A doctor at AIIMS told Outlook: 'We have no problem with the government deciding to shift our patients to private hospital but the issue is of violation of WHO guidelines and putting the lives of others at risk.'
On April 1, when Madhya Pradesh chief minister Shivraj Singh Chouhan ordered the immediate transfer of the state’s health commissioner Prateek Hajela, the media largely focused on the 1995-batch IAS officer’s controversial stint as the Supreme Court-appointed coordinator for the Assam NRC.
There was hardly any mention of the exact reasons that led to Hajela’s unceremonious exit. Most media reports quoted government sources to say that Hajela had been removed because of “gross negligence of duty” at a time when the state was grappling with rising incidents of coronavirus infection. Some claimed that the decision came after Hajela failed to convincingly reply to Chouhan’s queries on the state’s preparedness for combating the pandemic. Hajela, who had assumed charge as health commissioner of M.P barely four months ago, was promptly replaced with Faiz Ahmed Kidwai. Hajela refused to respond to queries by Outlook over his sudden dismissal.
Ordering a bureaucratic reshuffle is the prerogative of a chief minister. However, the removal of Hajela also raises certain questions – besides the obvious one on why, in the midst of a major health crisis, was the seniormost health official of the state being moved out.
A day before he was dismissed from his charge, Hajela had issued a statement detailing the measures being taken by the government to tackle the coronavirus crisis. The statement included details of the number of government medical colleges and hospitals along with their capacity to treat Covid-19 positive cases. Details of existing and upcoming testing facilities for coronavirus were also mentioned along with exact numbers of the present availability and expected requirement of PPE kits, N95 masks and three-layer masks. It also mentioned containment zones that had been created in some districts of the state.
According to Hajela’s statement, there were six government medical colleges in Bhopal, Indore, Jabalpur, Gwalior, Rewa and Sagar with a combined ICU capacity of 394 beds and 319 ventilators along with eight private medical colleges with a combined capacity of 418 ICU beds and 132 ventilators that had been identified for treating coronavirus patients. The number of Covid-19 positive cases across M.P when Hajela released this statement, on March 31, was 66. Evidently, the government-run medical facilities were well-equipped to not just accommodate the existing Covid-19 patients in the state at the time but also had sufficient capacity for treating new cases.
Sources in the government’s health department say that in Bhopal, three government hospitals – AIIMS, Hamidia Hospital and Bhopal Memorial Hospital and Research Centre (BMHRC) – had been identified to treat Covid-19 positive cases. These hospitals, as per orders issued by Pallavi Jain Govil, principal secretary of the state’s public health department, under relevant provisions of the Madhya Pradesh Diseases, Covid-19, Regulations 2020, were declared as state-level Covid-19 treatment centres where “only Covid-19 patients” could be treated.
However, something seems to have caused a rethink within the government after April 1, prompting the Chouhan administration to allow shifting of patients from identified Covid-19 government hospitals to private medical colleges and hospitals in Indore and Bhopal. Repeated calls and messages to health commissioner Kidwai by Outlook seeking clarity on the issue went unanswered.
The move to shift Covid-19 positive cases was, by itself, in contravention of guidelines issued by WHO and the ICMR under which patients receiving treatment for coronavirus infection must not be shifted to another hospital as doing so could increase the risk of transmission to others and also put the patient’s life at risk. A doctor treating Covid-19 patients in Indore told Outlook that the M.P government’s decision to divide hospitals into three categories – green, yellow and red – to segregate patients based on the severity of the infection was “proving to be a disaster”. The doctor said, “a patient with mild symptoms has to be admitted to a green category hospital but the moment his condition deteriorates, he wishes to be transferred to a yellow or red category hospital because of the impression that he’ll get better care there… the transit takes its toll because there are obvious complications in shifting patients who are on oxygen support or need to be put on mechanical ventilator. Dr. (Shatrughan) Panjwani, for instance, passed away within a day of being shifted to Indore’s Aurobindo Hospital and there are several other similar examples.”
The banality of shifting patients from one hospital to the other aside, there are other curious issues at play in M.P. In Bhopal, over 50 per cent of the Covid-19 positive cases are officials from the state’s public health department and the National Health Mission. “The first senior official who tested positive (on March 31) was managing director of the health corporation, J. Vijay Kumar. Within the next few days, over a dozen other officials tested positive, including Pallavi Jain Govil, additional director Veena Sinha, deputy directors Pramod Goyal and Himanshu Jaiswal and joint director Upendra Dubey. Kumar’s gunman and several other staff of the public health department tested positive too,” said a government official, adding that despite showing symptoms, Kumar and Govil had continued to attend meetings with Chouhan and other senior bureaucrats.
In blatant violation of the government’s orders at the time, Kumar got himself admitted at Bhopal’s Bansal Hospital, a premium private hospital. Bansal Hospital was not even identified by the state as a Covid-19 treatment centre. Govil has continued to defy Covid-19 protocols by not getting herself admitted to a hospital and simply going into self-isolation where doctors have to visit her daily to monitor her condition. Two other senior officials were reportedly threatened with suspension before they agreed to be hospitalized – on the condition that they would not be treated at a government-run facility but at the privately-owned Chirayu hospital.
By April 8, there were 15 Covid-19 positive cases from the public health department and the NHM who had been admitted to AIIMS, Bhopal while some six senior officials were admitted to Chirayu. By now, the government had already declared Chirayu Hospital a Covid-19 treatment centre and announced that all patients in M.P receiving treatment for the infection in any hospital – private or government – will be covered under the Ayushman Bharat scheme, irrespective of their financial status. The agreement with Chirayu for treating Covid-19 patients confirmed the hospital’s founder Dr. Ajay Goenka, “is for a period of three months… the government will pay Chirayu for the treatment of all Covid-19 patients and compensate the hospital for the loss of its revenues during this period”.
With senior public health officials admitted to the privately-run Chirayu hospital, which boasts of several luxury facilities, resentment seems to have set in among the junior staff being sent to the modest AIIMS. After the wife of an NHM worker admitted at AIIMS posted a video lamenting the lack of proper care being given to her husband at AIIMS after he “contracted the infection from senior officials”, Kidwai issued an order on April 8, directing the transfer of 11 government servants admitted at AIIMS to Chirayu. The following day, orders were issued transferring another four public health department officials to Chirayu.
“We have no problem with the government deciding to shift our patients to Chirayu but the issue is of violation of WHO guidelines and putting the lives of others at risk. Also, what is the point of getting three government hospitals vacated if first preference for admitting patients will be given to private hospitals? Is the government suggesting that it doesn’t have confidence in AIIMS or its own hospitals,” a doctor at AIIMS told Outlook.
As on April 11 evening, the number of Covid-19 positive cases in Bhopal had reached 131. Of these, only eight were admitted at AIIMS – three of them in ICU – while the majority of the rest were all sent to Chirayu hospital. AIIMS has a capacity for admitting 98 confirmed coronavirus cases and 118 suspects – the hospital currently has 18 suspects admitted who could be discharged if their reports come negative. At the BMHRC and Hamidia hospital, there are no coronavirus patients admitted. “Hamidia is only screening patients but no one is being admitted there even though they have set up isolation wards. The BMHRC director (Dr. Prabha Desikan) had written to Govil on March 24 informing her that while the hospital had made arrangements for isolation ward to accommodate 40 Covid-19 patients and an ICU for seven others, it required an additional staff of 550 physicians, consultants, residents, nurses and intensivist pulmonologists to account for six teams that can work in shifts. The additional staff was not provided,” a source in the health department told Outlook.
Meanwhile, at Chirayu the stream of incoming patients has been steady. “I have 140 patients at Chirayu now,” Goenka tells Outlook, adding that the hospital’s total capacity is an impressive 800 beds. “Of the total capacity of 800 beds, I can accommodate 100 patients in the ICU and 32 in private rooms. We have 50 ventilators and can offer oxygen support for 400 other patients. At present 20 of our patients are on oxygen support,” he added, explaining that the only challenge for his hospital right now is to “retain our staff because of the stigma being associated with coronavirus… I have a total staff of 2800 out of which 1600 don’t want to work because of fear of ostracism.”
Several doctors at government hospitals in Bhopal and Indore told Outlook that while facilities at private-owned hospitals like Chirayu or Aurobindo are superior in terms of the comfort factor for a patient, there is no difference in the medical treatment these hospitals can offer to a coronavirus patient as opposed to one admitted in a government hospital. “Perhaps without realising it, the government is signaling a lack of confidence in its own hospitals and doctors. As per Hajela’s last official statement, government hospitals were fully equipped to deal with the crisis for now, why then are certain private hospitals being given preferential treatment by the government…In Delhi or any other state where government hospitals were well-equipped, sending patients to private hospitals has been kept as a last resort,” said a doctor.
Congress MLA and minister in the recently toppled Kamal Nath government, Jitu Patwari told Outlook that “in such a crisis, we wish to stand with the government in its fight against this health crisis but how can we condone the total mismanagement of the situation by these people who only wanted power by any means… the state doesn’t even have a health minister and the whole health department is indisposed. On top of all this, some private hospitals are being allowed to reap the benefits of the crisis while our doctors in government hospitals are waiting for patients.”
Within the state’s political circles, rumours have already begun to float on whether the largesse being extended to select private hospitals is not purely for their capacity to deal with the pandemic. After all, Goenka and Aurobindo Hospital founder Vinod Bhandari have served time in prison and are currently out on bail as accused in the Vyapam scam which had broken out during Chouhan’s earlier stint as chief minister.