LAHORE - The Mayo Hospital management has failed to comply with the directions of the Punjab Health Department to strictly implement upon the recommendations of an inquiry committee for making improvement in emergency department. The three-member inquiry committee of senior doctors was constituted to probe the incident of a young girl's death at emergency department. The hospital management was given a time period of one week to improve the functioning of the emergency department of Pakistan's largest hospital - Mayo Hospital- by implementing upon the recommendations of the inquiry committee otherwise be ready to face departmental action. The recommendations were presented by three-member inquiry committee headed by Prof Dr Javed Akram and comprising Prof Dr Mushtaq Haroon and AMS admin Dr Majeed of the Mayo Hospital. It was constituted to probe into the death of a young girl and FSc student Sadaf Munir who was brought to emergency department on June 19 with minor pain in abdomen but died when on-duty doctors allegedly gave no proper attention to the patient and used delaying tactics in providing treatment to her. Some important suggestions and shortcomings were highlighted in the recommendations by the inquiry committee to improve the functioning of the emergency department as well as provision of a smooth system for the patients for timely treatment. The basic purpose of the recommendations was to avoid patients' deaths at the largest emergency department of the Mayo Hospital in future.  When contacted the MS Mayo Hospital Dr. Zafar Ikram said that it was not possible to implement upon the recommendations in a shot period of one week however, the hospital management was all set to comply with the orders of the Punjab health department. Treatment at same floor The patients especially those visiting in critical condition are being treated at different floors of the emergency department. The same had happened with the deceased girl who allegedly died due to negligence of the doctors when she was first given treatment at ground floor, then sent to the third floor of the same emergency department building and again she was brought at second floor where she remained unattended for some time. At the end when her condition got critical she was referred to the ground floor where ultimately she breathed her last. It was suggested strongly in the finding report that patients should be handle or treated on the same floor. Patients-doctors ratio The most important issue that need immediate attention of the hospital management was the increase in the strength of on-duty doctors at the emergency department of the Mayo Hospital. At present one doctor is available for atleast 15 patients while this ratio should be atleast one doctor for five patients. Replacement of bureaucratic system by removing EMO, CMO Emergency Medical Officers (EMOs) and Causality Medical Officer (CMO) posted at the emergency department were representing the bureaucratic system. Their postings are of no use as these officers are a burden on the exchequer of the government and use delaying tactics while handling the patients. At present 17 CMOs and 18 MOs are working at the emergency department of the Mayo Hospital. These two lucrative postings are always misused for ulterior motives. The patients should be referred to the registrar of the on-call unit instead these officers to avoid further nuisance and to provide relief to the patients. Proper Documentation The committee suggested that the documentations of a patient about history of disease should consist on one emergency card. Before discharging the patient, one part of the card should be kept in the record of the emergency management while another be handover to the patient. For departmental record, computerized system should be ensured. Counselling Room Prompt action should be taken to establish the counselling room to brief the relatives/attendants to brief them about the patients' health condition when required. Especially, if any patient's death occurs, at least two senior health officials should be present at the counselling room to brief the relatives/attendants of the victim patient about all the treatment procedure adopted while treating their patient to avoid their anger. Media debriefing room Another most important step is to establish media debriefing room to give all details to the media persons about the causality of a patient or agitation of the patient's relatives if occurs. Close Circuit Cameras The close circuit cameras were installed to record all the procedure of health provision, minor and major incidents, and activities of the doctors, paramedics, patients, attendants and other visitors. The close circuit cameras were out of order when incident of young girl Sadaf Munir's occurred. The cameras should be immediately got repaired. Repair of Medical equipments The finding reports also suggested to take immediate action for the repairing and maintenance of medical equipments at the emergency department of the hospital which play vital role in diagnosing the disease before starting any treatment. Most of the equipments were not functioning at the time of incident when the inquiry committee probed the matter. A comprehensive report about the functioning of the medical equipments should be sent to the hospital management on daily basis. It has been learnt reliably that situation in the emergency department was same that had been reported before submission of the recommendations of inquiry committee as the hospital management took no implementation on the Punjab health department's directions regarding implementation on the recommendations.