Bengaluru: All that was needed was a ventilator to save 19-month-old Gagana. But we are asked to believe that the city’s premier hospitals didn’t have even that! Gagana, who fell from her second floor home, was refused admission in two hospitals before being first admitted to Indira Gandhi Institute for Child Health (IGICH) and then rushed to Nimhans, where she breathed her last on Monday. When will our hospitals learn to equip themselves to handle emergencies?
Last December the parents of both Akash and Anand had been running from pillar to post to get their children timely treatment and a ventilator. Sadly, they couldn’t save them.
This time around, baby Gagana lost her life despite her parents running to three different hospitals in the city for the child’s treatment. The silicon city that houses more than one crore people and is boasted of as the health hub of the state, sadly has very few dedicated ICU beds and ventilator support at its government hospitals. “The poor man cannot dream of even a day at any of the private hospitals in the city, which would cost him a minimum of Rs 20,000 and hence government hospitals are the only places to go,” says Dr Sateesh, former medical superintendent of Nimhans.
The government-run Bowring hospital, which witnesses three emergency cases daily requiring ICU and ventilator facilities, currently has 14 ventilators at the adult ICU which are occupied round the clock. “Of the 14 ICU beds, 10 are for step-up cases and four for infected cases and at any given time all these 14 ventilators are working,” says Dr Prasanna Kumar, Resident Medical Officer (RMO) of Bowring Hospital. Sadly, this is the case with all the government-run hospitals across the city.
“There are about 16 ventilators and ICUs in Victoria Hospital at the moment. There are plans to increase the number to forty very soon,” informs Dr Durganna, medical superintendent, who agrees that there’s a shortage of ventilator beds and adds, “We take the patients only when there is a vacancy or else we refer them to other hospitals.”
The city seems to be crumbling under the burden of handling such cases. Speaking with Deccan Chronicle, Health Minister, U.T. Khader adds, “Undoubtedly there is this issue of ventilator shortage and demand for ICU care is huge. We have rolled out Rs 10 crore to increase the ICU and ventilator beds at Indira Gandhi Institute and the work is already under way there. By December that centre might start functioning.”
However, it is not just ventilators that would be a solution to the problem. “The cost involved is very high and almost each ventilator bed costs the hospital some Rs 7-10 lakhs and apart from that, 3-4 nurses are also required for each ventilator bed. One cannot just put a patient on the ventilator and forget about it. And sadly this crisis is being experienced by all the government hospitals every day,” adds Dr Sateesh. He adds, “Even if there are 70 ventilators, the 71st would face such a situation!”
“We have eleven ventilators and all 11 were full at the time the child was brought in. We did not refuse the child admission, but we did take some time to arrange the bed for the child,” says Dr Asha Benakappa, director of Indira Gandhi Institute, which has come under fire after the fateful Monday incident. What the city needs are not just ventilators, but also a better healthcare management of emergency cases.
“What we really need is proper networking among the hospitals, which is very important so that hospitals can interact with each other about availability of the beds in the ICU and ventilators as well. A system to look into this would be useful,” adds the former medical superintendent of Nimhans. “The government should place facilities in all the government hospitals and any patient admitted should be given an opportunity to get treatment at these hospitals and to see that these hospitals ensure that they get the full treatment,” says a doctor from the administration of Bowring Hospital.
Everyday there is a Gagana who needs ventilator support at Nimhans, says director
The death of baby Gagana has led to a huge controvery and blame has been laid squarely at the doors of Nimhans for their inability to provide a ventilator to the child when most needed. The beleaguered director speaks with DC at length about this never-ending debate. “The shortage of ventilator beds is a huge problem and out of the five critical cases that are at ICU daily, a minimum of three patients require ventilator,” says Dr P Satish Chandra who adds that the institute witnesses some 120 road injury trauma cases everyday.
“We operate a minimum of 10 cases at the neurosurgery department daily and there is a major surge of patients that flow into the hospital. Sadly, each ventilator bed requires 3-4 nurses daily,” points out the Director who has been under fire because of referring the child to Indira Gandhi Institute of Child Health. The director also points out the underlying issues about the whole ventilator controversy adding, “Not only is it the ventilator, but there is the question of oxygen supply to each of such beds, electricity, water and other technical support, let alone the nurses and doctors. There is a hidden cost of Rs 10,000 and we are trying to do our best with the funds and the human resource and nurses that we have. It is not just Monday but everyday that we face this issue of shortage. Everyday we see a Gagana. Some patients require ventilator for one day and some for months and we cannot get them out of ventilator because of some other patient. Currently there are 35 ventilators and 140 nurses.”
However, the Institute is planning to add 125 beds at the Neuro centre which will have 25 ICU beds with ventilators and 80 beds for the general ward. “There should be at least ten ICU beds at every medical college in the city so these issues do not arise. Every state should have two trauma care centres and every district should have four ICU beds at the health centre,” he says.
Grief too deep to express
“My child would have been alive today if treatment was given at the right time. They would have definitely treated my child if we were from a rich and influential family,” says Venkatesh, the distraught father of Gagana.
Ever since the news of the child’s demise reached the parents, the mother of the child has been inconsolable. The shock was so deep that she was not even able to weep normally. She was heard saying, “I have lost one of my eyes. How will I live? I will die without my child.”
When Deccan Chronicle reached their house on J.C. Road, there was an uncanny silence and sense of sadness in the entire locality and everyone had the same question to ask the government: Don’t poor people have any right to get medical treatment?
“This is what happens with the poor in this country. Our children are denied emergency medical treatment. So, should we let our children die in this manner?” questions an emotional neighbour Amuda. She added, “The child was made to wait for two hours in the ambulance. The father literally pleaded with the hospital staff to treat the child, but the staff shouted and said the hospital didn’t belong to his father. The staff screamed and asked us to get out.”
Another neighbour Ashmaat added, “It has been just a couple of months since they shifted here. They were a very silent family and the mother does not interact much. We were just getting to know each other when this incident happened. We consider all the children in this locality as our own. We could feel the pain that she is going through. It is not easy to see your child bleed to death. And especially when the child could have been saved if the hospital authorities had been more vigilant.”
The parents have lodged a complaint against the Indira Gandhi Institute for Child Health (IGICH) at Siddapura, Jayanagar police station. Interestingly, despite such reports of negligence from government hospitals, no minister or official has contacted the parents, not even a word to console them or to apologise.
The body of the child was brought to their house at J.C. Road at 11 am on Tuesday and all the neighbours bid their last goodbye to the child. Then the parents left for Kolar to conduct the last rituals.
No negligence by doctors: Khader
Instead of taking action against doctors for not providing timely medical attention to 19-month-old Gagana, who died after a fall from terrace of her house, Health and Family Welfare minister U.T. Khader strongly defended the doctors at Nimhans and Indira Gandhi Institute of Child Health (IGICH) hospitals. Mr Khader told reporters here on Tuesday that there was no negligence on part of doctors. In fact, Gagana got timely treatment after she was taken to IGICH, he added.
After falling from terrace, Gagana sustained multiple injuries and there was blood clot in the brain, therefore Nimhans doctors had told her parents to take her to IGICH. At IGICH, the intensive care units were full, but the doctors accommodated her at ICU after shifting one child to semi-ICU. Though Gagana has admitted to ICU, she did not respond to the treatment, Khader explained.
“Allegation regarding non-availability of ventilator is false. Our 108 ambulances have ventilator facility and till she admitted to ICU she was on ventilator located in the ambulance. At Nimhans the doctors had provided all medical attention,” Mr Khader said.
The child died due to brain hemorrhage. Due to multiple injuries the chances of her survival was bleak. In this case there is no negligence on the part of doctors, he said.
“In fact, any child including mine, if she fell from second floor, chances of survival are very bleak. Parents must avoid such incidents in future, there is no use blaming the doctors regarding such incidents,” Mr Khader said.
The Health Minister further stated since two hospitals do not come under his department, he will suggest Medical Education Minister to look into the issue.
ICUs will be set up: Since there is acute shortage of ICUs in the government hospitals, the government has decided to set up ten-bed intensive care units at all district hospitals. Along with ICUs, blood storage units will be set up at taluk hospitals, Mr Khader said.
‘We did our best’
The child who had fallen from the second floor and crashed onto the ground on her head, fracturing her right skull and dislocating her shoulder, was gasping for breath when a call was made to 108. The ambulance arrived at about 11.30 am. Soon, an advanced ambulance equipped with medical facilities was pressed into service and began treating the child.
“When we received the child, she was very critical. She was in an unconscious state and was bleeding from the nose. There was an internal bleeding, too. We immediately put the child on a ventilator and began monitoring her Glasgow Coma Scale (GCS) based on three parameters — Best Eye Response, Best Verbal Response and Best Motor Response to record the conscious state of the child for initial as well as subsequent assessment,” said an emergency medical expert, who treated the child for nearly two hours in the ambulance.
He said that the child needed immediate surgery besides artificial respiration support. If the child was attended to immediately and was operated on, the complications could have been averted to a certain extent. “The ambulance which was called in around 11.30 and reached the spot at 11.45 treated the child for over two hours. Whatever best possible we could do, we did to monitor the child’s condition,” added the medical expert.
