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There is a need for a transparent policy on hospital admissions
Dr KK Aggarwal
A 4-day-old girl died at a government hospital in Bareilly after being shunted between different departments for 3 hours, reported India Today on Thursday.
The Chief Medical Superintendent (CMS) of the mens wing at the government hospital was suspended after the death of the four-day-old girl, an official release stated. Departmental proceedings have also been ordered against CMS, womens wing. "A critically ill child was brought to the mens wing of the hospital, where paediatricians were available. Instead of stablising the child, her family was sent to the womens wing, from where the child was sent back," officials said. According to reports, the four-day-old baby girl died after being shuttled from one wing of the hospital to another. The girl born at a private hospital on June 15 had difficulty in breathing after which her parents brought her to the government hospital in Bareilly. Her family alleged they were made to run from one wing of the hospital to another for over three hours due to which the infant died.
There is an unspoken rule that most hospitals will not admit outside serious patients, those who are not being treated in their hospitals.
For instance AIIMS (and many government hospitals) across the country does not accept
- Outside patients on ventilator or on CPAP/BiPAP
- Patients diagnosed and undergoing dialysis outside the hospital
- Patients for blood tests done unless they are inpatients or are undergoing treatment at the hospital.
- Neonates born outside
- Non booked delivery emergency cases
- Patients to provide terminal care
- Patients to provide home care
- Patients to provide long term care
A needy patient on ventilator in a private hospital is in a soup; he cannot be transferred to a government hospital and also cannot afford up to one lakhs day in the private sector. The end result is frustration, which may at times manifest as violence.
These unwritten norms also has been exploited by the commercial sector and made them the costliest segment of the hospital treatments. Emergency care, which needs to be the cheapest in any social sector, has become the costliest.
The question arises under which law, have these norms been created.
The four guiding tenets of medical ethics are beneficence (do good) and nonmaleficence (to do no harm) along with patient autonomy and justice. As clinicians, we have been trained to use our skills and knowledge to diagnose illnesses that patients suffer from and treat them. It is important that equity, equality and justice should prevail in any health care decision. The basic concepts of dignity, equality, liberty and brotherhood, without discrimination of any kind, have been established in Articles 1 and 2 of the Universal Declaration of Human Rights.
Right to equality is a fundamental right guaranteed by the Constitution of India.
Article 14 guarantees the right to equality “Equality before law”, which means that every citizen is equal before the law and is equally protected by the laws of the country, which cannot be denied by the state: “The State shall not deny to any person equality before the law or the equal protection of the laws within the territory of India Prohibition of discrimination on grounds of religion, race, caste, sex or place of birth.”
Article 15 prohibits discrimination on grounds of religion, race, caste, sex or place of birth.
Article 21 protects life and personal liberty and states “No person shall be deprived of his life or personal liberty except according to procedure established by law.” The scope of Article 21 has been expanded considerably and now also includes right to health, right to clean environment, right to live with dignity, right to adequate nutrition, right to education. In 2017, the Supreme Court declared right to privacy as a fundamental right under Article 21.
The patient has the Right to non-discrimination as listed in the draft of Patient rights Charter prepared by National Human Rights Commission, which says, “Every patient has the right to receive treatment without any discrimination based on his or her illnesses or conditions, including HIV status or other health condition, religion, caste, ethnicity, gender, age, sexual orientation, linguistic or geographical/social origins. The hospital management has a duty to ensure that no form of discriminatory behaviour or treatment takes place with any person under the hospital’s care...”
The format for medical record as prescribed in Appendix 3 of the MCI Code of Ethics Regulations, 2002 does not include socioeconomic or financial status of the patient.
FORMAT FOR MEDICAL RECORD
(see regulation 3.1)
Name of the patient : Age :Sex :Address :Occupation :Date of 1st visit :Clinical note (summary) of the case: Prov. : Diagnosis : Investigations advised with reports: Diagnosis after investigation: Advice :Follow up Date:
Observations:Signature in full …………………………. Name of Treating Physician
ICMR and AIIMs have launched Mission DELHI (Delhi Emergency Life Heart-Attack Initiative) within a range of 3 km around AIIMS. It is an emergency medical service, where motorbike-borne medical assistance unit can be quickly summoned for a person suffering heart attack or chest pain as the “first responders”. The pilot project has been launched in a radius of 3 kms around All India Institute of Medical Sciences (AIIMS), New Delhi and would be linked with Centralized Ambulance Trauma Services (CATS). Recently one of the patients was refused admission because at 3.2 km, he was outside the radius of 3 km.
Clause 2.1.1 of the MCI Code of Ethics Regulations reminds us of our obligations to the sick. “Though a physician is not bound to treat each and every person asking his services, he should not only be ever ready to respond to the calls of the sick and the injured, but should be mindful of the high character of his mission and the responsibility he discharges in the course of his professional duties. In his treatment, he should never forget that the health and the lives of those entrusted to his care depend on his skill and attention... A physician advising a patient to seek service of another physician is acceptable, however, in case of emergency a physician must treat the patient. No physician shall arbitrarily refuse treatment to a patient. However for good reason, when a patient is suffering from an ailment which is not within the range of experience of the treating physician, the physician may refuse treatment and refer the patient to another physician.”
Patients come to hospitals with great hope.
Where will they go, if they run the risk of being denied care at a hospital and are asked to go to another hospital, which might again turn them away and this cycle may continue....precious time is lost.
Clearly, there is a need for a transparent policy on hospital admissions.
Dr KK Aggarwal
Padma Shri Awardee
President Elect Confederation of Medical Associations in Asia and Oceania (CMAAO)
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Past National President IMA