We refer to the letter Unnerving experience at KLH and would like to state that it is policy of Hospital Kuala Lumpur to carry out a detailed investigation of each complaint received. We take each complaint as an opportunity to see if there are any shortcomings in the way patients are managed and if so, to take the appropriate remedial measures.

A detailed review of this patient showed that she was seen at the Emergency Department of HKL at 10.30 pm on the night of March 9 with a complaint of having had seizures at home. She was seen and given appropriate treatment at the Emergency Department and once stable, a decision was made for her to be admitted to the Medical Ward for further investigation and management.

Keeping patient safety as paramount, it is the policy of Hospital Kuala Lumpur that even if patients are entitled to First Class, they will be admitted to an active third class ward's acute cubicle till their condition is sufficiently stable to be moved to a lower dependency ward.

Considering her underlying concurrent medical conditions and her episode of seizures, an appropriate decision was made to admit her to the acute cubicle in the active Medical Ward. She was transferred from the Emergency Department to the ward and arrived at the ward just past midnight (12.30am) on March 10.

On arrival, she was placed in the acute cubicle and she was immediately attended to by the nurses and doctors an call. A review of the patient's medical notes and charts showed that while in the ward she was managed appropriately as per current management guidelines.

Her vital signs were stable and regular blood sugar monitoring revealed that at no time was she in danger of having a hypoglycaemic attack (low-blood sugar).

At 8 am on the morning of March 10, she was seen by the ward consultant and based on the findings of his examination of her and a review of results of urgent investigations ordered , he felt her condition had improved and he then ordered that she be transferred to the semi-acute cubicle in the same ward, pending review of additional results that would be back later that afternoon.

Keeping in mind that this patient's presenting complaint was of a seizure, for her own safety, she was placed in a cot bed, in the semi-acute cubicle. It is with a purpose that some cot beds are made such that they cannot be propped up because it is to ensure that when the patient is fed, it can be done under the supervision of the ward staff to prevent aspiration (food accidentally going into the lungs).

At 8.35am on March 11, she was reviewed by the ward consultant. Taking into consideration the good progress the patient had made since her admission and that all vital signs were stable, in his opinion, he felt that she was stable enough to be transferred to the first class ward.

To prevent transmission of infections, it is standard hospital policy that a patient can only be transferred to a new ward or bed only after the assigned bed has been cleaned and disinfected. That is why although the consultant made a decision to transfer her to the first class ward in the morning, it was only done at 4.20pm that evening as the patient occupying that bed in the first class ward had to leave before the bed could be cleaned and disinfected.. There are standards that have to be followed to ensure patient safety.

Amongst other issues raised in the letter was that the ward was overcrowded. We do not deny that there are times when additional beds need to be placed in our wards. This is because as rightfully noted by the writer of the letter it is very convenient for patients to come to Hospital Kuala Lumpur.

This constant demand on the available beds in Hospital Kuala Lumpur added to our policy of not turning away patients once the ward is full results in us at times needing to place additional beds in the ward. However where possible, stable patients will be sent to other wards as soon as possible. A point to note is that on the night the writer's mother was admitted the ward did not have any additional beds.

As mentioned earlier, all pillows and mattresses in the ward need to be cleaned and disinfected before a new patient is allowed to use them. Being an active ward with many ill patients, the rate of pillows and mattresses being stained by blood or other body fluids is high; as such there are times when it takes longer to clean these soiled pillows resulting in a temporary shortage of pillows.

At such times the ward's contingency plan is to borrow pillows from other wards. As for fans, each cubicle has between 8-10 beds and has two ceiling fans so as such it is not true to say that a single fan is used for 20 beds. As for hot and humid days, the ward sister has additional stand fans which can be placed at appropriate places so as to ensure patient comfort without compromising on safety of patient movement within the ward.

As a standard policy, any patient or relative who needs additional information on the current status of a patient or on any procedure to be done can talk to the ward doctors, especially the doctor or specialist in-charge of the patient.

If the relatives are not around when the doctors are in the wards doing their rounds, then an appointment can be made for the patient's relatives to meet the relevant doctor. Otherwise the doctor on call would be able to give them the information needed.

The writer is director, Kuala Lumpur Hospital.