Featured image: Representative image of the funeral of a man who died due to COVID-19 in Baramulla, on April 25. Photo: PTI
Srinagar: The death of a woman who had given birth to stillborn twins and the subsequent discovery that she was COVID-19 positive has once again brought the lack of adherence to norms in Kashmir’s healthcare centres under the scanner.
On Saturday morning, the woman, then pregnant with the twins, reached the Anantnag Maternity and Childcare Hospital, from a remote village, Kharpora, of south Kashmir.
The doctors admitted her in a general ward for expecting mothers. By 11 am, she had delivered the twins. Both were dead. Late in the afternoon, the patient, in her thirties, died as well. Her family alleged that doctors had been negligent.
When the doctors came to know that the deceased was from a COVID-19 red zone, they took her samples for tests. But, in violation of the guidelines for handling COVID-19 suspects, the hospital administration sent her body home for burial.
Several relatives and neighbours assembled to mourn the death of the woman; her funeral, which was complete with rituals, was attended by many too.
Late on Sunday, reports confirmed the woman had been COVID-19 positive. Hospital administration now faces allegations of mismanagement in what are clear violations of WHO guidelines.
Among villagers, there is understandable panic.
Who sent the body home?
A senior pulmonologist at Government Medical College, Srinagar, said the body should have been kept in the mortuary till the final report was received. “Allowing its burial against the WHO guidelines is criminal. She was an expecting mother and had come from the red zone which made her highly vulnerable to the infection,” said the doctor. “You don’t know how many people who visited her house and participated in her funeral might have contracted the infection.”
Dr Showkat Jeelani, principal, Government Medical College, Anantnag, blamed the hospital administration for sending the body home. “It was a violation of protocol,” he said. “The hospital administration took the decision without taking me into confidence.” The hospital is under the administrative control of the GMC.
The principal said medical superintendent of the hospital, Dr Mirji Andrabi “did not discuss the case at all” with him. “I came to know about it later,” he said.
But, the medical superintendent passed the buck on COVID-19 nodal officer, Dr Ghulam Jeelani. “We followed his instructions. But we wrapped it in a cover and asked the family members to ensure that only five people participate in her funeral,” he said.
Were the local administration or health authorities informed to ensure the burial as per WHO protocol? “We did what the nodal officer instructed,” said the MS. He, however, said the GMC principal was in the know.
The Wire reached out to the nodal officer for his comments. He first said, “Come to the hospital and we will talk.” When told the medical superintendent had claimed they followed his instructions, he said, “I followed the protocol. There were two ways of handling the body – either keep it in the mortuary and wait for the results or dispose of the body as if it were a positive case. We followed the latter procedure.”
Asked why the body was handed over to family and not buried as per the WHO protocol, he shifted the blame on the medical superintendent. “I explained the two options to him. I told him if the attendants agree to take the body straight to the graveyard for burial with a maximum of five people offering funeral prayers, then it can be allowed. My role was limited to this,” he said.
The nodal officer did not respond to the queries on how attendants could have buried the body in the absence of protective gear and without the supervision of doctors. But, he said the medical superintendent should have ensured the body was taken to the graveyard and not home, under police protection.
He also talked about videos on social media which showed a large gathering at the house of the deceased woman. “This is against the protocol,” he said.
Was the village surveyed for expecting mothers?
With sharp rise in the number of COVID-19 cases, the J&K government last week directed surveys in each district to identify pregnant women and plan for their treatment in case of an emergency.
The doctors at the hospital said the deceased woman had had a “full-term pregnancy” and was a “high-risk patient.” But, she reached the hospital on her own despite living in a red zone where any kind of movement is to be strictly monitored and treatment of the cases like hers is to be planned in advance.
“She came in an ambulance, but there was no referral note from local health facility nor was there any communication from the officials in charge of the red zone,” said the doctor.
Syed Yasir, assistant commissioner revenue, Anantnag admitted to a degree of negligence but said there was “need to ascertain the facts and find how it was allowed to happen.”
Cause of deaths and further allegations
In a video that has gone viral on social media, a youth is seen alleging that the doctors did not attend to her for a long time. “They started the treatment only after her condition deteriorated,” says the young man.
A senior doctor at the hospital, however, denied the allegations, saying they decided to treat the patient instead of sending her to Srinagar as she was in an advanced stage of her labour.
“She delivered the first stillborn baby at around 10 am and the second baby, who had also died, almost half-an-hour later,” the doctor said. “These were intra uterine deaths (IUDs). The first one was the case of a dead macerated baby, meaning the death had occurred more than three days ago. The second baby was a fresh stillbirth case,” said the doctor.
That fact that the woman was first admitted to the general ward meant for expecting mothers also raises the question as to whether other patients have been exposed as well to the infection. The decision, according to the pulmonologist, was in violation of the guidelines which says that any pregnant woman arriving in a hospital has to be treated as COVID-19 probable. It was only after the patient suffered IUD that was shifted to an isolation ward, where she died.
But, moments after her COVID-19 report become public on Sunday, Yasir took to Twitter to claim the woman had not died of COVID-19.
The unfortunate death of a pregnant woman yesterday at MCH Ang can’t be attributed to COVID, though samples taken post her death have reported positive. The alleged negligence on part of maternity hospital is being enquired into!
— Syed Yasir (@yasirsyedx) April 26, 2020
But the GMC principal, Dr Jeelani, contradicted the officer. “Since it was a COVID-19 case, the cause of death would be COVID-19, naturally. We have sought a report and it will make things clear,” he said.
In its daily COIVID-19 bulletin, the administration has also updated the number of deaths due to COVID-19 in J&K to seven, including the woman from Kharpora.
Dr Jeelani also questioned why the authorities in charge of the red zone did not ensure shifting the deceased to the hospital under the COVID-19 protocol laid out by the government. “The doctors at the hospital had no information that she was from the red zone,” he said.
Another doctor at the GMC said the “lapses in managing the case at different levels” happened despite the fact the village had been declared red zone on April 24, a day before the woman arrived in the hospital. At least 10 persons including nine members of a single-family from the village had tested positive for COVID-19.
Fear and inquiries
An official said fear has gripped Kharpora and adjoining villages. “A team of health workers visited the village for tracing contacts of the deceased on Monday. Everybody is in shock there and questioning lapses on part of the authorities,” the employee said, asking not to be named.
Dr Mukhtar, the chief medical officer at Anantnag said they have put around 200 people in quarantine, including those who came in contact with the woman before her death and participated in the funeral. “Contact tracing is on,” he said.
Hospital staff are worried too. Three doctors and two paramedics who came in contact with the woman have been sent to home quarantine and the general ward has been fumigated.
Facing flack, the GMC and the J&K administration have ordered separate inquiries to probe the “mismanagement” and alleged negligence by doctors in treating the patient. “We are expecting results by tomorrow and whosoever is found guilty will be punished,” said the GMC principal.