Outside experts set to head all 14 new AIIMS

AIIMS, PGI-Chandigarh, AIIMS management, Jawaharlal Institute of Postgraduate Medical Education & Research, indian medical institutes

MOVING AWAY from the AIIMS-Delhi model, where the Union Health Minister heads the highest decision-making body of the institute, the Health Ministry is looking at roping in external professionals or retired faculty from renowned institutes such as AIIMS, PGI-Chandigarh and others to head the 14 new AIIMS being founded across the country. Getting external professionals or technical experts to chair institute bodies of all the new AIIMS was one of the recommendations of the committee set up under former Department of Biotechnology Secretary Dr M K Bhan to look into the governance structure of the new institutes.

At AIIMS-Delhi, the Institute Body, the top decision-making wing in the institute’s hierarchy, comprises the Health Minister as chairman, Health Secretary, HRD Secretary and several other government functionaries, besides external representation such as the vice-chancellor of Delhi University. The governing body, which is lower in the decision-making hierarchy, is also headed by the Health Minister, followed by the standing finance committee headed by the Union Health Secretary.

“The idea is to both free the new institutes of political interference and also look at the logistics side — it is possible for the minister to attend two governing body meetings at AIIMS-Delhi, but to do so for 14 AIIMS is hardly possible,” a Health Ministry official said. “Getting a professional to head the institute body would improve the quality of functioning and bring in technical know-how and expertise that a political person cannot bring.”

The official said that the Bhan committee had recommended bringing in external technical experts at the helm to act as a mentor. “But we are still studying the report. It is possible that this requires changes in the existing AIIMS Act,” the official added. Dr Bhan, a former professor of AIIMS, is playing a similar expert’s role at the Puducherry-based Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), where he chairs the highest decision-making body of the medical institute.

The committee also envisaged an umbrella governing structure for all the other AIIMS, headed by the Health Minister and the Union health secretary among its members. The board will have control over the governance of all 14 AIIMS but not over AIIMS-Delhi or PGI-Chandigarh. The present governance structure is likely to continue at the Delhi institute, the oldest and the most prestigious of AIIMS, sources said.

Among members of the empowered board, as recommended by the committee, are secretaries of the Departments of Health Research, Biotechnology or Science and Technology, as also members from outside AIIMS —- on the lines of the current structure of the AIIMS Institute Body. With the Centre struggling to find suitable candidates for faculty positions in the upcoming AIIMS, the Bhan committee has also suggested increasing the retirement age of director and other faculty members from 65 to 67 years. Meetings of the standing finance committees of each AIIMS could be chaired either by the Union Health Secretary or any other person nominated by him, but not below the rank of Additional Secretary, the panel recommended.

AIIMS Bhopal shuts one of its busiest OPDs due to lack of doctors, faculty

AIIMS, AIIMS bhopal, all india institute of medical sciences, AIIMS doctors, AIIMS OPD, AIIMS OPD shut, AIIMS medical facilities, indian express news, india news

The dismal condition of AIIMS in Bhopal has come to the fore and it is shocking that it had to shut down one of its busiest OPDs due to lack of doctors and faculty, according to Indian Express report. Established under the ambitious Pradhan Mantri Swasthya Suraksha Yojna, AIIMS Bhopal started clinical services on August 15 in 2012, and OPD services on January 26 in 2013, reports say. Since 2013, AIIMS OPD for mental patients had witnessed footfall of 8,452 persons till May 2015. The closure came at a time when a national survey conducted in 2016 by NIMHANS showed that 15 crore people suffer from common mental health disorders in the country.

It has been learnt that the two professors who were looking after it have quit. The institute is yet to get a full-time director. Apart from this 80 percent of faculty posts are lying vacant, and it has filled only 73 of the 327 sanctioned slots for senior resident doctors. Of 41 departments, only 25 are functional, the reports say. On March 2014, AIIMS Bhopal had 27 departments with 61 faculty members. According to official records, the institute now has 41 departments but on the ground, the number of functioning departments has dropped to 25, and staff to 59, the report says.

The Department of Cardiothoracic and Vascular Surgery, which deals with cardiac conditions, has been functioning on paper but has not attended to a single patient since June 2015. In May 2015, its only faculty, an assistant professor from AIIMS New Delhi had quit. “This is a basic requirement for any tertiary care hospital but the department has been shut. We are hopeful that it would be reopened in the next few months,” a senior official in the institute’s administration wing told IE. At the Oncology department, where the only assistant professor who joined the radiotherapy department in July 2013 quit seven months later. The institute hasn’t provided any cancer-related services for the last three years.

This is also AIIMS: No doctors, no faculty, a crowded OPD shuts

AT LEAST 15 crore people suffer from common mental health disorders in India, according to a national survey conducted in 2016 by NIMHANS, the country’s premier mental health facility. But for over 19 months, the All India Institute of Medical Sciences in Bhopal did not see a single mental health patient.

In May 2015, AIIMS Bhopal shut down its OPD for such patients — one of its busiest, it had attended to 8,452 patients since 2013 and at least 15 patients a day in its last month. Reason: all of the two professors quit, one from NIMHANS in Bengaluru and the other from AIIMS in New Delhi.

The Indian Express visited the AIIMS facility in Bhopal and accessed official records to find that the dismal state of its psychiatry department mirrors a larger problem at one of the six new such functional institutes set up for “correcting regional imbalances” in healthcare. Quite like the pile of debris lying next to the unlit corridors behind the gleaming glass and brick facade of the AIIMS building in the heart of Bhopal.

AIIMS Bhopal started clinical services on August 15, 2012, and OPD services on January 26, 2013. Five years on, it’s yet to get a full-time director, has 80 per cent of faculty posts lying vacant, and has filled only 73 of the 327 sanctioned slots for senior resident doctors.

“Can you imagine AIIMS shutting down its mental healthcare services? In March 2015 alone, the institute attended to 1,059 patients. But within the next two months, the services were shut. In December 2016, one doctor was recruited, but that was a resident doctor and not a full fledged faculty,” says a senior consultant with AIIMS Bhopal. And this, when the NIMHANS survey dug up this ratio from Madhya Pradesh: one psychiatrist for 20 lakh people.

“For almost 15 months, patients had to be referred to other hospitals in the state or outside. When is the last time you have heard AIIMS referring patients? AIIMS is supposed to be the country’s top referral centre,” says the consultant.

That’s not all. Consider these findings:

41 depts on paper, only 25 functional

On March 2014, AIIMS Bhopal had 27 departments with 61 faculty members. And, according to official records, the institute now has 41 departments. But on ground, the number of functioning departments has dropped to 25, and staff to 59.

For instance, the Department of Cardiothoracic and Vascular Surgery, which deals with cardiac conditions, is functioning on paper but has not attended to a single patient since June 2015. In May 2015, its only faculty, an assistant professor from AIIMS New Delhi had quit. And this, for a department that catered to 4,180 patients in the two years it functioned.

“This is a basic requirement for any tertiary care hospital but the department has been shut. We are hopeful that it would be reopened in the next few months,” says a senior official in the institute’s administration wing.

It’s a similar story at the Oncology department, where the only assistant professor who joined the radiotherapy department in July 2013 quit seven months later. The institute hasn’t provided any cancer-related services for the last three years.

Besides, AIIMS Bhopal is yet to get key departments, such as cardiology, nephrology, endocrinology, gastroenterology, urology and nuclear medicine.

Heavy load, few doctors

The Ophthalmology department operates the fifth busiest OPD at the institute, catering to 19,886 patients in 2015-16. But from May 2016 to February 2017, it has been running without a single faculty member and with just two resident doctors.

“We are one of the busiest OPDs here, which is why it’s even more important that there is at least one senior faculty member to handle complex cases. Currently, resident doctors with less than three years of experience are managing the OPD,” says one of the resident doctors.

But what’s more worrying, say doctors, is the inadequate infrastructure. The department has only one refractionist to determine errors of refraction in the eye. “We ask patients to visit private facilities and come back to us. A single person cannot handle such a load and when this person is on leave, the department comes to a standstill,” says the resident doctor.

This lack of basic infrastructure, says the doctor, means non-availability of services. “Being an institute of national importance, we should have started cataract surgery by now under the national programme for control of blindness. But since 2015, the department has performed only minor surgeries and no major surgery,” says the doctor.

No casualty, emergency services

Five years since it began operations, AIIMS Bhopal does not have dedicated casualty and emergency services. For instance, the Orthopaedic department, considered to be emergency care department, does not have an emergency and trauma care.

“We cannot handle acute trauma cases. With the present infrastructure, we can only conduct elective surgery, which is scheduled in advance and does not involve an emergency. Even if we get a minor trauma case, we have to refer it to other hospitals,” says a resident doctor at the department.

Doctors blame the “lack of human resources and infrastructure” for the delay. “The departments of anaesthesiology and radio-diagnosis have just one faculty member each. Only if these two departments have enough resources and infrastructure, can the Orthopaedic team provide any emergency services,” says a doctor at the Orthopaedic department.

“We will soon begin casualty and emergency services on priority,” says the administration official.

Students ask: what clinical training?

If the treatment facilities at AIIMS Bhopal are far from “premier”, the teaching programme is no better. Students complain about “lack of quality teaching, faculty and infrastructure” and the “unacceptable” practice of having to “visit” other colleges to complete their clinical training.

“If this was a private college under the Medical Council of India, admission would not have taken place for a singe MBBS batch. The medical college would have been forced to shut down,” says a student in his final-year MBBS course.

The student, who was ranked among the top five in Madhya Pradesh for the entrance exam, says he now regrets choosing AIIMS, Bhopal “over other top ranking colleges”. “The problem starts in third and fourth year, when we have to undergo clinical training. We are being taught by a senior resident with less than three years of experience,” says the student.

“For example, at one point of time, there was no faculty in general surgery and cases were referred to a private hospital. During that period, we could hardly attend to any patient here. We are basically trained to be clinicians. But since we refer patients, we attend to only minor cases,” says the student.

“Even if we have cases, we don’t have any faculty to report to. In gynaecology, we have to note the medical history of the patient and report to the faculty. But there is no faculty to tell us whether what we are doing is right,” says the student.

Other students say the lack of infrastructure has led to a “drop in the quality of clinical training”. “For instance, the blood bank has been operationalised after four-year delay. But the institute has a licence only for ‘whole blood transfusion’. We don’t have a licence for transfusion of components, such as red blood cells, white blood cells and platelets… 90 per cent of high-risk pregnancies require such transfusions,” says another student.

And yet, what students find particularly difficult to digest is the “practice of sending us to other hospitals”. “The department of psychiatry is shut for more than two years, and we have to go to other hospitals for clinical training,” says a student.

Asked what an 80 per cent faculty shortage meant for students, the final-year student says, “One resident doctor does the rounds in the in-patient department. He also teaches undergraduate students. Then he goes to the OPD, where he sees at least 35 patients. Finally, he has to supervise 20 students posted at the department,” he says.

Will take time for AIIMS Bhopal to become a brand: Prof Nitin Madhusudan Nagarkar

Prof Nitin Madhusudan Nagarkar, director of AIIMS Raipur who was given additional charge of AIIMS Bhopal in 2015, speaks to The Indian Express about plans to resolve concerns about lack of adequate faculty and infrastructure:

AIIMS Bhopal is severely hampered by a lack of adequate infrastructure. How are you addressing this issue?

A lot of work has gone into the development of the institute in the last two years. The construction of a medical college was priority, and that is now complete. As far as infrastructure is concerned, we have started MRI and CT scan services at the institute. We have also successfully started post-graduation in paramedical departments. The priority has been to complete the civil infrastructure that was part of the original plan and by the end of this year we will have 900 beds. We are positive about the development of the institute and we aim to provide quality patient care in central India.

How are you planning to get qualified faculty?

Recruitment has been fast tracked since I have taken over as director. We have recruited 50 per cent of nursing staff in the last one year. In the last six months, we have been busy conducting interviews for 251 posts for faculty. I must say the response has been very positive. We received 1,500 applications for the 251 posts. The institute has conducted three rounds to finalise the list. Now the governing body will decide the final outcome. We are hopeful that by July 17, when the meeting is scheduled to take place, there should be a clear picture about recruitment.

AIIMS, Bhopal was planned on the lines of the country’s premier AIIMS in Delhi. How do you compare the two?

My approach is very positive. One cannot compare an institute that is 60 years old with one that’s just three years old. It is just a matter of time. For AIIMS Bhopal to become a brand, it will take some time.

The shortage of faculty has affected students pursuing undergraduate courses at the institute? Do you think their concerns are justified?

I am from PGI, Chandigarh, which is an institute of national importance. But in those days, we faced a similar situation. These institutions will gradually grow. In fact, students who graduate in such circumstances put in greater efforts and have successful careers.

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

AIIMS, AIIMS bhopal, no emergency room, AIIMS bhopal infrastructure, no AIIMS OPD, indian express news, india news, AIIMS news

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.

Six new AIIMS struggle to fill up posts

Image result for aiims bhubaneswar

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.

AIIMS nurse death: Doctor says Kaur was operated upon without anaesthesia

AIIMS nurse death: Doctor says Kaur was operated upon without anaesthesia

Shocking details emerged about the tragic death of the 28-year-old AIIMS staffer, Rajbir Kaur who died during childbirth at the institute, when a doctor who was part of the medical team revealed on Wednesday that the deceased was operated without anaesthesia.

“Despite refusal by Senior Resident doctor of Anaesthesia Department N Nisa to allow Kaur to be operated on the back table in the maternity Operation Theatre, it was the doctors from Gynaecology Department who shifted her to the back table for the caesarian section,” the doctor said on the condition of anonymity.

Kaur, who died on February 4 after caesarean delivery, had suffered a cardiac arrest during the surgery, leading to more complications. During treatment, she also lost her baby.

Doctors from the Gynaecology and Anaesthesia Departments committed a series of procedural lapses that led to the nursing officer’s death, said the doctor.

Doctors should use the front table for surgeries related to pregnancy as the back table in the maternity OT is meant for normal procedures such as examining patients with gynaecology-related difficulties.

The doctor said that after Kaur was shifted to the back table, the team of gynaecologists had told Manish, a Junior Resident doctor from Anaesthesia Department present on duty, that they will perform the caeserian section with local anaesthesia if he did not administer any anaesthetic.

The doctor said both depended on each other for administering anaesthetic to the patient, but none actually did.

“As the team started performing the surgery, Kaur jumped up due to extreme pain after the first incision. After that when Manish went to check on her, the team realised that the patient was not given anaesthesia,” the doctor said.

Later, Manish, during the caeserian section, gave Kaur an anaesthetic agent to calm her down.

The gynaecology team was led by Seema Singhal, a senior doctor and a faculty at the All India Institute of Medical Sciences.

Among other procedural lapses, the doctor said that the medical team had not secured an airway before starting the surgery, which led to difficulties in breathing for the patient.

“It was only N Nisa who later arrived and ensured the tracheal intubation. Had the team followed the instructions of N Nisa, things would have been under control,” the doctor said.

Tracheal intubation is the placement of a flexible plastic tube into the windpipe to maintain an open airway.

The medical team had also not prepared the patient well for the surgery due to which the patient witnessed pulmonary aspiration during the surgery.

“When the entire chaos was unfolding in the OT, the suction apparatus was not working either,” the doctor added.

Although, the nursing officer was revived and shifted to the ICU, she remained in coma for three weeks before being declared dead on February 4.

“The morbidity was due to a cardiac arrest, however, later her other organs also got damaged leading to her death,” the doctor said.

Later, a probe committee, constituted to investigate the alleged procedural lapses, had terminated N Nisa on February 21.

AIIMS ‘lacks’ facilities for smooth access to disabled

Image result for Accessible India Campaign

The country’s premier medical institute AIIMS “lacks” facilities which allow smooth access to the physically challenged on its premises, a recent audit conducted by the hospital administration has revealed.

The audit comes in the backdrop of the Ministry of Social Ministry of Social Justice and Empowerment advising public health facilities to conduct an inclusive accessibility audit to identify infrastructure gaps and make buildings disabled friendly as a part of the ‘Accessible India Campaign’.

Multiple lapses led to nurse’s death, finds AIIMS probe

Image result for committee clipart

An AIIMS committee has identified several procedural lapses leading to the death of a 28-year-old staffer in childbirth, raising serious questions on the services offered at the country’s most prestigious medical institution.

The victim, Rajbir Kaur, a nursing officer, was admitted on January 16 for normal delivery. The labour was progressing well till 5am the next day when there was a sudden drop in fetal heart rate, necessitating emergency surgery. The probe committee, headed by Dr S C Sharma of the ENT department, found that an anesthesiologist was not present during the caesearean section operation. Instead, the job was performed by a junior resident (JR) who neither had the experience nor was trained enough to handle such a complicated case.

Sources said the JR gave general anesthesia to make Kaur completely unconscious when most caesarean sections are done under spinal anesthesia. He also intubated the patient improperly. Intubation is meant to maintain oxygen level during surgery. However, in Kaur’s case, “instead of trachea – the pipe that connects the mouth to the lungs – the tube was inserted into the food pipe”, a source said.

The child was stillborn and Kaur went into distress due to aspiration – entry of stomach material into the respiratory tract. The nursing officer also suffered a cardiac arrest. She was revived but then she remained in coma for three weeks before being declared dead on February 4.

The inquiry committee also found that the consultant-on-call of obstetrics and gynaecology – whose presence is mandatory – did not turn up for the emergency operation despite being informed. She has been issued a show-cause notice by the hospital while the senior resident (SR) of anesthesiology, who was on duty, has been dismissed.

A displeasure memorandum has been issued to the SR of gynaecology, who can complete his medical training but will remain unemployable at AIIMS in future. A warning has been issued to the JR of anesthesiology who prepared the patient for surgery but later left under pressure from the residents of obstetrics and gynaecology.

Though instances of alleged medical negligence at AIIMS are many, sources said, this is a rare case where institute has been forced to accept negligence and take stern action. Also, for the first time, institute has agreed to pay Rs 10 lakh as compensation to the next of kin of the nursing officer and assured a job to a family member on compassionate grounds.

Dr K K Aggarwal, president of the Indian Medical Association, said the responsibility of consultants too should be fixed in case of procedural failure. “Residents cannot be blamed solely for such lapses,” he said.

V Srinivas, deputy director (administration) at AIIMS, has ordered the head of anesthesiology to ensure consultants from his department are available round-the-clock to oversee and supervise anesthesiology services. The panel also directed the setting up of a committee under the chairmanship of the hospital management to augment health services to AIIMS employees.

Two years ago, the son of an AIIMS employee had died at the hospital during dengue treatment. Five senior residents tendered their resignation after an inquiry report found lapses.

“Overall, we are satisfied with the AIIMS decision. But a meeting is planned with Union health minister J P Nadda to discuss certain issues,” said Manish Behl, husband of Rajbir Kaur.

“The lapses found in Kaur’s case have dented AIIMS’ image as the most prestigious medical institution in the country. If this is how the institute treats its own staff, god knows what happens in case of ordinary citizens getting treatment,” said a senior doctor at the institute.

AIIMS nurse death: Distress call made to doctor but he didn’t think it was genuine

Image result for distress call

A senior resident of the anaesthesiology department, whose services were terminated by AIIMS over the death of pregnant nurse Rajbir Kaur, told an inquiry committee that he was not present for the delivery because he did not believe the call from the gynaecology team regarding foetal distress was “genuine”.

Facing allegations of medical negligence, the senior resident defended his actions before the committee after the nurse’s death at AIIMS on February 4. Two other junior residents also faced action over her death.

The inquiry committee highlighted a number of lapses, including the fact that the C-section surgery on Kaur was conducted in an operation theatre not equipped to handle cases under general anaesthesia.

In his testimony before the eight-member inquiry panel, headed by Professor S C Sharma, head of the AIIMS ENT department, the senior resident deposed that he had, in the past, received many calls for foetal distress that were “not genuine”. So, when he received a call in Kaur’s case, he dismissed it, which led to a delay in treatment.

It is also learnt that the senior resident was absent from the maternity OT for another twin delivery, which took place before Kaur’s C-section surgery.

A senior resident of the gynaecology department, against whom the AIIMS director will issue a “memorandum of displeasure”, was asked to start Kaur’s case without full knowledge of the details.

Other lapses, the inquiry committee found, include Kaur being shifted to the back table of the maternity OT, which is typically not used for C-sections. Although the committee was told this was done to save the baby, it pointed out that the back table did not have a ready stock of emergency drugs and the OT was not fully prepared to handle such an emergency under general anaesthesia.

The committee concluded that an under-prepared OT and the absence of the senior resident of anaesthesiology were responsible for a failed intubation, which led to complications, including bradycardia or slow heart rate.

An artificial breathing tube had been mistakenly inserted into Kaur’s food pipe instead of her respiratory tract, and that food particles had entered the lungs, causing further complications. The inquiry committee pointed to the lapse as well, stating that the tube in the oesophagus could not be detected immediately because Kaur’s vitals were not linked to a monitoring system.

It is also learnt that there was chaos during the emergency, with the junior resident of anaesthesia getting little time to arrange items for intubation. Due to the chaos, two complications developed — in regurgitation, or expulsion of material from the pharynx or oesophagus; and inspiration, the process of drawing breath. The panel pointed out that the situation could have been averted had the senior resident of anaesthesia been present.

AIIMS fires senior resident doctor over nurse’s death

Image result for AIIMS fires senior resident doctor over nurse’s death

The nurse, Rajbir Kaur, with husband Manish Behl

Taking a serious view of the death of a pregnant nurse, Rajbir Kaur, at AIIMS on February 4, the institute’s administration Tuesday terminated services of a senior resident of the anaesthesiology department, who had been accused of medical negligence.

The administration said the moves comes after the inquiry committee found the senior resident “guilty” of “wilful absence” of his duties.

It also said the AIIMS director will issue a “displeasure of memorandum” against another senior resident of the gynaecology department, involved in the surgery. A formal declaration will be issued against the doctor, and she will not be employed with AIIMS once her contract ends.

The administration also issued a showcause notice to the consultant on call of obstetrics and gynaecology, under whose supervision the surgery was performed, asking why action should not be taken against him. Officials said the panel found that the consultant on call “was not present for the emergency operation despite being informed”.

Following Kaur’s death, three senior residents — two from gynaecology and one from anaesthesia — had been accused of medical negligence. The administration had said they would be “off duty” till a final call is taken based on findings of the eight-member inquiry panel headed by Professor S C Sharma, head of the ENT department.

“Based on the committee’s findings and two rounds of meetings at the level of director, AIIMS, the following administrative action has been taken. An amount of Rs 10 lakh compensation shall be given to the nurse’s next of kin,” V Srinivas, deputy director, administration, AIIMS, said.

Officials said a “warning” will be issued to the junior resident in the anaesthesiology department as the panel found he had “left the operation theatre under pressure from residents of obstetrics and gynaecology”.

Officials told The Indian Express that the inquiry had found that Kaur’s was a “low-risk pregnancy” and that labour was was “progressing well” till there a was a “sudden drop in heart rate, necessitating emergency surgery”.

The administration also directed the head of department, anaesthesia, to “ensure that a consultant will be available” to supervise anaesthesiology services in ICU, main OT, radiology department, and maternity OT.

‘Baby was limp at the time of birth’

The eight-member inquiry committee looking into the death of nurse Rajbir Kaur has concluded that her “baby was limp”, indicating that the brain tissues possibly did not receive enough oxygen due to the difficult birth, sources said.

“When the newborn is out, it cries and moves its limbs. But in this case, the baby was limp. It can happen when the brain tissue is not receiving enough oxygen. This happens if labour is obstructed, or if there is an issue with the mother. It happens during difficult birth,” said a senior doctor.

Even as the AIIMS administration terminated a senior resident doctor, the Department of Forensic Medicine and Toxicology has kept the findings of Kaur’s post-mortem “pending” and sought “queries” from the Delhi Police. Sources said a final opinion will be given after the police’s reply.

Kaur’s family said they were “satisfied” with the AIIMS administration’s decision. “But we are waiting for the police to register an FIR on a complaint filed by us,” said Manish Behl, Kaur’s husband.