Bengal health regulatory bill turns spotlight on guidelines for ICUs

By Sahana Ghosh

Kolkata, March 14 (IANS) Beware, a trip to the ICU may not necessarily ensure better treatment but could actually leave you high and dry in terms of money and health, warn experts ranged against unscrupulous private hospitals taking advantage of unsuspecting patients in the absence of proper guidelines for such units.

Setting up and implementing Standard Operating Procedures (SOPs) for ICUs (Intensive Care Units) and CCUs (Critical Care Units) would not only elevate standards of treatment in the units but also thwart disreputable hospitals from fleecing patients, say some experts, while others assert there is no need for additional guidelines.

"A patient admitted to a general bed in a hospital is charged Rs 2,500 while in the ICU at the same hospital, he or she is charged Rs 10,000. The prices vary just across the door," M.L. Saha, Department of General Surgery, Institute of Postgraduate Medical Education & Research/SSKM Hospital, Kolkata, told IANS.

"The reason is in an ICU, a patient is entitled to certain equipment and facilities. But many establishments charge patients extra for these essentials as the patient is not aware," he added.

He said nursing service, resident medical officer service, cardiac monitor, pulse oximeter and 24x7 oxygen supply are some of the key necessities in a functional ICU.

"It's in the Clinical (Establishments) Act. Since patients are not in the know, they are billed extra for oxygen supply (and the like)," Saha said.

The issues of excess billing and unwarranted shifting of patients to ICUs and CCUs were hotly debated and discussed following the West Bengal government tabling the Clinical Establishments (Registration, Regulation and Transparency) Bill 2017.

Under the new Act, SOPs on ICUs and CCUs would be recommended for private hospitals.

"The state government has guidelines for government set-ups but not all private hospitals have such SOPs. Under the bill, we will suggest SOPs for them," Director (Health Services) B.R. Satpathi told IANS.

Kunal Saha, President of People For Better Treatment, said although the specific requirements for an ICU may vary from country to country, and even between hospitals within the same country, minimal standards for running a CCU must be maintained, as outlined by Society of Critical Care Medicine (SCCM in the US), by all hospitals.

"All ICUs must have minimal life-saving equipment, including continuous oxygen supply, heart-lung monitor, defribrillator, isolated unit et al, as well as round-the-clock doctors/nurses. But even this minimal material is absent in many small, medium or even large hospitals in India even though they all routinely admit patients in their so-called ICUs," Kunal Saha told IANS.

Another reason for putting patients in ICUs is that since visitors are generally not allowed in these designated units, any untoward treatment or dealings with the patient is less prone to be exposed to his/her family waiting outside, he added.

Kunal Saha blamed the Indian medical authorities, including the health departments and Medical Council of India, for being "painfully silent" and "never caring" for the hapless patients who are taken for a ride by these "greedy" private hospitals by charging inflated bills in the name of ICUs.

This matter was recently brought to the notice of the Supreme Court by the organisation, which was representing a case of alleged medical negligence filed by Asit Mondal whose daughter-in-law, Sunanda, died in a Kolkata hospital on December 29, 2013.

The SC in 2016 asked the Centre and health secretaries of all states to submit affidavits on a standard SOP for ICUs and CCUs.

Kunal Saha said the SOPs will help not only to save lives "by elevating the standards of ICU treatment but will also help to stop unscrupulous nursing homes and hospitals without proper facilities to slap any patient a highly-inflated bill just claiming that the patient was treated in an ICU".

He recommended vigilance for those admitted in ICUs. "And collect all medical documents for future justice. Also question the treating doctors and try to keep a record of your discussions."

Welcoming the proposals for SOPs, R.D. Dubey, President, Indian Medical Association (South Kolkata branch) and member of West Bengal Medical Council, said such guidelines must be established by people with credible backgrounds.

"Such SOPs should be set up by healthcare experts who know the situation on ground and not bureaucrats or politicians. Also, the information about these experts should be available for all to see. They must be credible and the contents must be open to all," Dubey told IANS.

Dubey advocated placing trust in one's physician. "One has to trust the doctor," he said.

Noted bariatric surgeon B. Ramana, however, felt more rules and regulations are not needed.

"I don't think more rules and regulations are needed. I think clinical guidelines are already established on when to move a patient to the general ward, etc," Ramana said.

"A large majority of those in the medical profession are still driven by ethical codes and their focus is on treating the patient. Surely, there are corrupt elements. (But) billing-related issues that are often the focus of media attention are completely out of the ambit of the doctor," he added.

(Sahana Ghosh can be contacted at sahana.g@ians.in)

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