AIIMS Patna: No emergency services, blood bank, mortuary or cardiac OPD

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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.

Dean, senior doctors booked for abetting suicide of resident doctor

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Five doctors, including the dean of the Government Medical College (GMC) Surat, were booked in Khatodara police station on Wednesday for allegedly abetting suicide of a 24-year-old resident doctor. The victim had ended life on Tuesday by jumping from an under-construction hospital building on New Civil Hospital (NCH) campus. The accused were also booked under Prevention of Atrocities Act following allegations levelled by father of the deceased.

The complaint was lodged by Dinesh Parmar, 56, deputy engineer in Dakshin Gujarat Vij Company Limited office at Bharuch. Police booked Dr Milan, Dr Naresh Makwana, both senior resident doctors in surgery department, Dr Nimesh Verma, head of surgery, Dr Jayesh Brahmbhatt, dean of GMC, and Dr Ganesh Govekar, head of department of forensic. The accused were booked for abetment of suicide and Prevention of Atrocities Act. Dhaval, 24, son of Parmar, allegedly committed suicide on Tuesday by jumping from ninth floor of the under-construction multispecialty hospital on NCH campus.

In his complaint, Parmar alleged that Dhaval had come to study at GMC Surat one and half month ago in masters of surgery. His senior doctors Milan and Naresh were harassing him mentally and physically, Parmar alleged. They also made caste specific slur for Dhaval and due to their harassment the deceased ended life, the father claimed in his complaint.

Six new AIIMS struggle to fill up posts

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THE SIX new AIIMS are struggling to fill vacancies, with the Union Health Ministry not too hopeful about getting the right candidates for the 1,285 posts this year. One proposal being considered now is to hire retired professors up to the age of 70 years on contract as faculty. Last year, a total of 1,300 posts were advertised for the AIIMS at Bhopal, Bhubaneswar, Jodhpur, Patna, Raipur and Rishikesh. Only 300 were selected and just 200 finally joined. At his annual press conference last month, Health Minister J P Nadda admitted, “We are not getting good people. Hum chalis-chalis logon ko reject kar rahen hain (We are rejecting up to 40 people at a time).”

Each AIIMS received 600-800 applications on an average last year, which means only one in 14 applicants was found to be deserving and only two of three who were selected joined. The number of vacancies this year is only a little lesser. Bhopal has advertised 251 posts, Bhubaneswar 178, Jodhpur 204, Patna 253, Raipur 204 and Rishikesh 205. A total of 305 posts are sanctioned in each AIIMS, and the number of posts filled ranges from 55 in Patna, to 135 in Bhubaneswar.

Officials associated with the recruitment process at the Union Health Ministry and at the new AIIMS say the problems in getting qualified faculty are manifold. While the substantially higher salary structures in the private sector for specialities such as nuclear medicine and neurosurgery is one factor, making recruitment for senior posts like professor and additional professor extremely difficult, the other is the lack of facilities in the smaller centres where the new AIIMS have come up.

Elaborating on the proposal to hire retired professors on contract as faculty, a Health Ministry official said, “That way we may get good, competent people who have retired from institutes like AIIMS-New Delhi, and PGI-Chandigarh.”

While a professor at an AIIMS would get around Rs 2.12 lakh monthly salary including HRA, an additional professor is entitled to around Rs 1.91 lakh. In the private sector, depending on a doctor’s discipline and the demand for it, he or she can earn up to Rs 7-8 lakh, said the director of one of the six AIIMS.

Last year, AIIMS-Jodhpur advertised 200 posts, got 700-800 applications, and found only 70-odd good enough to hire, said Director Dr Sanjeev Misra. This year, for 220 posts, the institute has received a thousand applications and some 80-odd may finally be recruited.

“The response is very good, but we are clear we do not want to compromise on quality. That is why the selection process is stringent. We are looking for excellence in teaching and research because if we do not set standards high, it will become like any other medical college. Institution-building takes time, even AIIMS-Delhi took 60 years to reach its present standards,” Dr Misra said.

AIIMS-Bhubaneswar, with 135 of 305 faculty posts filled, is the best placed among the new institutes. Director Dr Gitanjali Batmanabane believes it is because people from Odisha want to go back there to serve it.

“It is more difficult to get faculty in disciplines that are in demand in the private sector, but our position is relatively better because people are keen to work for the state. I am hopeful of reaching 960 beds by the end of the year,” she said.

AIIMS to get IIT-type governing council, setup of 14 more medical institutes announced

AIIMS to get IIT-type governing council, setup of 14 more medical institutes announced

The government is mulling a common governing council for all AIIMS in the country, on the lines of that of the IITs, to simplify governance procedures and bring uniformity in the rules of these medical institutes.

The move comes after a high-powered committee, constituted to look at the governance structure of all new AIIMS, recommended evolving an umbrella organisation for framing common policies in terms of HR, recruitment, equipment procurement guidelines and administration in all institutes.

The committee was headed by M K Bhan, former secretary in the Department of Biotechnology.

Currently six AIIMS — in Bhubaneshwar, Bhopal, Jodhpur, Raipur, Patna and Rishikesh — are functional, apart from AIIMS, New Delhi. Besides, the government recently announced setting up of 14 more AIIMS.

Though the role of the health ministry should be one of policy making and extending budgetary and financial support, in reality, it is drawn into varied executive functions and day-to-day affairs to an undesirable level, with adverse consequences, both for the ministry’s own working as well as of the institutes, the committee observed.

“As per norms, at least one or two institute body and two governing body meetings are to be held at each AIIMS, which means, the health minister being the president at every AIIMS will have to attend around 63 meetings in a year which is practically not possible.

“Setting up a single common governing council will keep the minister away from day-to-day affairs of these medical institutes as he can be the chairperson of the council and take major decisions related to policies,” said a senior health ministry official.

Further, to ensure the best faculty at all these new AIIMS, the committee suggested bringing in people from institutes of national importance on deputation at AIIMS, hiring retired doctors on contract and also employing NRI doctors at good salaries.

Further, to provide experienced leadership and mentorship at every AIIMS, the committee suggested increasing the retirement age of the director and other faculty to 67 years.

Referring to the IIT governance model, the committee said in its report that the IIT system has an IIT council which takes care of the system as a whole focusing on issues that cut across the entire network.

“Individual IIT governing boards oversee the functioning of the respective institutes within the provision of the statute, ordinance, rules and regulations approved by the council,” the report said.

For setting up the governing council, the committee also suggested draft amendments in the existing AIIMS Act, Rules and Regulations.

After 5 decades, doctors may get a cadre like IAS, IPS

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More than five and a half decades after a central committee had recommended the setting up of an All India Medical Service cadre along the lines of the Indian Administrative Service (IAS) or the Indian Police Service (IPS), the central government has moved a proposal to create such a cadre. Health being a state subject, the union health secretary has written to the chief secretaries of all states soliciting the views of the states.

“The creation of an All India Medical Service under the All India Service Act 1951, like IAS, IPS, etc. for creating a body of professional doctors across the country has been under the consideration of the government for quite some time. Considering the fact that health is a state subject and the major requirement of health professionals is at the state level, it has been decided to solicit the views of all state governments on this issue,” stated the letter sent to the states.

The letter, dated June 9, went on to state that doctors of the Central Health Service (a Group A service under the health ministry dealing with monitoring of various health programmes/schemes) have never worked in the states and hence “do not have an appropriate perspective of the problems being faced by the state governments”. Creating the All India Medical Service could help bridge this gap and “improve technical leadership and management both at the Centre and state levels,” the letter said.

 

The Health Survey and Planning Committee, better known as the Mudaliar Committee, which submitted its report in 1961 had observed that three areas — provisioning of adequate medical care, both preventive and curative; training of medical and paramedical personnel; and those for dental care and for research — were interlinked and that it was only through a coordinated programme of action in which centre and states cooperated “satisfactory and speedy results” could be achieved. Hence it had recommended the formation of a central health cadre in which senior posts in the Central and state health ministries would be included.

 

Such a central cadre, which existed before independence, the Indian Medical Service (IMS), was abolished in August 1947. The committee’s report noted that most of the highest administrative and specialist posts in the states were manned by officers of IMS, the Women’s Medical Service and the Medical Research Department, who were officers of an all-India cadre, thus “providing a certain measure of coordination between the Centre and states in spite of the fact that health was a ‘transferred subject’ under the Government of India Act 1935”.

 

More recently, in 2005, the report of the National Commission on Macroeconomics and Health (NCMH) chaired jointly by then finance minister P Chidambaram and health minister A Ramadoss had stated that it was necessary to take a bold decision “to constitute an All India Cadre of Public Heath Services, on lines like the IAS/IPS”.

 

“It is a great move if the government can pull it off. This is much needed, as those in the existing Central Health Services have no experience in the states and are often restricted to Delhi postings or to central government institutions in the states. They have no clue about rural health or how public health is delivered through the various tiers of the government health system. They get no training or an all-India perspective like the IAS or IPS officers receive in Mussoorie followed by their postings to rural districts. We need a complete revamp of the Directorate of Health Services so that they can function like they are meant to, as the technical and policy advisory wing for the health ministry,” said former health secretary Sujatha Rao, who was also a member of the NCMH.