NEW DELHI—In the first week of May, as the number of novel coronavirus cases and deaths spiked in Ahmedabad, the Gujarat government did two things in quick succession: on May 6, it ordered all private clinics, hospitals and nursing homes in the city to reopen in 48 hours or lose their licenses.
The following day, May 7, the state government imposed a near-total lockdown in the city making it almost impossible for private hospitals and nursing homes to follow the order issued the previous day as public transport was not functional and there were restrictions on movements of people on foot or in personal vehicles.
As a consequence of this, the government ended up being in confrontation with private healthcare service providers at a time when it wanted them to share some of the load on public hospitals which have been filled with coronavirus patients as well as those seeking treatment for other ailments.
Two influential groups of healthcare providers, the Ahmedabad Hospitals and Nursing Homes Association (AHNHA) and the Ahmedabad Medical Association (AMA) have written strongly worded letters to the Ahmedabad Municipal Corporation protesting the “coercive methods” and “insulting treatment” by the corporation and the city police force which prevent them from ensuring mobility and safety for both their staff as well as patients.
In conversations with HuffPost India, representatives of both organisations also raised concerns about the inadequate availability of affordable and good quality protective gear like face masks and Personal Protective Equipment (PPE) for healthcare workers, as well as the existence of “fly by night companies” for manufacturing these products.
“The attitude of police towards doctors and our health workers is very abusive and insulting.”
- Ahmedabad Medical Association in Letter to Municipal Commissioner on May 7
Gujarat, Prime Minister Narendra Modi’s home state, is one of India’s worst-hit states, with over 8903 cases of COVID-19 — the illness caused by the novel coronavirus. At least 70% of these cases are concentrated in Ahmedabad. The city also has one of the highest fatality rates in the country; nearly 7% of COVID-19 patients in Ahmedabad have died of the virus compared to only 1% of cases in New Delhi.
The rising number of cases and deaths prompted change of guard in COVID 19 control activities in Ahmedabad. The state government appointed senior IAS officer Rajiv Gupta as overall in charge to control the spread of the coronavirus and Mukesh Kumar replaced Ahmedabad Municipal Corporation (AMC) commissioner Vijay Nehra to lead the municipal corporation’s battle against the pandemic. The May 6 order on private hospitals, and the May 7 lockdown were amongst Gupta’s most controversial decisions after he took charge.
These controversial decisions came in the backdrop of a far from satisfactory performance record of the AMC, which is tasked with handling the city’s COVID-19 response on the ground. The corporation did not involve the AMA or anyone else from the medical fraternity “in anything related to COVID”, Dr Mona P Desai, the AMA’s president, told HuffPost India.
“If, from the beginning, their help had been taken, the scenario would have been much different today,” Dr Desai said. “Initially, when the lockdown started, they told us to stop the OPDs. They thought that since the patients won’t come, there will be less communication and less transfer of the disease. So at first, they ordered us not to start the OPDs, start with teleconsultation. Even IMA sent us emails about it.”
This was significant because before the lockdown, she pointed out, teleconsultation was supposed to be a crime and “we were not supposed to give any prescriptions on the telephone otherwise we would be fined. That was the government rule.”
But after the initial days, Dr Desai speculated, “they realised not letting doctors open OPDs was adding to the burden of the government hospitals because both non-covid and covid—all patients were going there. Because obviously private ones were shut.” The sudden order to open clinics on May 6, Dr. Desai said, was illustrative of a compulsion arising out of this situation.
WHY PRIVATE SECTOR HEALTHCARE PROVIDERS ARE UPSET
Though it is the public hospitals which have played the main role in battling the coronavirus pandemic across India, several state governments have also taken over private hospitals and converted them into covid hospitals to treat infected patients on account of the rising numbers of those infected by the virus. Gujarat government has been doing the same by converting many private hospitals into many covid hospitals.
But as Ahmedabad emerged an epicentre of the pandemic, with a majority of coronavirus cases being detected in the city, the state government took the more drastic measures of may 6 and May 7 cited earlier in this report. On May 6, it ordered all private healthcare providers to open their establishments within 48 hours or lose license.
The next day, May 7, the city administration ordered a week-long total lockdown which affected both civic life as well as practise of private medical practitioners whose establishments were not converted into COVID 19 centres adversely.
The AMA wrote to the city’s municipal commissioner on May 7 itself.
“The government is forcing doctors to open clinics and hospitals but we have certain problems. Kindly look into the matter urgently and solve them on priority,” the letter said, highlighting six key issues.
Some of these were: the lack of public transport was making it difficult for patients and hospital staff to travel between their homes and hospitals and clinics so mobility concerns need to be addressed; COVID 19 testing must be allowed for patients who are in pre-operative or ante-natal stages and doctors who are 60 years old or have morbid health problems, they must not be obliged to start their clinics as they are at higher risk of contracting coronavirus,
“The attitude of police towards doctors and our health workers is very abusive and insulting,” the association further noted. “The notification given to doctors by the AMC has a very threatening and insulting language” and called for “mutual respect” between the police, bureaucrats and doctors.” The letter also pushed for letting the doctors mandate that a COVID-19 test be necessary if a patient is to be operated upon.
“We would appreciate it if you take the fraternity into confidence for opening the clinics and nursing homes rather than using coercive methods. Coercive methods can only lead to confusions and misunderstandings.”
- The Ahmedabad Hospitals and Nursing Homes Association, Letter to Municipal Commissioner on May 7
The Ahmedabad Hospitals and Nursing Homes Association wrote a similar letter to the Municipal Commissioner on the same day.
“We would appreciate it if you take the fraternity into confidence for opening the clinics and nursing homes rather than using coercive methods,” the letter said. “Coercive methods can only lead to confusions and misunderstandings.”
The association raised a separate bunch of requests and concerns, including identification of vendors and quality parameters for provision of PPEs and other healthcare equipment; arrangements for maintenance staff like plumbers and electricians who can address quick issues; arrangement of food for patients and their relatives; some mechanism to ensure maintenance of medical equipments must also be made.
Only one of these demands had been addressed thus far and that also partially, Dr Bharat Gadhavi, president of the Ahmedabad Hospitals and Nursing Homes Association said.
The municipal corporation had provided forty buses to the Ahmedabad Medical Association, he said. “I don’t know how feasible and logical it is. It has been handed over to the Ahmedabad Medical Association. It is not the body which is going to handle the routes etc,” said Dr. Gadhavi. “On the contrary, the government should do something. They should arrange transport for all the emergency services staff which can be brought in.”
But Dr. Desai felt the buses may help in the days going forward.
Both Dr. Gadhavi and Dr. Desai expressed concerns about the quality of healthcare equipment available to hospitals.
“Right now there are plenty of vendors. We don’t know which is a good quality material; they are dealing with the lives of the staff,” said Dr Gadhavi. “If a bad quality material comes...because right now fly by night operators have come in. They are all providing this material. There is no quality parameter set.”
He felt the authorities must identify the good ones from the bad to help healthcare workers buy from the right ones. “The government has to do its job. Monitoring. They are not doing that right now,” he said.
Dr Desai, of the AMA, said some vendors were offering the AMA, which in turn supplies the healthcare equipment to individual doctors, at “obscene” rates. The AMA had procured some masks and supplied them to doctors at reasonable prices but she wasn’t very satisfied with the quality.
“There are a lot of problems with quality. They are not giving us standard masks and they are cheating us like anything. But we have no choice,” she said.
The government must keep the price cap and quality cap on them, Dr. Desai said. “Those whose textile units are non-functional, they are making masks and PPE kits. They don’t know what we want and what actually should be there according to scientific specifications. You are playing with our health,” Dr. Desai said.
SCARCITY OF GOOD QUALITY & AFFORDABLE PROTECTIVE GEAR
Gujarat State Unit President of the Indian Medical Association Dr Chandresh S Jardosh told HuffPost India he had written to the state health secretary on March 29 alerting to unavailability of PPEs, N95 masks and surgical masks, and had asked for this equipment to be made available at reasonable prices.
More than a month later, Dr Jardosh said, the IMA had only received around 50,000-60,000 N95 masks for doctors which were distributed among its 30,000 members zone wise and as per requirement. But this was a pittance. He said lakhs would be required and the number in which they were available was insufficient.
The IMA Gujarat state branch chief also said that instances of police troubling and preventing healthcare workers continue and it is a persistent problem. He also said, echoing his colleagues in Ahmedabad, that the problem of inadequate availability of good quality PPEs, surgical and N95 masks was persistent across the state.
“We provided 40 AC buses and if need be more will be provided.”
- IAS Mukesh Kumar, Ahmedabad Municipal Corporation In-Charge to HuffPost India
HuffPost India reached out to Gujarat Health Secretary Jayanti Ravi and Ahmedabad Municipal Corporation’s current in-charge Mukesh Kumar to know how the government was responding to concerns raised by healthcare providers in the private sector and their associations.
While Ravi’s response is still awaited, Kumar responded saying that the Ahmedabad municipal corporation’s biggest hospital, Sardar Vallabhbhai Patel Institute of Medical Sciences and Research, has been well provided with healthcare equipment.
Responding on May 12, Kumar said, “As of today, SVP has more than 18500 full body PPE kits, 16500 N95 Masks and 35000 3 layer masks in stock today. Which is sufficient to meet 10 days demand of SVP hospital. There is no shortage of any PPE for the staff working in SVP hospital.”
“All the staff working in COVID positive area are provided with PPEs as per guidelines,” Kumar said. “Today the doctors of SVP hospital demanded for a specific type of N95 masks other than the currently provided N95 masks. Which was made available to them immediately.”
When asked what was being done about the specific issues and concerns raised by the private healthcare service providers, Kumar said, “We provided 40 AC buses and if need be more will be provided.” He did not respond to queries about other issues.