In Part 1 of this series, we found that despite government’s claims, Bengaluru has only about 3,500 hospital beds dedicated for COVID treatment. In this part, we explore why private hospitals have not complied with the government orders to give up beds and treat COVID patients.
In a recent webinar on COVID, Viswa Mohan Tripahi, a resident of Mantri Alpyne apartment, narrated their ordeal trying to find a hospital bed for another resident who had developed symptoms. “The person’s oxygen levels were dropping fast. They dropped to the 80s and we couldn’t find a hospital for treatment. Everyone was asking for a test result or permission letter. Finally, we found a bed through personal contacts.” Many others aren’t as lucky. There have been several reports of hospitals turning away patients, sometimes even resulting in deaths.
As per Karnataka government’s orders, all private hospitals in the city have to set aside 50% of their beds for COVID patients. But in Part 1 of this series, we saw that less than 20% beds in private hospitals have been set aside. So, while BBMP has listed 11,000 beds from across private hospitals in its real-time bed availability portal, it’s estimated that only about 2,000 of these beds are in effect open to COVID patients. (Another 1,500 beds from government hospitals bring the total reserved COVID bed numbers in the city to 3,500.)
Of late, the government has started issuing notices and cancelling licenses of private hospitals who turn away patients. While some hospitals don’t in fact want to treat COVID patients, many others say they have genuine constraints.
Hospitals lack infrastructure, some wrongly listed
When BBMP created its database, it simply listed 50% private hospital beds in the city as reserved for COVID. But many hospitals don’t have the necessary equipment like ventilators, oxygen cylinders, ICU beds, etc., to be able to treat COVID patients. Also, many small hospitals have only one entry and exit. Whereas to set up a COVID ward, a hospital needs to block off an entire section of the building with its own entry and exit, which wouldn’t be possible for smaller hospitals.
Santosh Doddiah, founder of the initiative Covidbeds.org that tracks and updates COVID bed numbers, says “There are hospitals like BMS Hospital, Chiraayu Hospital, Manasa Trinity, Athreya and more, which don’t have the necessary capability and are wrongly listed. Then there are nursing homes, cancer hospitals and eye hospitals like BW Lions, Majnushree, etc., which can’t possibly treat COVID patients.”
Shortage of doctors and other staff
Even when hospitals have vacant beds, many say they don’t have enough staff to handle the additional requirements for treating COVID. A senior office-bearer at Ananya Hospital, Rajajinagar, says, “What use is a bed if there are no doctors and nurses? Two of our doctors who could treat COVID were infected themselves. And out of 26 nurses, 14 left the job out of fear.” Six ICU beds in the hospital are non-operational now due to the shortage of doctors and nurses. So, while the BBMP portal says this hospital has 25 beds reserved for COVID, it in fact has only 11-12.
Bowring and Lady Curzon Hospitals, Aster Hospital and ACE Suhas Hospital also complained of the same problem. A senior doctor at ACE Suhas Hospital, Jigani, says, “The load is so high, it’s very difficult to manage. Half of our nurses have left the job, even some maintenance staff are not coming to work. If they do work, our costs will go up due to the higher salaries that the nurses, doctors and other staff are demanding.”
Despite these issues, hospitals say they’ve had to turn away fewer patients ever since BBMP’s centralised bed allocation system came into place.
Centralised bed allocation system helps, say hospitals
A senior doctor at a large private hospital says, on condition of anonymity, “Earlier, even when we were almost full, I would get multiple patients every day and would have to decide whether there was any point in admitting some of them. We had to turn away many like this. But it’s been better in the past week or so. Such cases are much lesser now.”
Representatives from all other hospitals I spoke to agree, saying they have not had to turn away as many patients since the new system began. Earlier, a large number of patients had to scurry from hospital to hospital, looking for a bed.
|How BBMP’s bed allocation system works|
Tushar Girinath, in charge of the centralised bed allocation system, explains that a patient’s test results gets first uploaded to the ICMR (Indian Council of Medical Research) portal, from where it makes its way into BBMP’s database. “After this, a team is sent to the patient’s house to assess their condition. Then a bed is found for the patient from our system.”
Two main criteria are considered for bed allocation – the patient’s symptoms, and distance from their location. There are four types of beds – General, High Dependence Unit (HDU), Intensive Care Unit (ICU) and ICU with ventilator.
Since the BBMP portal has erroneous data on hospital beds, BBMP and the State Health Department work with an offline list in the back-end to allocate beds to patients. This offline list is manually updated everyday, says Tushar. According to Tushar and many of the hospitals I spoke to, a government team surveys hospitals everyday to get updates on the number of beds, condition of patients and equipment.
BBMP assigns the patient to a government healthcare institution or an empanelled private institution where COVID beds are already reserved. Tushar says, “If they [patients] choose to arrange something privately in a private hospital or a private CCC (COVID Care Centre), BBMP notes down their details so that their condition can be tracked.”
However, private hospitals are largely unwilling to take in patients who are not routed through the centralised system. In the centralised system, a person gets an SRFID number at the time of COVID testing, and if they test positive, they get a BU (Bangalore Urban) number from BBMP. These ID numbers are used to identify patients in the BBMP database.
But in many cases, the COVID-positive person may develop serious symptoms rapidly, and may not have a test report or BU number when they approach a hospital for admission.
No test result, no admission
Just recently, Santosh of Covidbeds.org was approached by a 44-year-old woman who had severe breathlessness and was hoping to find a hospital bed with a ventilator. She tried the helplines, but got no response that day even though they took her details. She also hadn’t been tested.
Santosh says, “We tried calling many private hospitals in the city, all of whom refused to treat her because she hadn’t been tested. No private hospital is taking in patients without a BU number”.
She found a bed with ventilator only the next day, after Santosh reached out to Lady Curzon and Bowring Hospitals. He says that this was just one of many similar cases in the past month. In his experience, government hospitals are far more likely than private hospitals to offer assistance to patients experiencing breathlessness and don’t have a test report.
Even if a person has gotten tested, in many cases the results take 6-7 days to arrive. This has led to delayed treatment and even deaths. As mentioned earlier, in the centralised system, the patient’s test results are first uploaded to the ICMR portal and then updated in the BBMP database. Only then does BBMP inform the patient of the result. The patient’s condition could deteriorate in the meantime. Santosh says, “BBMP is allocating BU numbers manually, which is taking too much time. This can be automated”.
In any case, private hospitals can’t deny admission to patients for not having a BU number, says Tushar. He cites a government order of June 16 directing private hospitals to treat all ILI/SARI patients (those with cough, fever and respiratory issues).
At the webinar Viswa Mohan Tripahi attended, Pankaj Kumar Pandey, the Commissioner for Health & Family Welfare, too had clarified that hospitals need to admit people without test results, and that 1912 ambulance helpline had been set up precisely for such emergencies.
However, the hospital personnel I spoke to say they cannot admit patients without BBMP’s mediation. A senior doctor at Manipal Northside Hospital, Malleswaram, says, “Patients are supposed to reach out to nodal officers or helplines, and then be routed to us. We can’t take anyone in without BBMP permission.” This hospital is now entirely managed by the BBMP, and only treats COVID patients.
The same is true for Ananya hospital, which still retains some non-COVID beds. “If someone reaches out to us, we refer them to a nearby fever clinic for triaging. ICMR verification is necessary, as beds need to be saved for those who really need it,” says the senior office-bearer at the hospital. ACE Suhas, Aster, Lady Curzon and Bowring also say that they are dependant on BBMP routing patients to them for treatment.
Santosh, who has surveyed many hospitals, says hospitals don’t take in patients without a test report because they don’t know where to put them. “They [doctors and private hospitals] say they don’t know if they should admit the patient in the COVID or non-COVID ward. Both are dangerous, and without a test report it is impossible to tell.” Tushar admits there are delays in test results, and says they are working on it.
Bengaluru’s current healthcare crisis doesn’t lend itself to simple solutions. It remains to be seen what steps authorities will take to address the situation. But in the meantime, citizens continue to struggle to find COVID treatment or even accurate data on bed availability in the city.
► Does Bengaluru really have 13,000 hospital beds for COVID?
► COVID response: “Bengaluru is overlooking every management lesson from history”
► Tests not 100% reliable, Gujarat tells court; reluctant to ramp up testing
This is the sad state of affairs of Karnataka. In one of the comments, I read it as “M”arnataka. Unfortunately, with the current sad state of affairs, it is correct name for our state.
Beds without staff it is very difficult to treat the patient. Appropriate PPE should be available. Proper duty rota should be available for nursing staff when they are on Covid duty.
Why our cm admitted to manipal hospital and why cant in victoria. If he thinks services are not good at victoria then it is not good for anyone. If it was good then He should have set an example by admitting there instead of choosing manipal. These politicians are for nothing just to loot publics hard earned money. I believe kings administration was far better than this so called democracy.
I don’t know why only poor and middle class group are finding it difficult to get beds or die due to covid but most of the influential and politicians get bed easily and are surviving even if they are comorbidities associated. Maybe their immunity is very strong…
Its a mammoth tragedy that the IT capital of the world, with so many brilliant people who can earn billions of dollars of foreign exchange for the country cannot somehow come together to put a system in place that can route the patients (confirmed or suspected) to a bed.
Our elected leaders know fully well the lack of capacity within the government to deal with such a gargantuan problem. The city needs a Bangalore Agenda Task Force (BATF) like body with brilliant private sector honchos directing the bureaucrats to deal with the crisis. Private sector folks are trained to collect, analyse, decide, implement and manage based on data in which area the government officers have not much strength.
Even now it is not too late for the Chief Minister to invite the leaders of the IT, BT, AeroTech, IIM, IISc to form a Super Advisory Committee and Subcommittee for various sub-aspects with real powers (just as BATF was) to issue directions to the top officers and their subordinates to implement the issued directions.
We currently have a doctor’s committee advising on the medical science issues.
But this beast is a pure resource management problem and the above mentioned honchos are good at it.
All medical establishments can not treat covid cases,without proper infrastrucure we may rather spreading the infection.To admit a covid case we need to have many protocols to be fallowed ,covid and non covid cases can not mixed seperate entry exit should be provided, doctors and other staff must be seperate,they should stay in the hospital premises for 7 days and should be quarartined for seven days before retuning saervices again.If they become covid positive 28 days quaratine.Imagine is it possible for smaller setups to provide all these facilties
What is the problem in setting up a 5000 bed ICU equipped govt hospital with possible fundraising by Govt with trusteeship owner basis or cooperative basis. Such 4 or 5 hospitals would resolve all issues…govt may allotted land and buildings.Qualified medical and service staff. Pop model equippage can run the hospital on instant basis…what is required is attitude..not getting lost in red tape in this hour of human tragedy of Biological warfare times.
Civic Involvement and Expectations.
If we want to improve the system, we have to get involved. Unless Civilians participate actively, proactively, bureaucrats remain uninformed and unmotivated. They use the framework of Govt. funds for activities for their personal gains through any number of means imaginable.
There are so MANY problems. If we expect perfect solutions at time of crisis, that is unrealistic. We have to get involved in to the functioning of our society and govt. Simply voting is not the end of our responsibility. Start with giving at least 1-hour / week to the nation, our communities.
Then the system will evolve, bureaucrats and politicians and systems will work for the collective good.
Sir, In case of emergency of covid 19 patients, to whom to contact and procedure to get treatment.
sir very nice but for covid we should put big big banners in every ward where hospitals will treat in that ward big banners some what like birthday celibration where big rajneeti people were putting in there ward so every poor people can know .information of that perticular ward
Everything is topsy turvy in BBMP land. No result, no bed Agreed, but result declared after Yamraj’s visit, so no use. It is futile to expect results within a reasonable time, Why cannot be beds allocated based on Oxymeter reading?
Most of the private hospitals are run by politicians, what do you expect? It’s a scam in Bangalore, have you heard about sleeping partners in business terms? If yes, you will realise this
It’s scam everywhere in India, including Bengaluru.
What digital India we don’t understand not even (health needs to humans)
If the private hospital not admitting Covid-19 patients. That registered Marnataka Medical counsel. Why government not to take against the government notification. Why the government not taking any action against violations hospitals Criminal and civil prosecutions. The government dum and deaf
Aptamitra helpline number is of no use
If the patient calls up those numbers the calls are not received.
As doctors if we come across Suspected COVID cases-/Frank Covid cases we are not able to guide a patient (A relative/friend/known to people)
I THINK THERE SHOULD BE THERE SHOULD BE A DEDICATED HELPLINE MANNED BY VOLUNTARY ORGANISATION LOCATED IN BBMP OFFICE SUPERVISED BY BBMP.
OTHERWISE THE BBMP PERSONNEL HAVE BEEN POUNDED DAY AND NIGHT FROM THE PAST FEW MONTHS AND THEY ARE NOT ABLE TO TAKE IT
Yes, there are very less beds in hospital.