Unsigned prescription, absent orderlies: how a man died in Delhi without getting hospital admission

The man was picked up by the police on the night of January 2 for allegedly molesting a woman in an inebriated state and suffered serious injuries after jumping out of a moving PCR vehicle

A view of Dr. Ram Manohar Lohia Hospital (RML) in New Delhi. Image for representational purposes only. | Photo Credit: The Hindu

Medical negligence and bureaucratic quibbles cost the life of a 47-year-old man, who died on January 3 after three government hospitals in the national capital denied him admission, according to official documents accessed by The Hindu.

Pramod was picked up by the police on the night of January 2 for allegedly molesting a woman in an inebriated state and suffered serious injuries after jumping out of a moving PCR vehicle.

Over the next seven hours, the accused was shuttled between four hospitals, three of them run by the Delhi government — Jag Pravesh Chandra Hospital (JPCH), Guru Teg Bahadur (GTB) Hospital, and Lok Nayak Hospital — and one Central government hospital — Ram Manohar Lohia (RML) Hospital, before he succumbed to his injuries.

According to the Health Department’s preliminary inquiry, JPCH did its best to treat the injured person even as the three larger hospitals offered excuses, such as dysfunctional equipment and unavailability of ICU beds, to deny him treatment.

Sequence of events

When Pramod was brought to JPCH, the hospital intubated him and started assisted ventilation, records show. However, given the patient’s deteriorating health and limited resources, he was referred to GTB Hospital. A junior doctor was also provided to monitor his health and facilitate admission.

A report submitted by JPCH to the Delhi government on January 4, based on the testimony of the junior doctor, read, “Dr. Jyoti [the junior doctor from JPCH] contacted the doctor on duty [at GTB Hospital] and informed them regarding the critical condition and the requirement of immediate admission and management [of the patient].”

“She was directed to prepare an emergency card first,” stated the report. As Dr. Jyoti approached the registration counter, she was asked to get the chief medical officer’s (CMO) consent.

Snuffed out

How four hospitals in the national capital treated a severely injured patient

January 2, 10:14 p.m.: Brought to JPCH, where he was intubated and put on assisted ventilation, and referred to GTB Hospital.

11 p.m.: Denied treatment at GTB Hospital. The patient was not even taken to the emergency ward for examination.

January 3, 1:40 a.m.: Denied treatment by doctors at Lok Nayak Hospital’s neurosurgery department, citing the absence of an ICU bed with a ventilator even though, such a bed was reportedly available.

4 a.m.: Denied admission at RML Hospital as the prescription prepared by Lok Nayak Hospital was not duly stamped and signed.

5:45 a.m.: Brought back to JPCH. Died soon after.

Source: Delhi government documents

When Dr. Jyoti contacted the CMO, the report states, “he refused the same with the reason that the CT scan machine was not working and that a ventilator was also not available”.

The head of GTB Hospital, in a letter to the Health Department on January 4, confirmed the details in JPCH’s report: “It is a fact that the casualty registration paper was not made, and the patient was not brought into the casualty for examination.”

The patient was referred to Lok Nayak Hospital. In her report, the JPCH junior doctor said Pramod was stabilised at the casualty ward and referred to the neurosurgery department. However, the doctor on duty denied him admission, citing the unavailability of an ICU bed with ventilator and nursing orderlies.

A letter by Lok Nayak Hospital to the Health Department on January 4 states that Pramod was not admitted to the hospital due to the negligence of two doctors on duty at the neurosurgery department. “Ventilator and ICU bed was available, but the patient was not admitted,” the letter read. It added that complaints had also been made earlier against the neurosurgery department for refusing admission to patients on the pretext of the lack of beds and ventilators.

The JPCH report added that Dr. Jyoti reached RML Hospital on the morning of January 3 and contacted its CMO, with whom she shared the patient’s medical reports. “However, the CMO on duty at RML Hospital also refused [to admit Pramod] as no stamp and sign was available on the prescription” prepared by Lok Nayak Hospital’s neurosurgery department.

The patient was again brought to JPCH, where his condition deteriorated further, and despite cardiopulmonary resuscitation, he passed away.

Action against doctors

Last week, the Health Department took action against four doctors from Lok Nayak Hospital and GTB Hospital. Each hospital was asked to terminate the services of a senior resident doctor who was on duty on the intervening night of January 2 and 3. The department also recommended suspending one senior doctor each at the two hospitals.

On January 5, the Health Department directed the Delhi government hospitals not to deny treatment to patients “under any circumstances”. On January 15, Chief Minister Arvind Kejriwal approved a proposal for “swift and rigorous” measures against the four doctors. A day later, the Delhi Medical Association opposed the move, saying doctors were being made “scapegoats”.

When contacted, RML Hospital did not offer a comment.

Talking about the reports filed by the different hospitals, a senior Delhi government official said, “At GTB Hospital, they did not even attend to the patient saying that the CT scan machine is not working. Even if it was not working, they should have at least attended to the patient.”

“Doctors at Lok Nayak Hospital said that an ICU bed with a ventilator was not available, which is false. These are gross acts of negligence, which is why action was taken against the four doctors based on reports from the heads of the hospitals,” the official said.