Health chief's response to complaint: women's HIV status 'inconclusive', not confirmed

[rooster59]

Health chief's response to complaint: women's HIV status 'inconclusive', not confirmed

By The Nation

 

 

A senior public health official has questioned a woman’s claim that an inaccurate diagnosis by a state hospital that she was HIV+ had turned her life upside down.

 

“Patient files show her infection status is inconclusive because she has not yet undergone a set of complete tests at Thungsong Hospital,” Nakhon Si Thammarat’s public-health chief Dr Charaspong Sukree said on Friday after the woman’s complaint was widely publicised.

 

Charaspong added that the woman had also missed two scheduled appointments with doctors at the hospital.

 

He said he felt the need to speak up because the patient’s account didn’t tell the fully story and was unfair.

 

Maneerat Konghom, 31, claimed she had endured years of discrimination and social rejection since 2014, when she told friends the hospital had diagnosed her as having contracted the HIV virus. She says she found out only last year that she is in fact HIV-free.

 

Her lawyer also suggested earlier this week that Maneerat might consider filing a Bt30million compensation lawsuit.

Charaspong explained in detail on Friday that Maneerat tested positive to HIV in a Rapid Test but tested negative to the virus in a second (ELISA) test.

 

“Doctors then had similar tests conducted again and the results were the same. So as a precaution, they prescribed antiretroviral drugs for her and her newborn baby in January 2014,” he said.

 

“She was supposed to take another test the following month but she refused and after that, she also missed another appointment.”

 

Charaspong said about a year later, Maneerat returned to the hospital to deliver another baby.

 

“Similar tests were conducted and the same results came up. After two days, she left the hospital and has not returned in the years since. The hospital could not contact her either,” he said.

 

Then, on January 22 this year, the hospital heard that Maneerat had filed a complaint against it and was demanding Bt250,000 compensation.

 

According to Charaspong, the hospital then had a meeting with Maneerat on June 4, when she admitted being at fault for having missed appointments. Nevertheless, the hospital said they would pay her Bt50,000 as a goodwill gesture, an offer she accepted at the time.

 

After that meeting, however, Maneerat appeared to have changed her mind, did not return to pick up the Bt50,000 cheque and went to the media instead.

 

The good news is that the woman has definitely not contracted the virus.

 

“The hospital has also conducted complete tests for her and concluded that she is free from HIV,” Charaspong said.

 

Source: http://www.nationmultimedia.com/news/30372394

 

-- © Copyright The Nation Thailand  2019-07-06

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[geoffbezoz]

Typical, deny any responsibility.

[scubascuba3]

It is strange someone could be initially HIV+ and then after further tests not. I could understand it being the other way around due to the window

[Sheryl]

If what they say is true -- and it makes sense relative to standard medicsl practice -- they are not tesponsible, the patient is for failing to keep sppointments for the follow up testing.

This is very common behavior in Thai patients in my experience. They are very quick to assume that every lump is not only cancer but incurable cancer, and to take initial screening results as definitive proof of a dreaded disease. They then often respond to such situations by running away literally or figuratively. Even educated people sometimes do this and among the less educated it is the rule, not the exception.

It is possible that the hospital staff did not adequately explain to hrr that tesults were still unconfirmed but we have no way or knowing if this was so and it can be very hard to explain such nuances to Thai patients who are not at all sophisticated in their understanding of medical matters.



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[Sheryl]

It is strange someone could be initially HIV+ and then after further tests not. I could understand it being the other way around due to the window

There are different types of tests and their ease and cost is inversely proportional to their specificity (possibility of a false positive result).

 

It is standard practice to start with inexpensive rapid tests especially in low risk screening situations like antenatal care (which ie where this occurred) and then follow up with an Elisa test for those positive on rapid screening (as was apparently done) and then more expensive tests that directly measure presence of the virus (which is what she failed to keep appointments for).

 

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[GroveHillWanderer]

1 hour ago, geoffbezoz said:

Typical, deny any responsibility.

How is it in any way denying responsibility? They did a number of tests which gave contradictory results (a fairly common phenomenon, as @Sheryl explains). They wanted her to come back for further tests to confirm the results but she didn't return and as she admits, she was at fault for missing the appointments. 

[RJRS1301]

59 minutes ago, scubascuba3 said:

It is strange someone could be initially HIV+ and then after further tests not. I could understand it being the other way around due to the window

The Rapid Test is considered to be the conclusive test, as it is a very sensitive test, and if found to give a "positive" it is always followed up with the ELISA.

https://www.ncbi.nlm.nih.gov/pubmed/24404993/

 

I am surprised that there was not the offering of counselling for her, immediately following the RAPID Test result, and also informed the possibility of a "false positive".

I question what type of follow up the hospital attempted following the ELISA results.

Seems there was a system failure .

 

The fact the hospital would have had her first test results, when she returned for the second delivery I would have thought would have alerted them to give counselling and support 

 

 

[KiChakayan]

18 minutes ago, Sheryl said:

There are different types of tests and their ease and cost is inversely proportional to their specificity (possibility of a false positive result).

 

It is standard practice to start with inexpensive rapid tests especially in low risk screening situations like antenatal care (which ie where this occurred) and then follow up with an Elisa test for those positive on rapid screening (as was apparently done) and then more expensive tests that directly measure presence of the virus (which is what she failed to keep appointments for).

 

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And how about the "false negative" cases?

[RJRS1301]

I am wondering if the testing facilities here offer "pretest" counselling, to explain what any test results may mean irrespective of the results.

This is also an opportunity to explore with the client their sexual history talk about possible risk behaviour, give information on risk reduction, and also to refer client if other issues are identified.

Also post test counselling, and recommendations for follow up, and confirm clients understanding of what results may indicate.

 

Edited July 6, 2019 by RJRS1301

[Sheryl]

And how about the "false negative" cases?

With any test there is a trade off between sensitivity (risk of a false negative) and specficity (risk of a false positive). For initial screening sensitivity is most important. With the exception of people in early stages of infection the sensitivity of rapid tests is high.

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[fleur3]

1 hour ago, scubascuba3 said:

It is strange someone could be initially HIV+ and then after further tests not. I could understand it being the other way around due to the window

The first test was a simple rapid test. After that you need to do a specific and extensive test to confirm. Is often done. 

[geoffbezoz]

1 hour ago, GroveHillWanderer said:

How is it in any way denying responsibility? They did a number of tests which gave contradictory results (a fairly common phenomenon, as @Sheryl explains). They wanted her to come back for further tests to confirm the results but she didn't return and as she admits, she was at fault for missing the appointments. 

So how is it then they said in the final para " “The hospital has also conducted complete tests for her and concluded that she is free from HIV,” Charaspong said. "  ?

[GroveHillWanderer]

31 minutes ago, geoffbezoz said:

So how is it then they said in the final para " “The hospital has also conducted complete tests for her and concluded that she is free from HIV,” Charaspong said. "  ?

That just shows that once they were finally able to get their hands on her (after she eventually returned) and do the follow up tests they had wanted to do initially, they were able to get a proper diagnosis. However once again, she didn't return to get these test results and went to the media instead.

 

Based on all the evidence I can see here, the hospital has tried to act properly but they were stymied in their efforts by the patient's repeated failure to show up for appointments or meetings.

[scubascuba3]

I am wondering if the testing facilities here offer "pretest" counselling, to explain what any test results may mean irrespective of the results.
This is also an opportunity to explore with the client their sexual history talk about possible risk behaviour, give information on risk reduction, and also to refer client if other issues are identified.
Also post test counselling, and recommendations for follow up, and confirm clients understanding of what results may indicate.
 

I'm not sure where you get this counselling from, i doubt they have much available

[RJRS1301]

3 minutes ago, scubascuba3 said:

2 hours ago, RJRS1301 said:

I am wondering if the testing facilities here offer "pretest" counselling, to explain what any test results may mean irrespective of the results.
This is also an opportunity to explore with the client their sexual history talk about possible risk behaviour, give information on risk reduction, and also to refer client if other issues are identified.
Also post test counselling, and recommendations for follow up, and confirm clients understanding of what results may indicate.
 

I'm not sure where you get this counselling from, i doubt they have much available

In Australia, NZ and UK it is part of the protocols in government funded hospitals, sexual health clinics and NGOs .

Hence my question.

[scubascuba3]

In Australia, NZ and UK it is part of the protocols in government funded hospitals, sexual health clinics and NGOs .
Hence my question.

Yeah but we are talking about Thailand, where they seem to still have a head in the sand mentality especially in Pattaya

[RJRS1301]

1 minute ago, scubascuba3 said:

26 minutes ago, RJRS1301 said:

In Australia, NZ and UK it is part of the protocols in government funded hospitals, sexual health clinics and NGOs .
Hence my question.

Yeah but we are talking about Thailand, where they seem to still have a head in the sand mentality especially in Pattaya

That is why I  was asking the question, hoping someone who knew the protocols here would be able to give me the facts

[Krataiboy]

Her mistake was telling "friends" she was HIV positive. A recipe for grief.

[hotchilli]

5 hours ago, Sheryl said:

There are different types of tests and their ease and cost is inversely proportional to their specificity (possibility of a false positive result).

 

It is standard practice to start with inexpensive rapid tests especially in low risk screening situations like antenatal care (which ie where this occurred) and then follow up with an Elisa test for those positive on rapid screening (as was apparently done) and then more expensive tests that directly measure presence of the virus (which is what she failed to keep appointments for).

 

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I think this is what happened.. she hasn't really got a case to go to court.... a rapid test showed she had the virus... follow-up tests proved she didn't... having missed further appointments I think she has undermined her own case.