On April 22, a day when Ahmedabad reported 5,142 new Covid-19 cases, a video of a young man lying on the road outside the Shardaben Hospital was widely shared on social media. The man had been denied admission in the designated Covid-19 hospital because he did not arrive in the government-run 108 ambulance service, sparking online outrage and media attention.

Five days later, even as Ahmedabad recorded 5,790 cases on Sunday – the highest in the state of Gujarat – several civic hospitals dedicated for Covid-19 care in the city continue to admit patients only if they are brought in a 108 ambulance.

Those arriving by autos, private vehicles or other private ambulances are being asked to come in the state-run ambulance service to access triage and treatment. Triage is the process of examining patients and determining who gets priority for treatment based on the the severity of their condition.

Ahmedabad city currently has just 120 ambulances under the centralised 108 ambulance service, which is receiving thousands of calls a day from desperate patients and their families. The service is inevitably forced to pick and choose among patients with severe symptoms of Covid-19, which means that some either have to wait for as many as 10 or 11 hours before they can get an ambulance, or choose another mode of transport to get to a hospital.

This rule restricting hospital admission to those coming in 108 ambulances has had fatal consequences for some Covid-19 patients. One of them was Indrani Banerjee, a nanosciences professor at Gujarat Central University, who died gasping for breath on April 11 after a civic-run Covid hospital in Ahmedabad refused admission since she was not brought there in a 108 ambulance.

On Sunday, as Union Home Minister Amit Shah and Gujarat Chief Minister Vijay Rupani inaugurated the new, 900-bed Dhanvantari Covid Hospital in the city, the administration made it clear that the hospital would only be available to those using the 108 ambulance service to get there. A press note from the Chief Minister’s Office stated, “Only referral patients will be admitted for treatment in this hospital under the 108 centralised system.”

While Scroll.in was unable to reach Dhanvantari Hospital for comment, other hospitals in the city claimed they were merely following directions by the Bharatiya Janata Party-run state government.

“We can only accept Covid patients if they come through 108. It is the rule of the government, so we are following it,” said an official at Shardaben Hospital in Ahmedabad, who did not want to be identified.

At Sardar Vallabhbhai Patel Hospital, where the Ahmedabad Municipal Corporation has set up a 1,200-bed designated Covid-19 wing, an official claimed that the “108-only” rule was not being followed for the main public hospital. “But yes, in the AMC quota, we can accept patients only through 108 ambulances,” said the official. “In any case, right now we don’t have any beds available.”

Scroll.in sent queries to Jayanti Ravi, Gujarat’s principal health secretary, about the reason behind the rule and whether the state plans to discontinue it, but did not receive a response.

However, a junior official at the state health department claimed that the rule is meant to “help the municipal corporation coordinate admissions better”. “This rule is going to be discontinued, but as of now it is still in force,” the official told Scroll.in on Monday afternoon.

A woman is consoled, after her relative died due to the coronavirus disease outside a Covid-19 hospital in Ahmedabad, April 19, 2021. Photo: Reuters/Amit Dave

Despite a High Court query

Since the start of April, the severity of the second wave of Covid-19 in Gujarat has been encapsulated by visuals of long lines of ambulances waiting outside hospitals for a change to get patients admitted. On April 12, one news channel counted as many as 21 ambulances, sirens blaring, parked in a line outside Ahmedabad’s civil hospital.

On April 20, the Gujarat High Court had taken note of this problem. While hearing a suo moto public interest petition on the Covid-19 situation in the state, the Court sought information from the state government on why patients arriving at hospitals in private vehicles instead of 108 ambulances were not admitted. “If they come in private vehicle, why would the hospital not admit them? You can at least examine the patient and say that you do not need admission and you may go home,” the court said.

Despite this, the “108-only” rule persists in Ahmedabad’s hospitals, leaving citizens stumped and angry.

“This rule has no logic, it is bizarre,” said Manjula Pradeep, a social activist based in the city. “By the time a patient waits for an ambulance, treatment will be delayed and he may not survive. Who will take responsibility? I cannot understand why they are doing this. Maybe the state government is becoming very autocratic, but in this chaotic, emergency situation, they need to understand that they cannot impose this kind of rule.”

Corrections and clarifications: The article has been edited to state more clearly that the rule restricting hospital admissions to only patients arriving on 108 ambulances applies to Ahmedabad and not other parts of Gujarat.