As >water levels rose , Chennai saw every single system associated with modern life abysmally fail —houses collapsed, roads caved in, communication networks went down, sewage pipelines were wrecked, and carcasses floated on roads. Patients in government and private hospitals across the city took a beating.
Completely unprepared for disasters: >the hospitals in Chennai — private as well as government — were particularly vulnerable, improvising solutions as the situation developed. At least 13 primary health centres in Kancheepuram and Tiruvallur districts were affected. The Tambaram Taluk Hospital in Chromepet ran outpatient (OPD) services from a wedding hall for two days after evacuating many of its inpatients to other hospitals.
Water had entered the ground floor of the ESIC Hospital in K.K. Nagar too.
Patients were shifted to a higher floor. But the worst affected was MIOT International, where 18 patients on ventilator support died on December 2 and 3, as per the Health Secretary’s press release. Within days, police registered a case under section 174 of the Criminal Procedure Code (Cr.PC) against the hospital. The post-mortem reports are likely to be submitted this week.
The floods in Chennai bring to the fore the need for stricter implementation of hospital safety standards. The last time this topic was debated was after what has come to be known as the ‘AMRI fire tragedy.’ In December 2011, around 3 a.m. a fire broke out in the basement of the seven-storey hospital in Kolkata — Advanced Medical Research Institute (AMRI) Hospitals. By morning, 90 patients had choked to death.
A few months before the AMRI tragedy, Kavita Narayan, a disaster management expert trained by the Federal Emergency Management Agency (FEMA), along with some of the best minds in the country — structural engineers, doctors and specialists in hospital design — had written a policy document that laid out in great detail what was expected of medical and non-medical staff in case of any disaster.
Every single one of the 111 pages of Hospital Standards Safety Committee had answers that could have saved lives. The document had exhaustive instructions to doctors, nurses, and management about how to plan and evacuate in case of emergency. It even laid out how and where to store which equipment; how to avoid flooding in critical units; the norms of fire safety, etc. The document has been gathering dust since December 2013, when it was submitted to the National Disaster Management Authority (NDMA).
In an ideal situation, the response begins soon as water levels start rising or, as in the case of AMRI, the fire was spreading.
In Tamil Nadu, the private sector currently caters to roughly 60 per cent outpatient services, and 40 per cent of in-patient services, as per the State Health Department. The Clinical Establishments (Registration and Regulation) Act, 2010 — enacted by the Central Government — which prescribes minimum standards to be followed has not been notified by Tamil Nadu because they already have a State Act. As of now, the Central Act is notified only in four States — Arunachal Pradesh, Himachal Pradesh, Mizoram, Sikkim and all union territories except Delhi.
While the State has an Act in place to regulate private players, expecting any norms and standardised care from private hospitals is like building castles in the air.
Here is why: for nearly 18 years, the Tamil Nadu government has been sitting on The Tamil Nadu Private Clinical Establishments (Regulation) Act, 1997. The Act came into force in April 1997, the rules for it are yet to be notified.
The State government has three options: either adopt the Central Act, or enact its own or, lastly, make changes on the existing Act governing clinical establishments. Tamil Nadu has done none of this.
“We actually got the idea for the Central Act from Tamil Nadu. We were hoping it will pressure the State government to implement the existing law, if the Centre also passes it. Tamil Nadu passed the Act in the Assembly. Since then, it has been in animated suspension. We kept pushing for it but the lobby of private hospital owners is so strong that no progress has been made for nearly two decades.” said Sunil Nandraj, who was an adviser to the government as the Clinical Establishments Act was drafted.
Health Secretary J. Radhakrishnan said: “We are in the final stages of framing the rules for the Act. Several meetings have already been held with all stakeholders, and the rules will be notified shortly.”
With even minimal standards lacking, enforcing disaster preparedness is a far cry in India, Ms. Narayan said. “The draft hospital safety document has very specific rules — to the extent of specifying exact locations of storing emergency equipments. We do not follow any of this because India currently does not have a policy for this,” she said.
As the weather returns to normalcy in Chennai, the citizens should ask the question whether medical culture as well as governance in this country is willing to accept the virtues of regulation in the interest of patient safety.
Otherwise, this is the grim reality of Indian hospitals: they harm as much as they heal.