On the night of June 1, Renu, 27, a native of Ropar village who was 17-weeks pregnant, developed intense pain in her abdomen. Her harried husband immediately took her to Ropar civil hospital. As they reached the nearest health facility, the family says, it was the nursing staff that examined the patient and informed them that she has suffered a miscarriage. With no doctor available in the hospital, Renu’s family members say they were offered a choice: to select one out of three Chandigarh hospitals.
“I was asked to decide from PGIMER, GMSH-16 and GMCH-32 and then only would they mention it on the patient’s OPD card,” said the husband Ramesh Kumar, a businessman. He adds that after consulting some of the family members, they decided to choose GMSH-16.
Kumar says he was told that PGI and GMCH remain overcrowded with patients and GMSH may be less chaotic. “We reached on June 2 around 7.30 in the morning and the doctors here conducted a surgery in the evening,” he said. Even though the patient was discharged a day later, she is now again admitted to GMSH, after she again developed some medical complication.
At the gynaecology ward of GMSH-16, Kumar is still seeking answers to his questions.
“The government in Punjab claims to be providing best health facilities. Doctors here said that it was a minor procedure and could have been easily done at Ropar hospital. But on the ground no one works and they make people suffer by referring them to Chandigarh. It is nothing but harassment,” he said.
Renu is not the only such case. She is one among thousands of patients who are referred from the neighbouring states of Chandigarh, and Punjab tops the list.
Chandigarh, which has an estimated population of more than 10 lakh as per 2011 census, has one of the best health facilities available currently in the country. With two best hospitals, including premier medical hub PGIMER, located in Chandigarh, health officials say that due to “unnecessary referrals”, mostly from Punjab and Haryana, multi-specialty hospitals like PGIMER, GMSH and GMCH are reduced to work like district hospitals.
The Chandigarh health department’s official figures reveal startling facts. In 2017, out of 16,607 deliveries conducted at the GMSH-16, as many as 9,323 patients belonged to Chandigarh and 4,462 were from Punjab, followed by other states.
The OPD patient numbers provided by Public Relations Office (PRO), PGI, also reveal that the highest number of patients who visited PGI’s OPD in 2017 were from Punjab. Out of 26.84 lakh patients, 9.9 lakh patients came from Punjab, followed by 5.4 lakh patients from Chandigarh and the remaining from other neighbouring states. The hospital saw people come from as far as Bihar and Assam.
As per the data compiled by the Chandigarh health department for the year 2017-18, in all the health facilities, including PGIMER, GMCH and civil dispensaries, there were 68 lakh patients who visited the OPDs for the given period. The indoor patient statistics say 2,39,917 were recorded for the same period.
At a time when Chandigarh continues to witness an unprecedented increase in the number of patients, the Chandigarh health department and the PGIMER have announced several new health projects in the city. But doctors and other health experts say it is not going to bring any major relief and focus should rather be shifted on to stopping the referrals.
Increasing rush of patients
PGI has announced eight major health projects in the city while the Chandigarh Administration is too planning to come up with new health facilities in the city, including 300-bedded trauma centre by GMCH.
“The issue of unnecessary referrals has become serious. There is no referral system at present and anyone can just walk in. We have seen that there are 30-40 per cent cases, which can be easily dealt with at the hospitals in the neighbouring states and they are easy to diagnose and treated,” Dr B S Chavan, the current officiating director-principal of Government Medical College and Hospital (GMCH), Sector 32, told Chandigarh Newsline.
He says adding infrastructure in the city is not the only solution. “We recently created the overflow ward thinking there will be no need for trolleys, but the rush continues and we still see no respite,” said Chavan.
According to Chavan, the problem can be only solved if only critical cases are referred to Chandigarh. “Only those cases should come to Chandigarh, which are critical, and the district hospitals and medical college should increase the infrastructure so that maximum cases are dealt with there. If you can’t stop the patients from visiting the hospitals, we will not be able to do anything in Chandigarh because we cannot refuse treatment to anyone,” said Chavan.
A senior UT health official says the city’s health facilities are flooded with patients from Punjab and Haryana.
“Even if you create 100 new projects in Chandigarh, it will not bring any relief. Chandigarh has a population of more than 11 lakh and the health infrastructure here is one of the best in the country. But at present even the institute like PGI is forced to attend to the minor cases, which can easily be treated by a doctor posted even in a dispensary,” said the health official. “The situation is such that we have started getting representations from our staff that a solution needs to be finalised to deal with this problem.”
“The doctors referring patients to Chandigarh hospitals shows lack of confidence among the doctors in peripheral areas to handle the critical cases, or sometimes they don’t have the required facilities available,” said Dr Rajesh Chhabra, president, PGI Faculty Association.
“Need of the hour is to focus on strengthening the health infrastructure in the peripheral areas which can help bring down numbers of patients visiting the hospitals in Chandigarh,” Dr Chhabra added.
PGI, which is considered as north India’s premier medical hub, is the worst hit and bearing the maximum load. Meant to deal with the referral and critical cases, the institute OPD is even seeing cases of “fever and cold” as per the doctors.
PGIMER Director Jagat Ram in the 47thannual report of the institute had quoted in January, “The patient care load over the years has been increasing exponentially and now it is becoming unimaginable.”
The report had said from the annual attendance of 1,25,163 outpatients and 3,328 admissions in 1963-64, the figure has gone up to 25,55,455 outpatients and 89,584 admissions in 2016-17.
At present, everyday people coming from different states of north India reach as early as 5 am to get a registration card made at PGI. The institute, which was till two years ago seeing OPD registrations of around 8,000, today sees OPD number of more than 10,000.
Dr Jagat Ram told Chandigarh Newsline earlier this week that even approaching the health departments of three neighbouring states, there seems to be no change on the ground. “PGI is in a very difficult situation because there is no stopping the patient numbers from the neighbouring states in OPD and IPD. The biggest problem is when a patient reaches here, we cannot refuse the treatment,” he said.
The PGI faculty recently approached the director to put a cap on the daily limit of OPD numbers on the pattern of AIIMS-New Delhi. “There is an opinion among the faculty that there should be some capping on OPD numbers. The institute will take up the matter with the governing body,” said Dr Jagat Ram.
At the PGI OPD, many patients say that they were advised to visit PGI because they provide the best treatment. “My 12-year-old grandson fell from the scooter and he suffered a fracture. We initially visited a doctor in our village dispensary and then the district hospital. We were not happy with the treatment then and we straightaway came to PGI. Here the doctors have done the plaster. Thank God, he is recovering now,” said Harbhajhan Singh, a resident of Ludhiana. Ludhiana city has Dayanand Medical College (DMC), which is a tertiary care teaching hospital, but Singh says he was not aware of any such college.
What is the solution?
At present, there seems to be none. At a meeting conducted in November last year under the chairmanship of the then Chandigarh Health Secretary Anurag Aggarwal, it was decided that there should be a proper referral mechanism via 108 ambulance service. During the meeting, it was also discussed that no referrals should be sent without instructions. The GMCH officials, who attended the meet, had suggested that Civil Hospital in Mohali and Civil Hospital in Panchkula should be the first reporting places for the patients being referred from the districts of Punjab and Haryana. Six months have passed; there is no change on the ground.
“It [adding infrastructure] will help marginally, but will not solve the complete problem,” said Dr Ajay Aggarwal, a city-based doctor and former president, Indian Medical Association Chandigarh. “The issue of sending minor cases to Chandigarh over the years has not been solved. You have people coming with fever and other small problems to PGI, which is tertiary care. So how are you going to treat those patients who actually need your help?”
“There should be a referral audit in all the hospitals in neighbouring states. Let the authorities find under what circumstances patients were referred. Once the audit report comes then only can things improve because administration will be able to take action accordingly. Time has come that health authorities should sit together and find a solution,” said Dr Rajesh Chhabra.