Three recent incidents in Andhra Pradesh, in which people were seen carrying the bodies of their deceased relatives on their bike, have stoked a discussion about the state’s ambulance infrastructure, especially with regard to its ‘Mahaprasthanam’ hearse service. The criticism surrounding these incidents, the videos of which have gone viral on social media, was met with nearly uniform responses from the officials concerned: “An inquiry was ordered. The hearse ambulance service (Mahaprasthanam) was not available at the time. The relatives were in a hurry and hence did not want to wait for a Mahaprasthanam ambulance to arrive. The 108 ambulance service is meant for emergencies and not to carry dead bodies.” But the government’s defences aside, why was the hearse service unavailable in the first place? Is Andhra facing a shortage of ambulances? TNM takes a look at the three incidents to understand what exactly went wrong.
Tirupati: Boy’s body carried on bike
The first incident was reported on April 26 in Tirupati’s Sri Venkateswara Ramnarain Ruia Government Hospital. A man was forced to carry the dead body of his 10-year-old son, Jesuva, on a motorbike, after private ambulance drivers stationed outside the hospital demanded very high charges to drive the body to their hometown, 90 km away from the hospital. After the video of the helpless man carrying the body became viral, four private ambulance drivers were booked. An inquiry was carried out by the Tirupati District Medical and Health Officer (DMHO) and the Revenue Divisional Officer (RDO). The Resident Medical Officer was suspended and a show cause notice was issued to Hospital Superintendent Dr T Bharathi.
The incident had also grabbed national headlines, following which Chief Minister Jagan Mohan Reddy ordered a strengthening of the vigilance system, including the laying down of a new set of protocols and strict adherence to the same. As per sources, he has also called for two complaint numbers to be established for people to reach out to, in case of any such troubles in the future. The direction further stated the complaint number, once established, needs to be well publicised for public awareness. In this wake, the officials concerned have been in talks with the telecom operator to establish the helpline number, it is learnt.
Nellore: Boy’s body carried on bike
The second incident from Nellore came to light on May 5, after the video of the relatives of an eight-year-old boy carrying his body on a bike went viral on social media. A person was seen riding pillion on the bike with the boy’s body on his lap. The man alleged that a 108 helpline’s ambulance driver refused to carry the child’s body, citing that the helpline was only meant for emergencies, despite the Mahaprasthanam vehicle not being available. This was the second such incident to have surfaced within 10 days.
Speaking to TNM, V Vinay Chand, CEO, Dr YSR Aarogyasri Health Care Trust, said the 108 service is dedicated for emergencies and can be hailed for transporting patients to hospitals. “We can’t use those resources to carry dead bodies, as saving lives is the priority. The ambulance is for people in need of medical care,” he said. Interestingly, in the Nellore incident, a video was later released by the government in which the father of the boy narrates how the family had decided to take the body themselves without waiting for the ambulance, as they were in a hurry.
Tirupati: Girl’s body carried on bike
In the third incident, which also took place in Tirupati, a man was forced to carry the body of his daughter, Akshaya, from the Naidupeta Government Hospital on a two-wheeler, after the ambulance drivers allegedly refused help. As per the probe by the district administration, the girl’s father had approached the hospital’s ambulance drivers seeking help to transport the body, but was refused. The father then reached out to the auto drivers, who too demanded a large amount. Finally, he ended up carrying his daughter’s body on his bike.
When asked about the incident, Tirupati Joint Collector DK Balaji said the 108 ambulance services will be provided only to bring patients to the hospital. “Their services are limited to that. The Mahaprasthanam ambulances, meant to transport dead bodies, are available only in tertiary hospitals. The Naidupeta hospital is a small facility,” said the Joint Collector. In what comes across as a meek defence, he also stated that the father was in a hurry to take away his daughter’s body. However, the fact that this was the third such incident in a short span has raised questions about the hearse service system in place in the state.
In all three incidents, the common problem factor was the availability of a hearse ambulance, or its lack thereof. Dr M Raghavendra, Director of Medical Education (DME), told TNM that the state has 53 Mahaprasthanam vehicles deployed at the 11 teaching hospitals, five district headquarter hospitals and one area hospital. “There is a demand for Mahaprasthanam ambulances in other government hospitals as well. We are in the process of looking into this,” he added.
In total, Andhra Pradesh has a fleet size of 748 ambulances, of which 731 are presently functional and 17 have been kept as backup, Vinay Chand pointed out. “This fleet size is more than any other state. Minor hiccups happen only when there are too many emergencies on the same day. The state has an ambulance for every mandal. Besides, Mobile Medical Units (MMUs) are deployed in almost every rural mandal including tribal areas. The state has 676 MMUs, for which the helpline is 104. In addition, the Chief Minister has now directed to set up a dedicated helpline to lodge complaints regarding the ambulances.”
But Dr D Jayadheer Babu, president of the Government Doctors Association, has a different opinion. “No state has enough ambulances to meet 100% of its requirements. Even if Andhra has many ambulances, the number of hearse vehicles is definitely inadequate. If we look at the numbers after the recent division of districts, the state has only 53 vehicles for 26 districts. On an average, 10-12 deaths are reported in each of the major medical college hospitals in the districts. This clearly means that more hearses need to be deployed. The government needs to take this up seriously to ensure such incidents do not happen again.”
According to officials, Mahaprasthanam vehicles are usually parked at the bigger government hospitals, which have around four to seven vehicles each. Any patient who requires the service of a Mahaprasthanam vehicle needs to reach out to the hospital authorities, following which the head nurse or the superintendent can arrange the service. “Quite often, drowned in sorrow, the relatives are in a hurry to take the body home. The ambiguity surrounding the procedure to hail a free Mahaprasthanam vehicle, however, often causes people to depend on a private ambulance instead. In turn, the private operators take advantage of this helplessness and fleece the people. This is why people are forced to transport their dead in their own vehicles,” a government doctor explained.
“In the light of the latest incidents, the government is considering two action plans to make the hearse service more accessible to citizens,” said Dr Raghavendra. One is to establish a toll free number as a helpline for those who need to avail the Mahaprasthanam service, he said. According to sources in the Health Department, another option is to expand the services of the already popular 104 helpline, so that the same number can be used to hail a Mahaprasthanam vehicle as well. A final decision will be made after studying the feasibility of both options, said an official. Meanwhile, a request has also been sent to the BSNL to earmark a catchy number, in case the department plans to roll out a new helpline dedicated to the Mahaprasthanam service, saving people the hassle of having to approach the hospital authorities with a request for the same.
“After the first Tirupati incident gained media attention and turned into a political issue, the Superintendent was issued a show cause notice and the RMO was suspended. But suspension of doctors is not the solution,” said Dr Jayadheer Babu. “There has to be inter-departmental coordination. A proper procedure should be put in place to deal with such concerns, with the consequence of vigilance and police action for those who do not adhere to the system. Periodic reviews need to be carried out to keep track of the number of deaths in every region, and the number of people who availed the government’s free hearse service,” he said.
Transport of dead bodies involves big money, and wherever money is involved, there is a mafia, the doctors’ association president said. “When the government’s vehicles are busy, the hospital staff connects the deceased person’s family to private ambulance service providers. This is a mafia that can be tackled by ensuring we have adequate vehicles available and a vigilant monitoring system in place,” he added.
Those three incidents were unfortunate, Dr Raghavendra told TNM, further alleging that this was happening because private ambulances were looting the patients and their families. “Dead bodies are usually not transported at night. The bodies are stored in the mortuary and shifted the next day,” he said. The relatives, however, often prefer to take the body back home as soon as possible, causing them to turn to private operators for help. “But now, after the recent incidents, we have directed the service provider to go ahead and shift the body at night as well, if requested by the deceased person’s family. This is now a 24x7 service. Hospitals have been instructed to keep at least two vehicles and drivers ready during night time,” the DME added.