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Wednesday, June 03, 2020

Sealing fears, dip in patients, wary staff are making private hospitals play safe

Private hospitals fear admitting Covid patients will expose their frontline staff to infection, and this could attract adverse action.

Written by Prabha Raghavan | Mumbai, New Delhi | Updated: May 1, 2020 11:08:20 am
covid 19, coronavirus, coronavirus news, coronavirus latest news, covid 19 tracker, covid 19 tracker india, covid 19 india tracker, covid 19 india tracker state wise, covid 19 tracker state wise, india covid 19 tracker state wise But as the number of positive cases continue to rise and reports of hospitals turning away patients pour in, states want private nursing homes to open fully.

It has been a struggle for Dr Rohintan Dastur, Medical Director at South Mumbai’s Bhatia Hospital, to get his 700-odd staff back to work after it was first sealed on April 8. He offered them transport, hotel stay to cut travel risks, and even one-and-a-half times the salary.

“They were scared,” says 67-year old Dr Dastur, his face half-covered by an N-95 mask as he walks in an empty lane near his home at Cuffe Parade. The 200-bed hospital managed to resume limited services just a day ago. Nurses and doctors have reported to work, but house-keeping staff is still staying away. The hospital is admitting only emergency Covid cases.

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Bhatia Hospital is just one of the 10 private hospitals that had to shut down temporarily after the Municipal Corporation of Greater Mumbai used the blunt instrument of sealing when some heath care staff reported Covid positive. The metro with maximum cases and deaths witnessed an almost complete collapse of private healthcare in the early days of the Covid pandemic.

Private hospitals fear admitting Covid patients will expose their frontline staff to infection, and this could attract adverse action. To top this, there is little clarity on testing patients – upon admission as well as pre-operatively. Two, following government advice, many patients rescheduled elective or planned surgeries. OPD (out-patient department) consulting has anyway reduced to a small fraction of pre-Covid days.

But as the number of positive cases continue to rise and reports of hospitals turning away patients pour in, states want private nursing homes to open fully. With the Municipal Corporation of Greater Mumbai (BMC) struggling to expand its isolation beds, the Maharashtra government Thursday warned hospitals against refusing patients – Covid or non-Covid. The Delhi government too issued an order asking all nursing homes and hospitals to resume services, and admit non-Covid patients.

But private healthcare facilities in Mumbai are wary after the sealing experience. Those willing to reopen find little to no support from paramedical staff.

In Kolkata too, private hospitals feel they are ill-equipped to handle suspected Covid patients. When patients with Covid-like symptoms come, they just redirect them to dedicated COVID-19 hospitals. Peerless, which has an 11-bed isolation ward and is equipped with ICU beds and a couple of ventilators, admits Covid patients. But RTIICS doesn’t. Private hospitals in Kolkata did set up a few isolation beds following a meeting with the state government on March 20, but many are scared and fear they are ill-equipped to handle suspected Covid patients, and hence refer them to dedicated Covid hospitals.

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These fears echo throughout the country, especially in smaller private facilities that either shut shop due to lack of PPE, reduced manpower, or the inability to financially sustain themselves following a sharp drop in walk-in patients.

Large corporate hospitals too are feeling the heat.

For instance, Max Healthcare’s non-frontline staff across the board, including senior doctors who are not directly involved in its Covid and other facility operations, have taken pay cuts of “above 25 per cent” so that the hospital chain can “continue to be operational during the time of Covid”, Abhay Soi, Chairman, Max Healthcare, told The Indian Express.

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“Other industries have the option of reducing operations or laying off staff, but the healthcare industry faces a peculiar problem – we have to bear increasing costs at this time while simultaneously ramping up capacity to meet a growing requirement,” he said.

Several hospitals, especially in Tier II and Tier III cities, are also wary of the “mahamari aspatal (pandemic hospital)” tag affecting business for many months to come even after the epidemic subsides. For instance, Bihar has more than 250 for-profit and not-for-profit private hospitals, empaneled under the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana. Most of them had, however, shut operations fearing they would not be able to contain the infection if it spread in their hospitals, some state government officials said on condition of anonymity.

However, in states which have the capacity given the fact that the case load is manageable, the government has kept private hospitals on standby, while it prioritises treatment at its own facilities. For instance, depending on the requirement, only selective private healthcare facilities in Madhya Pradesh have been involved by the state as dedicated centres.

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“If we involve everyone, it would be chaotic,’’ said Dr Lokendra Dave, member, state-level Technical Advisory Committee, who is also one of the members of a government team tasked with medical treatment and hospital management. Another reason for this is that not all private facilities have the equipment and resources to follow the protocol of treatment, he said.

“While there is a risk that they could end up spreading the infection, the government has to also ensure that there are facilities for treatment of non-Covid patients. The government may involve more hospitals if they have facilities,” he said.

The case is similar in Uttar Pradesh, which has not barred private hospitals from treating patients, but has limited Covid facilities to private medical colleges. According to Principal Secretary (Health) Amit Mohan Prasad, the plan is to hire another building like a lodge, smaller private hospital, hotel or hostel around every hospital with an isolation facility so that asymptomatic patients can be shifted there. This way, hospital beds can be vacated for serious patients.

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“We have several private medical colleges already in our fold and that gives us a total bed capacity of 10,000 (government and private combined). We have notified a lot of private hospitals and, as and when the need arises, we have told them that they should be ready within three-five-day notice to prepare themselves for providing Covid care. In the meantime, we expect private hospitals should be giving other essential services like dialysis at their facilities,” said Prasad.

In Telangana, private facilities like Apollo Healthcare were earlier restricted by directions to send all of their COVID-19 positive patients to government facilities, said Dr Sangita Reddy, Joint Managing Director, Apollo Hospitals Enterprises.

In other instances, there is ambiguity in state government policies in involving and allowing private facilities.

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“An area where additional clarity would help is the testing of patients on admission as well as pre-operatively. This seems important to safeguard other patients and staff from patients who may be positive, but asymptomatic or mildly symptomatic,” said Dr Ashutosh Raghuvanshi, Managing Director and CEO, Fortis Healthcare.

“Situations like this may result in quarantine of large numbers of medical staff, which we can ill afford at this juncture,” he said. Fortis Healthcare has set up isolation wards and earmarked 350 isolation beds across its 28 hospitals.

Hospitals like Apollo too face constraints in treating patients coming to their facilities for crucial, non-Covid treatment. Unsure if they are carrying the coronavirus, which puts Apollo’s staff at risk of infection, the hospital is bulking up on its use of personal protection equipment. While Apollo can still afford this, smaller private nursing homes and facilities in states like Maharashtra have also been demanding PPEs for their staff.

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“In every emergency room now, all our staff wears PPEs, because we don’t know who has come in. Everyone is treated as (Covid) positive, because we have this major constraint of testing,” said Dr Reddy.

“There is a lack of communication between government departments. While one department will understand the merit in allowing us to operate a certain way, another department will say the opposite,” said the executive of a private hospital in Delhi on condition of anonymity.

In other states like Gujarat, private hospitals were never discouraged from treating Covid patients. However, following the nation-wide lockdown, these hospitals operated on thin staff, taking in patients who required emergency procedure, congruent to the state health department’s advisory to avoid planned procedures.

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On April 19, Gujarat decided that those willing to pay and get treated in private hospitals, can do so in three facilities in Ahmedabad – Sterling Hospital, HCG Hospital and Narayana Multi-speciality Hospital. Sterling and HCG Hospital had started treating Covid patients last week, while Narayana Multi-speciality Hospital was still in the process of drafting its treatment protocol.

In the absence of defined treatment protocols and lack of access to protective and testing equipment earlier, some private hospitals were refusing admission to patients with flu-like symptoms, instead directing them to government facilities. Despite warnings and advisories by states, many private hospitals are still unwilling to risk whatever little business they are getting from non-Covid patients.

(With inputs from Sohini Ghosh in Ahmedabad, Ravik Bhattacharya, Santanu Chowdhury and Atri Mitra in Kolkata, Santosh Singh in Patna, Avaneesh Mishra in Lucknow, Milind Ghatwai in Bhopal, Abantika Ghosh and Aashish Aryan in New Delhi)

PART 3: For private hospitals, Covid synonymous with loss

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