This email is to highlight the problems and suffering faced by the patient Rajkumar Rai (Patient ID:[protected] and by us, as his attendants, while he was hospitalized for 14 days in Fortis Gurgaon for treatment of Covid 19 under Dr. Raman Abhi. We have our doubts on the decision of admitting him to your hospital for the treatment when we evaluate the pain and suffering he had to face before he left this world. He felt not only alone and unattended but also continuously complained of the general and medical mismanagement.
He was admitted to the hospital on 30 April 2021 when his oxygen saturation levels were around 88% with mild fever of 101 Celsius. At the time of admission, we were informed that we will be given daily updates of his progress and medication being administered. However, we did not receive a single call in the 14 days of his hospitalisation for any medical/treatment related updates. We had to chase the hospital staff for hours from morning until evening just to know his vitals and ensure his wellbeing. During this process we called at various phone numbers given to us and could only get limited update from nurses or the ward staff who were also not sure or confused between patients sometimes. No duty doctor talked to us to clearly explain his condition and how he was responding to the medication and treatment plan. The same concerns were emailed to the patient care services on 09 May 2021.
After multiple follow-ups we could get some update from the treating consultant Dr. Raman Abhi. The updates given by him were also very brief and in initial few calls he did not even cared to share the details of patient’s vitals. After facing this issue several days, we were advised to meet him in his OPD instead of chasing him on the call. Each time we met the doctor he gave us very unsatisfactory replies without even listening to our questions and kept asking us to reassure the patient. We requested the duty doctor as well as Dr. Raman Abhi to speak to the patient once, either through a phone call or a video call. However, the doctors simply refused each time. We informed the doctor of the patient’s discomfort every day we spoke to him but the doctor never gave us the reason or his plan of action for treatment of those symptoms of the patient. Our patient was having trouble in breathing since the third day of his admission which kept on becoming worse until 11 May 2021. The patient's requirement of oxygen kept increasing from the day of admission. It started with 4 litres and moved to 15-16 litres until he was moved to the Nightingale ward. Each time we informed this to the doctor he asked us to just reassure the patient instead of telling him the patient’s symptoms. We kept reassuring the patient on doctor’s advice but his condition kept on going worse. The medical team took no action or change in treatment to address the rising requirement of oxygen. Neither was the patient moved to high flow oxygen mask or Bi-PAP machine to address the increasing need of oxygen. When we spoke to the doctor on 3 May, he informed us that the patient is on 6 litres oxygen and can be discharged in 2 days once he maintains 93% on 4 litres oxygen. He can be supported with an oxygen concentrator at home. However, when the condition of the patient was deteriorating, the medical team did not diagnose the reasons, alter the medication or address this condition. The CT scan conducted by the hospital was on 8 May, which showed a CT score of 19. The patient was admitted in the hospital with a CT score of 13, also informed to the doctor. We fail to understand the increase in score in 8 days after admission of the patient when the required treatment/medication was provided as per the doctor.
The patient was admitted with a moderate pneumonia case but the deceased summary states the diagnosis as severe pneumonia case. Why did the medical team take 8 days from the admission of patient to conduct the scan when the entire case history was already provided at the time of admission and how can the deceased summary misreport the facts of the case while the condition of the patient actually deteriorated after hospitalisation? Dr. Raman Abhi informed us that the CT scan report of the patient shows progress, however, he still did not address the increasing requirement of oxygen by the patient and extreme difficulty in breathing. In none of our discussion with the doctor during the hospitalisation, we were informed about the damaged lung as mentioned in the deceased summary. If the same was damaged, then why the required treatment was not administered? Why was the option of ECMO not explored? And we fail to understand the deteriorating condition if he was given the right medication/treatment. It shows lack o[censored]tter coherence with the actual condition of the patient, treatment given, updates given to the attendant, results in the blood report (showing drop in CRP, D-Dimer, LDH and Ferritin levels) and the CT scan report.
It was only on 10 May that our patient said that he could breathe a little better as he practiced to sleep in prone position for a few hours. His saturation levels also increased to 95% that day for the first time in his entire stay. However, his cough was still troubling him. Then suddenly on 11 May he felt extremely restless and difficulty in breathing. He asked the duty nurse to check his oxygen saturation levels which had dipped below 80%. He was immediately shifted to the Nightingale ICU ward on a Bi-PAP machine. This sudden shift in the procedure was a shock to the patient and for us. This procedure happened without any prior intimation when the patient had started having lunch after the insulin dose was administered to him. The patient was asked to leave his food and was shifted to the ICU room. This shift to the ICU was not informed by the hospital staff to the attendants. It was only when the patient called his family that they got to know about this sudden change in his health condition and movement to the Bi-PAP machine. We tried connecting to the duty doctor, nurse desk and Dr. Raman Abhi, but nobody spoke to us. This is after we had visited Dr. Raman Abhi in the OPD to take an update on our patient's condition. We even tried the patient care services number but did not get any update on his bed/ward number or heard from the medical team. The patient did not get food for 2 hours after he was given the insulin dose.
The next morning on 12 May, we received a call from the Nightingale ward to get collect the phone of the patient because it was not allowed. That was the first call we ever received from the hospital. On inquiring about his condition, we were told that the patient is on Bi-PAP machine and is in stable condition with oxygen saturation levels of 91%. Upon visit to the hospital, we asked the doctor our concerns on his deteriorating condition to which we received a very rude reply from Dr. Raman Abhi that we should not be concerned unless it is not an invasive procedure. He was rather not sure if the patient has been put on the Bi-PAP machine or not. He informed us that he had advised to put the patient on Bi-PAP machine in case the condition worsens but in until his morning visit, the patient was not shifted on to the Bi-PAP machine. According to the doctor, he was still on high flow oxygen mask. When we went to the Nightingale ward to collect the mobile phone of the patient, we were informed by the head brother that the patient was moved immediately to the Bi-PAP machine previous afternoon and now shifted on to an invasive ventilator since his oxygen level had dropped below 50. It was again a shock for us because we had just visited the doctor who had not informed us of this procedure and according to whom the patient was under intensive monitoring and observation. This must have been a trauma for our patient with whom we could not talk to before he was put through this procedure. Hearing of this sudden change in action, as advised by the duty doctor we headed towards Dr. Raman’s OPD to understand the condition and the next plan of action. This time the answer we got from him was “GOOD if he has been put on a ventilator, maybe he needed it.” Along with this answer we got an advice from him that we should not have come to him twice in the same day since he can abuse the attendants who contact him more than once in a day. For next two days, no duty doctor/hospital staff gave us an update on the patient's condition. We visited the ICU every morning to know about his condition and all we got to hear was that the patient’s condition is critical and his oxygen saturation levels are 88-90%. On 13 May, we were informed that the there is some air outside his lungs and they would perform a surgery to let out that air. On following up in the afternoon, as we kept waiting in the hospital, we were informed that his saturation levels have improved and is around 88-90%. According to the information provided to us, there was no change in his condition prior and post the procedure. On 14 May, at 12:30-12:45pm, we got the same answer that the patient’s condition is getting more critical and he is on low BP. We asked the staff to provide him with medication to increase his BP and not to remove the patient from ventilator support without checking with us. By afternoon when we did not get any update, despite asking multiple times, we spoke to Dr. Raman (as his OPD was not operative) and he informed us that the patient is critical. We asked him for an ECMO machine and he said that the hospital has only 3 machines which have been occupied by relatively younger patients (20-year-old). We fail to understand how a hospital as big as Fortis have only 3 machines and whether the criteria o[censored]sage is age or health condition of the patient. This option was never offered to the attendant and was in fact checked by us. We sensed that we are being kept in dark, we lost our patience and requested the staff to let us meet the patient once. In the evening of 14 May 2021, at 4pm, when we reached the ICU room, we were made to wait for 30 minutes outside the ward despite the MOD informing the medical staff of letting us go inside in advance. When we were finally allowed to go in, we were told by the head brother that the patient has suffered with 2 cardiac arrests. Between 1pm and 4:30pm, if the patient had already suffered 2 cardiac arrest then why was the attendant not informed. Does this not account as an emergency situation/update for the attendant? On going inside to the ward, we witnessed the most horrible situation of our patient who was being given CPR (chest thumps without the machine) by a team of doctors and they told us that they have been trying for 45 minutes and that we should stop now. Thereafter, we were given the worst news possible that he had suffered a cardiac arrest thrice and the doctors could not save him after multiple CPR procedures since that morning. Until today we have not been explained how a patient with oxygen levels of more than 88% on 30 April and 95% on 10 May 2021 and improving blood reports and CT scan reports suddenly suffered a cardiac arrest after being shifted to an ICU where patients are under careful supervision of trained and capable doctors. When we touched our patient he was cold, stiff and his hands and feet were swollen. We are not doctors but we certainly know that a patient's body does not go cold and stiff while being administered a CPR and that it takes few hours after demise. This clearly indicates an artificial CPR process being administered to the patient which is nothing short of cold bloodedness on behalf of the medical team. Around 4:45pm, we were told by the team of doctors inside the ward that the patient is declared dead. However, the deceased summary states the time of death as 5:28pm. All the given scenario indicates that the patient had demised much before it was informed to us. Clearly, another misrepresentation of facts and lack of extreme transparency on behalf of the medical team.
The episodes of humiliation, disrespect, mismanagement, lack of transparency and suffering were many during these 14 days. To list some of them:
1. The patient was given bed bath and change of clothes only once during these 14 days, that too after repeated requests and reminders.
2. Many times, the patient had to call us to request the nurses to give him food and water after his multiple unsuccessful attempts to call a nurse. We could get him some help only after fanatically calling the nurse desk for hours.
3. Once his medication through IV drip had exhausted and he was suffering from severe chest pain and kept banging his hands and legs on his bed and pressing the bedside bell, while we alongside kept calling the nurse desk in the hope someone picks up the phone and send him some help. We later learnt that the bell was not functioning properly.
4. He was given his first dose of Remdesivir on 4 May while the initial plan to start the dose was on 30th April and then give 4 more doses on subsequent dates. When we had inquired the plan for administering Remdesivir doses on 5 May with Dr. Raman Abhi he explained that he had asked the staff to stop the medication since it was not beneficial after 2 weeks since first covid-19 symptoms. However, the patient called us on 5 May saying that the nurse had come again to give him Remdesivir. The patient had updated the nurse about the conversation we had with Dr. Raman Abhi and asked her to provide the medication advise by the doctor. We spoke to the duty doctor, Dr. Pankaj, who informed us that Remdesivir has to be stopped and there is some confusion. He assured that he would speak to Dr. Gursimran about it who had given the instructions to the nurse. The next day, we spoke to Dr. Raman Abhi and told him about the incident. He told us that the patient had already been given 3 doses so it was important to complete the full dose. However, until that day the patient was given only 1 dose as can also be substantiated from the detailed invoice which shows that after 4 May and 5 May, the next dose of Remdesivir was administered on 7 and 8 May 2021.
5. On review of the detailed invoice, we identified a medicine named 'Kabitran 25mg, Atracurium 2.5ml' that was administered to the patient in huge quantities on 12 May. The medicine has been billed thrice on 12 May with the total quantity of 90 units and again 50 units on 13 May. One of the side effects of this medicine is low blood pressure and increase in heart beat which might be the cause of the low BP reported for the patient on 14 May and eventual cardiac arrest. We do not understand nor have an explanation from the doctors on usage of such high quantity of this medicine. Further, if it was being administered for the required reasons which also clearly indicate the condition of the patient then why was the attendant not informed of the same.
6. The second medicine administered was 'Zaxter, 1GM, Meropenem' which is billed at a price of INR 2, 979 each vial. The total amount billed for this medicine is INR 35, 748 for which the retail price on online medical store is INR 899 per vial. The third medicine given to the patient was 'Albucel-LS 20%' billed at INR 7, 075 per unit and the retail price of the same medicine available online is INR 5, 526.
7. Dr. Raman Abhi informed us that the patient would be given insulin through IV in the Nightingale ward which would help control the sugar levels of patient. We would like to understand why the same could not be provided to the patient in the general covid ward which could have saved the patient from deteriorating.
8. The patient was tested for COVID-19 only on 30 April upon admission. Thereafter, even after repeated requests to re-perform the RTPCR test it was either not performed or not shared with us. Patient showed the first symptoms of COVID-19 on 17 April, after more than 20 days of first symptoms the patient was not declared negative for COVID-19 and no test results were shared with us.
9. We had also requested the duty doctor, nursing staff, Dr. Raman to provide physiotherapy sessions to the patient. However, after repetitive requests, the patient was finally provided these sessions only as a formality. The patient informed us that the physiotherapist barely made him do any breathing or chest related activities.
We have cleared all the payments requested by the hospital and conducted ourselves in the most civil and respectful fashion despite such an unprofessional approach by the hospital and the team of doctors treating our patient. We are very saddened by the treatment received by our patient in such a reputed hospital. Also, we are full of doubts on the sequence of events in the last few days and the speed of change of procedures that was escalated. The hospital owes us clear explanations and in the event o[censored]nclear, ambiguous, or defending stands we will have to look for other redressal forums inside and outside the hospital and involve the concerned authorities.
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