Some members of the local medical fraternity are raising questions about a new rule being used by some patients to ignore public health advice for them to seek treatment for COVID-19 in isolation facilities..
Consultant Manager of Home Quarantine, Dr Adanna Grandison confirmed on Friday that since the start of the COVID-19 home isolation programme, dozens, including 145 of the over 3,500 people in home isolation, have refused treatment for the virus. She added that other infected people are declining to take prescribed medication.
However, the medical practitioner maintained that patients have always held the right to reject medical care even when suffering with other ailments. For the purpose of home isolation, they are required to sign a ‘refusal of transportation and escalation’ form.
“In any medical setting, there is something called patient autonomy, but they would have to fill a waiver and that is done electronically on the phone where the person contacting you would explain that they are about to fill a waiver on your behalf and you have essentially refused care,” Dr Grandison told Barbados TODAY.
“At the end of the day, once that patient is within sound mind, the patient can refuse, and there are some patients who would prefer to say ‘I prefer to die at home. I am not getting any care’, and that is not only with this programme, that is with a person, for instance who has a cancer diagnosis. They can have a safe surgery, ‘I do not want you cutting me, I am not taking any surgery, I do not want any care, I just want to go in peace’,” the doctor said.
In fact, she revealed that at least two COVID-19 patients passed away after refusing treatment.
The developments are unfolding at a time when many others are dying from the disease at the Accident and Emergency Department of the Queen Elizabeth Hospital without taking a single test.
Despite the right to patient autonomy, Dr Grandison noted that the Ministry of Health and Wellness reserved the right to flag citizens based on the severity of their cases. Persons identified as a ‘yellow’ or ‘red’ medical risk are contacted by a secondary medical team and persuaded of the benefits and the risks associated with staying at home.
Others deemed as social risks are assessed based on factors like their home environments and may be deemed unsuitable for home isolation because of the likelihood of exposing other relatives. In many cases, Dr Grandison revealed that the concerns are based on fear because of the stories reported by others on their isolation experiences.
In all cases, she added that persons who test positive are legally obligated to isolate themselves from the population. Under the Emergency Management [COVID-19] Order, they may also be compelled to enter institutionalised isolation if, because of their behaviour, they are deemed a flight risk.
Nevertheless, some doctors, who spoke on condition of anonymity are complaining that the rules have not been fairly applied.
“These are people who were tested, tested positive and came to the attention of the system and they have to be moved. Now, they say that it is open to everybody, that you can refuse to be moved from your residence. My question is ‘how come before, there was no waiver to sign, you had to go, and CMO had the powers to make you go?’” asked one practitioner.
“The pastor and his wife and the other people before got dragged out with police at the door. So how can these people now sign a waiver, who are in a worse situation than them?” asked another, in an apparent reference to April, when police, army and health officials found themselves at the centre of a standoff with a family from the World Harvest Ministries.
“It just really seems like people in the housing areas aren’t the ones getting the waiver. To me, it seems they are two Barbadoses, maybe three.”
Vehemently refuting the claims, Dr Grandison noted that among the 145 on the waiver list were citizens from various areas including Bush Hall, St Michael, Kingsland Gardens, Christ Church, Drax Hall, St George, Hillaby, St Andrew, and Crab Hill, St Lucy.
“It is all over and it has nothing to do with socio-economic standing. Absolutely not, because everybody deserves the same level of care,” said Dr Grandison. She said that her team would continue its efforts to convince them to seek treatment.
As debates rage on in the public domain about the types of drugs being used at the main isolation facilities, she said medical practitioners were in no position to demand that patients accept medication or intubation.
In a news release on Friday, the Ministry of Health revealed a massive decrease in the number of patients in home isolation, based on an auditing process carried out to clear a backlog of cases that had not yet been purged from the system.
“It should be appreciated that all urgent or serious cases were detected and referred for appropriate care, but the Home Isolation teams were unable to contact some cases due to incorrect contact information provided or recorded at the time of testing,” said the release.
“The Ministry of Health and Wellness is seeking the cooperation of the public by requesting that all persons who are or were in home isolation for longer than 10 days and are yet to receive a Discharge Certificate to contact the Home Quarantine and Home Isolation,” the statement concluded.
kareemsmith@barbadostoday.bb
