Adverse outcome in patients can be because of many factors. Most of the time it is serious illness, natural poor prognosis of disease, genuine complications or infections. Sometimes, It can be deficiency of equipment, malfunction, lack of infrastructure or facilities. There can be poor training or lack of proper human resource and many others. There may be unintentional or human errors by doctors or staff. Root cause for most of the problems can be traced to administrative and system deficiencies rather than mistake of doctor. But since doctor is universal final link, when a patient dies, who is visible on the bedside. So by application of an average wisdom, it is the doctor who will be held responsible for any problem or adverse outcome. Administration and people who are responsible for building infrastructure, procurement of equipment and allocating finances or manpower are not visible in forefront. It is very common for the doctors to find themselves in a helpless situation, specially in presence of deluge of patients, difficult circumstances, scarce resources and other administrative issues. In cases of adverse outcomes, administration can pretend to hide behind the common escape route by punishing doctors and hold them guilty for the adverse events, as no other cause or person is visible. By retrospective analysis and wisdom of hindsight along with luxury of time , it is a cake walk to give verdict of one’s choice later, by fault finding analysis.
Non availability of ventilators or malfunctioning is not an issue, for which doctors are responsible. Procurement and allocation of funds is an administrator’s domain. But it is common that doctors can be accused for not saving a life. They can be punished, dragged to court and even assaulted physically by crowds. Dismal percentage of availability of ventilators in Delhi Hospitals is a tip of the iceberg. This can be even worse in other parts of the country. Ironically crowds visiting the hospitals only see and blame the doctor, who is present on bedside and trying to save the patient. Patients hold them responsible for malaise of the system and fail to see the presence of large administration and industry, that is behind the scene. An unfortunate era, when the doctors are blamed on individual basis for system failure. In present circumstances, Lack of medical wisdom among masses is a cause of huge discouragement for doctors.
With High court being proactive in asking about the number of ventilators, the administration can not pretend to hide behind any more, but masses need to know the real truth.
Only 3.4% beds on Delhi Govt Hospitals have ventilator facility against the minimum requirement of 10% in every state run medical center. For over 10,000 beds, only 348 ventilators are there. That is an extremely low number.
After 3-year-old Farhan died in the national Capital for an alleged want of proper ventilator care earlier this month, the state government of Delhi has told the High Court that a substantial number of ventilators in its government hospitals are not working. The state also told the HC on Tuesday that they were aiming to have a web portal up and running within two months, which would provide an online daily update on ventilator and bed availability across Delhi’s government hospitals.
After directions were issued by the HC, the state asked all its hospitals to provide a status update on ventilators and according to the information received from the government hospitals, up to 52 ventilators (13 per cent) of the total of 400 ventilator beds (including 300 ICU and 100 non-ICU) available in the hospitals are non-functional. “Fifty-two ventilators are non-functional and efforts are being made to get them repaired. The procurement of 18 ventilators is under process,” said the reply filed by the state government in the High Court on February 12.
The state government also stated in its reply that as far as maintaining real-time information on the availability of vacant beds in Delhi government hospitals goes, it may not be feasible to implement real-time availability information in the initial phase and the Delhi State Health Mission should be advised to start uploading information on bed availability in all the hospitals once a day in the morning.
The state government also said the State Programme Officer (MIS) of the Delhi State Health Mission has been requested, in
a letter dated January 31, to prepare a web portal for online bed/ ventilator availability and that such a Web portal should be made functional within two months.
The state government through an email sent on February 7 has also requested all the hospitals to complete repair, condemnation and procurement of ventilators at the earliest, according to Nutan Mundeja, Director General of Health Services.
After the matter of alleged unavailability of healthcare to Farhan came to light, the High Court moved a motion against the Union of India and sought a reply.
The number of ventilators as compared to bed strength in government hospitals is meager. “In private hospitals, there is one ventilator bed for every four normal beds. In government set-ups though, even as we have over 10,000 beds, we have only 348 ventilators. That is an extremely low number. Also, these ventilators may not be evenly distributed across the city,” pointed out stated U Jhamb, Director, Professor and Head, Department of Paediatrics at the hospital.