Chief Ex­ec­u­tive Of­fi­cer of the North Cen­tral Re­gion­al Health Au­thor­i­ty (NCRHA) Davlin Thomas has cre­at­ed a firestorm fol­low­ing claims that the new team of doc­tors he put in­to the ro­ta­tion at the Cou­va Hos­pi­tal achieved a 60 per cent de­crease in mor­tal­i­ty of COVID-19 pa­tients. Thomas is­sued a me­dia re­lease just af­ter 1 am Sat­ur­day, say­ing that the new team of doc­tors al­so achieved a 25 per cent in­crease in dis­charges.

How­ev­er, in a re­sponse late Sat­ur­day, the T&T Med­ical As­so­ci­a­tion (TTMA) bashed Thomas for his state­ment, say­ing that it has "se­ri­ous con­cerns" about it. The TTMA went so far as to ac­cuse Thomas of ma­nip­u­lat­ing da­ta to serve his nar­ra­tive and de­scribed those ac­tions as "un­con­scionable."

"The re­lease on­ly serves to de­mor­alise our front­line health­care work­ers who have ded­i­cat­ed their lives over the past year to­wards COVID-19 man­age­ment," the body said.

Mean­while, The T&T Reg­is­tered Nurs­es As­so­ci­a­tion (TTR­NA) al­so took um­brage at Thomas's state­ment.

In a so­cial me­dia post, the TTR­NA said that it was a "most shock­ing sta­tis­tic and an even more shock­ing im­pli­ca­tion."

Both Health Min­is­ter Ter­rence Deyals­ingh and Chief Med­ical Of­fi­cer Dr Roshan Paras­ram al­so dis­tanced them­selves from Thomas's da­ta.

When asked about Thomas's state­ment and fig­ures at Sat­ur­day's COVID-19 up­date, Deyals­ingh said the me­dia re­lease was "open to in­ter­pre­ta­tion" and passed fur­ther ques­tions to Paras­ram.

"The Chief Med­ical Of­fi­cer and I have been dis­cussing it and he would give the an­swer," Deyals­ingh said.

But Paras­ram said he too had heard Thomas' an­nounce­ment and did not know where the fig­ures came from.

"What we have been do­ing all along through the epi­dem­ic is mor­tal­i­ty and mor­bid­i­ty meet­ings and that hap­pened every month, so that has been on­go­ing," Paras­ram said.

The ques­tion raised by the me­dia was whether the for­mer team of doc­tors were lax in their re­spon­si­bil­i­ties and the death rate had im­proved af­ter they were gone. Paras­ram said that the Min­istry of Health had not found that to be the case.

"There is a group of physi­cians, all the hos­pi­tals get to­geth­er, we look at the cas­es to learn what has hap­pened and why it has hap­pened. We have not found any­thing un­to­ward so far," he said.

Paras­ram said if the group "picks up on any­thing un­to­ward" ac­tion would be tak­en against the spe­cif­ic RHAs.

"When you say state­ments like that, a 60 per cent re­duc­tion at an in­sti­tu­tion, we see num­bers re­main more or less the same in terms of deaths through­out the sys­tem," Paras­ram said.

"It could just mean that there are more deaths at an­oth­er in­sti­tu­tion in that time frame but again it has to be looked at."

NCRHA CEO Davlin Thomas

Thomas says new team used 'counter-in­tu­itive, out­come-based strate­gies'

Speak­ing to Guardian Me­dia ear­ly Sat­ur­day, Thomas at­trib­uted that turnover to the new team "us­ing counter-in­tu­itive, out­come-based strate­gies" that the old team did not utilise. He said these new strate­gies changed the "process­es and sta­tus quo" and "re­framed care to en­gage mul­ti­dis­ci­pli­nary team si­mul­ta­ne­ous­ly."

The new team, Thomas said, un­der­stood that the dis­ease "is new to the en­tire world." Thomas, how­ev­er, did not re­spond to sub­se­quent ques­tions for more de­tails on what ex­act­ly the process­es and strate­gies were.

But, the TTMA said, "The ob­jec­tive da­ta re­veals that be­tween the 18th to the 27th, the na­tion­al sev­en-day av­er­age mor­tal­i­ty fluc­tu­at­ed be­tween 12-14 deaths /day and has risen even fur­ther there­after. The sug­gest­ed death rate at the Cou­va Fa­cil­i­ty is not re­flect­ed at all in the na­tion­al av­er­age and hence has made no im­prove­ments to the lives of our pop­u­la­tion who con­tin­ue to face this on­slaught."

Ac­cord­ing to the TTMA, sta­tis­tics can­not be viewed in si­los. The med­ical body sought clar­i­fi­ca­tion on four is­sues, in­clud­ing whether the NCRHA have any ev­i­dence to es­tab­lish that the new team, which re­placed four se­nior doc­tors who were ro­tat­ed out of the sys­tem, brought about the "so-called re­duc­tion in the mor­tal­i­ty."

"It is al­so pos­si­ble, among oth­er fac­tors, that this re­sult may be due to the medi­um-term im­pact of the im­ple­men­ta­tion of the poli­cies of the out­go­ing team," the TTMA said.

The TTMA said that re­cent changes to the ad­mit­ting cri­te­ria at the Cou­va fa­cil­i­ty "specif­i­cal­ly ex­clud­ed" the North West Re­gion­al Health Au­thor­i­ty and the South West Re­gion­al Health Au­thor­i­ty from ad­mis­sions, "which would ef­fec­tive­ly have a sig­nif­i­cant re­duc­tion in the num­bers of se­vere­ly ill pa­tients be­ing ad­mit­ted and there­fore these pa­tients' deaths now oc­cur out­side of the fa­cil­i­ty in­stead of with­in."

The TTMA said, "These deaths al­so need to be ac­count­ed, as they do re­main a re­sul­tant im­pact of man­age­ment changes at the CMMF."

The TTMA said that if the man­age­ment prac­tices at Cou­va had cre­at­ed mea­sur­able re­sults in eight days, then the stan­dard­ised poli­cies would be rolled out to in­clude the changes.

"The TTMA strong­ly ab­hors the use of these state­ments to vil­i­fy high­ly ef­fi­cient health­care work­ers for ul­te­ri­or rea­sons and do not serve any pur­pose in the fight against the pan­dem­ic," the med­ical body said.

Police enter the Couva Hospital recently.

RISHI RAGOONATH

TTR­NA: Shock­ing sta­tis­tics

The T&T Reg­is­tered Nurs­es As­so­ci­a­tion al­so slammed Thomas’ re­lease, say­ing it was con­fused about his claim that there has been a 60 per cent de­cline in COVID-19-re­lat­ed deaths and a 25 per cent in­crease in dis­charges at the Cou­va Hos­pi­tal due to the ro­ta­tion of doc­tors on May 20.

In a Face­book post yes­ter­day, the TTR­NA claimed that Thomas' state­ment con­tained the re­lease is “man­u­fac­tur­ing sta­tis­tics" to sway pub­lic opin­ion. Ac­cord­ing to the TTR­NA, it is a "most shock­ing sta­tis­tic and an even more shock­ing im­pli­ca­tion."

"The im­plied al­le­ga­tion is that Dr... and the oth­er spe­cial­ist doc­tors weren't do­ing a very good job and the na­tion should be thank­ful for the CEO's ac­tion. That alone is enough to be a de­press­ing in­fer­ence on any med­ical prac­ti­tion­er. For­tu­nate­ly, all of us who have worked with Dr... and the oth­er med­ical pro­fes­sion­als, will know their world-class ca­pa­bil­i­ty.

"The oth­er sta­tis­tic of a 60 per cent death rate re­duc­tion in eight days, be­ing com­pared with death be­fore the 20th May is even more con­fus­ing. What da­ta was the CEO us­ing?"

TTR­NA said us­ing the Min­istry of Health's tab­u­la­tion, it shows:

1) March 12th, 2020 to May 19th, 2021, the death rate of COVID-19 in Trinidad and To­ba­go was 1.8% (Death rate=Deaths/Cas­es).

2) May 20th, 2020 to May 28th, 2021, the death rate has risen to 3.21% (which is high­er than the world av­er­age of 2%).

"So clear­ly, the CEO was not speak­ing about the na­tion­al sta­tis­tics. Deaths na­tion­al­ly were not his con­cern, nor were deaths in the par­al­lel health­care sys­tem or even with­in the NCRHA's oth­er COVID fa­cil­i­ties."

The TTR­NA said Thomas was ex­clu­sive­ly fo­cused on the Cou­va Hos­pi­tal.

"The same fa­cil­i­ty that our mem­bers have been com­plain­ing about that were not ac­cept­ing crit­i­cal­ly ill pa­tients over the last eight days," the TTR­NA said.

"While the CEO clev­er­ly did not speak on the num­ber of ad­mis­sions to the fa­cil­i­ty, nor has the MoH stat­ed ad­mis­sions per fa­cil­i­ty, we can ex­am­ine this:

"Let's look at the Min­istry of Health COVID-19 up­date #729 (pri­or to May 20th) and #730 to # 738 (May 20th till May 28th).

One will see cu­ri­ous sta­tis­tics emerg­ing:

1) Cou­va is treat­ing 15 less pa­tients (149 down to 134).

2) Cou­va is treat­ing 22 less crit­i­cal pa­tients who would have been in ICU or HDU (65 down to 43).

3) Pa­tients be­ing treat­ed out­side of Cou­va fa­cil­i­ty has in­creased from 394 to 500.

4) Of­fi­cial fa­cil­i­ties used to treat COVID-19 pa­tients al­so have in­creased from 11 to 16.

5) MoH con­tin­ues to not in­clude COVID-pos­i­tive pa­tients who are treat­ed out­side of the of­fi­cial COVID fa­cil­i­ties."

The TTR­NA said that over the last week, the as­so­ci­a­tion was bom­bard­ed with calls from mem­bers about the dif­fi­cul­ties they were fac­ing across RHAs, in­clud­ing hav­ing to treat crit­i­cal­ly ill pa­tients in var­i­ous A&E tents and makeshift COVID wards that were not suit­ed with the nec­es­sary in­fra­struc­ture (ven­ti­la­tors, mon­i­tors, etc) nor the ap­pro­pri­ate spe­cial­ist nurs­es or doc­tors to care for these pa­tients on a long-term ba­sis.

“These pa­tients need­ed im­me­di­ate ac­cess to ICU or HDU care, how­ev­er, they were not be­ing ac­cept­ed in Cou­va for con­fus­ing rea­sons,” the TTR­NA said.

Over the past week, Thomas and the group of four doc­tors have been spar­ring af­ter they were re­moved from the Cou­va Hos­pi­tal. While Thomas said the move was to stave off fa­tigue and give the doc­tors a break, the doc­tors said this was not so.

The NCRHA de­nied that claim and the Unit­ed Na­tion­al Con­gress brought the is­sue to its po­lit­i­cal plat­form. Thomas has since blamed the mix-up on a "com­mu­ni­ca­tion prob­lem."