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Improving critical healthcare

Improving critical healthcare

India’s emergency healthcare system is in tatters. The moment there’s an accident it’s the police who are called first rather than getting the attention and help of the bystanders, who could attend to the victim, if there was no fear of harassment. While trauma care barely exists, attendance of even heart attack or other emergencies is no better. Road accidents alone are resulting in 1, 60,000 deaths every year. An accident takes place every minute and a death due to these takes place every four minutes. One-third of the victims are in the age group of 15-25 years.  Out of desperation any emergency involving pain or panic of deterioration is taken to a corporate hospital even when the family cannot afford that care, since public hospitals do not betray the confidence. Good ambulances are a few and most of them have no medical equipment. Only a few doctors are trained in emergency care. This is terrible because the first 60 minutes after an accident are vital, the so called golden hour.  Recent case of Vinay Jindal, 20, who died after his scooty had rammed with a speeding car in Delhi.  Following the sad happening India’s Prime Minister said:” The government, would soon bring a road transport and safety Bill and launch cashless treatment for mishap victims. The victim would not have to worry for the first 50 hours to pay for the treatment.” The intention and the declaration are noble.

As of now Emergency care to serious patients of all kinds is offered in areas designated as ‘casualties’ that are unfortunately manned by junior doctors / trainees with little skill and are mere ‘referral points’ for specialized care.  However, Valuable golden hour is lost in this process. Problems are worse in rural areas, where even the most basic emergency care for heart attack or accident victims has been found to be lacking and the victims are sucked into the vortex of quackery at the best. Will enactment of this law will lead to prevention of the accidents? Will it provide the much needed attention in the golden hour? Will it lead to more physicians, trained in critical care?  With the experience of several laws like clinical establishment act 2010, in the past the reply seems to be in the negative.

 

Have we got good roads that are not accident prone? Why crucial roads are under-capacity and under-designed; why over-bridges and subways are missing, that compels residents to put their lives and those of other road users at risk; or why highways are inadequately lit. The quality of the road construction, maintenance of roads, unscientific road Humps, violation of traffic rules, drunken driving, are the root causes of accidents. Poor public transport and too many vehicles on the roads/parking is another problem. Total ban on under-age driving, strict compliance for getting driving licence, clampdown on drunken driving and Good Samaritans’ protection law are essential requirements. Promoting ‘nar sewa-narayan sewa concept can also help.

 

Doctor cannot refuse any case?

Supreme Court r ruled in several cases that the failure on the part of a hospital/doctor to provide emergency treatment results in violation of right to life guaranteed under Article 21. National Consumer Disputes Commission held that hospitals are duty bound to accept accident victims and patients who are in critical condition and that it cannot refuse treatment on any ground. However none of the courts has applied its mind to exempt those doctors from this duty who are unable to treat such a serious patients for various reasons viz lack of training/ knowledge/ capacity, paucity of equipment or manpower, poor health of the doctor or lack of wherewithal e.g. an aged eye specialist being asked to stabilize a heart attack/ multiple fractures patient, before transporting him to a cardiac/ trauma centre. The  clinical establishment act has put this onerous duty on private doctors, abdicating its own duty, irrespective of the capacity/ capability /age /health /finances of the doctors. Can’t they opt to retire or have freedom to work for fixed hours as per physical capability or choose their patients in the sunset years of their lives? Will this be not better that doctor refuses a patient when he cannot manage it well? Instead of any good CEA 2010 will lead to collapse of family neighborhood medical advice and help, since most of such clinics cannot attend to any emergency.  If Government is serious to help the emergency patients, it should shun such tokenism. It should set up hospitals for emergency services, train more doctors in emergency medicine and provide legal and financial support to the private doctors to set up such centres on voluntary basis and pass a law that their services are paid from insurance and not used  as a charity. They should also get immunity from prosecution at par with public health institutions.

Next the citizens should be counseled to help each other without fear of police or law. Even religious discourses can give such advice. Aren’t the cumbersome and opaque judicial processes making people hesitant to help a fellow human being while he is seriously injured?

In a study among the lowest socio-economic group, 95% of respondents demanded  legal protection from arbitrary and unnecessary harassment. People do not want to be a part of lengthy investigation procedures. The Good Samaritan should not be assumed to be the perpetrator of the accident at the first go. Police should be compassionate to the helper so that such acts of helping others can be an example for others in future. The time of the person who has helped should be respected; they should be allowed to leave after taking the basic details of the accident.

 

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