Tanuj arora didn’t expect his father Yashpal, 60, to pass away within a fortnight after he first fell ill on January 2. It started with Yashpal vomiting everything he ate.
“We tried giving him medicines to prevent indigestion and vomiting. After two days of no change in his condition, I took him to a private nursing home, which is close to home,” narrates the 23-year-old dairy shop owner in Moti Nagar.
Here, Yashpal was detected with a severe gastrointestinal infection and was shifted to the ICU ward.
“The doctors kept him in the ICU till January 9. By then, the bill had reached Rs 75,000.”
The doctors then told Tanuj that Yashpal had to undergo surgery immediately. However, the cost was steep.
“My family is not financially strong, and my monthly salary is only Rs 15,000. When I conveyed this to the hospital administration, my father was shifted to a general ward on January 11,” Tanuj says.
The family desparately tried to arrange for funds, but by January 14, they failed, and Tanuj, narrated his ordeal to the authorities, who recommended his father be transferred to Ram Manohar Lohia Hospital (RML).
Tanuj gathered the required documents and admitted his father to RML. “For two days, the doctors kept him under inspection, and administered medication. However, on January 16, I was told that he has to undergo surgery.”
By this time, Yashpal’s situation worsened. His blood pressure was dangerously low. He had become weak and pale. Fearing the worst, Tanuj gave his go-ahead for the surgery.
“Before he was operated on, the doctors conducted a Covid test. My father tested positive. At 8pm, I was told the hospital has no ICU bed in the Covid ward, and that I should take my father to Lok Nayak Hospital (LNH). They prepared a Leaving Against Medical Advice (LAMA) note, and after confirming at LNH, sent me here,” says Tanuj.
Since his father’s condition was worsening, he signed the prepared letter without reading it.
Tanuj reached LNH with his father at 10pm and handed over the letter. But going through its contents, the hospital authorities were puzzled as to why the RML authorities had prepared a LAMA note for a patient that was critically ill.
“Anyway, he was admitted to the Covid ward and I was asked to retrieve my father’s treatment summary from RML at 3.30am. By the time the doctors began to prepare Yashpal for an operation scheduled for 4.30am, he breathed his last."
As per case studies collected by The Morning Standard since January 1, 2022, a total of 15 patients lost their lives in the national capital due to hospital shunting without proper referral.
Hundreds of patients lose their lives every year, often in the ambulance itself, as a lot of time is wasted in the frantic search for a hospital bed.
When the paper contacted the 102 Ambulance Service, the emergency medical transport service shift in-charge Dori Lal came on line, stating the patients getting tossed from one hospital to another is an everyday affair, and none of the faulty hospitals have been brought to book.
“We see 50 such cases each day. Often, our ambulances go all over the city the whole day with just one patient looking for a hospital bed. Till the ambulance’s oxygen cylinders run out, we try our level best to get a patient admitted. But how much can we do?” Lal laments.
He says at times doctors turn them away at the main entrance itself when they are still inside the ambulance, and refer them to two or three better-equipped health centres.
“We ask them to refer us to only one hospital that can guarantee sure admission to the patient, but they do not even look at patients. At times, patients die in the ambulance,” adds Lal.
Covid protocols, an obstacle
Since the onset of Covid, city hospitals are facing limited healthcare facilities.
Despite All India Institute of Medical Sciences (AIIMS) having a dedicated Covid building and Safdarjung Hospital having the maximum number of Covid beds, patients struggle to find a bed here, even after low rate of hospitalisation of Covid patients in the third wave.
In most of the cases accessed by this reporter, the non-Covid patients tested positive days after being admitted.
Citing limited Covid beds, hospitals like AIIMS, Safdarjung and RML shift their patients to LNH without any official coordination, say doctors at LNH.
The Morning Standard last week had reported about 21-year-old Yuvraj Singh, who met with a road accident in Dehradun and had travelled all the way to AIIMS trauma centre for treatment in an ambulance that cost Rs 20,000, but was refused admission.
The doctors at Dehradun’s Himalayan Hospital had referred him to a higher centre with better facilities but did not confirm with AIIMS beforehand. Family members of Yuvraj say the authorities told them on a personal level to take him to AIIMS.
At AIIMS, the authorities that the family that the trauma centre has been converted into a Covid ward.
He was rushed to Safdarjung Hospital, where he was tested positive. From here, he was referred to LNH, where he lost his life.
A similar case happened to Pawan Kashyap, 42, who lost his life on Sunday, after being shunted from Safdarjung hospital. Pawan, who was specially abled and an employee at a petrol pump, started experiencing acute stomach ache.
His brother Roshan rushed him to Safdarjung Hospital, where he tested Covid positive. The staff told Roshan there are no vacant beds for Covid positive patients.
They did not even prepare a referral note for Pawan. Roshan had to write the note on the basis of which LNH admitted Pawan, but it was too late.
Misuse of LAMA
As per Dr Ritu Saxena, Deputy Medical Director, LNH, even simple cases reach a complicated stage only because of patient shunting and a lack of referral policy.
“This is a violation of Supreme Court guidelines,” she adds. As per SC guidelines, hospitals cannot refer a patient to another hospital before stabilising the patient.
In the case of extremely ill patients, a doctor or a trained health staff should accompany the patient, but this protocol is not being followed, observes Dr Ritu.
However, majority of the time, the patients are referred to a “higher centre” without any support from the hospital, says Dr Ritu.
“There must be a proper referral form that notes phone numbers of the doctors and staff of the hospital from where the patient is being referred with valid reason as to why the patient is being shunted,” says Dr Ritu.
With no well-defined policy on patient referral, junior doctors without any stamp or paperwork scribble a note for the patient to be taken to a higher centre.
“Doctors misuse LAMA and as the patient and their relatives are in panic mode, they sign on the LAMA form which is not right,” says Dr Ritu.
“There should be a referral policy within the central institutes where patients can be referred in an official capacity,” says Dr Dinesh Gora, a senior resident doctor deployed at the Trauma Centre. But, doctors cannot do much if the hospital does not have enough facilities.
Infrastructure and Manpower
Dr Jugal Kishore, Head of Community Medicine Department, Safdarjung Hospital, says hospitals in the city are not equipped to treat every patient seeking admission. He also blames AIIMS for shifting patient load to Safdarjung Hospital.
“While AIIMS is doing really well, by paying its doctors the best salaries in the industry, and recently opening a number of branches across the country, their doctors still shift patients to Safdarjung Hospital without proper briefing. When we already have staff shortage, how can we treat such a large inflow of patients?”
He also says that private hospitals often put patients in a spot.
“After the patients’ condition deteriorates and their money is exhausted, then the private hospital refers them to a government hospital...,” says Dr Kishore.