Covid-19: VHA demands sufficient beds and Maha gov't help

Vidarbha Hospital Association Image Courtesy:medicalbuyer.co.in

Vidarbha Hospital Association (VHA) has raised two key issues that stand in the way of providing proper care to Covid-19 patients: first, the mismatch in the number of beds available, and second, the difficulty in maintaining economic feasibility in the absence of gov’t assistance.

Speaking to SabrangIndia, VHA Secretary Alok Umre voiced concern about Maharashtra government’s recent new hospital rules that called for a huge increase in hospital registration fees. The VHA is set to file a high court petition with Dr. Pradeep Arora to condemn the sudden hike in prices.

“I don’t understand why should fee registration be increased? Where will hospitals recover these costs? From patients? Then, they will say private hospitals have increased costs. They do not know what is happening here,” said Umre.

According to media reports, the new rules increase the earlier fee of Rs. 250 for the entire hospital to a staggering Rs. 1,000 for a single hospital bed. This means that a hospital boasting 100 beds will have to pay an annual amount of Rs. 1 lakh just for the renewal and registration of the same.

Further the rules call for structural changes that will be difficult to implement even for well-functioning private hospitals. As Umre pointed out, the main concern is that the burden of such costs will fall on patients, cutting off certain groups from private healthcare.

A need for a centralised bed allocation system

When asked about a potential third wave of Covid-19, Umre urged everyone to follow social distancing guidelines. He also requested government authorities to increase the number of government hospital beds.

A Covid-19 patient requiring oxygen is bed-ridden anywhere between 5-15 days. This creates a severe shortage of beds for Covid and non-Covid patients even though the medical staff works relentlessly.

As such, the VHA asked the state government to create a centralised bed allocation system like the Huoshenshan hospital in Wuhan, China that was specially designed for Covid-19 patients. District hospitals can be converted to such hospitals and their beds capacity can be increased to 1,000 beds or so.

An additional benefit of this is that patients will not have to travel across the district to avail a bed. In Nagpur, where the VHA is based, private and government hospitals are spread across the city. So, patients ended up travelling where there were no Covid-19 cases.

“We have limited beds and unlimited patients. This imbalance needs to be addressed,” he said.

Hospitals struggling to bear financial costs

The government rules under the January 14 notification are especially worrisome after the second-wave of Covid-19. Hospitals across the country are recovering from the sudden surge in demand for equipment and supplies.

For example, many hospitals complained and condemned the huge increase in oxygen cylinder prices. While the media talked about free oxygen tankers provided by the central government, Umre said that the cost of these tanks was passed on to hospitals. These charges were four-fold of their original amount.

He asked, “Prices increased from around Rs. 170 to over Rs. 500 for oxygen cylinders. They cited transport charges etc. How are we to pay for this?”

The VHA demanded that the state government either cease the increase of oxygen prices or assist hospitals to incur costs. It may be mentioned that with this as the background, the central government during the Parliament’s monsoon session said “there were no deaths due to lack of oxygen” in India.

Further, the second wave reported more incidents of violence against hospital personnel. All over India, there were reports of mobs breaking into hospital to harm staff or equipment.

On July 23, the VHA sent a letter to Nagpur Commissioner of Police to highlight the attacks on healthcare staff. In it, they cited a recent Bombay High Court decision that called for creation of district-wise committees of doctors.

“We would like to be enlightened about the existence and composition of a valid committee in our city. All field police personnel need to be alerted that any steps or decisions taken without support of appropriate jurisdictive scrutiny by such a constitutionally valid committee will be considered illegal,” said the VHA.

Umre said the organisation received a reassuring response from the city police in this regard and thanked the Commissioner for the noted decrease of hospital violence in Nagpur since then. Incidentally, the VHA had filed an FIR against violence on doctors which was in the interest of all those medical personnel who suffered due to a mob earlier this year.

“Every hospital was trying to do its best. Why did they try to set fire to Hope hospital? We demand a safe environment to work in. I think it is a very legitimate right of any hospital to demand a safe atmosphere,” said Umre.

The mention of fire was in reference to an April incident when family members of a deceased Covid-19 patient tried to set the hospital on fire in a fit of rage.

Bio-Medical Waste management

Aside from such blanket issues, Vidarbha hospitals recently complained of problems on the waste disposal front. On July 20, the VHA wrote to the Maharashtra Pollution Control Board (MPCB) about the incomplete Bio-Medical Waste (BMW) collection from a few hospitals in Nagpur.

The letter said that the Superb Hygienic Disposals (SHD), responsible for BMW pick-up, transportation and disposal had failed its duties in the past one month. This grossly violated the maximum prescribed time-limit of 48 hours as per BMW Management Rules.

“This prolonged storage of BMW owing to non/partial pick up is potentially very hazardous to health workers and patients/relatives etc. After a lot of communications, the waste is slowly being cleared now. If this continues, we wish to reiterate that Superb Hygienic Disposals, owing to their callous attitude, will be solely responsible for any biohazard that may happen,” said the letter, detailing the company as a repeated offender.

The SHD on its part cited payment issues from hospitals’ end. To this, Umre told SabrangIndia, “They collected over one lakh rupees from each hospital. These prices are capped by the government that the company has priorly committed to. But during Covid-19, they charged us extra.”

Umre said that many hospitals ended up paying the charges due to the pressing circumstances. However, those who refused now reported inefficient services from the SHD. The VHA stated that even if the claim was genuine, the company still cannot suspend its services.

Meanwhile, the MPCB said that such issues are in the purview of the Nagpur Municipal Corporation. According to Umre, NMC Assistant Commissioner Ram Joshi has promised to look into the matter.

The VHA demanded that the SHD return to its original service rates as per the MoU between it and the Indian Medical Association.

“Rather than suspending services partially or completely, the VHA advised the company to seek legal recourse, in larger public interest,” said the medical organisation.