The sobering comment by Former Health Minister Duane Sands has set off a public debate mixed with fury and uncertainty.
Sands on a local radio station, Guardian Radio, “The Hitback,” with Nahaja Black, said the heightened case of coronavirus in the country has placed doctors in a position to decide who lives and who dies.
The earnest reality of the pandemic has caused doctors to place patients with other life-threatening diseases like heart disease and cancer on the back burner, causing some to die.
With a high degree of certainty, the former minister said, “I understand the implications of my comment…that is happening now.”
Other countries have done the same
Physicians in the United States of America, Canada, and Italy have already been forced to make such moral decisions.
These countries have larger populations and the unexpected wave of the virus has filled their hospitals beyond capacity. Back in early March, Italy’s health system said there were too many patients for each one to receive adequate care. So, the Italian College of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI) published guidelines that doctors should follow as cases worsen.
These patients should be left to die as they place demands on scarce medical resources, according to the document written by a group of medical doctors.
Patients that are old
Patients with comorbidities
Patients who require intensive care
They are guided by the utilitarian approach which stresses the principle, “the greatest good for the largest number,” which would ensure that patients with the highest chance of survival will access intensive care.
Doctors in the Bahamas are reaching that point
When health facilities are full to capacity, physicians are placed in a position where they are unable to manage and provide care for a patient who may need respiratory assistance.
Dr. Nikkiah Forbes, director of the Infectious Disease Programme said she has not personally seen a patient die because of the ability to provide care, but the country is close.
“If we continue beyond capacity, those difficult decisions may have to be made,” she said.
Health workers confirmed that the Bahamas is in a surge and the system is being pushed beyond capacity, emphasizing that the ability to provide care in that environment is challenging.
Nearly twenty people assembled near the front of the Princess Margaret Hospital demanding better treatment and a new facility for patients.
The group gathered, shouting, “Our Lives Matter” with group leaders Kendle Colebrook and Attorney Maria Daxon. They decried the recent deaths of pregnant mothers and newborn babies.
Wearing t-shirts that read, ‘Enough,’ Colebrooke said, “The babies that died in there are our children. They are us, they are us.”
Daxon said, “We came to support the women who died and lost their babies…How many other women are going to die before you spend the taxpayers’ money on a new hospital.”
One woman said as her niece gives birth in a few weeks, she has warned her not to go to PMH.
“I tell her to go private. They killing people in here. You going in here normal, and when you come out, you coming out as COVID.”
The police called to the scene, stood nearby as the small group voiced their concerns.
The group said they lay the blame at the feet of Prime Minister Hubert Minnis and Health Minister Renward Wells.
This comes after a young mother Kayla Edwards-Dean said she was ignored in the hospital and gave birth to twin boys, later learning that the twins died after delivery.
36-year-old Zennrine Ramdas died of womb infection last week, after giving birth to a baby girl in August.
And 20-year-old Shakinah Dean, a confirmed COVID-19 case, died last month after giving birth to a baby boy. Her mom said she did not receive adequate care and was left unattended.
Addressing media on Tuesday morning outside of Cabinet, Wells said he feels a sense of empathy for the mothers.
“Hearing the kind of things that we are hearing in regards to the loss of life, it doesn’t sit well with them, it certainly doesn’t sit well with me and we’re going to do all we can to continue to preserve the life of the Bahamian people.”
Wells said the Public Hospitals Authority is investigating the matter, although no official complaint has been made.
“We have not received any direct complaints, written complaints but the ministry is looking into it,” he said.
The group promised to assemble again on Wednesday.
The long standing problem of boarders at the Princess Margaret Hospital is impeding the health facility’s capacity to house individuals infected with the deadly virus.
Speaking on the issue at the Ministry of Health’s COVID Update, Minister of Health Renward Wells said the issue of boarders is affecting the health system and its handling of COVID-19.
“It cannot be right for all ill patients to lose their lives because they cannot access proper facilities at the hospital,” he said
“Our health professionals are hard pressed to find places to care for very ill people. We need those beds,” Wells continued.
He determined that there are 33 boarders at the Princess Margaret Hospital, some, he says, have been discharged for many years, but family members have not taken them home.
In recent days, health officials decried the lack of beds at the facility as the COVID-19 numbers continually climb. Officials say improving health infrastructure to accommodate the cases and ensuring the most efficient use of beds are most critical.
He then made an impassioned plea to family members of the boarders, “Please, please, help us to help you.”
Wells added that to prevent the collapse of the healthcare system, government has instituted lockdowns to establish social distancing protocols to delay the spread, to reduce the number of people getting sick at the same time and allow for more time to improve the capacity to fight the virus.
COVID-19 cases have climbed to 830, with 69 new cases. 719 COVID-19 cases are active cases and 30 are hospitalized.
Wells warned that the country should brace for more COVID-19 deaths.
Former Minister of Health Duane Sands addressed the issue of boarders before his resignation during the pandemic.
At the time, Sands said his ministry was looking into using nursing homes to accomodate the boarders at PMH, as the situation burdened public finances, exacerbating bed shortage at the facility.
He said it costs several million dollars to care for 31 boarders, at the time.
Health officials would not confirm or deny that it closed three wards at the Princess Margaret Hospital due to 50 persons being exposed to COVID-19. Neither did they respond to concerns that a patient on the maternity ward tested positive for the virus.
When pressed by reporters at the COVID-19 update conference, PMH Chief Hospital Administrator Mary Walker said the facility has conducted “an aggressive reconfiguration of wards across its three institutions,” namely the Princess Margaret Hospital, the Rand Memorial Hospital, and the Sandilands Rehabilitation Centre.
Walker said the reconfiguration occurred because of an increase in the number of staff and persons coming to the hospital testing positive for COVID-19, which she said placed a strain on the bed capacity at the facility.
Walker added that “every effort is being made to ensure that no COVID-19 positive patients are housed or treated at the main campuses of our hospitals.
On Wednesday, the Nassau Guardian reported that three wards including Male Surgial Ward and the Female Medical Ward were not admitting new patients, as nearly 50 patients were exposed to the virus.
It further claimed that an elderly woman in the Female Medical Ward tested positive for the virus over the weekend, as a patient in another ward was exposed to the virus by a healthcare worker.
Minister of Health Renward Wells vaguely addressed the reconfiguration of wards stating only that it “is geared toward better managing patient admissions subject to their medical needs and gender.”
Wells noted that the current exposure of employees and patients across the nation’s hospitals is being managed, subject to international Infection Prevention Control guidelines for infectious outbreaks of this kind and the policies of PHA. He said every effort is being made to mitigate the spread of COVID-19 within the institutions.
Wells said that the Pubic Hospital Authority has increased the distribution of Personal Protective Equipment (PPE) for staff working across hospitals to ensure the safety and protection of valued employees.
Members of the public were asked to contact their personal physicians or local community clinics during the day for non-emergencies, and only access the Accident & Emergency Department in the event of an actual emergency or after-hour services.
Ambulance Services are limited to emergencies only.
It is not known how many health care workers are currently affected with the virus, but in April, nearly 200 workers were quarantined for exposure to COVID-19.