SEPTEMBER 24 2015

By Naresh Minocha, Our Consulting Editor

THE avoidable dengue crisis in national capital region (NCR) has served as a perfect opportunity for populist politicians and the media to indulge in hospitals-berating.

Headlines/hashtags aptly capture their attempt to whip mass hysteria over alleged medical negligence. Check out these: 1) Debate: #KillerNegligence: Care, but for profits? 2) Dengue, neglect claims a second young life in city. 3) Delhi dengue death toll at 11, govt warns hospitals. 4) Dengue scare grips Delhi: Cabinet discusses options against errant private hospitals. 5) Dengue: Act against refusal, overcharging by hospitals, Centre asks Delhi Govt.

Both the politicians and media have, on the other hand, virtually maintained silence over citizens' criminal negligence in taking preventive & protective measures as specified in the familiar do's and don'ts. Dengue is a highly 'unpredictable' viral disease for which there is no specific cure.

Hostile and biased reportage is thus likely to harden the negative opinion of the unruly and ignorant citizens' towards the medical profession.

As it is, the growing attacks on hospitals deprive other patients of urgent medical attention. It is here pertinent to cite violence that followed the death of a dengue patient at a hospital in Noida, adjoining Delhi.

On 11th September, the kith and kin of the deceased not only broke a few bones of a doctor but also went on rampage within and outside the hospital for over an hour. The next day a 100-strong mob again resorted to violence including stone-pelting on cars passing on the main road to protest against medical negligence of patient, who had died within few hours after her admission. The flash strike by doctors and para-medics heightened the misery of patients.

Such incidents create apprehensions among the hospitals about the risks of admitting critically ill or injured patients. Hence the deplorable buck-passing strategy of certain hospitals to refer dengue patients to 'bigger' hospitals.

This thesis also gets credence from the contradiction between accusation that private hospitals refuse to admit severe dengue patients and the claim that they are over-charging. Why should a greedy hospital turn down an opportunity to earn more and larger income quickly? As for issue of over-charging, the allegation is irrelevant as there is no statutory control over hospital charges levied by private hospitals. The tariff varies from hospital to hospital.

This analysis is no way an attempt to rationalize the fault of hospitals in admitting critically ill patients or charging exorbitantly.

There is a definitively a case for strong, independent healthcare regulator who should enforce strict medical norms and impose penalties against defaulting hospitals. A ray of hope in this direction is coming from Competition Commission of India (CCI) which intends to commission a baseline study on pharmaceuticals and healthcare sector in NCR.

Says CCI, "the Commission has come across various issues in the pharmaceutical sector and healthcare delivery systems/services including non-availability of essential medicines, increasing price of drugs, nexus between pharmaceutical companies and pharmacists, nexus between pharmacists and doctors, nexus between doctors and pathological laboratories, nexus between doctors and pharmaceutical companies, and nexus between hospitals and insurance companies etc."

Coming back to AAP Government's utter failure to prevent dengue crisis, it has tried to deflect attention by slamming private hospitals for negligence and profiteering. It has arbitrarily fixed charges for dengue clinical tests conducted by private clinics. It has also blamed both the Centre and the municipal corporations for the emergence of crisis and its improper handling.

Delhi Chief Minister Arvind Kejriwal reportedly said: "We are planning to come out with a law so that hospitals refusing treatment to an emergency patient can be penalized. In the next couple of days, we will call a special session of the legislative assembly to bring in the law."

Nobody in the media asked Mr. Kejriwal, why his Government has not mooted a law to make violence against doctors and hospitals a non-bailable, terrorist offence.

Instead of threatening to takeover private hospitals and fix tariff for clinical tests, Delhi Government should first stem the multiple rot in hospitals that it controls.

It should stop privatization of healthcare services within these hospitals most of which have manned by temporary or contracted staff. It should provide job security to doctors and para-medics by ending the current policy of keeping their jobs in the ventilator mode.

This pitiable state of affairs in AAP Government-controlled hospitals is best illustrated by 89-days tenure offered by Lok Nayak Hospital (LNH) to doctors and para-medics. The notice dated 18th September 2015 inviting applications for ad hoc appointment of junior resident doctors, for instance, stipulates one-day mandatory break after 89-day tenure. The notice says that job can be extended up to a maximum period of one year.

Another notice inviting applications for laboratory staff clearly states that 89-day tenure is linked to "fever management" at the LNH.

Mr. Kejriwal, how secure and confident would a chief minister feel if his tenure is limited to 89 days? Why is AAP Government continuing the practice of making doctors' ad hoc appointment for 89 days? It inherited this outrageous human resources management strategy from previous Congress Government.

While inspecting a hospital, Delhi CM quipped: "It is heartbreaking. We have become blind in the race to make more and more profit. We shouldn't forget our humanity. Nothing would have been lost if the hospital had treated the child. Would it have affected their profit margin so much?"

Mr. Kejriwal, it is indeed heartbreaking that AAP Government did not launch dengue awareness campaign for citizens on time. Mosquito bred merrily with AAP splurging public money on political propaganda (Jo Kaha, Wo Kiya advertisement campaign). In the blind endless ego trip for AAP supremo and to score brownie points over Modi Sarkar, Kejriwal government forgot to spare time on healthcare for its core supporters. They live in unorganized localities and are thus most vulnerable to dengue.

Mr. Kejriwal, your ego would not have got marginalized if you had diverted a small fraction of Delhi's Rs 523 crore advertising budget for 2015-16 on issuing Dengue alerts to the public.

AAP Government belatedly launched dengue helpline only on 14th September when the disease had taken toll of dozen citizens and created panic in NCR!

If Kejriwal has any concern for Aam Adami, he should flip through Singapore Government's dedicated website (http://www.dengue.gov.sg/) on prevention of dengue and introspect.

The revelation resulting from introspection would be: All dengue deaths could have been avoided if AAP Government launched anti-dengue campaign on the pattern of Singapore's.

The allegations of medical negligence should be taken with a pinch of salt as there is no drug or vaccine that can cure dengue. Moreover, the disease is deceptive and has to be only managed in severe cases.

Experts from Latin America, South-East Asia and at WHO headquarters agreed in 2008 that "dengue is one disease entity with different clinical presentations and often with unpredictable clinical evolution and outcome," says World Health Organization (WHO) in 'Dengue: guidelines for diagnosis, treatment, prevention and control'.

As put by WHO guidelines, "While most patients recover following a self-limiting non-severe clinical course, a small proportion progress to severe disease, mostly characterized by plasma leakage with or without hemorrhage. Intravenous rehydration is the therapy of choice; this intervention can reduce the case fatality rate to less than 1% of severe cases. The group progressing from non-severe to severe disease is difficult to define, but this is an important concern since appropriate treatment may prevent these patients from developing more severe clinical conditions."

The first and the best remedy is thus prevention of breeding by mosquito that spreads dengue. This can be achieved only the cooperation of citizens, local civic authorities and the State Government.

Nobody took the primary blame on this count during the persisting Dengue crisis. Similarly, the aggrieved parents did not take the secondary blame for the negligence in protecting their children from mosquito bites through use of sprays, repellents and protective clothing. Everybody, however, found it convenient to make hospitals the punching bags.

Hospitals-ransacking and doctors-bashing are nowadays a trend. This, in turn, is further aggravating the healthcare muddle in the country.

Like Arvind Kejriwal, other populist leaders also periodically rant against medical profession. In October last year, Jeetan Ram Manjhi, the then Bihar Chief Minister, for instance, threatened to "chop off hands" of doctors if there was "any negligence in treatment of the poor".

During the same period, another populist leader Pappu Yadav had fixed three-tier fees for doctors with a cap of Rs 300 for senior, specialists. He reportedly raided private clinics of some doctors and locked them for allegedly fleecing poor patients. He upped his ante against doctors by dubbing the Indian Medical Association (IMA) as "Indian Murderers Association".

In the violence against doctors, Populism-smitten Modi Government has relied on dictum "discretion is better part of valour." It ought to prepare a blue-print on complete overhaul of healthcare governance for the benefit of all stakeholders. Such an initiative is urgently needed to break the vicious cycle of woefully inadequate healthcare facilities provoking impatient and ignorant citizens to attack medical professionals, who, in turn, avoid admitting critically ill patients to ward off violence.