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The | Mumbai, New Delhi |
Updated: May 1, 2020 8:37:06 am
But as the number of positive cases continues to rise and reports of hospitals rejecting patients arrive, states want private nursing homes to be fully opened.
It has been a struggle for Dr. Rohintan Dastur, Medical Director of Bhatia Hospital in South Mumbai, to get his 700-person staff back to work after it was first sealed on April 8. He offered them transportation, a hotel stay to reduce travel risks, and even 1.5 times their salary.
“They were scared,” says Dr. Dastur, 67, with his face half covered by an N-95 mask as he walks in an empty lane near his home in Cuffe Parade. The 200-bed hospital managed to resume limited services just a day ago. Nurses and doctors have reported that they work, but cleaning staff still stay away. The hospital only supports Covid emergencies.
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Bhatia Hospital is just one of 10 private hospitals that had to temporarily close after the Mumbai Municipal Corporation used the forceful sealing instrument when some health care personnel reported that Covid tested positive. The subway with the highest number of cases and deaths witnessed an almost complete collapse of private medical care in the early days of the Covid pandemic.
Private hospitals are afraid to admit that Covid patients will expose their front-line staff to infections, and this could attract adverse action. To make matters worse, there is little clarity in the evaluation of the patients, both on admission and before the operation. Two, following government advice, many patients rescheduled elective or planned surgeries. The OPD (Outpatient Department) consultation has been reduced anyway to a small fraction of the days leading up to Covid.
But as the number of positive cases continues to rise and reports of hospitals rejecting patients arrive, states want private nursing homes to be fully opened. With the Greater Mumbai Municipal Corporation (BMC) struggling to expand its isolation beds, the Maharashtra government warned hospitals on Thursday against rejecting patients, whether Covid or not Covid. The Delhi government also issued an order asking all nursing homes and hospitals to resume services and admit non-Covid patients.
But private healthcare facilities in Mumbai are cautious after the sealing experience. Those willing to reopen find little or no support from paramedical staff.
Also in Kolkata, private hospitals feel they are ill-equipped to handle suspected Covid patients. When patients with Covid-like symptoms arrive, they are simply redirected to dedicated COVID-19 hospitals. Peerless, which has an 11-bed isolation room and is equipped with ICU beds and a pair of ventilators, admits Covid patients. But RTIICS does not. Private hospitals in Kolkata set up some isolation beds after a meeting with the state government on March 20, but many are fearful and ill-equipped to handle suspected Covid patients and therefore refer them to dedicated Covid hospitals. .
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These fears echo across the country, especially in smaller private facilities that close their doors due to a lack of PPE, reduced workforce, or inability to support themselves financially after a sharp drop in walk-in patients. .
Large corporate hospitals are also feeling the heat.
For example, Max Healthcare’s non-frontline staff across the board, including senior physicians who are not directly involved in its operations at Covid and other facilities, have received salary cuts of “more than 25 percent” for the Hospital chain may “continue to be operational during Covid’s time,” Abhay Soi, president of Max Healthcare, told The Indian Express.
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“Other industries have the option of reducing operations or laying off personnel, but the healthcare industry faces a peculiar problem: we have to bear increasing costs at the moment and at the same time increase the capacity to meet an increasing requirement”, said.
Several hospitals, especially in Tier II and Tier III cities, are also wary of the “mahamari aspatal (pandemic hospital)” label that plagues businesses for many months, even after the epidemic subsides. For example, Bihar has more than 250 private for-profit and non-profit hospitals, framed under Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana. However, most of them had closed operations for fear of not being able to contain the infection if it spread in their hospitals, some state government officials said on condition of anonymity.
However, in states that have the capacity given the fact that the case load is manageable, the government has kept private hospitals on hold, while prioritizing treatment at its own facilities. For example, depending on the requirement, only the state has involved selective private health centers in Madhya Pradesh as dedicated centers.
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“If we involved everyone, it would be chaotic,” said Dr. Lokendra Dave, a member of the statewide Technical Advisory Committee, who is also a member of a government team tasked with medical treatment and hospital management. Another reason for this is that not all private facilities have the equipment and resources to follow the treatment protocol, he said.
“While there is a risk that they may end up spreading the infection, the government must also ensure that there are facilities for treating non-Covid patients. The government can involve more hospitals if they have facilities, “he said.
The case is similar in Uttar Pradesh, which has not prevented private hospitals from treating patients, but has limited Covid’s facilities to private medical colleges. According to Chief Secretary (Health) Amit Mohan Prasad, the plan is to contract another building such as a hostel, a smaller private hospital, a hotel or hostel around each hospital with an isolation center so that asymptomatic patients can be transferred there. In this way, hospital beds can be vacated for critically ill patients.
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“We already have several private medical schools in our fold and that gives us a total bed capacity of 10,000 (combined government and private). We have notified many private hospitals, and when the need arises, we have told them that they must be ready within three to five days to prepare to provide Covid care. In the meantime, we expect private hospitals to provide other essential services like dialysis at their facilities, “said Prasad.
In Telangana, private facilities like Apollo Healthcare were previously restricted by instructions to send all of their COVID-19 positive patients to government facilities, said Dr. Sangita Reddy, joint director of Apollo Hospitals Enterprises.
In other cases, there is ambiguity in state government policies in involving and allowing private facilities.
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“One area where additional clarity would help is evaluating patients on admission, as well as preoperatively. This seems important to protect other patients and staff from patients who may be positive, but asymptomatic or mildly symptomatic, “said Dr. Ashutosh Raghuvanshi, Managing Director and CEO of Fortis Healthcare.
“Situations like this can result in the quarantine of large numbers of medical personnel, which we cannot afford at this time,” he said. Fortis Healthcare has established isolation rooms and assigned 350 isolation beds in its 28 hospitals.
Hospitals like Apollo also face limitations in treating patients who come to their facilities for crucial non-Covid treatment. Not knowing if they carry the coronavirus, which puts Apollo staff at risk of infection, the hospital is increasing its use of personal protective equipment. While Apollo can still afford this, smaller private nursing homes and centers in states like Maharashtra have also been requiring PPE for their staff.
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“In every emergency room now, all of our staff uses PPE, because we don’t know who has come in. They are all treated as (Covid) positives, because we have this important testing restriction,” said Dr. Reddy.
“There is a lack of communication between government departments. While one department will understand the merit of allowing us to operate in a certain way, another department will say otherwise, ”said the executive of a private hospital in Delhi on condition of anonymity.
In other states like Gujarat, private hospitals were never discouraged from treating patients with Covid. However, after the national shutdown, these hospitals operated understaffed, and cared for patients who required an emergency procedure, consistent with advice from the state health department to avoid planned procedures.
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On April 19, Gujarat decided that those who are willing to pay for and receive treatment in private hospitals can do so at three facilities in Ahmedabad: Sterling Hospital, HCG Hospital, and Narayana Multi-Specialty Hospital. Sterling and HCG Hospital began treating Covid patients last week, while Narayana Multiple Specialty Hospital was still in the process of drafting its treatment protocol.
In the absence of defined treatment protocols and lack of access to testing and protective equipment in the past, some private hospitals refused to admit patients with flu-like symptoms, rather than directing them to government facilities. Despite warnings and warnings from states, many private hospitals are still unwilling to risk the small businesses they receive from non-Covid patients.
(With contributions from Sohini Ghosh in Ahmedabad, Ravik Bhattacharya, Santanu Chowdhury and Atri Mitra in Kolkata, Santosh Singh in Patna, Avaneesh Mishra in Lucknow, Milind Ghatwai in Bhopal, Abantika Ghosh and Aashish Aryan in New Delhi)
PART 3: For private hospitals, Covid is synonymous with loss.
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