Intensive careless unit for you

The death of five persons, all below 40 years, in Delhi government-run Sushruta Trauma Centre has brought the functioning of intensive care units in city’s government hospitals in focus. It is hardly news that most of the ICUs don’t work satisfactorily.

Multiple issues need to be solved before patients in critical condition get the care they need – without developing irreversible damage to their health, and without paying high charges at private centres.

“This is not the first time that we have seen a mishap in an ICU. Most of the cases are minor and go unreported. However, some leave unrepairable damage to the patient,” says a senior doctor at Lok Nayak Hospital.

He says once due to non-availability of staff at night, a patient was not given the required medicine through injection although it was prescribed by the doctor.

“As there was no nurse, the patient had to wait till morning before the injection could be given. This was not uncommon practice,” says the doctor.

“What the staff did not understand was that the patient was suffering from diabetes, and delay in giving that particular medicine could cause harm to that patient, though not to others,” adds the doctor.

The patient ended up being paralysed for life.

The incident at Sushruta Trauma Centre has brought many issues to the fore. First is the lackadaisical attitude in managing ICUs and their equipment at night. Second is the lack of trained personnel to handle advanced instruments.

“It is all related to contractualisation of services. If you leave important functions to a sub-contractor, this is bound to happen,” says an official, who has been transferred from the trauma centre after the incident.

He says one can’t supervise hospital staff directly, so the authorities have to depend on contractors for this purpose.

“The contractor never accepts that he has recruited staff less than the quotation. We also can’t look at resumes of working staff to see if they fulfill the needed qualifications,” says the official.

“This incident has suddenly generated so much interest to re-look at the working of ICUs and their staff. But the problems have persisted for much longer.”

Probe committee

A three-member enquirycommittee was formed by the city government under the special secretary. Its report clearly puts the blame on the contractor, who did not provide the requisite trained staff. The government has issued an order instructing the health department to deploy efficient and experienced junior specialists at the Trauma Centre.

General lacunae

The emergency wards and ICUs of general hospitals in Delhi seem to be ridden with problems, beginning with being unwelcoming to patients. Stretchers to carry patients from the ambulance to the ICU are of very low quality.

“Every organ of a person in a critical condition is vulnerable. How the body is handled can make a big difference,” says Dr Kish Kapoor, who runs an emergency medical service centre in East of Kailash.

In Guru Teg Bahadur Hospital, monitors to keeps tabs on vital functions of a patient’s body have not been installed, though they were bought more than a year ago. Similarly, Deen Dayal Upadhyay Hospital frequently complains of lack of oxygen cylinders. Many ICU beds go unoccupied for days without proper supply of oxygen.

“We are facing this trouble for many years. Some administrative lacunae must be leading to this situation,” says a staff nurse.

Even the ICU at Aruna Asaf Ali (Civil) Hospital did not run for 10 days last May as the air conditioner stopped working.

“In peak summer, we cannot keep patients in ICU without the air conditioner as this may lead to catching infection. Even a drop of sweat of the attendant can turn fatal for patients,” says a surgeon at the hospital.

Waiting line

Compounding the troubles is non-availability of ICU beds even in most critical conditions.
“I was referred to GB Pant Hospital by Ram Manohar Lohia Hospital as no ICU bed was available for free there. Even here, it has been three days and I am waiting to admit my father to the ICU,” says Sanjay Narwa, whose father Mahesh Narwa had a cardiac arrest a week ago.

Though Mahesh was treated in the emergency ward for a day, he was referred to the ICU for further treatment.

“I cannot get him admitted to the general ward as we will lose our number in the queue for ICU,” says Sanjay.

The normal wait for the ICU at the All India Institute of Medical Sciences is four days to a week. It is common to see patients taking rounds of several government hospitals as they are constantly being referred to another hospital. One after the other prescription says, “bed not available”.

“This also shows complete lack of sensitivity while referring a patient,” says advocate Khagesh Jha, who has filed a number of public interest litigations on health facilities in the city.

“There are clear guidelines by the government and the High Court that a patient cannot be referred without confirming from the other hospital whether the facility he or she is being referred to is available. In this case, it’s the beds. But this rule is being flouted,” he says.

Pay for services

Tertiary care is becoming costlier in the city. This is true not only for private hospitals, but also government-run institutes. Hospitals with free ICU beds have much higher rates.
In Delhi government hospitals, there are differential rates for availing ICU services.

General hospitals provide all treatment for free. But ICUs of autonomous institutes, where the possibility of getting a free bed when required is much higher, charge exorbitantly.

The Institute of Human Behaviour and Allied Sciences, which provides care exclusively for patients with mental and neurological problems, charges Rs 1,000 to Rs 1,200 per day for the ICU. The cost for ventilator is Rs 700 over the normal ICU charges.

The Institute of Liver and Biliary Sciences charges Rs 3,500 for the ICU and Rs 1,500 extra for ventilator. The services are exclusively for liver problems.

“Once such specialised institutes come up in the government sector, doctors have a tendency to refer patients to them. Also, lack of beds in ICUs haunt doctors. This will make tertiary care costlier. Instead, the government should spend on creating more free-of-cost ICUs,” says an endocrinologist at GB Pant Hospital.