A 52-year-old businessman in Bengaluru with COVID-19 passed away for want of medical care last week. He was denied treatment by 18 different hospitals before he died at his residence in the city.
Over the last couple of weeks, several reports have emerged, where patients with COVID-19 have had to run from pillar to post to find a bed in a hospital. After the death of the 52-year-old man, the state government had issued show cause notices to nine private hospitals, stating that action would be taken if patients with COVID-19 are denied treatment. However, even after his death, several cases of patients being denied treatment have emerged.
Read: The harrowing stories of Bengaluru COVID-19 patients who struggled to get medical help
As of Monday, there are 8,197 COVID-19 patients in Bengaluru. While patients who are asymptomatic with co-morbidities, and those who present with mild symptoms are sent to COVID-19 Care Centres, those with moderate symptoms are treated at designated healthcare centres, while patients who have severe symptoms are admitted at designated COVID-19 hospitals.
Bengaluru has 3,879 beds in government hospitals. The Karnataka Health Department states that only 24% of the total beds in government hospitals have been occupied.
Private hospitals have set aside 1899 beds for the treatment of COVID-19 patients in the city. Out of these, 1154 beds have been occupied, while 745 are vacant. This means that 60.76% of beds dedicated for COVID-19 patients in private hospitals are already occupied, according to the Karnataka Private Medical Establishments Association. Despite beds being available, a number of private hospitals continue to turn away COVID-19 patients.
The larger question here is why are patients struggling to find beds?
TNM spoke to representatives of private hospitals, a member of the COVID-19 expert committee and also the Minister for Medical Education in Karnataka, to find out the cause for the existing situation.
“We have non-COVID-19 patients. Before the government announced on June 23 that private hospitals also had to treat COVID-19 patients, the beds were already occupied. Patients’ families, politicians, doctors, and ‘corona warriors’ keep calling different hospitals to check whether beds are available and most say they don’t. We have only around 25 private hospitals in Bengaluru with over 100 beds. Turning these into COVID-19 hospitals is not easy and the government did not give us enough time to prepare,” said Dr Ravindra, General Secretary of the Karnataka Private Medical Establishments’ Association.
Dr Ravindra said that in both government and private hospitals, there are several asymptomatic patients, who are being treated in hospitals, contrary to the state’s treatment protocol. “We had requested home isolation for asymptomatic patients in April itself. The government announced this just a few days ago. If this delay was sorted, then there would be more space in hospitals and COVID-19 care centres,” he said.
He further noted that the state government had time and again indicated that government hospitals would be able to tackle the COVID-19 situation in the state, especially in Bengaluru. Dr Ravindra said that despite suggesting to the government that mobilising infrastructure in private hospitals would take two weeks to a month, they were blindsided by the sudden announcement on June 23 that private establishments would have to provide 50% beds for COVID-19 patients.
“We kept asking the government again and again whether we should be preparing to tackle COVID-19 cases. The only talks we have held so far are related to the price cap for COVID-19 treatment. Suddenly, one day at 6pm on June 23, we learned that private hospitals too were supposed to treat COVID-19 patients. We were blindsided. These issues of bed availability are occurring as the government is largely unprepared and did not use the lockdown period effectively,” Dr Ravindra added.
He further stated that as the state government did not provide adequate time for private hospitals to ramp up infrastructure, several hospitals are now facing problems. “Operation theatres have to have negative pressure infra arrangements. Almost all private hospitals in Bengaluru don’t have this. If there is negative pressure, then airflow from the OT will be stopped even if doors of the OT open and close. Since, many hospitals don’t have this, if the OT door is open, the chances of the virus spreading from a COVID-19 patient inside the OT to those outside is high. This can’t be done in a matter of two weeks. The government’s planning and lack of execution of these plans during lockdown has led to this state,” he said.
He stated that the state government formed a committee under the chairmanship of SR Vishwanath, political advisor to Chief Minister BS Yediyurappa, to discuss how to tackle the shortage of beds. Dr Ravindra, who is also part of the committee, said that it was set up only on June 29 and the committee has not met even a single time to come up with an action plan.
Dr Ravindra said that Additional Chief Secretary Jawaid Akthar held talks with representatives of KPME thrice since March 22, when the lockdown began. But the preparations that were supposed to take place in the two months of lockdown were largely neglected, he alleged.
“The government was supposed to set up a call centre in April itself. KPME had suggested that a centralised call centre automated to allocate beds and tend to patient queries is really necessary. This would have helped us avoid the current situation where people have to call 20 to 30 hospitals to find out if there is a bed. Now the government is telling us to set up our own call centre for private hospitals. This is not right,” Dr Ravindra added.
Dr HN Ravindra, President of the Indian Medical Association’s Karnataka chapter, said that in most private hospitals, which have been designated for COVID-19 patients, doctors, nurses, paramedical staff and housekeeping staff have stopped coming to work, as they are scared of contracting the infection.
“The worst hit are the housekeeping staff. They come from low income backgrounds, most of them cannot afford physical distancing. They have small children and their parents living in the same house and their fear of contracting the infection is not unfounded. The government has just failed to motivate these frontline workers. With reduced staff, private hospitals are also short on staff to treat patients even if we have beds,” Dr HN Ravindra added.
He said that just like government doctors, even those doctors working in private COVID-19 hospitals must be given monetary incentives like increased pay. “Although this is a temporary solution, it will at least motivate them to work in the short term,” he added.
Dr Giridhar Babu, an epidemiologist working with the Public Health Foundation of India, who is working closely with both the state and central governments for COVID-19 management says the handling of the crisis needs course correction.
“It's not a shortage per se which is the problem but the coordination is. A realistic mapping of beds with a real time allocation should be aided by technology. When we need the apps most, they are not there,” he told TNM.
Another reason for the ‘shortage’ in beds at private hospitals may be on account of the fixed tariff set by the Karnataka government for the treatment of COVID-19 patients.
Read: COVID-19 price cap for private hospitals: Docs, public health experts, patients slam K'taka govt
Suggesting that private hospitals were unhappy with the price cap, Dr Babu said, “It appears that it might be due to several reasons. It is not surprising that beds are available if people walk in for paying cash whereas they are not when patients are presented to them from the Government. Why aren't the beds and areas segregated for COVID-19, and have free access to BBMP for admission?”
When asked if the government should take over private facilities by invoking the National Disaster Management Act, like in Maharashtra, he said it would not necessarily result in solutions and opined that the government works closely with the private sector to manage the pandemic.
“By force, the Government would have to face the same troubles as the private in bringing in the required manpower and skill set required to run the hospitals. Engaging with the private sector has begun only recently. We should explore all other options before any drastic moves are even contemplated,” he told TNM.
Karnataka Medical Education Minister Dr K Sudhakar warned private hospitals of strict action if they continued to turn away COVID-19 patients. He, however, refused to acknowledge the government’s lethargy in ramping up resources to treat the expected surge in cases. “Those who fail to treat patients sent by the government will face legal consequences. We can stop their OPD (outpatient department) from functioning or even revoke their license. But we don't want to be authoritative and want to take a cohesive approach,” Dr K Sudhakar told TNM.
Dr Sudhakar, however, agreed that there is not enough motivation among healthcare workers and doctors to continue to be on the frontlines. “There is not enough motivation for health workers and doctors and we have to find a way to motivate them. I appeal to medical workers and doctors to come forward and serve in this time of crisis,” he added.