A suspected COVID-19 patient is being shifted to a hospital ward, in Dalgate, Srinagar, May 2020. Photo: PTI/S. Irfan.
Srinagar: When Abrar Reyaz, a law student, turned 24, he took to Facebook to solicit prayers for good health. He died on June 30.
A promising lawyer and a budding writer from southern Kashmir’s Shopian district, Reyaz died of a head injury caused in a road accident. His sudden death shocked the Valley, triggering an emotional outburst from even those who had never met or seen him.
The reason for this outrage was the decision of health authorities to shift him from the trauma health facility of Shri Maharaja Hari Singh (SMHS) Hospital in the Valley to the Chest Disease Hospital (CDH) after he tested positive for COVID-19.
While SMHS Hospital is a multi-disciplinary institute with a state-of-art neurosurgery department for managing head trauma cases, CDH treats patients with pulmonary ailments. These days, it also doubles as a fully designated COVID-19 facility – the only reason to shift Reyaz, who was then on life-support.
But according to Reyaz’s relatives, from the time he was moved to the CDH until he died, no specialist doctor was available to check up on his injury.
Reyaz’s death brought to the fore some issues with the Jammu and Kashmir government’s standard operating procedure to treat COVID-19 patients, who are shifted to CDH irrespective of any life-threatening ailments they might be suffering from.
The people of the region as well as victims’ relatives have also upbraided doctors and hospital administrators for blindly following protocols that over-focus on COVID-19 – a disease with a mortality lower than 5% – over other, more deadly causes of death, including road accidents and non-communicable diseases.
“He needed treatment for head injury, not COVID-19. But nobody listened to us till he died,” said Zuhaib Ahmad, one of Reyaz’s cousins.
COVID-19 protocol
Reyaz was on his way home with his father and an uncle when the car they were traveling in met with an accident on the highway in Pampore town, on June 27. All three were grievously injured. The uncle died on his way to the hospital while the father-son duo was shifted to SMHS.
Reyaz’s father is currently undergoing treatment at SMHS for fractured ribs and a spinal injury. He is unaware of his son’s death.
According to family members, and a doctor The Wire spoke to, Reyaz had shown signs of improvement when he was placed on a ventilator in war no. 10 in SMHS Hospital.
However, following a phone call from hospital authorities that he had contracted COVID-19, doctors and other hospital staff rushed him to CDH. “The doctors even shelved the plan to conduct his second CT scan to assess the status of his injury,” according to Ahmad.
Dr Saima Rashid, the principal of the Government Medical College, Srinagar, also said Reyaz had been shifted to CDH after other patients in the same ward grew agitated after discovering Reyaz had COVID-19.
“We followed the protocol. The surgical ICU was full of patients and we shifted him to the CD Hospital as per the policy,” Dr Rashid said.
According to her, Reyaz didn’t need any surgical intervention. “Besides, people from anaesthesia and critical care [units] were managing the patient at both hospitals,” she told The Wire. However she didn’t address the question of whether he needed a neurosurgeon’s attention as well.
As per the Jammu and Kashmir COVID-19 response protocol, all patients requiring multi-specialty care are required to be shifted to CDH once they test positive for COVID-19 irrespective of their health condition.
A doctor at CDH told The Wire on condition of anonymity that their “hands are tied” as they are supposed to follow the protocol. “Even a layman could tell you that [Reyaz] needed a neurosurgeon to take care of him, not a pulmonologist,” the doctor added. “It is the head injury that proved fatal for him, not COVID-19.”
Administrators tussle
Reyaz’s case is not the first – of a patient who needed critical care but ended up at CDH. Last month, a 58-year-old-woman who was placed on a ventilator at SMHS was shifted to CDH, and she died less than an hour later. On June 15, an 18-year-old patient with head trauma died at CDH as well, a day after he had been shifted from SMHS.
In May, Dr Naveed Nazir, the head of the department of pulmonology at CDH, had questioned this protocol after three patients admitted at SMHS were shifted to CDH on May 18. They died the same day – due to complications arising from cancer, subdural haemorrhage and cardiac stroke.
A neurosurgeon at SMHS Hospital said Reyaz had suffered a subdural haematoma with diffuse axonal injury – usually caused when the head is rapidly accelerated – in the accident. Until he was being treated at SMHS Hospital, he had been attended to by a team of neurosurgeons. But that was not the case at CDH.
An official from SMHS Hospital’s administrative wing said there was an “urgent need” to set up a separate isolation facility at the hospital for COVID-19 patients who needed care for critical ailments, instead of shifting them to CDH.
Once family members had been informed of the decision to shift Reyaz to CDH, they pleaded to have him referred to Sher-e-Kashmir Institute of Medical Sciences (SKIMS) instead. SKIMS is another multi-specialty hospital in Srinagar. Notably, it has a separate facility for COVID-19 patients as well.
But administrators at SKIMS “refused” to admit him, saying “all beds with life-support system were occupied,” according to one person familiar with the matter.
The medical superintendent at SKIMS, Dr Farooq Jan, refuted this account, however. “I didn’t get any call from the hospital administration, but a relative of the patients phoned me for shifting the patients. Such decisions are taken at the hospital level, and not at the behest of patient’s relatives,” Dr Jan said.
Dr Rashid disagreed: “We have the call recordings of the conversation” in which Reyaz’s admission was declined, she said.
So Reyaz had to be moved to CDH around 8 pm on June 29. He succumbed to his injuries the next day.
