Hospitals now insist on COVID-19 status before attending to patients

Many private hospitals are now turning back sick persons unless such individuals are able to present their COVID-19 certificate, a situation that has inadvertently led to many non-COVID-19 deaths.

Reacting to the practice, a consultant paediatric surgeon and Chief Medical Director (CMD) of Lagos University Teaching Hospital (LUTH) Idi-Araba, Prof. Chris Bode explained that a prominent relation died in March due to this practice by private hospitals.

“He was a cardiac patient who suffered a stroke and was referred to a teaching hospital in a nearby state. The teaching hospital did not open their gates, asking for a COVID-19 test result before they would attend to him. He was taken to a second teaching hospital a hundred kilometres from the first but was similarly rejected at 11:00 p.m. He died on the way to a third hospital after midnight. This was a father, husband, brother, and community leader,” he said.

Bode said a number of related deaths could have been avoided if health institutions, private and public, had embraced elaborate, widespread training for their workers early enough.

Similarly, an epidemiologist and Director General of NCDC, Dr. Chikwe Ihekweazu, said: “While we have to make difficult decisions to balance the demands of responding directly to the COVID-19 pandemic with the need to maintain the delivery of other essential health services, hospitals should not demand COVID-19 status before treating patients for other health conditions. Instead, hospitals should establish a process to screen for COVID-19 such as temperature checks and history taking. If an individual is suspected to have COVID-19, the hospital should have a referral pathway that does not prevent the individual from accessing care for other conditions.”

He said refusing to provide life-saving care to patients could influence their health-seeking behaviour, leading them to self-medication or a search for help in non-accredited facilities.

“We must also recognise that there are patients with terminal illnesses that require regular care in hospitals such as dialysis for those with chronic kidney disease. Denying these patients care can worsen their health conditions and reduce their life expectancy.”

Ihekweazu said hospitals that provide care to patients with terminal illnesses such as Human Immuno-deficiency Virus (HIV) should reduce routine consultations and distribute essential drugs to patients for longer periods. “This way, we can reduce the number of people going to hospitals,” he said.

President, Pharmaceutical Society Nigeria (PSN), Mazi Sam Ohuabunwa, maintained it is against medical and pharmaceutical oaths and ethics to turn patients away for whatever reason.

“It sounds counterintuitive and silly. Where are COVID patients supposed to go except to hospitals and healthcare institutions? So, for me, it is simply idiotic to ask for any certification on the COVID status of any patient before treating or admitting them into a health facility.”

“They criminalised the treatment of COVID-19 patients outside the isolation centres. They wanted to ‘own’ exclusively the management of the COVID-19 pandemic. This, to my mind, is the foundation of turning away patients or demanding certificates because you never could tell who has COVID-19, and nobody wants the shame of having his hospital or healthcare outfit shut as it happened with some notable private hospitals.

“Secondly all the PPEs and other protective equipment were sent primarily to isolation centres and some tertiary government hospitals, largely shutting out the private hospitals and primary health centres.”

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However, a consultant physician and medical director of Medical Art Centre (MART) Maryland Ikeja, Lagos, Prof. Oladapo Ashiru, said it was difficult to decide.

“Individual clinics must decide what is best for them. The fact is, even if a patient is negative, he or she may be at the infective stage when the disease is asymptomatic. The best advice is for doctors to manage all patients with a protective protocol.”

Meanwhile, Director General of Nigerian Institute of Medical Research (NIMR), Dr. Babatunde Salako, recommended: “Emergency centres should be created for COVID-19 related illnesses in government hospitals, to take care of those mild cases that are at home but who may develop progression of the disease.

“Hospitals should not reject patients. Rather, they should create award for triage of patients while waiting for COVID-19 test results. Of course, they need PPEs for this. And since private hospitals charge money, they should not have problems with that. Government hospitals, however, have no right to reject patients. But the government needs to provide PPEs, which I am aware the government is doing.”