(First of two parts)
PERFECTO “Jojo” and wife Benilda May Rom rushed to the hospital to seek aid for their sick daughter, Elliana Grace. But 10 days after, Ellianna died.
The parents shared that what they experienced inside the Southern Philippines Medical Center (SPMC) in Davao City was a series of traumatic events.
They claimed that their sweet little girl was a victim of the hospital’s “malpractice and negligence.”
“I want to be at peace now. I can no longer bring back my daughter’s life. But I also want to give her justice because she suffered too much. She was healthy and only had simple Gastroenteritis. But because of negligence and malpractice...,” Jojo, interrupted by his tears, wasn’t able to finish his statement for a couple of seconds.
But he continued: “Because of this evil (Covid-19) protocol, some doctors and nurses are not anymore performing their moral mandate which is to care and connect with the patients. But she already died. This is no longer our battle. I am sharing this story to prevent other children or patients - in general- suffer the same fate. There should be a change in the system.”
But what exactly happened?
Before hospitalization
According to the patient’s parents, they had their 18-month-old daughter checked at Davao Adventist Hospital after Ellianna got a fever when she consumed bits and juices of a cotton fruit (santol) on September 9.
All her laboratory results were normal except for her blood.
“The results said her blood has infection, high white blood cells. She was frequently discharging bodily wastes. We were advised to have her admitted. So, we decided to bring her to Brokenshire Hospital for admission because we know a doctor there and it’s her birth hospital,” he said.
When they arrived at the Brokenshire Hospital around 8 a.m. on September 11, they waited for around four to five hours before they met and interviewed by a doctor.
“The hospital’s staff already gave a heads up that we will undergo a long process before admission. But we were willing to wait even if it means queuing for hours just for Elliana to be admitted and have proper medication,” Benilda shared.
It’s indeed not the best time to be hospitalized because of the long, arduous process due to Covid-19 protocols.
Again, Elliana’s results were normal, except for her blood infection. Her fever and diarrhea continue. She was immediately tagged as a Covid-19 suspect.
Benilda narrated that around 2 p.m., an infectious disease specialist referred them to SPMC as dictated by the standing protocol that all Covid-19 suspected cases must be forwarded to the state-run hospital.
“I was hesitant at first but we were left with no choice but to follow,” the mother said.
But the doctor, she said, failed to inform them that they will be sent first in an “isolation” facility along with other Covid-19 suspects.
“We felt like they were put in an ambulance without proper referral. My wife was only briefed when she’s inside the ambulance, that they will be housed first in an isolation facility and my daughter will be subject to swab tests. But we followed anyway thinking that SPMC is capable of responding to my daughter’s most immediate medical care,” Jojo said.
’Isolation’ or ‘Consolidation’ facility?
Around 3 p.m., the Rom family arrived at SPMC. They were immediately put inside a Covid-19 isolation facility - the start of their series of unpleasant experiences at the hospital.
“We refuse to call it an isolation room. It’s more of a ‘consolidation’ room where they house all Covid-19 suspects from other hospitals. It is a room with no ventilation. It has no electric fan, let alone an aircon. Our daughter was put there along with other patients suffering from cancer, dengue, pneumonia, etc.,” Jojo said.
He described the room as 10 to 12 square meters small with limited beds shared by patients. He said with the current facility’s condition, chances of further contamination are even multiplied.
“They’re putting you to even risky exposure. One bed is shared by two patients. My wife is just sitting while breastfeeding Ellianna. Mura sila’g baboy na ready na katayon, ingon ana ang feeling inside that hell room (They were like pigs prepared to be roasted, that’s the feeling inside that “hell” room),” the father recounted their horrible experience inside the room.
“Patients are just left most of the time, unattended. If I didn’t personally ask them to at least provide them with an electric fan, they will not put one,” he added.
Ellianna was only swabbed after three hours. No immediate medical care was given. The baby, he said, was still in dextrose provided by Brokenshire Hospital. After the test, they were told to wait until further notice of admission.
Jojo even told one of the nurses to report to the management about their current situation in the isolation facility.
“Why are you pushing to accommodate all of these patients when in fact it is beyond your capacity? The system is the problem here. Why not empower other hospitals?” he told the nurse.
Where’s the compassion?
Due to the risk of Covid-19 infection and to protect the medical frontliners, doctors and nurses are advised, according to the protocol, to lessen contact with Covid-19 patients, including those who are still suspected.
Elliana’s dextrose was replaced at 11 p.m. on September 11, an hour before she was transferred to a Covid-19 ward facility.
Jojo understands the protocol of no-contact policy between patients and medical workers. But he thinks it went a little too much to the point that they are not anymore performing their moral mandate as a medical practitioner. As a result, immediate and proper care that is responsive to the patients’ needs was sacrificed.
From the isolation to the ward facility, nurses and doctors are not allowed to enter the vicinity unless necessary and emergency situations.
Ellianna was only administered with oral zinc, paracetamol and domperidone on September 12 morning; potassium and magnesium through an intravenous (IV) in the evening; and checked by the doctor on September 13 in the afternoon. Elliana still had fever, accelerated breathing and dry lips.
“What’s the use of their PPE (personal protective equipment)? I think the policy set is the one debilitating their profession. This system scraps their moral mandate to care and connect and engage to patients so they will know their status and respond properly,” Jojo said.
He shared that after their transfer to the ward, it took more than 24 hours before they were told about their child’s condition.
“And take note, we knew about the doctor’s recommendations and findings on Ellianna’s condition because I was frequently asking them to check the chart and inform us. We were there since Friday afternoon, but we were advised about our daughter’s condition on Sunday late morning,” he said.
The nurse, he said, even dismissed their paranoia because Ellianna’s disease was just a simple Acute Gastroenteritis.
“That’s the time we know that Ellianna can now eat banana and porridge. There was really no immediate relay of the doctor's findings and recommendations. If I wasn’t being pushy and assertive to share with us what’s in the chart, we wouldn’t know,” he said.
“Most of the communication is from my wife to me to the nurse. What if I don’t have load to communicate, what will happen to us? How about those patients who are not assertive and empowered to question and push them to take action?” he added.
Critical Ellianna
The parents observed that the dextrose drip was quite slow as their daughter only consumed around 200 mL from late evening on September 11 to Sunday noon. They kept on raising this concern to the nurses. But they were only told to press and tick the dextrose to allow better flow as they were not allowed to always enter the facility.
Until Benilda can’t stay cool as Ellianna’s condition is seriously getting worse. The baby was pale, had difficulty breathing and seriously ill.
“That’s the time the doctor went in to check on our daughter. After checking, they all seem startled. They found out the dextrose drip was not aiding her enough because it was folded. They transferred the dextrose to her left hand because the right hand wasn’t responding anymore. Her heart rate reached 200 per minute and she’s now on oxygen therapy,” she said.
The doctor said Ellianna should be intubated because of her breathing difficulty. The parents agreed as they trusted the doctor’s suggestion to save their child.
The intubation was performed late evening of September 13, in the ward facility outside the Intensive Care Unit.
During the first attempt, she spewed the food she ate. Benilda said the doctor asked the nurse for suction, but the latter’s response surprised her: “Wala ta’y ana nga supply karon, doc (we are out of supply for suction, doc).”
“Can they perform such medical procedure with incomplete supply and equipment?” the mother asked.
She was sedated on the second attempt but still unsuccessful. They stopped the intubation process as Ellianna’s heart rate slowed down to 140-160 per minute and her oxygen level went back to 95 -98.
“Based on my observation, the child’s brain was affected due to their procedure. It’s like the baby was choked. Because of their negligence for the past days, my daughter’s condition worsened,” Jojo claimed.
He also questioned why intubation was done outside of ICU.
They were transferred to CBDU because the hospital’s Pediatric Intensive Care Unit (PICU3) is already 100 percent occupied.
Sedation should only work for six hours, but to Benilda’s surprise, Ellianna was still not awake.
“True enough, the doctor said her prolonged sleep must be caused by a brain problem,” the father shared.
Covid-19-negative
Ellianna tested negative for coronavirus on September 14 based on her reverse transcription-polymerase chain reaction (RT-PCR) test on September 11. However, she was still admitted to PICU3 on September 15, a Covid facility, despite the negative swab test results. Doctors explained that the first test is not confirmatory especially now that the child’s condition is critical. Further tests must be done.
“I was worried more because we will be separated when she’ll be inside PICU3. While waiting for her to be transferred, I talked to my daughter while she’s asleep. I told her to fight and that I’m just outside waiting for her. I prayed for her and played her favorite songs,” the mother shared.
The patient was intubated immediately upon transfer in PICU3. The doctor, Benilda said, told them that the initial findings were pneumonia and meningitis, and will be subject to CT Scan for confirmation. Elliana was already on Glasgow Coma Scale (GCS)6.
“The doctor said our daughter must undergo lumbar puncture to determine if it’s bacterial or viral meningitis. But she should be at least on GCS 11. I told them that we are willing to wait until Ellianna’s condition improves,” Jojo said.
He added that while the baby was in a comatose state, second and third swab tests were performed on September 14 and 16. But all yielded negative results.
On September 19, noontime, they were advised to transfer to a non-Covid facility (PICU1). Ellianna is already on GCS 9. Her heart rate is normal, but she still has pneumonia and low platelet count.
Elliana’s last moments
The transfer was challenging as they have to travel from the second floor of the building to the third floor of the main building. It took them 10 to 15 minutes to transfer while the patient was on a stretcher and on self-inflating bags or Ambu bag support only.
“While our baby was being transferred, her heart rate fluctuates. But what was questionable was the monitor screen shows 140, 137, 98 heart rate per minute, but the warning light keeps on flashing. The warning sign means heart rate is already 180 to 200 per minute. Her oxygen level also went to as low as 90-93,” he said.
They immediately called the attention of the nurse but were answered with “our-machine-is-defective,-it-doesn’t-read-accurately-sometimes” response.
“She was unstable again. But before she entered PICU1, I saw voluntary movements by her foot and hand. And when we took a look at her from outside, Jojo saw her eyes open. We then immediately asked the nurse to visit her even just for a few moments,” the then-hopeful mother shared.
They were reunited for about five to ten minutes only.
“We talked to her and played her favorite violin music. We were so happy that she fulfilled our request for her to fight. But we were still worried as her heart rate, oxygen level and blood pressure were not normal. Her fever also persisted,” Jojo said.
Their reunion was cut short due to protocol. The couple left to buy some stuff for their baby. But little did they know, it’s their last moment as a family.
“Around 4 p.m., we received a call to get back to the hospital immediately. We then found out that Ellianna was being revived and on life support,” the grieving father shared.
Elliana was declared dead at 5:10 p.m. on September 19 with a diagnosis of Multi-organ Dysfunction Syndrome Secondary to PCAP D; Bacterial Meningitis; Non-Covid-19.
Jojo then questioned, how come the hospital categorically declared it as “bacterial” meningitis when the baby did not undergo lumbar puncture or lumbar tap? The patient never reached GCS11 to be allowed for such a procedure.
“Upon checking our bill, we were told that it was cleared and that we need not pay a cent. I don’t know what to feel, should I be happy or what? Who paid the bills? Yes we are thankful for that part but one can’t help but wonder when in fact our daughter wasn’t a Covid-19 case,” he wondered.
He also commented on the latest executive order released by the city government of Davao that will require patients referred to any hospitals in the city, regardless of their address, to have a negative RT-PCR test and chest X-ray results showing that they are negative for pneumonia.
“Wala man tay problema na i-swab, we will comply to that, pero pwede ba na kung sa SPMC na iswab test, ayaw mo pag swab until dili ma address ang primary reason nganong gipaadmit siya? Kay maoy nahitabo sa amoa. Nganong inyo man gipasagdan, gipahulat og maayo, mao na dehydrate and nagcomplicate ang bata,” Jojo underscored.
(We are not against the mandatory swab test. But can you please provide immediate care first to the patient? Address first the primary reason why he/she needs to be admitted to the hospital. That’s what happened to us. Why do we have to wait for days until our daughter was dehydrated and her condition went complicated before we were taken care of?)
Moving forward
Covid-19 deaths worldwide reached over a million. In the Philippines, the death toll is now at over 6,000. Of that figure, over a hundred are from Davao Region as of October 10. The pandemic claimed lives directly and indirectly. There are those who died from contracting the virus and there are those who died of complications because of the poor healthcare system plus “inhumane” Covid-19 protocols.
“I know this is beyond our doctors' and nurses' control. This happened because there is something wrong with our healthcare system. Covid-19 protocols are used to debilitate private hospitals, doctors and medical personnel to perform their primary function, which resulted in or may result in more disasters,” Jojo said.
“I am not sharing my daughter’s story to cultivate threat, anger and hatred. I don’t want people to be scared in our hospitals. I want this to be transformative, it may not be now, but I hope it will lead to a solution someday,” he added.
We learned about Lyanna’s story. Now, we are made aware of what happened to Ellianna. Who will be next?
(Editor’s note: Part two of this series will share the SPMC’s version of the story.)