In the month when we commemorate 70 years of independence, it was indeed heartbreaking to see more than 70 children succumb to Japanese Encephalitis (JE) in Baba Raghav Das (BRD) Medical College Gorakhpur, Uttar Pradesh. The tragedy is a harsh wake up call that pockets of India are still caught in a time warp as far as healthcare services are concerned. In a sad irony, the September issue of Express Healthcare is a curtain raiser to our upcoming conference, the second edition of Healthcare Senate, (September 7-9, 2017), which is focussed on the theme, ‘Building a Future Ready Healthcare Sector for India’. Gorakhpur forces us to accept that we are a long way from this goal. While politicians are busy playing the blame game, healthcare professionals can only learn from this tragedy, in the hope that such an incident is prevented. The findings of an inquiry committee put together by the Indian Medical Association (IMA) point to an overburdened medical/paramedical staff (at the scene of the tragedy, the BRD Medical College, Gorakhpur as well as PHCs/CHCs of neighbouring districts) lack of equipment and supplies (like oxygen due to non-payment of dues to the suppliers), poor cleanliness standards, etc. Perhaps the biggest new learning is the lack of hospital management skills.
According to the IMA, although there is no evidence of medical clinical negligence against Dr Rajiv Mishra (the Principal of BRD Medical College, Gorakhpur at the time of the incident ) and Dr Kafeel Khan (Asst Prof and Nodal Officer, Encephalitis Ward, Dept of Paediatrics, Medical College, Gorakhpur, who was credited with borrowing oxygen cylinders from private hospitals on the night of August 11 but was removed from duty). Prima facie it appears that ‘a case of administrative negligence against them cannot be ruled out’. The IMA report further points out that doctors are clinicians as well as administrators and it is important to make a distinction between clinical medical negligence and administrative negligence.
IMA’s suggestions to avoid similar situations in future include a novel one: the airlifting of critically ill patients to nearby best facilities. Helicopter ambulance services for critical patients are now becoming more common as are ‘green corridors’ for emergency transport of organs for transplant, but the cost is a major hindrance. Who will pay for such services, when the resource crunch is all pervading?
The suggestion that patients denied treatment at government hospitals should be reimbursed for the cost of treatment in the private sector at pre-defined rates could be abused, as one of the allegations is that doctors at the hospital were diverting supplies and patients to their private practices. It is alleged that the Principal’s wife was taking bribes from the company supplying oxygen.
More constructively, the IMA suggests that the insurance regulator’s Insurance Regulatory and Development Authority (IRDA) mandate for all private hospitals to get NABH accreditation should be extended to all government set ups. This would be a very good move but would obviously also need a lot of investment.
There are signs that individual states are cracking down on corruption. One such move is the Maharashtra government’s determination to stop or regulate the infamous ‘cut practice’ system, which adds to the total cost of healthcare. The state’s Directorate of Medical Education and Research (DMER) has received the draft of the proposed legislation, tentatively called The Prevention of Cut Practices in Healthcare Services Act, 2017 which is now open for comments from the public.
A good feature of the proposed Act is that it protects the identity of the complainant/ whistle blower, but also provides for a fine for frivolous complaints. The Act proposes five years in jail for offending doctors or a fine upto Rs 50000 or both. It also proposes to penalise repeat offenders though these terms have been left blank in the draft.
Another aspect is that it can hold the heads of hospitals responsible if a direct nexus is found between the violator and the people in charge of the facility, like the deans, director, partner proprietor etc. This is easier said than done but at least the Act attempts to be as comprehensive as possible. It also mentions a suspension of minimum three months for the facility.
Of course, these are early days. And intent is one thing, implementation another story. The Medical Council of India has similar strictures, but by and large has been unable to translate it from paper to practice. If indeed other state governments follow Maharashtra’s lead, we would be one step closer to a more affordable healthcare utopia.