COVID-19: In Mumbai, hospitals turn away patients; real-time tracking of beds ineffective

A Mumbai hospital denied Vinayak Jadhav admission for the lack of a COVID-19 test result. COURTESY VIREN JHADAV
31 May, 2020

Around noon on 12 May, Vinayak Jadhav, a resident of Mumbai’s Chembur neighbourhood and an 80-year old former banker, felt feverish and uneasy. At first, his family did not suspect that he had been affected by the novel coronavirus. He had barely stepped out of his home since the lockdown, except for a visit to an ATM ten days earlier.                                                                       

Viren, his son, took him to a nearby clinic run by Vishal Chopra, a diabetologist. Chopra, who is also attached to the Dr LH Hiranandani Hospital in Powai, asked Viren to rush him to the hospital directly. According to Viren, a doctor at the hospital asked Vinayak to undergo a COVID-19 test before they agreed to admit him.

“My immediate concern was that he should be admitted to the hospital so that they can start the treatment,” Viren told me. “Since he’s an octogenarian, I didn’t want to take any risk.”
But the hospital asked Viren to take his father home and come back once the result returned. “They told me it would take 48 hours,” Viren said.

This was a violation of Maharashtra government orders. As reported in the Indian Express, several government notifications make it mandatory for hospitals to treat patients even if a COVID-19 test result is pending. The government asked hospitals to create a waiting area for suspected COVID-19 patients and provide them treatment. It warned them of action under Epidemic Diseases Act, 1897 if they failed to comply. An 30 April government notification stated, “No patient is to be turned away without examination and required intervention under any circumstances.”

Vinayak’s test results arrived on May 14—he had tested positive. However, by then, the Hiranandani Hospital had run out of beds. “We panicked and began searching for all nearby hospitals through friends and contacts. Almost every other hospital, Fortis, Nanavati and Breach Candy, was full. At 8.30 pm, we were told about possible vacancies in SevenHills and Nanavati. We opted for SevenHills for its proximity.”

In November 2019, the Brihanmumbai Municipal Corporation, or BMC, took over the operations of the SevenHills hospital. Today it is Mumbai's largest quarantine facility. The hospital has two separate entrances—one for a private section managed by the Reliance Group and Jupiter Hospital, and the other for a bigger section, operated by the municipal corporation.

When Viren took his father to the private side via gate number three, he was told there were no ICU beds available. “One doctor asked me to take him to the other side next door through gate number four,” Viren said. Vinayak was finally admitted to the hospital’s COVID ward around 11.30 pm, seven hours after his test result had returned. By then, he was feeling breathless and his oxygen level was dropping. 

On the evening of 15 May, his condition deteriorated with his oxygen levels falling further. “To my utter shock, I learnt that they didn’t have a facility to provide oxygen to my dad,” Viren said. “The ICU beds were all full. We were told hundreds of patients are in the waiting list for the first available ICU bed. But they said my dad will be given priority. He finally got an ICU bed at 7.30 pm. Within two hours, at around 9.30pm, he passed away from multiple organ failure.”

Viren said they lost precious hours before his father got medical attention. Sujit Chatterjee, the chief executive officer of the Hiranandani Hospital, did not respond to an email seeking comment on why the hospital had asked for a COVID-19 test result as a criterion for admission.

Vinayak was one of several patients in Mumbai denied timely treatment for the lack of a COVID-19 test result. Several doctors I spoke to conceded that many hospitals in Mumbai are demanding COVID-19 test results as a precondition for admission despite guidelines against it. Vinayak’s case also points to the need for an effective system that that maps the immediate availability of beds in nearby hospitals in real-time, even as Mumbai becomes the epicentre of the COVID-19 outbreak in India.

As on 31 May, there were 65,168 COVID-19 positive cases in Maharashtra, with 2,197 deaths. According to a report by the Maharashtra Medical Education and Drugs Department, which analysed data from 47,021 cases, over 13 percent are senior citizens, while 42 percent of the cases fall within the 20 to 40 age bracket. Of the 1,588 deaths analysed, 71 percent had a comorbidity.

Chopra described Vinayak’s case as unfortunate and added that he had other patients who died in similar circumstances. “I remember speaking at late hours to his son who was desperately scouting for a hospital bed,” Chopra said. “In fact, at least four of my senior citizen patients lost their lives after running from hospital to hospital. My 81-year-old neighbour, who developed the symptoms of a stroke on Saturday at 8 pm, had to wait till Monday evening to get a bed. I feel helpless in such situations.”

However, he added that the ground realities are complicated. “We are facing a pandemic of mammoth proportions,” he said. “In a highly populated city like Mumbai, the ratio of available hospital beds to population was already low, but with the pandemic, it has become worse. These days, people stay in a hospital for at least 8 to 10 days. When the needy patient comes, hospitals are hard pressed for beds.” He added, “The other issue is that if I admit a mildly symptomatic patient in the COVID ward with positive patients around, and if he turns out negative later, we will be held accountable by the family. This is why hospitals are letting asymptomatic and mildly symptomatic patients to go for a testing and requesting them to wait.”

Brinelle D’Souza, a faculty member at the Tata Institute of Social Sciences, said that it was unfortunate that there continues to be confusion over hospital admission procedures and testing protocols even two months into the lockdown to slow the spread of COVID-19. D’Souza is also the co-convenor of the Jan Swasthya Abhiyan in Mumbai. The JSA is a people’s health movement that coordinates activities and actions on health care related issues across India. “I don’t know why most hospitals are asking for COVID test results for admission when guidelines clearly suggest otherwise. No emergency surgery can be denied for want of a COVID-19 test,” she said. “Hospitals need to take samples and send them for tests. Meanwhile, they must admit people and start treating them. They can’t wash off their responsibility.” 

I spoke to Suresh Kakani, an additional municipal commissioner at the Municipal Corporation of Greater Mumbai. He said that all hospitals that have COVID testing centres have been told to admit patients who come in the category of emergency cases and non-elective surgeries. “All government-run hospitals have a triage area where they can treat patients till the COVID test comes,” he said. Referring to a government helpline number, Kakani added, “We have also made a helpline facility with 1916. We get over 4,000 calls a day. The helpline gives you a token number after verifying your case and directs you to a hospital where vacant beds are available. We have developed a system to track vacant beds on real-time basis, but this is not open to the public for the fear of misuse.” 

In addition to the helpline, on 27 May the BMC announced that it had launched a dashboard that maps vacant beds for COVID-19 patients in public and private hospitals in real-time. The BMC said that the dashboard will be updated with real-time data every half an hour.

However, D’Souza said these measures have not been effective in practice. “Though MCGM did a mapping of available hospital beds, there is no real-time updation going on,” she said. “Despite us raising this issue at various forums, it continues to be disorganised.” She added, “The helpline 1916 continues to be difficult to get through. Patients and relatives in distress seeking information have complained that the 1916 has not been of any help to them. When I tried a couple of times for COVID positive patients seeking to do dialysis, my experience was bad too. Either the call wasn't going through, or if the call was answered, they had no clue to help me with the names of hospitals.” 

Referring to the BMC dashboard, D’Souza noted, “The new dashboard is still a work-in-progress with some hospitals giving proper details and others being inconsistent with updation. Private hospitals are mentioned but there is nothing about the number of beds and their availability.” She added that Mumbai needs a grievance redressal system as complaints against hospitals surge.

There have been other cases of senior citizens not getting hospital admission either due to the lack of beds or the lack of a COVID test result. According to a report in the Indian Express on 15 May, a 67-year-old retired municipal worker died in an autorickshaw in Mumbai after he was refused admission in the Holy Family Hospital in Andheri for a fifth time. The hospital claimed it had no beds. Two other hospitals refused to admit him without a COVID-19 test result. 

Viren held the hospitals responsible for his father’s death. “I lost my dad because of utter callousness of the hospitals,” he said. His mother, who has also tested positive for COVID-19 positive, is being treated at Breach Candy Hospital. “In her case, we managed to get a bed much early, and she is now stable,” Viren said, adding that early treatment has been the key to her survival.