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