The Chhattisgarh government has issued a show-cause notice to a leading private hospital in Raipur for allegedly forcibly discharging a suspected coronavirus patient without following due procedure. The hospital, however, claims the patient’s family took her away on their own accord.
The patient, a 37-year-old resident of Raipur, was admitted to the Ramakrishna Care Hospital, the city’s most advanced tertiary care hospital, at around 3.30 pm on March 17. According to her medical records reviewed by Scroll.in, her complaints included shortness of breath, fever and a dry cough.
Doctors at the Ramakrishna Care Hospital diagnosed her of Acute Respiratory Distress Syndrome and viral pneumonia. While Acute Respiratory Distress Syndrome is characterised by acute breathing difficulties, pneumonia suggests a lung infection. The disease caused by the novel coronavirus, Covid-19, has similar manifestations.
The hospital, the patient’s medical records reveal, sent her swab to Raipur’s All India Institute of Medical Sciences to be screened for the virus, while keeping her in an isolation ward. The swab was collected by officials of the state health and welfare department.
The same night, however, the patient was discharged.
‘Leave against medical advice’
The Chhattisgarh government’s notice states that the patient was evicted forcibly after doctors in the private hospital suspected her to be infected by the coronavirus. The notice issued on March 18 accuses the hospital of violating the Epidemic Diseases Act of 1897.
“The patient told us that the hospital authorities threw her out,” said Akhilesh Tripathi, deputy director at the state’s health and family welfare department. He said the patient’s relative brought her to the government-run Bhimrao Ambedkar Hospital where she was admitted close to midnight on March 17.
But the Ramakrishna Care Hospital claims the patient’s discharge was a case of “LAMA” or leave against medical advice. In other words, it was the patient who voluntarily chose to leave the hospital contrary to the advice of the doctors attending her.
“The patient had initially visited one more Government approved hospital which is best prepared for the current situation according to the patient and the family,” a spokesperson of the hospital said in a statement. Once admitted to Ramakrishna Care, however, the patient “continued to receive aggressive treatment that is required to stabilize her condition,” the statement said.
“The patient decided to leave at 9:30 pm and shift to the previously visited hospital, she left against medical advice (LAMA) despite being explained the risk to life for non-admission,” it added.
No signature of attendant in consent form
Records of the Ramakrishna Care Hospital note the patient’s discharge time as 9 pm on March 17. At that time, her body temperature was 99.4 degree Fahrenheit. The hospital records state her discharge was a case of “LAMA” or leave against medical advice.
Leave against medical advice requires patients or their attendants to sign a declaration note that states that they had been made aware of the consequences of not being hospitalised.
But in this case, the LAMA consent form does not carry any signature of her family members. The form, which is part of the discharge records, only bears the signature of the resident doctor at Ramakrishna Hospital.
Scroll.in contacted the patient’s relatives but they declined to comment.
‘They threw her out’
No matter what the circumstances of the discharge, Chhattisgarh health officials say the private hospital was legally bound to inform the government about it, since the patient was a suspected coronavirus case. Tripathi, the deputy director at the health department, alleged Ramakrishna Care Hospital failed to do so.
“She was diagnosed with ARDS [acute respiratory disease syndrome] which is a possible symptom of an infectious condition like H1N1 or Coronavirus, so it was the hospital’s responsibility to intimate officials concerned,” he said. “Not only did they not do that, they threw her out late in the night.”
A spokesperson for the hospital refuted the allegation. “The matter was immediately notified to the Ministry of Health and Family Welfare – the nodal agency about the patient going LAMA,” the spokesperson said.
Asked whether this was a reference to the Union Ministry or the state health department, the spokesperson clarified that it was the state health and family welfare department.
But the state health authorities deny having received any information. “Why would we send a notice otherwise?” asked Tripathi. “If they had informed us, we would have sent an ambulance to ferry the patient.”
Scroll.in asked the hospital to share documentary evidence of its communication with the government. The hospital did not furnish any evidence.
‘They acted out of fear’
The patient’s eviction has created a stir in the state’s medical community.
Yogesh Jain, founder of the Jan Swasthya Sahyog, a public health non-profit in rural Chhattisgarh, said Ramakrishna Care Hospital should have kept the patient till her test results were out. “It seems they acted out of fear that she had coronavirus,” claimed Jain. “If she had tested positive, they should have referred her to a designated treatment unit [of the government].”
On March 18, the patient tested negative for coronavirus. On Thursday, another swab of hers was sent for screening, the result of which is still pending.
Jain said the case could also be a reflection of some confusion over the role of private hospitals because the “government has still not mandated that all private hospitals that have in-patient and critical care facility are supposed to entertain and investigate people as is necessary”.
Yet he added that Ramakrishna Care Hospital with all its resources had “no business” discharging the patient in this case. “What happened was the opposite of leave against medical advice, she was pushed out,” alleged Jain.