SC Says Don’t Refuse, But Does NRS Care?
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04 December 2010
By Debashish Konar & Jhimli Mukherjee Pandey
In 1992, Hakim Sheikh fell off a train and suffered a serious head injury. The local health centre could not treat him and referred him to NRS Hospital. By then, five hours had been lost. At NRS, X–rays of his skull revealed that his condition was serious and he had to be admitted immediately.
But there was no bed available and he was referred to Medical College Hospital around midnight, only to be turned out for the same reason. His traumatic journey continued through the night. His next stops were Shambhu Nath Pandit Hospital and National Medical College Hospital. The next morning he was taken to Bangur Institute of Neurology where doctors referred him to SSKM as an "emergency case". But at 10am, doctors at SSKM refused admission on the ground that there was no facility of neurosurgery.
Sheikh was finally admitted to a private hospital. Later, he filed a writ petition against the callous attitude of doctors at government hospitals. The case reached Supreme Court, which gave a landmark judgment in his favour. It said that moribund patients cannot be refused by any hospital.
TOI’s visit to NRS, however, proved that nothing has changed. At night, serious patients are wheeled into the emergency unit, only to be wheeled out again. Some wail in agony, some scream without break, their relatives helplessly plead, first with the emergency medical officers, then with the security and lastly with police, only to be told, "Please leave, we cannot help you."
Is there any proof that there really aren’t enough beds? "Previously there was a display board where we had to announce the number of beds available. However, that system has been stopped," a doctor said. He hinted that unless you had the "right contacts", getting a bed here, whether paid or free, was virtually impossible, no matter what the condition of the patient.
"Providing emergency medical care to critical patients is an obligation of the state to safeguard the right to life," said Prabhat Mukherjee who is fighting for the cause of emergency admission as his son died unattended. Returning serious patients untreated is a crime. But who cares?
"Despite the SC order every day hospitals play the game of passing the buck as patients are not officially rejected but are referred to some other hospital. Those that cannot withstand the agony, die, as my son," said Mukherjee.
Mukherjee lost his only son, Suman, a decade ago, when he was hit by a bus and taken to a private hospital on EM Bypass. But he was denied treatment because those accompanying him did not have enough money to admit him to the ICU. He died.
A senior doctor at NRS Hospital tried to defend refusals. "As per a WHO guideline, patients cannot be admitted if there are no beds because they cannot be made to lie on the floor," he said. But then, it is common to see patients lying on the floor in government hospitals.
The SC guideline clearly says that in case beds aren’t available, patients should be treated on trolleys, but even that is not done.
Junior doctors blamed it on poor administration. "The seniors hardly turn up. There’s tremendous pressure on us. We start refusing only when we are saturated to the brim and take no more," said one.
Sudipto Roy, a former national president of IMA and a Trinamool Congress MLA, blames the Left Front government for damaging the infrastructure at the hospitals and allowing politics to creep in.
Assistant superintendent of NRS Hospital, Rajiv Mukherjee, did not contest TOI’s charges. He explained that the number of beds has remained unchanged for decades. To cope with the shortage, the hospital regularly treats patients on trolleys in the emergency war, he said. "The problem lies with our faulty referral system.
District hospitals blindly send patients to us, without making any effort to treat them. At least 50% of our beds are occupied by patients who should not have been sent here," Mukherjee reasoned.
A portion of the NRS emergency ward is being extended so that more trolley beds can be accommodated. "Sometimes the number of trolleys exceeds that of beds. At that stage we have nothing else to do but refer patients elsewhere, but care is taken not to refuse moribund patients," Mukherjee added.
Health secretary M N Roy said his department is trying to revamp hospital infrastructure and the focus is on increasing number of beds. "If you have specific cases of refusals, you should lodge a complaint. We are taking it seriously, as refusals cannot be tolerated and errant doctors or paramedical medical staff will be punished," Roy said.