AGARTALA, Aug 11 (TIWN): Dr. Priyanka Saha MBBS, MD (PSYCHIATRY), who was one of the family members of deceased Lt. Bina Pani Roy has written a letter to the GB and AGMC Superintendent asking certain queries. In the letter she wrote, “I would like to state the sequence of events that had happened pertaining to the admission and death of Mrs Binapani Roy (my grandmother) from 31st July 2020 to 2nd August 2020, in the COVID ICU of GBP hospital. My grandmother had bleeding per rectum (had long standing history of haemorrhoids) since 30th July late night. She did not have any fever and chest symptoms. At around 12 noon, the next day, i.e. 31st July, she had a fall in the bathroom and had to be carried out to her bed. Her vitals and oxygen saturation were checked immediately at home, and the saturation was found to be 44%. She was rushed to IGM hospital, where a rapid antigen test was done, which came as positive in less than 5 minutes”.

The Doctor’s further said in the letter :  “She (Lt. Bina Pani Roy) was immediately transferred to GBP hospital, where she reached at 3 pm. One hour post her arrival, she was attended by the junior doctors incharge there. They told the history of fall and haemorrhoids to the resident and no history of cough and fever they had mentioned.

Intravenous channel was made, she was put on high flow oxygen with mask, and intravenous meropenem was administered.

They left, saying that, for serious patients, one attendant has to stay bedside.

 If put on ventilator, there is lack of staff and residents to monitor such serious patient continuously.

My mother (eldest daughter of Mrs Binapani Roy), sat there wearing only a mask, fanning her with a handfan, as there were no fans or AC in that room. At 7.30 pm, senior consultant of General Medicine came for rounds, and he explained my mother that there will be risk with ventilator. Let her continue with the free flow oxygen. My grandmother was continuously bleeding per rectally. The patient in the adjacent bed told my mother  at around 10.30 pm that, there are no bubbles in the water of humidifier bottle of the oxygen line. My mother was calling me and my sister frantically to get her some help, if me or my sister would know someone.

 Her saturation was constantly around 64%. After hours, someone came and checked the oxygen line, inj tranexamic acid was being given, her diaper was changed( on repeated persuasion around 3am, as my mother was unable to lift her and change the diaper). It was around 4 hours or beyond that where her oxygen supply was not there and around 3 am one kind resident came for the change of diaper and it  was corrected that time, I thank the resident literally)

After the oxygen supply again, her saturation did come up to 80%, but she was semiconscious. I reached the COVID building at 2pm on 1st August, relieved my mother, bought all the necessary medications, glucometer( as told by my sister it was unavailable in ward and samples were not sent, which was advised on 31st July 2020 during consultant rounds), cannula, fluids, portable nebulizer ( I bought by myself),fan, wore PPE ( to ensure our own safety) and entered the 3rd floor.

As questioned, I bought the PPEs that I wore. I was constantly sitting beside my grandma from 2pm onwards, and relieved my sister, Dr.Avipsa Das who was in PPE till 2pm.

Around 2.30 pm - I checked my grandmothers, consciousness- could identify place and person, eye opening to verbal commands, often spontaneously was there, motor response (obeying commands), GCS – 12(approximately).

On 1st August around 3.30-4 (time exactly I don’t remember) when I saw her saturation dropping, I saw the mask there was no oxygen coming, neither the mercury pressure valve wasn’t working. I tried calling the resident and wasn’t getting anyone. I see no one around- no nursing staff, sulabh worker/ housekeeping, no resident (later resident got back and informed that he was in rounds).

I called again and again no one came.

I called the RMO regarding the same and was told he is not aware of it and no such complaints he has received. I called RMO probably 5-6 times when I saw my grand ma s saturation was falling. His response to my further calls – he didn’t pick up the phone!

Off late, after rounds the resident picked up the phone and told he has informed the pipeline people as well as trying for oxygen cylinder. Is it the job of a doctor if there is leakage in supply of oxygen or unavailability of oxygen.

A junior resident came in to correct it, but was unaware of the functioning of the oxygen instruments in ICU.  He came and changed the line to other patients who wasn’t requiring oxygen and again I see her saturation rising up.

Whom should I call if there is no oxygen? I have never felt so helpless in my life.

Approximately 4 hours oxygen supply was not there (during my shifting duty).

There is an unused duty doctors room opposite the HDU room, in which me and my sister changed our clothes and wore fresh PPEs on 1st and 2nd of August, till the time my grandma died. She was semiconscious, getting drowsier, dehydrated. No fluids were being given, because they can cause cardiac overload. No Chest Xray, No ECG, No ABG analysis was done. I checked my grandmothers GRBS – 286mg/dl and informed the resident when he came for rounds. The report of CBC, RFT were presumably sent on 31st July, but reports hadn’t come even till next day. We gave injection dexamethasone, inj enoxaparin, nebulization, started fluids at 50ml/hr from 2nd August early morning, after continuous request to the duty doctors. During the morning rounds by the resident around 10.30 am on 2nd august, the resident saw in portable pulse oximetry her saturation was 46% , however the monitors were showing 75%( huge discrepancy – is it a fault in pulse oximeter which was showing accurate results in other patients or the monitor was not working ???)

The resident told he will look into it after he finishes his rounds for other patients.

 I asked for the reports which was sent on 1st and was told on 2nd morning during rounds that the sample was rejected and fresh sample can only be sent on Monday.

Seeing this, We requested many people over phone if she can be taken home, because the only thing she was receiving was intermittent free flow oxygen (based on the availability of the same). We were being advised to get RT PCR test done, and if that comes negative, we can go home.

 I entirely understand that this PCR test is done only after 7 days of admission, but, because of absolutely no COVID symptoms, the suggesting doctors advised for that test out of their fair duty and sheer goodwill towards the patient.

Another senior consultant of medicine came for rounds the same morning. He advised for ventilation if saturation still stays around 75-80%. We were obviously baffled. She was already in arrhythmia since 2nd August morning, saturation was below 60%. She eventually passed away on 2nd August, at 6.24 pm, her death was declared at 7.04 pm.

She was wrapped in an orange bag and kept downstairs, with other unclaimed dead body for days. By help from Dept of Anatomy, the process of releasing her body was expedited and she was cremated that very night. We had to call the doctor in charge on the evening of 3rd August, and he read out the list where my grandma came as NEGATIVE. The report was already made on 2nd August.

 Now my humble questions to you sir –

1.Why was an elderly lady with no fever or chest symptoms, with entirely unrelated symptoms, not clinically examined?

2. Was there any treatment chart maintained?

3.Why was ECG, chest Xray, capillary blood glucose not done?

If asking for ABG is a luxury, then I will not mention that.

Why can’t a dedicated anaesthetist or chest physician not be present for the ‘serious’ patients?

Out of 100 patients, at least 10 patients will need extra care and attention.

4.Why was the ward not cleaned for weeks? ( fomites being a potential cause for hospital acquired infection), Why was there not even fans in the ICU? - statements of the patients in the adjoining beds.

The lady beside my grandma was urinating and defecating on her bed for last 7 days, and NOONE had bothered.

5.Why was continuous supply of oxygen not there?

I kindly remind you sir, I am talking about ‘ICU’

6.Why can the hospital not allow people to go home and die with dignity, if it cannot provide proper treatment?

 We were begging people over phone, and the consultants during round, to please let her go home. We were being told by RMO, that, we need to get permission of District Magistrate for that. Where do we find District Magistrate on a weekend?

7. If there is a h/o fall, what are the things we have been taught to check for in investigation to rule out ???( any head injury- CT scan to look for any bleed, was it done – NO)

8. Was there any input output chart maintained bedside, or a COVID patient doesn’t require such monitoring.

9. What is the coagulation profile of my grandma?  As we know in COVID cases, people die due to thromboembolism and hence we start on prophylactic heparin/low molecular weight heparin and increase based on the coagulation profile and d-dimer level.

Of course we asked for basic investigation- which was not done!

10. IN ICU – “intensive care unit” as we all know investigations come relatively faster in comparison to other general or special ward patients.

After consultant rounds on 31st – why wasn’t the investigations sent on the same day ?

If sample is rejected after 24 hours I get to know, why wasn’t a repeat sample sent?

I was being asked to reply to the following questions by you sir- who gave us PPE and who has given us permission to be beside the patient( I have mentioned in the initial part of the letter)

Me and my sister were nauseated, hypoxic in that PPE, locked inside for 2 days, drank less water and had only biscuits, so that we do not have to go to washroom, as there was no water in washroom. My PGT friends staying there sent us water, toiletries, they left stuff outside like other family members of patients. The reality hits us hard when we lose our precious family member due to sheer mismanagement.

I understand, perhaps saving her was beyond the scope of the available facilities and capabilities of the hospital. She could at least be sent home to die in dignity. The doctors helped us to the best of their abilities, but of course, their abilities were restricted by multiple factors.

Me and my sister’s seven day home quarantine ended yesterday.

 I, on behalf of my entire family, sincerely believe you will look into this matter and bring a positive amendment”.