DOCTORS in public hospitals have refuted allegations of negligence in their treatment of Covid-19 patients and under-reported deaths, including those who are pronounced dead on arrival (DOA), as the number of fatalities continue to soar.

DOA cases are cases where patients seeking treatment are declared dead on arrival at the hospital.

Several doctors who spoke to The Malaysian Insight said there is no such thing as disguising or under-reporting deaths in hospitals, as there are a set of procedures to follow.

They were responding to rumours on social media about Covid-19 patients not being given the best treatment, resulting in their deaths, or that deaths are being disguised as DOA cases.

This, the critics claimed, is being done to keep the daily death toll low. 

A doctor from Sabah, who declined to be named, said it was cruel and insensitive to be blamed for such a thing, and added that all patients who come to hospitals, regardless of their medical condition, are given proper treatment.

“It doesn’t go well with us, who are working tirelessly to save lives, to be accused of such a thing.

“We have a duty to treat and provide care for patients, even if they are in the worst medical condition. Why would we want to misreport deaths? No reason,” she added.

The doctor said there are differences between a DOA case and a death in casualty case.

“When a patient is still alive but if the condition is bad or deteriorating, we will carry out treatment and even cardiopulmonary resuscitation (CPR).

“We will continue CPR for 30 to 45 minutes, but if the patient still dies, then it is declared as death in casualty.

“But when a patient comes with no pulse, no breathing, has cold peripheries and cardiac monitoring shows asystole, then this will be declared as brought in dead,” she said, adding that the most common DOA cases are recorded among the elderly.

The doctor further said that under the pandemic, all DOA victims are kept in the morgue, while a reverse transcription polymerase chain reaction (RT-PCR) test is performed to determine if they are positive for Covid-19.

“So, a RT-PCR test will be done on the body and will need to wait for the results.

“If the result is negative, then we will release the body to the family but if it is positive, then we will declare it as a Covid-19 death and will report it accordingly.

“The families won’t be able to do the final rites but then the district health office will arrange to bury the deceased,” she said.

Another doctor from the Sg Buloh Hospital is also stunned by the claim that patients that die in hospitals while waiting for treatment are declared as DOA.

“What do you mean die in the hospital while waiting for treatment?

“They are in the hospital, so they should be treated. Usually, in Sg Buloh, we treat everyone as we take them to the emergency department and there is no such thing as not getting treatment,” the doctor, who declined to be named, told The Malaysian Insight.

Likely scenarios for DOA cases

In recent months, the number of DOA cases have risen in tandem with the growing number of daily fatalities. This follows the increasing pressure faced by an overworked healthcare system, due to the spike in infections.

Last week, the Health Ministry (MoH) said that it had seen an exponential rise in Covid-19 DOA cases, with the figures multiplying seven times since April this year.

Doctors had previously listed three possible scenarios that contribute to the rising number of Covid-19 DOA cases.

The first is that of a patient with cough and fever symptoms who seeks regular treatment without taking a Covid-19 test, and is later found dead at home.

The second is that of a Covid-19-positive patient who succumbs to the virus before being transferred to the hospital or low-risk quarantine centre.

The third is that of a person who feels fatigue, has lost their sense of taste, but who does not take those symptoms seriously.

Patients taking things lightly

Another doctor from a public hospital in Selangor, who only wanted to be known as Glen, said patients are taking Covid-19 lightly.

“There are some who are reluctant to get tested for coronavirus even if they have symptoms.

“They are scared of hospitals and doctors so they rely on their own treatment based on the Internet or seek advice from family and friends.

“Then, when the situation worsens, it is too late and they succumb to the disease at home. In such cases, of course DOA cases will increase. Why blame us (doctors) for it?” he asked.

Glen said the number of DOA cases can be reduced if individuals pay more attention to their health, be transparent with health conditions, and seek immediate medical treatment if they have any symptoms.

He said that patients in quarantine and low-risk assessment centres who experience worsening conditions get transferred to hospitals to receive proper treatment and care.

“A hospital will have all the resources, from medical equipment, healthcare workers and others but a quarantine centre is not like a hospital. It is not a hospital setting.

“They might have the manpower but it is never a hospital.

“So, that is why, when a patient’s condition worsens, they are transferred to the hospitals for further treatment,” Glen said.

Director-general of health Noor Hisham Abdullah had previously urged the public to be vigilant in monitoring their own health, especially Covid-19 patients who are undergoing home quarantine, and said that individuals should seek immediate treatment if they displayed “warning signs”.

He said that the warning signs are indicators that the condition of a Covid-19 patient is worsening.

Among the warning signs outlined by the MoH are prolonged fever, difficulty in breathing, chest aches, loss of appetite, worsening fatigue, changes in mental consciousness, confusion, coughing, vomiting, and worsening diarrhoea, reduced urination, bluish lips or fingers, and oxygen saturation dipping below 95%.

Noor Hisham said that as of July 2, Malaysia had recorded a total of 4,856 Covid-19 deaths from the start of the year, of which 670 are DOA cases.

He said that the three states with the highest number of DOA cases are Selangor (181), Sabah (85), and Kuala Lumpur (78).

The D-G said those who are pronounced dead upon arrival are mostly above the age of 50, which make up more than 70% of the DOA cases.

There were 1,131 deaths from July 3 to 13, including the single highest daily death toll of 135 on July 8. During this period, 124 DOA cases were recorded, with the exception of July 8, as the ministry did not reveal the DOA numbers.

Yesterday, Malaysia recorded the single highest daily Covid-19 cases at 11,079 new infections, taking the cumulative caseload to 855,949.

Another 125 fatalities were reported yesterday, raising the death toll to 6,385. – July 14, 2021.