NO CLINICAL services for cardiac patients, no functional blood bank, no emergency or casualty services, a waiting period of six months for basic tests, 253 of 305 faculty posts vacant, no post-graduate course — and no mortuary.
This is AIIMS Patna, which began out-patient services four years ago as one of the six new functional “apex healthcare institutes” started by the government on the lines of the All India Institute of Medical Sciences in New Delhi, the premier referral facility in the country.
During the Budget session in Parliament four months ago, Union Health Minister J P Nadda, while replying to a question on AIIMS Patna, admitted on record: “Cardiac patients are referred to AIIMS, Delhi or SGPGI, Lucknow.”
The scene on the ground shows why. At AIIMS Patna, dozens of patients thronging the new Out Patient Department (OPD) wade their way past construction material under a roof propped up by steel pipes.
In 2013, the year AIIMS Patna opened its doors, the Cardiological Society of India’s Bihar chapter had estimated that every fifth person in the state suffered from a cardiovascular disease and that such cases had increased five-fold over the previous decade.
“We are yet to begin services related to heart-related problems. The cardiology department is one of the 15 super speciality areas that have to be set up under the Pradhan Mantri Swasthya Suraksha Yojana. We will begin services soon, once the recruitment process is complete,” says an official at AIIMS Patna’s administration wing.
“We receive a lot of patients in general medicine with underlying heart-related problems but we have to refer them to other hospitals,” says the official.
The Indian Express visited AIIMS Patna and accessed official records to find that the lack of cardiology services was just one part of the story.
No emergency, casualty services
“A hospital without emergency services is like a body without a soul… it defies all logic and rationality that a state-of-art facility like AIIMS is running without emergency services,” states a petition filed last year by Vikash Kumar Pankaj, an advocate, in Patna High Court seeking directions for “immediate steps” to provide “continuous 24×7 emergency services”.
AIIMS Patna has a fully functional anaesthesia department but can’t begin emergency or casualty services. Why? “Non-availability of hospital building, operation theatres and faculty concerned in trauma and emergency,” says an affidavit filed by the institute’s administration in the High Court.
“Construction is nearly complete, an order for work has been placed for piped medical gas services. In all probability, emergency services should begin by August,” says the AIIMS official.
No blood bank or mortuary
“We have a storage facility but no functional blood bank. So, we cannot admit emergency cases even if other infrastructure is in place. Only after we receive a licence to start a blood bank can we start a 24×7 casualty,” says a doctor at the institute.
“Now, even for elective surgeries, which are planned in advance, we refer patients to other hospitals if there is no blood in our storage facility,” says the doctor.
But what’s really bizarre is that this institute has a department of forensic medicine and toxicology but cannot conduct post-mortems due to “non-availability of a mortuary building”.
“Construction is almost over. We have applied for the licence and will have a fully operational mortuary in the next two months,” says the official.
Key depts without senior consultants
At AIIMS Patna, important departments, such as Ophthalmology and Psychiatry, have been functioning without senior consultants to advise resident doctors on treatment or supervise key procedures and surgeries.
In February 2014, the institute opened out-patient services for Ophthalmology. “In just nine months, this became the fourth busiest OPD, catering to 10,964 patients. But this department is being run by resident doctors, who also perform surgical procedures, without a senior consultant to supervise us. We just don’t have any faculty,” says a resident doctor.
The psychiatry department is no different. “We run OPD services six days a week but without a consultant. Two consultants had joined the department in 2013 but quit a few months later,” says a resident doctor.
10 super speciality depts yet to start
Apart from cardiology, some of the 10 super speciality departments that is yet to start operations at AIIMS Patna include gastroenterology, nephrology (with dialysis), endocrinology and nuclear medicine.
“All cases at the general medicine OPD with symptoms linked to key super speciality departments have to be referred to other hospitals. Diabetes and hypertension are two of the most common problems. But AIIMS Patna is yet to get an endocrinology and metabolism department,” says a resident doctor.
Doctors also admit that even in established speciality departments, patients are referred to other hospitals “in the middle of treatment”.
“Recently, we admitted a woman with swelling all over her body. She was referred to the general surgery department, which found it was a case of acute kidney injury. She had to be referred elsewhere because this hospital doesn’t have a nephrology department with dialysis facility,” says the doctor.
Waiting period of 6 months
General medicine is the busiest OPD at AIIMS Patna. But some patients have been given a “waiting period of at least six months for something as basic as an ultrasound test”, say doctors. “The department refers approximately 300 patients for ultrasound tests. But as of now, the waiting period is till December. Our radiology department is overburdened due to limited infrastructure. We complete our diagnosis within two days but asking patients to come after six months with test results is clinically meaningless,” says a doctor.
1 cadaver for 100 students
Dissection of the human body, or a cadaver, is the basis of anatomy studies for first-year medical students. The cadavers are either “unclaimed bodies” from the mortuary or donated.
At AIIMS Delhi, a group of seven students get one cadaver for dissection. At AIIMS Patna, the entire first-year batch of 100 gets to study one cadaver.
“When we entered the third year, we realised how little experience we had in anatomy. We had even staged a silent protest last year against lack of laboratories. But without even a mortuary, there is little we can expect,” says a fourth-year MBBS student.
But what really sets AIIMS Patna apart from the rest, in terms of medical training, is that it has not started post-graduate courses. “Even AIIMS Bhopal, which is said to be lagging behind us, has started non-clinical post-graduate courses. We are yet to start because of lack of faculty and basic infrastructure,” says a doctor.