How did Couva Hospital achieve 60% decrease in Covid deaths, as CEO claims, while national rate soars?

NCRHA CEO Davlin Thomas: ‘[…] The numbers speak for themselves. The reduction in mortality rate by sixty percent (60%) is exceptional. This experienced and highly qualified multidisciplinary team has also achieved a 25% increase in discharges, with a near full to capacity bed occupancy…’

TTRNA president Idi Stuart: ‘[…] The CEO claiming a massive 60% decrease in the death rate, purporting to come mainly from the rotation he implemented on the 20th May 2021… while scores of patients, are awaiting to be admitted to the designated treatment centre for critical patients at Couva, they are being left in the general system to suffer a less than favourable outcome… 

‘[…] Simple maths to achieve 60% reduction in death rate. Reduce admissions, reduce critically ill patients being admitted, improve your death rate at the institution…’

North Central Regional Health Authority (NCRHA) CEO Davlin Thomas has been criticised by the Trinidad and Tobago Medical Association (TTMA) and the Trinidad and Tobago Registered Nurses Association (TTRNA) for his decision to remove several senior doctors from the Couva facility, which is the cornerstone of the Ministry of Health’s fight against Covid-19.

Thomas’ response is that the ‘rotation’ of senior staff, coupled with his organisational skills, actually led to ‘a 60% decrease in mortality’ at the facility. Wired868 has published a statement from the NCRHA, alongside the counter from TTRNA president Idi Stuart and the Trinidad and Tobago Medical Association (T&TMA).

The following is a statement from the North Central Regional Health Authority (NCRHA) on Friday 28 May 2021, after criticism of CEO Davlin Thomas’ removal or ‘rotation’ of four senior doctors at the Couva facility, which is the cornerstone of the Ministry of Health’s battle with Covid-19:

New team of doctors at Couva facility achieves a 60% decrease in mortality, announces CEO Davlin Thomas.

Following Dr [Tim] Gopeesingh’s claim last evening regarding an increase in Covid-19 deaths related to the Couva Hospital, CEO Davlin Thomas announced that the new team of NCRHA doctors at the Couva Facility has achieved a 60% decrease in deaths and increased discharges by 25% within the last eight days.

“The North Central Regional Health Authority is engaging a strategy of structured and continuous improvement using a systems approach which implies that we engage the situation with synthesis and holism, as opposed to silos and reductionism,” Thomas stated.

Thomas, whose Master’s Degree dissertation was focused on ‘improving quality’ on a platform of ‘organisational transformation processes’, asserted that the NCRHA was committed to bettering the patient care experience and that this has always been the driving and motivating force behind the ethos of the organisation.

“The medical team at the Couva Facility has done a phenomenal job,” Thomas indicated. “The numbers speak for themselves. The reduction in mortality rate by sixty percent (60%) is exceptional. This experienced and highly qualified multidisciplinary team has also achieved a 25% increase in discharges, with a near full to capacity bed occupancy. 

“I am very pleased with the work and service being offered there. The implications for what we are seeing in the current data is significant and extremely encouraging.”

Dr Ravi Lalla, medical chief of staff, highlighted the importance of having a specialised team with varying clinical expertise working with Covid-19 patients, and the critical role that it has played in providing improved rates to the benefit of patients at the facility.

“The team has succeeded in filtering out the noise and engaging the battle to save lives with all that we have,” said Dr Lalla. “Our team is dedicated to this cause. It is a collective effort that is systematically constructed on the contributions of each part to the whole—the cardiologist, the emergency medicine specialist, the intensivists, the nurses, the patient escorts, the technicians, the administrative support staff have all banded together to protect and preserve the life of each individual patient. 

“It takes the effort of us all to save one… and we are determined to do everything we can to ensure that no one dies, and every patient is given the best chance of not just survival… but recovery with a high quality of life.” 

Director of health Dr Malachy Ojuro commended the efforts of the team.

“Our aim is to protect, care for and save lives—no compromise,” said Dr Ojuro. “I would like to thank the team for their commitment and their sacrifice. We are very focused, regardless.”

The following is a statement from TTRNA president Idi Stuart, on Saturday 29 May, which attempts to respond to the initial NCRHA release:

Image before lives.

Over the last week, the TTRN would have been bombarded with calls from members about the difficulties they were facing across RHAs, about having to treat critically ill patients in various A&E (accident and emergency) 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.

While over the last week PMO Dr Maryam Richards gave statistics showing these facilities (inclusive of Couva Medical Facility) were not at 100% occupancy, all A&E departments and regions were left scrambling to care for their most critically ill outside of the parallel healthcare system. 

Closing clinics and wards, discontinuing elective surgeries, and moving around staff to manage new Covid units of which [the attendant doctors and nurses] had no prior experience. What was the purpose [of this] if room was still available over the last eight days?

Then it made sense yesterday with this press release. The CEO is claiming a massive 60% decrease in the death rate, purporting to come mainly from the rotation he implemented on the 20th May 2021. A most shocking statistic, and an even more shocking implication.

The implied allegation is that Dr Don Martin and the other specialist doctors [removed from Couva] weren’t doing a very good job and the nation should be thankful for the CEO’s actions. That alone is enough to be a depressing inference on any medical practitioner. 

Fortunately, all of us who have worked with Dr Martin and the other medical professionals will know their world class capability.

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

Using the Ministry of Health own tabulation it shows:

1. 12 March 2020 to 19 May 2021: the death rate of Covid-19 in Trinidad and Tobago was 1.8% (Death rate = Deaths / Cases).
2. 20 May 2020 to 28 May 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.

He was exclusively focused on the Couva facility. The same facility that our members have been complaining was not accepting critically ill patients over the last eight days. 

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 20 May) and #730 to # 738 (20 May til 28 May).

One will see, a curious statistic emerges:

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 the Couva facility has increased from 394 to 500.
4. Official facilities used to treat Covid-19 patients also increased from 11 to 16.
5. The Ministry of Health continues to not include Covid positive patients who are treated outside of the official Covid facilities.

This is astonishing and sad at the same time.While scores of patients, are awaiting to be admitted to the designated treatment centre for critical patients at Couva, they are being left in the general system to suffer a less than favourable outcome. 

Worse yet, it seems it was all done so this media release could be made yesterday—eight days after the CEO was found to be less than honest with the reasons for the rotation of the most senior doctors in the Covid fight.

Simple maths to achieve 60% reduction in death rate. Reduce admissions, reduce critically ill patients being admitted, improve your death rate at the institution. 

This is the classical definition of manufacturing statistics to sway public perception, even if it results in the loss of life. 

Image is everything.

The following is a statement from the Trinidad and Tobago Medical Association (T&TMA) on the release issued by NCRHA CEO Davlin Thomas:

The T&TMA registers its serious concerns regarding the release put out by the NCRHA entitled ‘New team of doctors at Couva facility achieves a 60% decrease in mortality, announces CEO Davlin Thomas’.

This release only serves to demoralise our frontline health care workers who have dedicated their lives over the past year towards Covid-19 management. Despite the fact that the overall mortality in the country remains high, this manipulation of individual statistics to serve a single organisation’s narrative is unconscionable.

The objective data reveals that between the 18th to 27th, the national seven-day average mortality fluctuated between 12-14 deaths/day and has risen even further thereafter.

The suggested reduced 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. The statistics cannot be viewed in silos.

Therefore the T&TMA seeks urgent clarification on the following:

1. Does the organisation have evidence to establish that the new team 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.
2. Recent changes to the admitting criteria at Couva during this period also specifically excluded NWRHA and SWRHA from admissions, which would effectively have a significant reduction in the numbers of severely ill patients being admitted and therefore these patient deaths now occur outside of the facility instead of within. These deaths also need to be accounted as they do remain a resultant impact of management changes at [Couva].
3. The overall death rate in the country remains high. Given that [Couva] has been the centre for the most severely ill patients then it is inferred that there is a 60% reduction in mortality among the most clinically severe patients, hence the national average mortality must now be a result of well patients dying. This is counterintuitive.
4. Finally, if the management practices of the [Couva] facility have indeed created such results in a matter of eight days, then standardised guidelines involving these same policies should be implemented everywhere to achieve a 60% reduction in mortality for all Trinidad and Tobago citizens—and not just the few who may have the opportunity for admission at [Couva].

T&TMA strongly abhors the use of these statements to vilify highly efficient health care workers for ulterior reasons and do not serve any purpose in the fight against the pandemic. We stress again the absolute importance of working together as one unit and not letting petty squabbles, politics and prejudices intervene. The virus does not discriminate so let us fight it with a united front.

At this time, the way forward is to support our frontline workers and assist them in their needs during their monumental battle against Covid-19.

Editor’s Note: The North Central Regional Health Authority (NCRHA) has not responded to requests from Wired868 for comment on issues raised by TTRNA president Idi Stuart on the support given to nurses and patients at his facility. The NCRHA also did not send the release above to this website.

Click HERE to read Idi Stuart explain what Trinidad and Tobago’s health care professionals need to address the current death toll and increased infections on both sides of the parallel health care system.

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