Pvt hospitals conceal actual bed-strength to deny EWS patients

As per the Delhi High Court order passed in 2009, Apollo Hospital is liable to provide one third of its functional beds for free treatment under the EWS category. The hospital uses 2009 data of its bed strength and claims to provide 200 beds to EWS category patients out of 595 beds. In reality, the hospital now has 716 IPD beds and 61 day care beds.

As per the Court order, the hospital should allocate one 236 beds to EWS category. "After several rounds of meetings with the hospital management, they are presently providing 110 beds in EWS category.

However, on paper they claim to provide 200 EWS beds," said Barkha Rani, Nodal Officer for EWS beds posted at this hospital.

Apollo hospital has a separate EWS General Ward of 38 beds on fourth floor from bed number 4101 to 4138 and 12 beds in EWS ICU ward from bed number 4148 to 4159.

"The EWS patients are usually admitted in these wards if not vacant they are provided beds in other wards with paid category patients," she added. It's evident from these facts that the efficiency of the Nodal Officer and access of the patients in the corridors of power are crucial to gets beds in this hospital.

"The stock excuses for not admitting/ providing OPD service to EWS patients include – doctor is not available, the particular treatment is only for paid patients, the particular facility is only for paid patients, or the particular treatment is outsourced," Rani pointed out.

However, the treatment in this hospital is not completely free and EWS patients are required to bear the cost of 'medicines and other consumables'. The hospital follows this 'inconsistent' policy even in the case of patients empanelled by their employers for treatment. For example, the hospital doesn't allow CGHS rates for treatment under certain super-specialities.

Other than Apollo, the 42 corporate hospitals covered under the Delhi High Court order are required to provide 10 percent of their beds 'completely free' to EWS patients. But, these hospitals conceal their actual bed strength to allocate fewer beds.

The Dharamshila Cancer hospital shows 200 beds on paper and allocates 20 beds to EWS patients, but its actual bed strength is 300. But the bigger problem is that the concerned government hospital does not refer patients here, so most of the time beds are vacant. This is also corroborated from the 'Percentage of Bed Occupancy' report.

As per records with Delhi government the occupancy of EWS beds in this hospital stood at 5.52 percent between March 1, 2015 to April 30, 2016. Similarly, Shanti Mukund Hospital shows 140 beds on paper but it has 221 beds. As per the bed strength mentioned in the hospital the bed numbers 101 to 120 are on first floor while bed numbers 201 to 222 are on second floor.

This information of bed strength was also confirmed by several hospital staff working in 'IPD Admission' department.

"There is no record of any survey to verify the actual bed strength of the hospitals providing free treatment to EWS patients," said Hem Prakash, Additional Director (EWS), Directorate of Health Service, Delhi Government.

As per 2007 and 2009 Delhi High Court order, these hospitals are liable to pay the Delhi government if they use EWS beds for paid patients. The money to be paid to the Delhi government shall be equal to the amount they charge for 'paid beds'. Delhi government was required to open a separate account 'Central Corpus' for this money to be used for welfare of EWS patients. The account is yet to be created.

Hopital	Bed strength of Paper	Actual Bed Strength
Apollo Indraprastha	595	716
Dharamshila Cancer	200	300
Shanti Mukund	140	222
Primus Super-specialty	120	150
Batra	495	600
Saket City	214	250

"We have appointed LOs to monitor 'free treatment' and assist EWS patients in the private hospitals which have 'free treatment condition in their lease deed'. Those don't have condition are managing it voluntarily," said Hem Prakash, Additional Director (EWS), Delhi Government. The admission of EWS 'surgery' and 'high risk surgery' patients in these hospitals depends on individual efforts of LOs and access of the patient in the corridors of power.

Since one hospital in each 'conditional' and 'voluntary' category are Ayurvedic hospitals there are 2.48 percent EWS CRV beds in 'conditional' hospitals while 'voluntary 'hospitals have dedicated 8.44 percent beds under this category. Conditional hospitals have 10.6% EWS beds in 'CRWV' while voluntary hospitals have 4.6 % beds in this category. Conditional hospitals have 86.9% non critical EWS beds while voluntary hospitals have 87% EWS beds in non critical category.

As per information on 'Real Time' there are total 640 EWS beds in 42 private hospitals in Delhi out of which 34 hospitals have the 'condition of free treatment in their land lease deed', while the rest have joined the scheme on 'voluntary' basis'. Only 3.9 percent of 640 EWS beds are of CRV category and total 12.96 percent beds are ICU (CRV and CRWV) category. However, these private hospitals use 20 to 25 percent of the 'paid category beds' under paid ICU. For example, Batra Hospital has 495 IPD beds and has provision for 50 EWS beds. The hospital uses 113 beds in ICU but provides only two beds for EWS ICU which is only 1.7 percent of total ICU beds.

An investigation revealed that a clever ploy was being used by the hospital to turn away surgery patients. As per information available on 'Real Time Availability of free Beds', an online service of Delhi government for EWS beds, Rockland is providing 10 EWS beds out of which one bed is under 'Critical Without Ventilator' (CRWV) category but in reality the hospital provides only six EWS beds that too only in Non-Critical category. All hospitals in the city have only two types of beds for paid patients General Ward (Non-Critical) and ICU/ Critical Wards while ventilator is provided as per requirement during operation or critical condition. According to hospitals, in case of EWS patients, they use CRV beds for highly risk surgery and CRWV beds for low risk surgery. The absence of CRV and CRWV beds in Rockland hospital makes it clear why 'surgery' patients/ critical patients are turned away. "After pressure from the top and hectic follow up they sometimes admit critical EWS patients but they have around 14 ICU beds for paid patients," said the LO.

"Delhi High Court in its historic judgment in 2007 had ordered private hospitals which have received land on concessional price on the name of charity, to provide 10 percent IPD beds and 25 percent OPD treatment 'completely free' to the poor. Despite several initiatives of AAP government to ensure free treatment to EWS patients, the hospitals are still to fall in line. In a series of investigative reports, Millennium Post tries to uncover the real picture."

"My father complained of blood in urine in January and we went to DDU Hospital, Hari Nagar. As the doctor suggested surgical intervention, I requested him to refer the case to a nearby private hospital under EWS category," said Kumar, son of the patient Sher Bahadur (40). "I first took him to Rockland Hospital on March 13; we conducted all the tests as directed by the hospital. They kept delaying the operation," he added. This is not a one-off case, as this hospital is known to send back 'surgery' and 'high risk surgery' patients. At present around 25 patients are desperately trying to get a surgery date. "I have forwarded these complaints to the senior officers several times. The hospital management is highly non-cooperative," said a Liaison Officer (LO) of Delhi government, posted at this hospital.