Date: 2020-04-18

16th April 2020.

Dear Sir,

Preamble

I sincerely thank you Sir for this opportunity given to me to explain my role in the admission, management and eventual release of the corpse of the deceased patient -Muideen Jimoh Obanimomo on 1st - 2nd April, 2020

1.0. Introduction

I am in serious pain to narrate and explain the events of 1st April, 2020 to save the life of my cousin - Muideen Jimoh Obanimomo who I brought to the hospital but eventually died on the same day.

So many commentaries, rumours, conjectures and speculations have been made about what happened and conclusions were reached that I brought a suspected COVID-19 patient to the hospital without due disclosures, thereby endangering the lives of my colleagues and health workers within the system. I am still at a loss as to what empirical facts or clinical evidence were available and relied on to reach such conclusions. From the available medical facts, my interactions and observation of the patient, there is nothing to justify that I brought a suspected COVID-19 patient to the hospital on 1st April, 2020. By my training as a medical practitioner, I do know that, medical conclusions are reached based on empirical clinical symptoms and signs as well as clinical investigations and not on speculations or rumours. 2.0. Allegation

The allegations and conclusions that I acted unethically in the management of the patient who incidentally was also my cousin, by bringing him to the hospital without disclosing his COVID-19 status and travel history is not true. The ‘facts’ relied on to conclude that I acted unethically remains a mystery to me. Indeed, it is traumatic that nobody cared to ask for my narratives before the decision to suspend me was reached.

Sir, to the best of my knowledge, the deceased- my cousin returned to the country from the UK but did not manifest any symptoms or signs of COVID-19 as at the time I took him to UITH for medical care and I don’t know of any of our policy that forbids that.

3.0. Facts

On the 1st of April 2020, at about 7:30pm the patient who is also my cousin called to inform me that he was not feeling fine. His complaint was that he was having abdominal discomfort and that he had had three episodes of loose stool in the last five (5) hours. According to him, this started barely 30-45minutes after eating an overripe pineapple. I asked him whether he had associated fever and vomiting to which he said there was none. I then asked him to take plenty of fluid and relax. He called later at about 8pm to inform me that he had had additional two loose bowel motions that were in large quantities and had started to feel dizzy and that his feet were heavy.

Due to the above responses of the deceased I asked him again whether he had associated fever or vomiting or headache or body aches, but he answered that there was none. I then asked him to get Ciprotab 500mg and Flagyl 400mg. I reassured him that he was going to be relieved by the following morning; only for him to call me again that his feet were getting increasingly heavy. It was at this point that I told him that I was coming to see him.

Acting with caution, I went to his house with my face mask, gloves and thermometer. On getting there, I met him and asked him what happened and he repeated the same story which he had told me over the phone. I asked him what other complaints he had, he said none. This time I asked him whether he had difficulty with breathing or cough or sore throat, to which he answered no. I then ascertained his temperature with the thermometer which came out to be 37OC. His normal body temperature and absence of respiratory symptoms reassured me that he had no symptoms of COVID-19. My assessment of him led me to the conclusion that he needed to be taken to a medical facility, hence my decision that he should be taken to the UITH for attention. I then took him in my car to the UITH and we got there around past 9pm.

From the time I had physical contact with him up till when we got to UITH, I was still looking out for any slightest signs of coughing or sneezing to raise any concern of symptoms of COVID-19. Again, there was none.

At the hospital, we both met the medical doctors on emergency call at the Accident and Emergency ward (A&E) who told him to lie on a couch. I told them the patient was my cousin and that he returned from the United Kingdom 13 days earlier and that he had been in self-isolation. I instructed them to stay at a distance to take his history. The disclosure of his travel history was documented in his case note and this can be verified from the attending doctors.

Thereafter, the first thing that was done on him was to check his body temperature with a temperature gun. This came out to be normal. From a distance, the doctors asked him for history of cough, sore throat or breathlessness or body aches all of which he said were non-existent. Dr. Azeez and Dr. Wasagu; the Senior Registrars that took his history can confirm that I never moved away or kept a distance from him and that I did not suppress any information as to his travel history.

The doctors asked the patient about his present complaints which he said were five episodes of large volume loose stools with abdominal discomfort after eating overripe pineapple about five (5) hours earlier and that he was feeling dizzy and his legs were heavy.

The patient gave all the history by himself to the attending doctors while I filled in the gaps with what I knew about his medical history, particularly that he was hypertensive and on Lisinopril, prazosin combined with hydrochlorothiazide. I also told them all what he had told me at home and what I had asked him to take before coming to the hospital. Whilst I was with them, I allowed the physicians to do their work. I only augmented what they were doing. When he was examined. He was not febrile - 37.2°C, not dehydrated and was not pale. However, his condition suddenly changed for the worse while being examined. He suddenly became drowsy, restless and tremulous on the right fingers. He started opening and closing his eyes repeatedly and was becoming stiff on his left limbs.

His blood pressure was about 130/60mmHg and his pulse rate was around 88beats/min. His respiratory rate was 18cycles/min, his arterial oxygen saturation was 99% and his lungs were clear. There were no enlarged organs in his abdomen. He was assessed to have had food poisoning. He was started on Normal saline to alternate with Darrows solution. His urgent RBS - 18.6mmol/l (after 500mls of N/S infusion)

Barely thirty (30) minutes into his hospital arrival, he released a loud noise and started to convulse for some seconds, this was self-aborted. Few minutes later he vomited, possibly aspirated and had cardiac arrest and I spontaneously started Cardio-pulmonary resuscitation (CPR) on him, and I was joined by the medical team on gloves and face masks. The nurse that assisted us also had face mask, gloves and gown on.

He had several sessions of CPR with intracardiac injections of adrenaline and calcium gluconate. During the CPR, I sent a registrar to call the anaesthetists and I followed up by going up myself to call them (two in number) to come and assist with intubation of a patient that just arrested. On their arrival, they were also informed of his medical history. He was intubated, and large volumes of vomitus was suctioned from his lungs. Then he was observed to be bleeding from the oropharynx. He was certified dead at about 1½ (one and half) hours later at about 10:50pm. He was packed and deposited in the UITH morgue around twelve (12) midnight.

The deceased family, of which I am a member decided to bury him at Offa - his home town in accordance with Islamic injunction. And we (the family) agreed to move his corpse in the morning to Offa for burial. I came to the UITH the following morning of 2nd April 2020, and I met the nurse in the A&E who said that I was to pay the sum of ?3,300 only for the mortuary to release the corpse. She said the porter who was to follow me with the deceased folder had gone to collect the face masks and gloves for A&E, I told her that I can as well go and pay and she released the folder to me. I paid the said amount at the hospital central pay point and receipts evidencing payment were kept in the deceased folder. While I was paying, my Chief Medical Director (CMD) Professor A.D. Yusuf called to commiserate with me at about 7:58am. I thanked him and took advantage of his phone call to request for his assistance to release an ambulance to convey the corpse to Offa which he graciously obliged. He asked me to get across to the hospital’s Deputy Director of Nursing Services (DDNS). I promptly did as the CMD instructed. The DDNS also commiserated with me and followed me to the hospital ambulance bay where she gave instructions to one of the drivers, that he (the driver) would be conveying the corpse of my deceased cousin to Offa. I was appreciative to her.

When we got to the morgue, I gave the receipts of payments to the attendant who went in, apparently to do some paper work. And not long, he came out to ask me to sign a register indicating that he had released the corpse to me. He also handed back some of the receipts which I kept in the patient's folder. Thereafter, I identified the corpse after which it was then loaded into the ambulance by gloved and masked attendants. At the hospital gate, the release paper from the morgue was presented to the security by the ambulance driver and after due verification, we were allowed to leave the UITH premises. Thus, I followed the official line of procedures in securing the release of his corpse. There was nothing untoward done in taking the corpse out of the hospital.

I wish to emphasise that up to the time of taking the corpse out of the hospital, no clinical facts existed to justify any claim or insinuation that the deceased was a COVID-19 patient.

As we were about to exit Ilorin, the DDNS called me by a proxy phone line and asked: "where are you?" I told her and she said that "hope it was not a COVID-19 patient that I brought to A&E". I replied her that there was nothing to suggest it, except that he had a history of return from UK travels. Immediately after the DDNS’s call, I informed my CMD (at exactly 8:52am) that I would be getting across to the Kwara State COVID-19 Technical Team and he agreed with me. Then I called their number-08064369063 (at exactly 9:02am) and one Dr.Mrs.Kamaldeen picked my call. I identified myself and told her what had happened. I also told her that we were taking the corpse to Offa, and that we were about leaving Ilorin. In response the woman said OK. She added that she was going to get back to me. She requested that I should endeavour to send the phone line and home address of the wife of the deceased in Offa. I immediately complied with her request. About thirty (30) minutes after, another member of the technical team called me. He told me that he had heard what happened and also said that I should send the phone line and address of the wife in Offa to him; and I did. All the calls referenced above as well as the contents of the conversations can be verified from the service providers. Sir, these claims of mine can be verified from the service providers. The relevant mobile lines are: Myself: 08033856580; CMD: 08035766489; State COVID-19 team: 08064369063.

Sir, I want to state that I had nothing to hide as I dutifully notified the medical team on call at A&E as of his recent return from the UK, and it was I (myself) that notified the Kwara State COVID-19 team with the approval of the CMD as to the turn of event when we had taken the corpse out of UITH. I wish to state that, from the time I notified the state COVID-19 team and the time the patient was buried, no instruction was given to me or to anybody else to the effect that the body should not be buried. If there had been such instruction, I would have been the first person to stop the burial to enable the appropriate authorities do whatever they felt were necessary.

Furthermore, just before getting to Offa, the nurse in A&E called to ask me for the deceased’s folder. It was at that moment that I realized that I did not return the folder to her. I apologized to her that I inadvertently had it with me after using it to pay for the mortuary clearance fees and we proceeded to Offa from there. It was my confused frame of mind arising from the sudden demise of my cousin that threw me overboard. So I promised her to return it as soon as I got back to the hospital.

However, on Friday, the 3rd of April 2020, an officer from the CMAC office called me for the folder. I pleaded with him that in as much as I knew the folder should be in A&E, I mistakenly had it with me and that I would return it on Monday. This was because the Kwara State COVID-19 team that came and took samples from the deceased's wife and I; instructed us to immediately self-isolate till Saturday when our results would be released. That turn of event made it practically impossible for me to return the folder on Friday as I had earlier planned. Few hours later, my Head of Department (HOD) also called that he had been directed to extract the folder from me and forward it to the Chairman Medical Advisory Committee (CMAC) office. I pleaded that the error was made in my confused mind and heavy heart; and I told him that he was going to have it by Monday morning, the 6th of April 2020 which he did. I could not return the folder before 6th April, 2020 because I was in self-isolation as instructed by Kwara State COVID-19 team. No information was compromised in the file. The medical officers who authored the information in the folder can be asked to confirm if anything had been changed.

I wish to emphasis once again that it was my devastated and unhappy frame of mind that led to the mix-up regarding the folder not being returned. But I returned it together with the mortuary clearance receipts and other receipts as directed on the 6th of April, 2020. I disclosed all the information I knew about my deceased cousin to all the medical team that attended to him. There was no red-alert symptom of COVID-19 infection at the time I took him to UITH; otherwise I would have notified UITH COVID-19 team. His history of return from UK and his self-isolation were given by him to the medical team and I corroborated them.

4.0. Conclusion

I submit that the deceased was properly registered as a UITH patient by obtaining a folder; and he was evaluated by doctors for a medical emergency - "Complication of food poisoning". And after his death he was deposited in the UITH morgue, but was released to the family after paying the mortuary clearance fees and all relevant receipts were given to the security at the gate. All these show that I have a clean conscience and acted in the best form of professional judgment.

I want to re-emphasize that if the deceased had complained of any of the red flag symptoms that might have suggested COVID-19 infection, or I noticed any of such symptoms I would have been the very first person to raise the alarm by notifying the UITH COVID-19 Committee. But there was none of these symptoms in him, and this has been corroborated by the negative results of COVID-19 tests that was done on all of us primary contacts (myself, the anaesthetists and the senior registrars that tried to resuscitate him when he had sudden cardiac arrest. I would not want to endanger my own life by carrying him in my car to the hospital, stayed with him or even carried out CPR on him if he had shown any symptoms of COVID-19 infection.

In as much as I would not have wanted to endanger my own life, I wouldn't endanger the lives of other healthcare co-workers or that of our family members that participated in his burial rites. That was why I disclosed his travel history, told the medical team to take his medical history from a safe distance and submit to test at the instance of the state COVID-19 technical team after notifying them as to the turn of events Furthermore, I gave all the information that I knew about my late cousin (the deceased patient) to the attending doctors; I neither held back nor distorted any information. All the documentation of his complaints, physical findings and clinical appraisal were done by the attending medical doctors. His medical history was fully disclosed, even by himself to the attending medical doctors, I only filled in the gaps. His corpse was only released to the family after satisfying all necessary due process. And while the folder was with me I did not write or alter anything written by the attending doctors.

Finally, I wish to re-emphasise that I acted throughout the material period in good faith. For instance, in order to clear the DDNS's doubt I got in contact with the Kwara State COVID-19 Technical Committee before proceeding to Offa for the deceased's burial. It is my prayer therefore that you disregard all insinuations that I brought a suspected COVID-19 patient to the UITH or that I did not disclose his travel history or that I smuggled the corpse out of the hospital.

Yours faithfully,

Professor SALAMI, Alakija Kazeem

Department of Medicine

UITH-Ilorin.