Injured law student dies as Kashmir hospitals flip on Covid protocol

• Patient with severe brain injury sent to Chest Diseases hospital
• Principal GMC says contacted SKIMS for referral, MS SKIMS denies receiving any official call
• No repeat CT scan done at SMHS
• Deceased declared COVID positive only verbally, no official confirmation given till death
• At CD hospital, family decries ‘faulty’ oxygen supply, no neurosurgeon available, retesting not done

Srinagar: A promising 24-year-old law student from Kashmir succumbed on Tuesday at a Srinagar hospital ill-equipped to treat the major trauma injuries he had suffered in a road accident.

Abrar Reyaz Sofi, pursuing BA LLB at Central University of Kashmir, was grievously injured on Saturday, June 27, at Pampore area of Pulwama district, when a truck collided into the car he was heading home in.

He passed away at Chest Diseases (CD) hospital here on Tuesday afternoon, after being declared COVID-19 positive a day earlier at SMHS hospital where he was on life-support and was being treated for major brain injury.

A resident of Bona Bazar in Shopian, Abrar, his ailing father, Riyaz Ahmad Sofi, and uncle, Syed Wasiq Peerzada, who was in the driver’s seat, were seriously wounded in the accident. The three were returning home after a visit to SK Institute of Media Sciences (SKIMS), in Soura, Srinagar, where Abrar’s father was undergoing treatment.

While his uncle succumbed on the way, Abrar and his father were brought to SMHS hospital in a grim state.

Riyaz had multiple rib fractures and other external wounds. His son Abrar had suffered a massive brain injury (sub-dural hematoma with diffuse axonal injury), and had to be placed on a ventilator, being monitored by a team of neurosurgeons and anaesthesiologists.

Though initially doctors said there were grim chances of his survival, Abrar’s kin and friends attending him were joyous when he showed some improvement by Sunday evening.

They were hopeful of Abrar’s recovery until a phone call on Monday afternoon declaring him as COVID-19 positive changed everything.

Abrar, till then a high-priority trauma case who needed and was getting satisfactory neurological intervention, suddenly became untouchable.

And then protocol took precedence over patient-care and common sense.

Doctors told the family that since SMHS didn’t treat COVID-19 patients, they had to shift Abrar to a COVID hospital.

As per a friend of Abrar, who was with him during these days, they tried their best to convince the doctors to shift Abrar to SK Institute of Medical Sciences (SKIMS), Soura, which is both a Covid designated hospital and has better neurosurgery facilities.

But doctors at SMHS claimed that SKIMS didn’t have a “ventilator available” even though they agreed that Abrar should ideally have been shifted to the Soura hospital.

In fact, about half-n-hour before Abrar was moved out of SMHS at around 8:15 pm on Monday, Principal Government Medical College (GMC), Prof Samia Rashid told The Kashmir Monitor that SKIMS had refused to admit him citing “non-availability” of beds.

“SKIMS have refused (to admit Abrar) because of non-availability of beds. Since he is Covid positive, he has to be shifted to Chest Diseases (CD) hospital where our anaesthesiology team will look after him,” she said.

Around the same time, Medical Superintendent SKIMS, Dr Farooq Jan too claimed there was no ventilator available when this reporter tried to contact him regarding Abrar’s referral.

Asked if they could arrange one for Abrar, Dr Jan said “you should try tomorrow (Tuesday) morning.”

As per Abrar’s friend, at SMHS, Heads of the Neurology Department, Dr Shafiq Alam, and Department of Anaesthesia, Dr Rukhsana Najeeb, informed them of their decision to shift Abrar to CD hospital.

“He (Dr Alam) even reasoned that there were on-call neurosurgeons at CD hospital, and Abrar wouldn’t face any issues, though we contended that he should have been moved to SKIMS instead,” the friend said.

“In fact, earlier in the day, when Abrar’s COVID results hadn’t been declared yet, Dr Rukhsana told me and Abrar’s cousin that if the test came out positive, they would shift him to Chest Diseases hospital. The doctors had already made up their mind, they were not even thinking of SKIMS,” he added.

Meanwhile, the caller from Covid-19 control room declaring Abrar positive had also told the family that they will receive a message confirming his test result on their registered phone number.

However, even till the time the young man was lowered in his grave Tuesday evening, the message, as per his family members, hadn’t come yet.

When Abrar was being shifted out of SMHS to CD hospital in a critical care ambulance, his family and friends, including this reporter, had exhausted all options pleading officials to refer Abrar to SKIMS instead.

Everyone was baffled how Abrar would receive proper medical attention at CD hospital, which, one, has no in-house neurosurgery department, and two, has lately been in news for all the wrong reasons.

“Abrar had sub-dural hematoma (SDH) with diffuse axonal injury which has mortality of 30% to 50% and COVID has mortality of 2% to 5 %. What should have been given precedence? Besides, how you can you refer a patient with severe road traffic injuries to a hospital that treats cough and cold?”

In fact, a doctor, who knows about Abrar’s case from day 1, told The Kashmir Monitor after his death that sending him to Chest Diseases hospital was “criminal.”

“Abrar had sub-dural hematoma (SDH) with diffuse axonal injury which has mortality of 30 % to 50 % and COVID has mortality of 2% to 5 %. What should have been given precedence? Besides, how can you refer a patient with severe road traffic injuries to a hospital that treats cough and cold?” the doctor said.

Abrar was then transported in a critical care ambulance to CD hospital where he reached at around 8:40 pm.

While completing the admission formalities at the hospital, the family got their second shock of the day when they were told by the officials that the unique number on Abrar’s medical file from SMHS wasn’t matching with the one on the COVID sample requisition form earlier sent from SMHS to the microbiology lab.

Besides, they were also informed that SMHS hadn’t “properly referred” Abrar over to CD hospital.

Around 10 pm, the officials from CD hospital called SMHS and questioned how come they had left Abrar without informing them or the HoD at the hospital.

 “They told us that the number was not matching, and SMHS had not formally referred the patient. The two hospitals sorted it out over the phone before formally admitting Abrar,” said Abrar’s friend who attended him during these days.

The Kashmir Monitor has seen a copy of both the COVID test requisition form and Abrar’s medical file. The MRD numbers do not match (though, it was not confirmed officially whether the numbers should match or are they supposed to be different.)

To mention, at around 11 pm on Monday an official (name withheld) at CD hospital is on record telling the family that the “mistake has happened from SMHS’ end” as they (CD) haven’t received the COVID report, however, have been telephonically told by a doctor at SMHS that Abrar is COVID positive.

Next morning, Abrar’s family met Dr Naveed Nazir, HoD Chest Diseases at the hospital, who refused to re-test Abrar for COVID claiming that even if he tested negative, the hospital, “as per the protocol”, will still treat him as COVID positive.

During this, Abrar’s friends also tried to contact a private lab in Srinagar, which said they had been barred from taking samples from hospitals after the last controversy involving a journalist’s COVID test results.

The Kashmir Monitor tried to contact Dr Naveed Nazir multiple times, however, he was not reachable before or after Abrar’s death.

Testing and referral were not the only struggles for Abrar and his family. His cousin Zuhaib, who attended him, said the attendants of other patients at CD hospital told him there had been problems with the oxygen supply.

“They told us that for the last three days there was some problem with the in-house oxygen supply, and the blood pressure of the patients was dropping. Even since Monday night when we arrived, we realised there was some issue especially with the oxygen supply,” he said on Tuesday, while waiting for Abrar’s body to be transported back to Shopian in an ambulance.

Zuhaib said that while SMHS had already delayed a repeat CT scan of Abrar since Monday morning till he was shifted out, even at CD hospital, the scan wasn’t done.

“Besides, no on-call neurosurgeon visited Abrar from the time he arrived at CD hospital till he died on Tuesday afternoon,” he said.

At around 2 pm on Tuesday, Abrar passed away at the hospital, leaving his family and friends gutted.

“The doctors told us he died of a cardiac arrest,” said Zuhaib. 

While authorities officially counted Abrar among the day’s Covid fatalities, family said he died of “huge medical negligence”.

By dusk, Abrar had been buried as per Covid protocol in Shopian, while his father continues to be in a serious condition at SMHS, unaware of his son’s demise.

Hospitals play blame game!

Principal GMC, Dr Samia Rashid claimed “Abrar was Covid positive and his name was in the list of the people who tested positive during the day.”

She added that since it would have been a “medico-legal” issue for them to keep a Covid patient at SMHS, they got in touch with officials at SKIMS Soura, who claimed they didn’t have a bed available.

“We were very reluctant to shift him to CD hospital because we wanted him to go to neurosurgery at (SKIMS) Soura but they refused to take him. So he was not neglected on our behalf,” Dr Rashid said.

She also refuted claims of discrepancy in Abrar’s Covid test result.

“If they (family) want the test report we can give them one. Besides, these reports are digitally shared with concerned DC, CMO, and other officials,” she said.

Contrary to GMC, Medical Superintendent SKIMS, Dr Farooq Jan, claimed he did not receive any call from SMHS about Abrar.

“We cannot take patients on attendants’ calls. Though we told them that we did not have a ventilator available and asked them to try next (Tuesday) morning,” he said.

Besides, the call should have been of the clinicians at SMHS, he said.

“We did not receive any official call from the hospital. Yes attendants, and some journalist called (referring to earlier attempts made by this reporter), but we told them it was not advisable to shift a patient who was on ventilator support at that time. If the hospital would have called, we would have tried arranging one (ventilator) by shifting patients (internally),” he said.

Dr Salim Tak, Medical Superintendent CD hospital, said Abrar died of “severe head injury coupled with him being COVID positive.”

“His condition was not well. He was very serious,” he said.

Asked about patients complaining of oxygen supply, Dr Tak said “there was no such issue as the hospital had two running oxygen plants.”

He too denied the discrepancy in Abrar’s test result.

(Hirra Azmat, The Kashmir Monitor’s health reporter, contributed to this story)