The plight of patients in private ICU-ICCU hospitals in the city
of Mumbai is pathetic. This fact provided reason enough to study the subject. An
examination of the conditions of these specialist units demonstrates that they
violate the most fundamental human right - the right to life - and the directive
principle of the right to health care. The phenomenal mushrooming of these
private ICU-and ICCU-hospitals in Mumbai parallels the commercialisation of the
medical profession and is fast destroying its ethics and morals.
There are no standards or regulatory bodies for private nursing
homes, or for the private ICCUs which cater to almost 85 per cent of the city’s
population. The terms ‘intensive care unit’ and ‘intensive cardiac care unit’
conjure up a picture of a struggle to survive; the most vulnerable and
unfortunate of humans, in need of the utmost care.
Critical care is a high-technology specialisation in medicine.
People admitted are often dangerously ill on admission. They can also be
high-risk cases - ill and with associated medical problems -stable but admitted
for observation because they could develop a life threatening situation at any
time. Proper critical care with timely diagnosis can save their lives. This
second category benefits most from proper and scientific critical care.
There are four categories of ICU - ICCU hospitals: government and
municipal which are free, subsidised charitable trust hospitals, private trust
and corporate hospitals, and totally private single or partnership ventures.
This study examined 40 ICU-ICCU hospitals in the last category.
Medical nursing homes in Mumbai tend to label a few beds ‘critical
care beds’ and proclaim themselves to be an ICU-ICCU hospital. The only
uniformity one could note in these units was a big hoarding; 50-70 square feet
for each bed and the attached gadgets; an ECG machine; a cardiac monitor (in
slightly over half of the units surveyed); a defibrillator, a suction machine,
oxygen cylinders, an Ambu bag with tubes, and some injections. The RMO was often
non-allopathic, the nurse often unqualified, and a qualified specialist was
rarely present at the time of the visit.
Critical care requires the presence of a team of qualified
specialists on the premises round the clock, and of a knowledgeable director who
coordinates the team of specialists managing the case.
However, in the private critical care hospitals visited, it was
found that relatives were asked to observe the cardiac monitor and alert changes
in cardiac rhythm to the sleeping RMOs and nurses. They were also asked to
provide nursing care such as sponging, feeding, making beds, giving medicines,
and giving bed pans.
The 40 ICUs-ICCUs visited (all were in the suburbs) admitted cases
referred by family physicians and specialists as well as by doctors who may have
a stake in the unit. Patients also came directly for emergency admissions.
The doctor on duty was rarely an allopath. Round-the-clock
critical care, monitoring, and assessment of the progress or deterioration of
the patient were all left to a non- allopathic doctor on duty, and to
unqualified nurses.The specialists were rarely in the hospital, often choosing
to order treatment by telephone.
Charges varied from Rs 600 to Rs 1,500 per day for a cot and use
of the cardiac monitor. All 40 hospitals surveyed offered a referral commission
ranging from 30 per cent to 60 per cent. This would result in compromised
services, unwarranted admissions and treatment, and even death.
In terms of the hospitals’ functioning, there was no evidence of
standard protocol for critical care, no teamwork amongst the treating
specialists, no holistic approach, no mortality auditing, no evidence that the
doctors keep themselves up to date on medical developments. The absence of
essential drugs such as injectable streptokinase and nitroglycerine is
deplorable.
Patients' relatives evidently accept as destiny the unnecessary
deaths that must occur from such negligent treatment. They are helpless, the
laws outdated, litigation prolonged and expensive, and there is no other system
to redress their grievances. Nor is support of any kind forthcoming from the
medical community, nor from defunct medical councils which protect the
profession, nor from apathetic governments , municipal corporations, medical
associations which include the Indian Society of Critical Care. This apathy and
lack of support at all levels will certainly have contributed to the shoddy
functioning of these so-called ‘critical care units’.
Apparently it is impossible to run a critical care unit with
minimum standards. The purpose of a critical care unit is to save lives.
However, this does not happen in these units. When you call an ICU-ICCU
hospital, it should give that care. Precious lives should not be extinguished
because you advertise something that you don't give.
Herat R Parmar,
Flat 4, Plot 34, "Ramgiri", 7th Road, Ghatkopar (E), Mumbai 400 077
(Based on
a thesis in the department of civics and politics, University of Mumbai)
Call for manuscripts:
The editorial in the BMJ calls for
manuscripts for its November 1999 issue which will be devoted to the impact of
new technologies in medicine.
While highlighting some ways technology may improve patients’
lives -microsurgery, informatics, transplantation, gene therapy, and dialysis -
it will also debate ethical issues such as the changing doctor-patient
relationship under the influence of the world wide web, the ethics of keeping
“expensive” patients alive, whether new technology is simply increasing the gap
between the haves and have-riots, and how to regulate the global explosion of
new technologies.
Reports of original research, educational articles, debate pieces,
and rigorous view articles looking at the impact of new technology in its widest
sense will be examined by an international panel of experts. All manuscripts
will go through the usual peer review process, and the deadline for submission
is May 1, 1999.
