गुरुवार, 27 अगस्त 2015

Fact-finding Report on Infant Deaths in Sishu Bhawan Cuttack Odisha

Fact-finding Report on Infant Deaths in Sardar Ballav Bhai Patel P.G. Institute of Paediatric (Sishu Bhawan), Cuttack of Odisha

Having gone through the repeated news about series of child deaths since few days in Sardar Ballav Bhai Patel Paediatric Hospital (Sishu Bhawan), Cuttack, the premier Institute in the state, the Civil Society Groups felt concerned about  the incident and decided to visit the Hospital on fact-finding mission  to ascertain the fact and factors responsible for such deplorable incident of huge child causalities in old hospital of the state. The eminent members of Civil Society Groups who visited the Hospital were as follows.

1.     Rabi Das, Eminent Journalist
2.     Pradip Pradhan, State Convener, Right to Food Campaign, Odisha
3.     Sudhir Mohanty, Advocate, Odisha High Court
4.     Khirod Rout, Advocate, Odisha High Court
5.     Debendra Sutar, eminent Social Activist
6.     Rohan Mohanty, RTI Activist and President, Odia Yuva Manch
7.     Miss Prativa Das, Woman Activist

It is needless to mention here that   this paediatric Hospital is recognised as one of the best Child Care and Research Hospital in Eastern India. The 416-bedded   Hospital has only 21 ICU (Intensive Care Unit). The parents from different districts and other states like Jharkhand carry their children to this hospital with hope to get best treatment for their infants in every day. Since few years, there is wild allegation by the common people and patients about negligence of the doctors and the staff of the hospital in respect of treatment to the patients i.e., infants. It is reported that due to negligence of Medical staff, corruption, poor infrastructure, mismanagement, the death toll of the patients is rising every year.  Within four days, 29 infant deaths were reported by Hospital authorities. The details of causalities in ICU  are as follows.

Year
Admitted in Hospital
Death of Infants
Percentage
2010-11
1972
412
20.89
2011-12
1982
454
22.91
2012-13
1820
278
15.28
2013-14
2016
326
16.17
2014-15
2183
564
25.84

The Details of the patients admitted  and died  in Ssihu Bhawan  are  as follows
Year
Outdoor
Indoor
Death
Percentage
2010-11
88563
10995
488
4.44
2011-12
91227
11268
527
4.68
2012-13
92790
12560
837
6.66
2013-14
107796
14023
903
6.44
2014-15
110381
17899
1114
6.22

Details of the Visit of the Team
On 25. 8.15, the Team reached at Hospital at around 11.30. The campus was crowded with the presence of representative of Political parties and electronics media.  After reaching the   campus, the team members rushed to the Wards and ICU of the hospital to see the condition of the children admitted for treatment and inspect the surroundings of the hospital.  During interaction with ICU staff, Smt. Sanjukta Mishra, ICU In-charge appraised the team about number of the problems.  There is only 30 Nursing Staff against requirement of 70 staff in ICU for 3-shift duty in a day. As per medical norm, there should be one attendant per each patient in ICU.  Similarly, there is huge shortage of doctor in the hospital.  The Hospital is generally managed by PG Students.  The treatment of patients is also affected due to shortage in supply of syringe, gloves and   supply of medicine to the hospitals.   She   also shared three circulars with the Team  which is one of the reasons for damaging health system   and making health service costly  and depriving the poor people to access  the health service in ICU of the  hospital.

A.  Circular No-1: The office order dated 21.9.10 issued by the Superintendent of the Hospital mentions that  the bed charges  of ICU and Ventilator charges  will be  collected  from the patients  as mentioned below.
1. Bed Charges for first 5 days @ Rs. 250/- per day and 6th day onwards @ Rs.500/- per day.
2.     entilator charges will be collected @ Rs. 500/- per day.

B.   Circular No.-2 -  The office order ( No. 1244/SVPPGIP,CTC dated 10.4.15 ) issued  by the  Superintendent  indicates  that  the charges  for ABG with Electrolyte, Glucose  and Lactate  will be from Rs. 350/- to Rs. 400/-. The Charges with Electrolyte (chemical method) will remain same Rs. 200/- per test.

C.   Circular No.-3 -  There is instruction  by the Superintendent  in his office order dated 14.7.15  that the dues for 3 ( three days)  in advance  from the parents  during admission  in I.C.U.  will be  collected  and the Sister-in-Charge  will  collect the dues  on day to day  basis.

The above-mentioned fees charged by the Hospitals   have made the treatment very costly and unbearable on the part of poor patients. The Team members also visited the ICUs and General Wards and found the condition of the most of the infants critical and did not notice any vacant bed in the hospital.  The Sister-in-Charge also reported that there are around 15 patients in queue to be admitted   in the ICU. 

Meeting with patients
Then, the Team members  interviewed  the parents of patients  asking few questions   about their  native place, reason for admitting their children in hospital, level of their satisfaction on treatment made by the doctors.  The response of the parents of the patients is as follows.

Sl. No
Name of parents
Native place
Testimony
1
Chaturbhuja Mohanta
Keonjhar
The Doctor of Keonjhar district Hospital referred his 13 year son to Sishu Bhawan  for  treatment, as his condition go critical.  His son has been admitted in hospital   since four days.  He has not been supplied any medicine free of cost. Every day, he is purchasing medicine.
2
Pinki Devi
Badbil  of Keonjhar district
As she could not get proper treatment at Keonjhar district hospital, she has brought her 7 month old child to this Hospital for better treatment on 25.8.15. Her child has been admitted in ICU. His condition is critical.  He has already purchased medicine   of Rs. 2000/- as per prescription issued by Doctor.
3
Laxmi Jena
Jajpur Road, Jajpur district
She has admitted her 3 day old baby in hospital.  The reason is the new born baby is having respiratory  problem.  As she   does not faith on CHC, she brought her baby to Sishu Bhawan for treatment.  The Treatment is groining on since 4 days. The condition of her baby  is still critical. 
4
Manoj Kumar Mohapatra
Sundaragarh
He carried her child to admit in Rourkela Hospital.  Having not been satisfied with the treatment, he got her baby  admitted in Keonjhar  District Hospital. Then, the Doctor referred  to Sishu Bhawan.   Every day, he is purchasing medicine of  Rs. 1200/-  to Rs. 1800/-  for treatment of her  child.
5
Harapriya  Behera
Kandarpur of Cuttack  district
She had admitted her  6 month old baby  in Hospital  since 22 days. Every day, she spends Rs. 2500/- towards the cost of treatment. She has already spent Rs. 40,000.00  till now with no result.

The Team members experienced deplorable   and pathetic condition of the parents who have come to this hospital from far way area with the hope to get proper treatment for their children. But their hope has been dashed out due to serious negligence of the medical staff and demand of huge expenditure, fees charged by the medical etc. 

Meeting with Superintendent and Medical Staff
The Team tried to meet Dr. Niranjan Mohanty , Superintendent of Sishu Bhawan but  found absence. It was informed that he had gone to attend high-level meeting called by the Minister for Health and Family Welfare   to review the incident of infant death in the hospital. Then, the Team members met Manager of the Hospital and discussed about reason of the huge child causalities. He  said that  most of the cases  and the  children getting admitted in hospital  are referred by  the  district  hospitals  from different areas. These babies are admitted with critical condition. So the chances of survival   always remain doubtful. He preferred to remain silence on other critical issues raised by the Team.

Experience of the Team with a BPL Patient and story of his harassment by Medical staff
The Team members came across a BPL Patient loitering in verandah of the Hospital and demanding return of the fees charged from his, though he is BPL hard holder.  On query, it  was  found that   he is  a man from  Jajpur  who had come with 3 years baby  for treatment.  He met the doctor at outdoor and the Doctor    wrote the prescription and advised him to go for different test by depositing fees at counter.  He went to Medial counter to get the blood tested. But the staff sitting at the counter demanded   the payment of the fees. When he showed his BPL Card and demanded his entitlement of free treatment,   the staff abused him and asked him either pay money or leave the place. After   exchange of arguments and counter-arguments for few minutes,   he was forced to pay the amount of Rs. 190/- and got money receipt.  Having heard the story, one of the Team members carried him to the   staff claimed to be person hearing grievances.  After hearing the grievances, he said that the outdoor BPL patients were required to pay the fees unless they are admitted in hospital.  It was found that the people who are covered under Rastriya Swasthya Bima Yojana, Biju Krushak Kalyan Yojana are also entitled to get free treatment.  But the doctors are not aware about this provision for which the eligible patients could not get free treatment.  Though the BPL patient demanded return of the money, he was denied.  This the test case  and brings to limelight  how the BPL people are  getting harassed  ad denied  free treatment despite  production of   proof of the documents.

Critical Issues ad Recommendations
1.  This Sishu Bhawan is one of the prestigious premier paediatric hospitals for treatment of the infants in eastern India.  This Institute has gained reputation because of huge infrastructure, well-equipped staff and trained doctors, nursing staff.   The patients from different parts of Odisha and neighbouring states also come to this hospital with the hope to get better treatment of their children.   But in due course of time, this Institute has lost its credibility and respectability due to maladministration, mismanagement, corruption, lack of fund, apathetic attitude of the state administration   and disgruntled and corrupt staff of the Hospital.  The reason of the preset death of infants   cited by the authority is that most of the patients are admitted in hospital on referral basis. It means, many patients are referred to this hospital from different hospitals, CHC, PHC across the state. But the reason is not at all acceptable and convincing.  The patients who failed to get proper treatment due to lack of infrastructure   or expert and efficient surgeon in any place of the state or their condition got critical   find no option but to come to Sihsu Bhawan with the hope to get best treatment.  It is obvious and expected to get best treatment from the Hospital for the children suffering from   multiple diseases and whose conditions are critical.  As because  there is  huge shortage of  doctor  and staff  and mal-administration,  the  standard of the  treatment in the  Hospital   has deteriorated which has  resulted  in rise of death of infants  in large numbers in different preceding years. So keeping in view the demanding situation and expectation of the people of the state for better treatment of their children, the State Govt. is recommended to intervene immediately to reform the administration in the Institute with filling up all vacancies in the post of Doctor, Nursing Staff  and other staff. The required financial support should be provided for development of infrastructure to meet the need of the Hospital.

2.  The State Govt. with commitment  for restoring  the glory of the Institute should order  for  a Judicial enquiry or a third party enquiry  by AIIMS or ICMR and  mismanagement of  the Hospital. The Govt. should be omitted to implement the recommendation of the agency in letter and spirit for the improvement of this premier institute.

3.  As the standard of the Treatment in District hospitals, Community Health Centre,  Primary Health centre   is deteriorating in all the districts  due to  shortage of doctor, staff and corruption, the people are   found reluctant to carry their patients to these hospitals and rushing to  this Institute  for better treatment. That’s why, this Institute is getting crowded and the number of patients increasing every year. So, the Team recommends  that  the State Govt. should take steps  on war footing way to revamp  and  reform the District Hospitals, CHC, PHC with appointment of required doctors and Staff  to make it well-equipped  to render best health service to the patients in different districts. The effective attention should be  paid  to revamp the  hospitals and Health centres  in tribal regions of the  state. 

4.  The State  Govt. should make  a mandatory  provision  for all the  MBBS passed doctors of all the Medical Colleges to work at least  5 years in Govt. hospitals  in different  districts prior to join in PG Course.

5.  The State Govt. should   strictly  implement the provision of  providing free treatment to the people  living below poverty line  and  the people covered under Rastriya Swasthya Bima Yojana    in any Govt. and private  hospital across the state.   Serious action should be taken  against  those staff  or  authority  violating it.

Members of the Team

Rabi Das                                               Pradip Pradhan
Eminent Journalist, Bhubaneswar        State Convener, Right to Food Campaign, Odisha

Sudhir Mohanty                                     Khirod Rout
Advocate, Odisha High Court                Advocate, Odisha High Court

Debendra Sutar                                     Rohan Mohanty
Eminent Social Activist                          RTI Activist & President, Odia Yuva Manch

Miss Prativa Das, Woman Activist
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To
Sri S.C. Jamir                                                                                       Date-27.08.2015
Hon’ble Governor
Raj Bhawan, Bhubaneswar

Sub- Seeking  direction to State Govt. To take prompt  action  to  save  the life of infants  dying due to negligence  and mal-administration in Sardar Ballav Bhai Patel P.G. Institute of Paediatric (Sishu Bhawan), Cuttack of Odisha

Esteemed Sir
We, the  representatives  of  Social Action Groups  bring  to your  kind  notice the  following matter  seeking  your  urgent intervention  and necessary  action.

Having gone through the repeated news about series of  child deaths since few days in Sardar Ballav Bhai Patel Paediatric Hospital (Sishu Bhawan), Cuttack, the premier  Institute in the state, the Civil Society Groups felt  concerned about  the incident  and   visited  the Hospital on fact-finding mission  to ascertain the fact  and factors responsible  for such deplorable incident of huge child causalities in old hospital  of the state.  

The  Team  met and discussed  with  Medical staff,  relatives of patients  and  the authority  and wanted to know from  the reason of the   infant causalities  and factors  responsible  for it. After  inspection of Wards and ICU and the  condition of the  children,  the Team  felt that  the situation is  completely  worst  due to  shortage of staff and  doctors, mal administration and corruption. This disaster is man-made  and the administration is completely responsible  for  large scale infant deaths  in the Hospital.

Having been deeply concerned over the   disastrous situation   in  this  Institute, we make the  following  suggestions   for  reforming and revamping  health care system  in the State  in general  and Sishu Bhawan in particular.  The suggestions  are as follows.

1. This Sishu Bhawan is one of the prestigious premier paediatric hospitals for treatment of the infants in eastern India. This Institute has gained reputation because of huge infrastructure, well-equipped staff and trained doctors, nursing staff etc. The patients from different parts of Odisha and neighbouring states also come to this hospital with the hope to get better treatment of their children. But in due course of time, this Institute has lost its credibility and respectability due to maladministration, mismanagement, corruption, lack of fund, apathetic attitude of the state administration and disgruntled and corrupt staff of the Hospital. The reason of the preset death of infants cited by the authority is that most of the patients are admitted in hospital on referral basis. It means, many patients are referred to this hospital from different hospitals, CHC, PHC across the state. But the reason is not at all acceptable and convincing. The patients who failed to get proper treatment due to lack of infrastructure or expert and efficient surgeon in any place of the state or their condition got critical find no option but to come to Sihsu Bhawan with the hope to get best treatment.  It is obvious and expected to get best treatment from the Hospital for the children suffering from multiple diseases and whose conditions are critical.  As because  there is  huge shortage of  doctor and staff  and mal-administration,  the  standard of the  treatment in the  Hospital   has deteriorated which has  resulted  in rise of death of infants  in large numbers in different preceding years. So keeping in view the demanding situation and expectation of the people of the state for better treatment of their children, We  suggest  that   the State  Govt.  Be directed to  intervene immediately  to reform the administration  in the Institute  with  filling up all vacancies  in the post of Doctor, Nursing Staff  and other staff. The required financial support should be provided for development of infrastructure     to meet the need of the Hospital.

1. The State  Govt.  Should be directed  to order for  a Judicial enquiry or  a third party nquiry by AIIMS or ICMR about  the incident. The Govt. should be comitted to implement the recommendation of the agency in letter and spirit for the improvement of this premier institute.

2.  As the standard of the  Treatment in  District hospitals, Community Health Centre,  Primary Health centre   is deteriorating  in all the districts  due to  shortage of doctor, staff and corruption, the people are   found   reluctant to  carry their patients   to these hospitals and   rushing to  this Institute  for better treatment.  That’s why, this Institute is getting crowded and the number of patients increasing   every year. So, the Team recommends  that   the State Govt. should be directed to take steps  on war footing way   to revamp  and  reform the District Hospitals, CHC, PHC with appointment of required doctors and Staff  to make it well-equipped  to render best health service to the patients in different districts. The effective attention should be  paid  to revamp the  hospitals and Health centres  in tribal regions of the  state. 

3.  The State  Govt. should be directed  to make a mandatory  provision  for all the  MBBS passed out doctors of all the Medical Colleges to work at least  5 years in Govt. hospitals  in different  districts prior to join in PG Course.

4.  The State Govt. should  be directed to strictly implement the provision of providing free treatment to the people living below poverty line and the people covered under Rastriya Swasthya Bima Yojana in any Govt. and private hospital across the state. Serious action should be taken against those staff or authority for violating it.

5. All the Office orders  issued by the  authority  for collection of different kind of fees  towards different  type of tests, ventilator  charge  etc. Should be withdrawn immediately.

N.B.- Fact-finding Report is attached for  reference

Signature of Members of the Team

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