Delhi: What happens if you have a heart attack in these times of COVID?

MEDICAL CARE FOR NON-COVID PATIENTS

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Pic of people waiting outside the emergency ward of Delhi's AIIMS hospital. Pic Pramod Purshkarna


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Subrata Das, a 65-year old resident of Chittaranjan Park, suffered a cardiac arrest. The family called the police, all the emergency services they could think of, but no one turned up. Finally, they managed to get one private ambulance and went from hospital to hospital, but none would admit the motionless patient.

“We weren’t sure if he was gone,” his daughter said in a post in which she described the way they were treated at one of the hospitals, “like animals.” It was a neighbourhood doctor who finally pronounced Das dead and issued a death certificate stating that he didn’t die of COVID-19. “Without it, I wouldn’t have been able to even cremate my father,” the hapless daughter wrote.

Around 6 am on April 25, 42-year-old widow Marina Francis, resident of Mayur Vihar in East Delhi, had a heart attack. Marina’s 21-year-old son Dennis Francis dialled 100 in vain for police help, when his calls to get an ambulance failed. After multiple attempts, an hour later a private ambulance did reach their building, but it was not equipped to deal with a cardiac case. On her way to the Dharamshila hospital, just 2 kms from her place, a breathless Marina, who also left behind a 12-year old daughter, breathed her last. Dharamshila hospital has four ambulances, but did not respond to their call as three of them are used to pick up and drop staff.

The six-week nationwide lockdown, that was meant to save lives, is taking a toll of non-COVID patients no less than COVID cases. Despite government orders that they should treat all patients, hospitals demand even critical cases bring a certificate that they are COVID-negative before even looking at them. Even more inaccessible to the non-COVID sick are hospitals in containment zones.

Manju Singh, 69, a resident at the plush Nirvana Country in Gurugram, has had recurring urinary tract infections leading to kidney complications, and has long been on antibiotics. Regular check-ups are vital to her wellbeing. Yet, Manju feels any hospital visit is to be avoided now, convinced that the government, while focused on fighting the coronavirus, has completely ignored the health of millions of others who are equally dependent on advanced health care facilities.

“Somewhere in the chaos, we seem to have overlooked these patients,” admitted Dr Vikas Panwar, Director of the Department of General and Robotic Surgery at Max Super Speciality Hospital in Delhi, in a media column.

Pregnant women turned away

Even by the most conservative estimates, patients like Manju in Delhi would run into thousands. A reality that finally dawned on union health minister Dr Harsh Vardhan. “I am receiving a lot of complaints regarding denial of treatment to patients suffering from critical ailments other then COVID-19,” the minister, himself an E&T doctor of repute, said in a video conference with Lt. Governor Delhi, health minister of Delhi, medical superintendents of major central and state government hospitals and municipal commissioners of Delhi, on April 17th.

Dr Harsh Vardhan confessed it was a testing time for everybody in the lockdown. “Patients who require urgent medical attention are venturing out with great difficulty to reach a hospital. We should not turn them away on some flimsy pretext, as certain procedures like blood transfusion, dialysis etc can’t wait.”

The minister also announced that while AIIMS, Safdarjung, LNJP and Rajiv Gandhi Super Speciality Hospital in the city had been dedicated to COVID-19 treatment, the other hospitals have to take care of the non-COVID patients.

But the minister’s words have fallen on the deaf ears of hospital managements, public and private. For instance, even as the government promotes deliveries in a hospital setting, the Lok Nayak Jaya Prakash Hospital which was a non-COVID hospital converted itself into a COVID hospital and turned away women on the verge of delivering their babies. Many women also say that doctors and hospitals are postponing the schedule of immunization shots that new born kids need.

File pic of Yashoda super speciality hospital in Ghaziabd, which now is in the orange zone and difficult for patients to access.

The Yashoda Super Specialty Hospital in Kaushambi, an upper middle class colony in Ghaziabad district found itself in the containment zone on March 28th, when Girnar, one of the 15-storey residential towers was sealed. Incidentally, Delhi Chief Minister Arvind Kejriwal’s personal residence is in that building. The red zone status (it is now in orange zone since April 16th) resulted in patients avoiding the hospital, even though the Yashoda team had offered Kaushambi residents free ambulance service during the lockdown.

The 200-bed hospital had tapered off most surgeries and special clinics and has been running only its emergency services with a skeletal staff. Vinay Kumar Mittal, president of the Kaushambi Residents’ Welfare Association (KARWA) was scheduled to have an eye surgery on March 29th. He says they postponed it indefinitely. The quarterly health check-up – for cardiac, arthritis and diabetes—that Mittal and his wife were to have had in mid-April, has also been postponed. “They told me to call after mid-May” said Mittal.

The hospital’s PBX is not working. A heart patient who managed to access the emergency service said a team of doctors and technicians were present in front of the main entrance, with thermal scanners and asking questions to rule out COVID-19, and he was then taken to an isolation ward first and only then to emergency. But on April 29th, the Emergency service was also closed as one patient tested positive.

Reality check

“Non-COVID patients are being looked after, we are doing online consultations, the very sick patients are being sent to other hospitals and they are being treated,” insisted Dr Naresh Dang, Senior Consultant in internal medicine at Max Super Specialty Hospital, Patparganj in Delhi. “Planned surgeries have been delayed, but emergency is being taken care of”. Planned or cold surgeries include procedures like knee replacement, gall bladder removal etc.

Incidentally, on April 27th, 33 staffers including two doctors of this hospital tested positive. All employees of Max Healthcare were tested after a doctor, a nurse and a non-medical staff of Max Hospital at Saket, a South Delhi locality tested positive. This hospital has a whole block dedicated to COVID-19 cases.

Talking about reports of non-COVID patients dying as they get pushed around from one hospital to the other, in the apprehension that they may test positive, Dr Dang said “government policies are such that they can put hospitals in a bit of a spot, so they are being careful.”

The Max Hospital at Patparganj is, however, accepting all serious patients: cases of heart attack, brain stroke, high grade fever that is non-COVID, pneumonia etc and they are getting admitted, he says, explaining that if suspected, the patients are tested for COVID in the emergency ward and kept in a pre-COVID ward for 24 hours as they await the results. Those testing negative are then taken in for treatment. But if an emergency heart patient needs intervention, they go ahead without a COVID test, taking all precautions including the use of Grade 3 PPE, Dr Dang explained.

Some non-COVID patients are taking the tele-consultation route. Dr Dang said he consults at least 30 patients thus daily, a small fraction of the number of patients he would see before the COVID virus attack. “If I feel they need hospital care that is not of emergency nature, I tell them to go to small nursing homes nearby and not big hospitals. Many small nursing homes are open, and they can take care of the non-COVID patients who don’t need big facilities like ICU.”

In the midst of these claims and counterclaims, the reality check for non-COVID patients is fairly clear:

  • Senior citizens across the board have been hit harder as they are more likely to need emergency medical care and most likely to be turned away by hospitals.
  • Excruciating dental pain will have to be tolerated till dental clinics open.
  • Government ambulances never responded even in the past, so why would they now?
  • It cannot be denied that many private hospitals that accept non-COVID patients could be unsafe.
  • Hospitals are not looking at the government sponsored Arogya Setu app on patients’ phones to see if it is showing green or red before turning them away.

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About Vijaya Pushkarna 17 Articles
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2 Comments

  1. An interesting article on an important topic. I read the article twice since I got confused after reading the article as you can see. I would appreciate if my doubts can be cleared. I am interested in the topic to understand how did AAP actually keep the promise of halving the power tariff while maintaining the fiscal balance. It almost sounds like we can have free lunch which cannot be true.

    “AAP had promised to halve the electricity bill. Mrs Bhalla’s bill was zero in Nov and Dec 2019. Malini who was paying Rs 6000 per month started to get a subsidy of Rs. 761 since August, 2019. Dinesh Kumar was getting zero bill for the last five to six months. Krtika Singh in Tilak Nagar has also been getting zero bills since August, 2019. AAP claims that it has reduced electricity bills by 50%.

    Article states at one place that subsidy announced was 20% up to 200 units, 35% from 201 to 400 units and zero after that.”

    I am giving the above quotes for my confusion.

    While the article giving the examples of Bhalla, Malini and Kumar creates an impression Delhi residents are getting “free electricity” since few months. Of course this is not true though the author ends up creating that impression at least in my case. Later the author after giving the new fixed charges shows how DERC reduced the fixed charges. There is no explanation as to how DERC reduced it. Since it is easy to reduce fixed charges by transferring to actual use through tariff increase, it would have been useful had the author explained why and how this happened. Did the government asked to reduce these fixed charges? After all some one has to pay it – either consumers through higher tariff or the government through higher subsidies or the generating/transmission companies by improving the efficiency or through reducing its rate of return.

    Having created the impression that AAP has met the promise of halving the electricity bill, it ends by showing how actual bill has reduced only by 18.56% for consumers with 2KW load, and by 28.43% for consumers with 5 KW. What happened to the implied claim of 50% savings?

    I agree that AAP has certainly reduced power bill by doling out subsidy. But as we all know there is no free lunch in this world. What impact this had on the budget? On the other hand if we find out that AAP managed to reduce power bill without having a “significant” impact on the budget (you told me that they even had a surplus) then one needs to appreciate it.

    Look forward to getting some explanation.

    regards
    Bhamy

  2. The AAP manifesto indeed said they would halve the electricity bills. People did not believe they would be able to implement the subsidy. Today it is not half for all, it is free for some and a saving of about Rs800 for those who consume less than 400 units, and absolutely no subsidy for those who consume more than 400 units.

    When they assumed office in 2013, they spelt out the subsidies– 20% up to 200 units, 35% from 201 to 400 units and zero after that. It would have reduced the bills to half for some, not all power consumers, but the government was gone in 49 days. When Arvind Kejriwal returned to power in 2015, it continued that way, and so there was no buzz about the power subsidy.

    That is when, in Aug 2019—a few months before the assembly elections of Feb 2020 –, the Delhi government tweaked the scheme, announcing a 100 per cent subsidy for those who consume up to 200 units for power a month, and Rs 800 off their bills for those consuming between 201 to 400 units. It is since then that the bills came to zero for those who consumed less than 200 units, and others got a subsidy of 800 rupees. It helped that October, November weather in the capital is very pleasant: you don’t need ACs or heaters, so many people saved Rs800 a month. Those who ran up over 400 units got no subsidy.

    The DERC is mandated to fix the tariff –fixed load charges as well as power tariff for consumers, so it did, not from their pockets or reducing the price they pay. The gap on account of the subsidy was bridged by the Delhi government through budgetary allocations.

    The Delhi government has paid for the power subsidy without impacting their budget adversely, and they say, it is their prudence –no frivolous expenses on themselves, Now, the Congress has said they will give free electricity upto 300 units, and the BJP has said they will continue to the AAP subsidies on power if elected!

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