NEW DELHI: A narrow flight of stairs leads up to a dialysis centre in central Delhi. To reach the place, the driver of the ambulance or car would have to negotiate a narrow street behind a market hosting sweet shops, a dhaba, a cloth shop and similar establishments. Loose electric wires dangle dangerously over entrances and shops. There is no parking available, since cars and two-wheelers have taken up all available space. To take the patient up, there is no automatic chair attached to the banisters—in fact, there are no banisters. Patients are carried up on chairs by drivers and relatives, and in some cases have slipped down the stairs, sustaining injuries.
Dialysis saves thousands of lives each year but many patients who suffer from kidney failure are at risk due to the unregulated and unaccountable growth of stand-alone centres across the capital defying most protocols for standardised treatment. These clinics exploit the fact that the Act passed by Parliament has not been made into a law by Delhi’s lawmakers (see box). Says Minister of Health and Family Welfare Harsh Vardhan: “I understand some dialysis centres are operating in unsanitary conditions and I agree they should be hauled up.”
The scary fact is that unlike other medical facilities that need government licences or monitoring by health bodies to function, dialysis centres do not require even registration with Delhi’s Directorate of Health Services. Though the lawmakers are aware of the mushrooming of these centres, they are helpless to tackle the problem. “I am aware that many dialysis centres indulge in malpractices. We are tackling many problems at the moment and this too will be looked into. We just request for some time as this is a new government,” says Vardhan.
In Delhi, around 5,000 patients undergo dialysis every day, but there are very few registered specialised units. Most big private hospitals have specialised units, which are registered under the Delhi Nursing Homes Registration Act, 1953. “Dialysis units running inside hospitals do not require registration,” said Dr R N Das, in charge of Nursing Homes, Directorate of Health Services. There are around 150 big hospitals, both government and private in Delhi. “On an average, 80 such hospitals have specialised dialysis units,” said nephrologist Dr Uma Kishore.
He said in Delhi the existing dialysis centres cannot meet the demand, which has led to the opening of unregistered clinics. “There are around 40 stand-alone centres operating across the Delhi and we need more,” added Kishore. However, he stated that the units must follow the protocols for standardised treatment and that the state government should adopt the Clinical Establishments Act 2010 within no time. “If not, people’s lives are surely at risk,” he said. Hence, the lack of standards like sanitation, hygiene, elevator, escalator and ramp facilities cannot be challenged.
A reality check by The Sunday Standard revealed patients visit stand-alone dialysis centres only to save money while compromising safety and hygiene. The cost of dialysis at hospitals is between `3,000 and `5,000 per session. The bills at such centres are, however, around `1,500. Most of these centres do not follow minimum standard protocols and offer treatment to mint money. They conduct around 70 to 100 dialysis per day with minimum number of staff and specialized hands.
Das said according to the guidelines set by the Indian Medical Association and Nursing Homes Registration Act, 1953, if a dialysis centre operates round the clock and has more than two indoor beds, it needs a licence. “Many of the stand-alone ones do not need licences as they don't operate full time,” added Das.
Many top nephrologists of Delhi state that unhygienic conditions of many dialysis centres are dangerous for the health of patients. Dr Sanjiv Jasuja of Apollo Hospitals said all patients needing haemodialysis should visit a hospital thrice a week for blood-cleansing. “The dialysis is done under strict ‘Infection Control Protocols’ only by trained personnel. However, haemodialysis patients are vulnerable to infections that could be transmitted through unscreened blood products or bad hygiene conditions,” says Jasuja.
Special accreditation agencies like NABH have inspection protocols for standardised delivery of dialysis. All private and corporate hospitals recognised by these agencies deliver standard quality dialysis. In case of other private operators, the negligence of Delhi’s MLAs is a heaven-sent opportunity to make money, no matter the cost to patients, literally and figuratively.
The Act Matters
The Clinical Establishments (Registration and Regulation) Act, 2010 has been enacted by the Central Government and notified on 1st March, 2012, to provide for registration and regulation of all clinical establishments in the country with a view to prescribing the minimum standards of facilities and services provided by them. The Act has taken effect in four states—Arunachal Pradesh, Himachal Pradesh, Mizoram, Sikkim—and all Union Territories. The Act is applicable to all medical establishments of both public and private sectors, including single-doctor clinics. Since health is a state subject (except in the above-mentioned states), it is incumbent on the Assemblies to pass this in order to make it a law in their own states. The only exception will be establishments run by the Armed Forces. So far, only Uttar Pradesh, Rajasthan and Jharkhand have adopted the Act under clause (1) of Article 252 of the Constitution.
Norms Under the Act
Delhi has not adopted the Act, leading to rampant proliferation of clinical establishment, including dialysis centres. Strict guidelines have been laid out in the Act regarding their functioning. A dialysis centre is a clinical establishment that provides the treatment of patients with irreversible renal insufficiencies. The Clinical Establishments Act has prescribed standards for these centres. Some of them are as follows:
A qualified nephrologist shall be the head of the centre. In areas where there is no qualified nephrologist, a certified physician (as per local law and regulation) shall be the head of the centre.
An MBBS doctor shall be available round the clock on site per unit.
The centre shall have qualified or trained nursing staff.
Three nurses per unit per shift
Two pharmacists
A lab technician
An X-ray technician
Ambulance services: The centre shall have provision of transporting patients for transfer/investigations etc in safe manner. The ambulance service shall be in-house and shall comply with the applicable local laws.
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In the story 'Danger Lurks in the Shadows at these Dialysis Facilities’ on dialysis clinics operating without licenses in Delhi that appeared in The Sunday Standard/The New Indian Express, a photograph of Fortis MEDCENTRE in Greater Kailash Part 1 has been erroneously carried. The facility meets all prescribed norms, has all the requisite registrations as applicable, follows all regulations and has in place standardised state of the art internationally accepted protocols and Fortis has an impeccable record of medical care.The errror is regretted.