CLOSED UATH SPINE UNIT STIRS CONTROVERSY
The hospital management has denied discharging him, insisting instead that it referred him for better care, though there is no record of a referral.
Ioever was discharged April 3 after unspecified “discussion” between UATH management and Dr Ahidjo Kawu, consultant orthopaedic and spine surgeon who was managing Ioever, Daily Trust has learnt.
Possible closure of spine programme at UATH had been in the offing but it came to a head when the hospital management instructed “me to discharge a patient who needed surgery urgently,” Dr Kawu tells Daily Trust.
Ioever was admitted in hospital with an injury to his spinal column late February after his company vehicle crashed on a run to deliver soft drinks in Kano.
The second bone in his lower back was fractured, according to an MRI scan he underwent in March.
Its covering as well as nerves at the base of the spinal cord were compressed, including those that normally send and receive messages between the lower limbs and pelvic organs—bladder, rectum and internal genital organs.
UATH chief medical director, Dr Peter Alabi, insisted Ioever “must have been referred.”
“If he was not referred anywhere, we will ask whoever [the] consultant was managing him and find out exactly what must have happened,” he said told Daily Trust in response to questions.
He explained standard practice. “If you know that you cannot effectively manage a patient till the end, don’t delay him or her. It is not abnormal to ask a patient to go to another hospital.”
Ioever wasn’t referred to any other hospital. Since his discharge early April, Ioever “is still at home and seriously in pain,” says his brother and carer Robert Ioever.
“He cannot eat well, because if he should eat, he must defecate, and the process of passing out stool is very, very difficult. He cannot sit up, much less stand up.”
He passes urine through a catheter line inserted into his urethra, just before his surgery was cancelled. Now his family is considering legal action to compel UATH to provide care.
According to Robert, the discharge came first as fault with machinery, then he was told “the CMD has cancelled our operation because they don’t have a doctor that can handle such cases”, and then being told of a standing order that surgeons only carry out spine surgeries “once in two weeks.”
He remembers being confused and his brother tossed from doctors to management until their discharge a week later.
Ioever has become the latest victim of strangled relations at UATH that affected its six-year-old spine surgery programme, which didn’t take off for the first two years after it was created.
Another patient Toyin Ayinla was last to undergo spine surgery before the closure.
His surgery on April 1 was interrupted with threat of stoppage in the wake of decision to implement the closure, sources say.
Ayinla injured his spine in October 2010 after attempting to push a campaign vehicle out of mud using his back.
He underwent management at University of Ilorin Teaching Hospital for over a year but his movement problems remained.
“Even to bathe myself became difficult. But now everything is okay. I bathe myself, I walk, I do everything now,” he told Daily Trust Tuesday morning on his way to a physiotherapy appointment at Unilorin teaching hospital.
The spine unit has garnered media headlines since it went operational four years ago, and sources indicate publicity surrounding it may be reason for its closure and its coming under attack.
“People close to the chief medical director convinced him that the head of the spine unit is trying to position himself to be the new chief medical director,” said Dr Kawu.
UATH was short of instruments required for spine surgeries, forcing a collaboration between the unit and the firm Spine and Scoliosis.
In one collaboration, equipment for cervical surgery, estimated at $236,000—some N50 million—and donated by US-based DePuy Spine Inc to Dr Kawu to operate on indigent patients in Nigeria after he completed a fellowship at the Scoliosis Research Society at the New York Hospital for Joint Diseases were held back by a customs agent in Lagos for nearly a year.
They include 78 implants and 419 instruments donated after a counterpart fee of $500 was paid, Kawu told Customs in a protest letter in July demanding the equipment be released.
On release, the equipment were distributed among six orthopaedic hospitals, including UATH.
Dr Alabi claimed no knowledge of previous use of spine surgery equipment, which was reported widely.
“We didn’t have any link with anybody to bring us any equipment that was seized by Customs. A particular consultant in this hospital was in a deal and I don’t know how he ended up with it,” the chief medical director said.
“It [the seized equipment] does not belong to the hospital. It belongs to whoever had a link with those people. It is not an instrument for the hospital. We were never in the picture. We didn’t have any interface with Customs for any equipment that was imported on our behalf.”
Asked whether referred in particular to Dr Kawu, the hospital’s spine orthopaedic and spine surgeon, he said, “If you want to suggest that, I don’t know.”
The equipment have been used for free surgeries since then. Other payment by patients cover equipment UATH lacks and services such as anaesthesia and theatre use but never the procedures.
They helped knock down cost of a surgery to decompress and stabilise injured spinal bone (as in Ayinla’s case) to around N500,000, compared to N1 to N2.5 million in other hospitals, Dr Kawu estimates.
Ayinla said he paid less than N400,000 to cover equipment for his procedure. Robert has paid more some N470,000 to buy rods and screws for his brother’s surgery, in addition to nearly N100,000 for anaesthesia, orthopaedic implants and theatre at UATH, which the hospital is yet to refund since Barnabas was discharged.
UATH management has since insisted Spine and Scoliosis, which sells implants to patients and supplies instruments, stop its supply, insisting they will acquire their own set.
“What they couldn’t achieve in six years, now they want to in one week. All the patients that required [spine] surgery are being turned back and left to their faith,” said Dr Kawu.
“The bottomline in this saga is ego and greed,” he said.
One source told Daily Trust that among reasons for closing the programme was concern that UATH could lose out on funding if its surgeons continue to use private equipment supplies to cut the cost of surgery on patients.
But Dr Alabi insisted UATH was “not putting any hold on spine surgery.”
“Whatever we doing now, we will continue to do and we can only improve. But we cannot put the lives of patients in danger in [that] what we cannot do and then we go and do it. That is not good practice. We are a teaching hospital and we go for the best.”
Surgery to correct spine deformity in Ummi Salma, 9, currently hospitalized at UATH, is to hold at Nizamiye, which donated its facilities free for seven days.
And Barnabas is still home with his spine injury, waiting and hoping.
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