Mumbai: Outsourcing ICUs in peripheral hospitals is waste of public money, say doctors

May 30, 2018, 07:39 IST | Vinod Kumar Menon

Civic doctors speak out against the state's policy of giving charge of intensive care units to third parties starting June 1

Bhagwati Hospital, Borivli (W) is one of the peripheral hospitals whose critical care unit will be outsourced from June 1
Bhagwati Hospital, Borivli (W) is one of the peripheral hospitals whose critical care unit will be outsourced from June 1

A pilot project floated by the civic corporation has upset doctors working at MICUs/ICCUs/SICUs/EMS in civic peripheral hospitals. The project is to outsource these departments to private players. While the BMC claims this has been done to tackle the shortage of doctors in critical care units, the irked doctors claim it is nothing but a waste of public money.

Come June 1, the critical care units of most peripheral hospitals will have doctors appointed by three agencies who have recently won two-year contracts amounting to Rs 23 crore. The three agencies are M/s Jivan Jyot Charitable Trust, Criti Care and Associates run by former Chief Medical Superintendent Peripheral hospitals Dr Seema Malik and a third centre to be run by Dr Sandeep Sharma of Sai Samruddhi.

Dr Avinash Supe
Dr Avinash Supe

The suburbs have 12 peripheral hospitals, divided into four groups on the basis of location. Interestingly, out of the four groups A, B, C and D, outsourcing at Group A hospitals (Bhabha Hospital, Bandra (W), V N Desai Hospital, Santacruz (E) and Bal Thackeray Trauma Care Hospital, Jogeshwari (E)) has been cancelled over political pressure.

A senior doctor at one of the peripheral hospitals in the suburbs said, "We have a fully operational and smoothly functioning ICU/MICU with the required number of senior doctors and Resident Medical Officers (RMOs). Our wards are usually full with emergency cases including cardiac emergency, which we handle round the clock. Why are they claiming that we have shortage of staff and our centre needs to be outsourced? The existing doctors are paid a monthly salary as per BMC norms (Rs 50,000-Rs 55,000 for resident doctors, who include post MBBS and MD/MS Registrars and Houseman, etc). BMC has already got more than 1,000 medical officers on its payroll, who are fulltime doctors deployed at both peripheral hospitals/dispensary and a few at medical colleges.

Dr Ketan Vagholkar
Dr Ketan Vagholkar

Interestingly, out of the nine hospitals picked for outsourcing in the western and eastern suburbs, MT Agarwal Hospital in Mulund, Bhabha Hospital, Kurla and Krantiveer Mahatma Jyotiba Phule Hospital, Vikhroli (E) are undergoing repairs, while Sant Mukta Bhai Hospital in Ghatkopar (W) does not even have ICU/MICU facilities.

While Jivan Jyot Charitable Trust has bagged six hospitals (Group B and Group D), for which they will be paid Rs 17 crore for two years, Group C hospitals of Rajawadi and Sant Mukhtabai, both in Ghatkopar (East and West), are with Dr Seema Malik's Criti Care, while Bhaba Hospital, Kurla, is with Dr Sharma for Rs 1.50 crore, said Dinesh Vibhute, spokesperson of Jivan Jyot Charitable trust.

Vibhute said, "BMC's pay scales for MBBS and postgraduates are very low. We have hired 35 to 40 MBBS and postgraduate doctors at a salary of Rs 60,000-Rs 65,000 per month for eight-hour duties and are hiring at least three MBBS doctors per hospital. A postgraduate MD/MS, including anaesthetists, are hired on a pay scale of Rs 1.50 lakh a month. Super specialty consultants like cardiologists, neurologists and neuro surgeons will be paid R1,500 and above per visit."

When asked to elaborate on the working system, Vibhute explained, that their role was to ensure that the doctors were made available to take care of patients in ICU/MICU/trauma units. They will be using the existing infrastructure of staff nurses, ward boys, equipment, machinery and medicines.

Asked about prior work experience in such a set-up, Vibhute said they had won a similar tender in 2004 for 10 years to take over the administration and day-to-day working of V N Desai Hospital, where they had to arrange for everything from doctors to medicines. "We continue to do so even after the tender period is over and have got an extension," he said.

Reminded that outsourcing was cancelled for V N Desai in the current proposal, Vibhute said that was only for the ICU/MICU. "We will continue to handle the functioning of the hospital." Attempts made to contact Dr Seema Malik and Dr Sharma did not yield any results.

Waste of public money
A doctor from a peripheral hospital, pointed out the actual cost that 
BMC would have incurred on hiring instead. Six RMOs (two MBBS/MD doctors on three shifts of 8 hours) per month on a salary of Rs 50,000 would work out to Rs 50,000 x 6 = Rs 3 lakh per month. For a year, that would be Rs 36 lakh and for two years, Rs 72 lakh, against the Rs 23 crore budget outsiders are now being paid. Also, the outsiders will only provide doctors.

He said, "The infrastructure, nurses, and other staff including medicines, have to be provided by BMC and the support staff including medical officers will continue to be paid by BMC." On BMC's claim about shortage of doctors, the doctor said, "We have four medical colleges run by BMC - KEM, Sion, Nair, and Cooper. And, it is mandatory for all graduates and postgraduates to sign an internship bond. Each college has around 700 graduates and 200 post graduates.

Even if 100 come forward, all BMC has to do is increase the salary from Rs 50,000 to Rs 65,000. They can save a substantial amount on this outsourcing." Another doctor said that M M Malviya Jospital in Govandi is affiliated to KEM Medical College and Babasaheb Ambedkar Hospital, Kandivli (W) is affiliated to Nair Medical College, which means graduate and post graduate students are visiting these centres to treat patients, and they already have registrars and housemen, yet these centers are outsourced.

'Outsourcing will lead to malpractices'
"Outsourcing of such facilities will not ensure the quality of doctors appointed. There is also the likelihood of malpractices starting in critical care units, such as prescribing costly medicines and disposables. Observations have revealed that ICUs are hotspots for malpractices. Therefore, appointing doctors and managing these units requires a lot of care and experience," said Dr Ketan Vagholkar, Professor of Surgery, Dr D Y Patil Medical College, who has worked for over 25 years in civic hospitals.

Solution for the problem
Dr Ketan Vagholkar strongly feels that the correct approach would be to consider fresh graduate MBBS doctors and MD/MS doctors to fill the vacant posts in critical care units at peripheral hospitals. "This will have a two-fold advantage - patients will get good quality doctors, and doctors will gain rich experience working at these centres. And, in the event of a shortage, doctors across the state, passing from government medical colleges, should be considered for these posts."

The other side
Dr Avinash Supe, director, Medical Education and Medical Health (BMC) said, "The requirement came in from the Chief Medical Superintendent of Peripheral hospitals and we floated an open tender to outsource the same on an experimental basis of two years. It is a tested method and I am sure it will work in the larger interest of the public. I am aware of the apprehensions, but the fact remains is that there is indeed a shortage of doctors.

If the existing doctors at peripheral hospitals are willing to pitch in and work, we are ready to provide all support and I will even cancel this tender," said Dr Supe.

He added, "We have found that most ICU facilities at these peripheral hospitals are not put to optimum use because of non-availability of doctors and the load at the medical college hospitals (KEM, Sion, Nair, Cooper) was increasing by the day. Outsourcing will ensure availability of doctors round the clock." When asked why medical graduates and postgraduates from the four BMC medical college were not being used instead, Dr Supe claims they had experience in the past where interns would quit the service mid-way once they got admission to overseas courses.

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