The state of state-run hospitals

Patients themselves avoid visiting the three peripheral hospitals knowing they will invariably land in JJ for one or the other test.

Published: January 29, 2014 1:11:08 pm
The stark difference in healthcare facilities has led to the overburdening of JJ, considered the parent state-run hospital in the city. The stark difference in healthcare facilities has led to the overburdening of JJ, considered the parent state-run hospital in the city.

The three peripheral state-run hospitals and the JJ Hospital are a picture in contrast. While JJ overflows with patients, its sister hospitals have beds lying empty, thanks to lack of facilities, says Tabassum Barnagarwala.

A walk through the corridors of any one of the three state-run hospitals in Mumbai – Gokuldas Tejpal (GT), St George’s and Cama and Albless – shows that half the beds in wards are lying vacant. The situation in Sir Jamshedji Jeejeebhoy Hospital (JJ Hospital) is just the opposite, with patients pouring in not only from the city but also from different parts of the country. JJ easily receives over six lakh visitors to its out-patient department in a year as opposed to a lakh or less in the other three hospitals. Its corridors are crowded with kin of patients, serving as temporary abode for them.

The stark difference in healthcare facilities has led to the overburdening of JJ, considered the parent state-run hospital in the city.

According to an official at GT Hospital, of the total 521 beds, less than half are occupied at any given time. In Cama and Albless, the situation is worse. Of its 505 beds, only 100-150 beds are occupied. St George’s medical superintendent Dr J B Bhavani admits that on an average, 50 per cent of the beds lie vacant.

On the other hand, the cardiology department in JJ Hospital has 30 beds, but there are 80-90 patients at any given time, says Dr N O Bansal, professor and head of the hospital’s cardiology department.

The reasons for empty beds in these three sister-hospitals include lack of super-specialty facilities, dearth of doctors and an overdependence on JJ Hospital for surgeries.

Patients themselves have turned shy of visiting the three peripheral hospitals knowing they will invariably land in JJ for one or the other test. Ashok Shankar (55), an epilepsy patient, was first admitted in GT Hospital this month due to availability of beds. However, his daughter had to take him to JJ Hospital for getting a small test done. “We don’t know what the test was, but the doctor just gave us a slip with the name of the test needed. It becomes difficult to make the patient travel,” says Shankar’s wife.

Lack of proper facilities

Vaishali Sawant (33), who was admitted in Cama and Albless hospital in October 2013 to undergo Caesarian, had to visit JJ Hospital thrice for tests. “I had to take my wife there for MRI and certain sonography tests which were not available in Cama. No ambulance was provided to us and we had to call a taxi to JJ,” Vaishali’s husband Sandeep, who lives in Nallasopara and had to travel to and fro daily.

While Cama specialises in gynecology and pediatric cases and is currently developing its radiotherapy department for cancer treatment, it still fails to provide full-fledged services in the field it specialises. For instance, patients requiring super-specialty surgery in gynecology or pediatric cases are either referred to JJ or a private hospital. Dr S S Jagtap, professor and head of orthopedic department at JJ, says, “We get cases since the other three hospitals lack the necessary skills. Knee or joint replacements are common orthopedic cases referred to us.”

Though Cama and Albless has recently started radiotherapy for cancer patients, a resident doctor there says the cancer treatment is limited to female genital organs only. “If we get a case of cancer in any other body part, we do not have the facilities and have to refer patients to Tata Memorial Hospital,” the doctor says.

According to Right To Information (RTI) data gathered by the Mumbai Newsline, Cama Hospital refers at least one cancer patient every month to Tata Memorial and nine patients to JJ for surgeries.

While GT Hospital has better facilities than Cama and Albless, lack of manpower means these are not utilised fully. Dr Kamlesh Rangari, a first-year resident doctor in GT, says, “We have a sonography machine, but it functions only for two hours, between 9 am and 11 am. In the absence of a person to supervise, it cannot be operated full time. Now, plans are being chalked out to make it functional full time.”

The sonography machine in GT also suffers from limitations. While it can be used for abdomen sonography, it is not fully equipped for cases that need deep probe sonography or detailed abdominal view. In such cases again, patients are referred to JJ hospital.

While GT has Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) scan facilities, these machines are functional only during day time, on public-private partnership basis. The hospital’s medical superintendent, Dr D R Kulkarni, says, “For patients who need MRI or CT scans at night, we have no option but to send them to JJ.”

GT and JJ are the only state-run hospitals in the city which have CT scanner and MRI services.

Interestingly, despite JJ being the parent hospital with all specialised services, it still has to rely on St George’s for using pneumatic drill (used for orthopedic surgeries). Bhavani says, “The pneumatic drill costs Rs 75 lakh and therefore only one hospital has it. JJ borrows it from us whenever they need it.”

The haphazard distribution of facilities is a handicap that ultimately causes patients to suffer.

Dearth of doctors and other staff

High vacancies for sanctioned posts cripple not only the city’s hospitals, but also the state’s healthcare system. According to RTI information gathered, till November 2013, St George’s had a whopping 67 per cent vacancy (52 out of 78 posts) for medical staff (Grade I and II) and 52.5 per cent vacancy for Class IV employees.

Cama had the least vacancy at 20 per cent (9 out of 43 posts) for medical, para-medical and teaching staff. Around 40 per cent of Class IV posts were lying vacant till November last year.

GT Hospital had the highest number of vacancies till November last year, with 74 per cent (47 out of 77) medical posts(Grade I and II) and 29 per cent of Class IV posts lying vacant.

Doctors agree that the declining enthusiasm among the 5,000-odd fresh MBBS graduates passing out every year in the state to join public hospitals is due to lucrative salaries in private hospitals and lack of facilities in the state hospitals. “While fresh graduates are offered a salary of say Rs 60,000 per month in state-run hospitals, they get one lakh-plus in private hospitals,” says Dr N O Bansal, professor and head of cardiology department in JJ.

Working conditions in public hospitals also act as a deterrent for doctors. Unlike Brihanmumbai Municipal Corporation which allows private practice for doctors after their working hours, a doctor working full-time in a state-run hospital is not allowed to operate in a private hospital. “This has either discouraged doctors from working in state hospitals or forced them to practise privately under cover,” Bansal adds.

Around four years back, the state government had given doctors the freedom to practise anywhere after their official working hours. However, the decision was reversed soon without any plausible reason, a doctor in JJ says.

An official from the state health ministry, however, says there is no reason for doctors to demand permission to practise privately after their working hours since they are paid a non-practising allowance, which is 35 per cent of their monthly salary.

Wait gets longer in overburdened JJ hospital

All three peripheral hospitals have no facility for cardiovascular thoracic surgeries, super-specialty operations or cardiac intensive care units. As a result, pressure has piled up on JJ Hospital, where a patient requiring cardio-vascular thoracic surgery has to wait for one to two months. There are two heart-lung machines that work round-the-clock for surgeries.

For pediatric surgeries, the waiting period in JJ is 15-20 days. Dr Ashok Rathore, head of pediatric department in JJ, says, “Pediatric surgeries are invariably referred to us despite Cama and St George’s having pediatric units, sometimes just to avoid complicated surgeries.”

Dr T P Lahane, dean of Sir JJ group of Hospitals, says, “While Cama has a neonatal intensive care unit(NICU), cases of intensive care for adults have to be referred to us because only JJ has those facilities.”

GT and St George’s have no NICUs or PICUs (pediatric intensive care units).

Even with two MRI and CT scan machines and several operation theatres, the waiting in JJ is getting longer by the day. While GT has four operation theatres, a source says one is not working properly. “Even to restore proper light on an operation table, it takes six months or more. The administrative delay has become common now,” a source says.

While JJ has five echo machines in its cardiology department, the other three hospitals have none.

According to RTI replies, of the 68 proposals forwarded by St George’s to the state government since 2010 till September 2013, 35 (51 per cent) are still pending at various stages. The major demands include those for ventilators, ambulances, lithotripsy machine and trauma care beds.

GT Hospital has sent a total of 26 proposals between 2010 and September 2013. RTI replies reveal that every year, proposals worth Rs 6-7 crore are forwarded by the hospital.

The Road ahead

In an attempt to improve medical facilities in the city, a new hospital building exclusively for super-specialty cases is in the works. According to Dr Ashok Rathore, head of pediatric department at JJ, while a department gets half-a-floor in the current set-up, the new building will provide a complete floor to each department.

“Facilities like plastic surgery, neurosurgery, cardiovascular thoracic surgery and many more will be expanded. More beds will cater to more patients,” Rathore says.

Nine departments will be shifted into the new 16-storey building, being built at a cost of Rs 600 crore.

“The new building is expected to be completed by June 2017,” Lahane says, adding that eight major projects are being pursued for Cama, GT and St George’s to improve and expand their existing facilities.

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