanced Cardiac Life Support – ACLS, Advanced Trauma Life Support – ATLS) for all staff assigned to emergency units.
• Staffing Ratios: Establish and enforce science-based nurse-to-patient and physician-to-patient ratios for emergency departments, factoring in patient acuity.
• Psychosocial Support: Implement programs to address clinician burnout and moral injury, which directly impact performance and retention.

3. Strengthening Pre-Hospital and Inter-Facility Coordination

• Ambulance Fleet Modernization: Accelerate the procurement and maintenance of advanced life support (ALS) ambulances with essential equipment (monitors, ventilators, defibrillators).
• Communication Network: Create a unified, reliable digital communication platform (e.g., dedicated radio/telemedicine link) connecting all ambulance services with all major emergency departments for real-time updates and pre-notification.
• Definitive Care Networks: Formalize agreements and clear transfer protocols between facilities, designating specific centers for trauma, cardiac, and pediatric emergencies to reduce chaotic transfers.

4. Data, Transparency, and Continuous Quality Improvement

• Mandatory Reporting: All public and private facilities must report key emergency care metrics (e.g., time to physician assessment, time to definitive treatment for time-sensitive conditions, mortality rates) to a central GHS registry.
• Public Dashboards: Publish anonymized, aggregated facility performance data annually to foster accountability and inform patient choice.
• Root Cause Analysis (RCA):strong> Mandate independent RCA for all “unexpected deaths” or serious adverse events in emergency settings, with findings used to update protocols and training, not for individual blame.