Shri Arnab Goswami ji

I am feeling sad at the death of children from dengue in the national capital. However I am also saddened by the deaths from tuberculosis, malaria, dehydration, encephalitis, cancer , heart failure , cirrhosis, head injury and kidney disease which occur daily and in numbers 200 times more each year than all deaths due to dengue put together over the past 10 years. A visit to any emergency department of any of the hospitals from AIIMS to Safdarjung to RML will reveal 30-40 patients who are in respiratory distress / arrest intubated and on manual ambu ventilation being done by relatives. But then to see this you will have to temporarily relinquish your perch in the plush airconditioned courtroom where you are the accuser, interrogator, prosecutor and judge all rolled into one. This however in no way condones the events preceding the death of these children.

However your high decibel advice on national channel to the Doctors to give IV antimalarial to patient of dengue in respiratory distress shook me to the core. This was revelation for me and believe me I do keep up to date on my medical knowledge sincerely and to the best of my ability. Though It does raise your TRPs to shout at doctors representing the private hospitals involved but is this not a case of what was known as the "whipping boy". Since the prince could not be caned, the whipping boy was punished when the prince committed mistakes at school. The doctors sir are the most irrelevant appendages today in India's healthcare delivery system which is callous and immune to such deaths. Your favorite politicians now adorn the treasury benches and slash the already meager health care budget by nearly 20 % without a whimper from your usually loud courtroom. But since ceaser's wife is above board obviously someone else is to take the blame and who else but the "whipping boy".

Whether in Government or Private hospitals the clinicians do not decide which ventillator to buy, how many to buy, how many ambulances to buy, whether to have 4 or 6 drivers on rolls and nor do they decide whether spending on foreign jaunts is more necessary than spending on healthcare of the nation. Why should a person need to go to a private hospital in first place in an emergency. Why can we not have 50 more ventillators in each Government and private hospital . After all cost of each ventillator is a meager Rs 5 lac and for a total of only 2.5 crore more invested in AIIMS and similar amounts in other Government hospitals wonders could be achieved to prevent suchlike deaths.

A question was also raised regarding lack of availability of pediatric intensivists. Though essentially true for the qualified pediatric intensivists , there is no dearth of doctors trained in paediatric intensive care who are afraid that courts would find them negligent because of lack of MCI approved qualification if they went ahead and treated these patients. Eitherway it is the function of the Government to assess the need of each speciality and superspeciality doctors 5 years from now and plan accordingly either to train them by creating more seats in institutions or by importing them from outside as is done by other countries.

A private hospital is a private enterprise built not with government help but despite the Government interference. The private enterprise creates an infrastructure within its limits and sells its services for a profit. But the Government has abdicated its responsibility and forced private hospitals to provide essential emergency healthcare services which is essentially a duty of the Government. Courts have also sided with the Government, but according to laws of natural justice a person dying of hunger outside a 5 star hotel can not expect free meal from the provider. So how can we force private hospitals to provide paediatric intensive care to each and every patient brought to them. This is specially when legal liability and exposure to suits being filed for negligence remain whether or not the hospital has been paid a single penny. The V P Shantha vs Indian Medical Association judgment of honorable SC has hung a sword of Damocles over every doctor and hospital even regarding free service.

Even the question of providing an ambulance with an accompanying doctor needs debate. Is it not the Governments duty to provide transport to critically ill through ambulances as has been done through 108 / 102 services. The constitutional responsibility of transport of a sick patient is of the state. Just because a patient enters a private healthcare facility and is given first aid on humanitarian ground, it cannot be considered that responsibility of complete treatment and cure is now of the private establishment. All private hospitals may not own ambulances and round the clock drivers.Even among the private hospitals , those which have availed subsidy from Government in terms of cheap land and have given undertakings to treat poor patients, need to be separated from essentially independent privately owned healthcare facilities.

Arnabji your show is followed in every household and your accusations and overall attitude towards doctors on prime time TV is devoured by all. You in a sense justify within them their anger and the violence some of them perpetrate against doctors with increasing frequency. I request you to be responsible and balanced in your programs at least where issues of national importance are being discussed and avoid giving advice like IV anti malarials to all patients of dengue.

Dr Neeraj Nagpal
Convenor,Medicos Legal Action Group, Managing Director MLAG Indemnity,
Ex President IMA Chandigarh
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