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Covid-19: India’s private doctors and government clash over pandemic response

BMJ 2020; 370 doi: https://doi.org/10.1136/bmj.m3711 (Published 22 September 2020) Cite this as: BMJ 2020;370:m3711

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India’s private medical community has accused government authorities of “indifference” to the plight of doctors and other healthcare workers on the frontlines of covid-19, while health rights advocates have complained that private hospitals are overcharging patients.

The accusations reflect what some doctors and healthcare representatives believe is poor coordination between government authorities and the private sector in mounting a response to the pandemic amid India’s rising rates of infection.

The Indian Medical Association (IMA) has said that doctors and private hospitals managing patients with covid-19 have faced harassment from administrators who are enforcing government directives but who lack expertise. In a document submitted to a parliamentary panel, the association said that non-medical officers have threatened doctors with penal action for non-compliance with covid-19 directives.

The health ministry, working with state governments, has helped establish 15 400 dedicated covid-19 hospitals across India, a mix of government and private facilities with over 232 000 oxygen supported beds and 63 700 intensive care beds. But the IMA has said that private hospitals in small towns have been “converted to covid-19 hospitals compulsorily” even though they lack infrastructure or personnel to manage patients with the virus. In some towns, the association said, private practitioners have been “forced” to provide services in covid-19 hospitals, leading to the neglect of their own patients or institutions.

The IMA’s general secretary R V Asokan told The BMJ, “There are many sources of friction between health administrators and doctors. We have anecdotal reports about doctors threatened with penal action under the Epidemic Control Act for failure to heed administrative directives.”

India has recorded a daily average of 90 000 new covid-19 cases over the past week, and over 5.56 million laboratory confirmed cases and over 88 000 deaths so far. Over 975 000 patients were under medical supervision on 22 September.

Inappropriate care

Doctors engaged in covid-19 care said administrators have at times misinterpreted directives and enforced inappropriate care. A senior infectious disease specialist in a tertiary care hospital in Karnataka, who requested anonymity, told The BMJ, “The most glaring example of this is the inappropriate use of antibiotics in covid-19 patients.” The standard treatment protocols, designed by doctors, recommend use of antibiotics only when needed, the specialist said. “We have, however, been pushed by health administrators into prescribing antibiotics to all covid-19 patients even when there are no indications for antibiotics,” the specialist said.

Girdhar Gyani, director general of the Association of Healthcare Providers of India, an organisation representing around 2500 private hospitals across the country, said the government has taken some decisions without consulting the healthcare sector.

He said, “One example is the order by the Delhi government asking private hospitals to reserve 80% of intensive care beds for covid-19 patients. What do we do about other patients who need these beds?” The healthcare providers’ body has challenged the order in a court.

Health rights advocates say, however, that they have received multiple complaints from covid-19 patients about private hospitals overcharging them by breaching price caps imposed by state governments.

Inayat Singh Kakkar, a patients’ rights activist with the All India Drug Action Network, a group of physicians and health rights advocates, told The BMJ, “We’ve seen a range of questionable practices in many private hospitals—mainly overcharging. In one case, a hospital asked the patient to provide consent to be billed under the higher hospital rates instead of government rates on the promise of better quality of treatment.”

She added, “While patients are being overcharged, there is almost no enforcement of price caps by the government and no grievance redressal mechanisms for patients. Complaints filed by patients with the Delhi government, for instance, have not been acted upon.”

Healthcare worker deaths

It was, however, the health ministry’s statement in parliament last week that the central government does not maintain data on covid-19 deaths among healthcare workers that has evoked the strongest reactions from the medical community. “This is gross indifference,” Asokan said.

The health ministry said that 155 healthcare workers, including 64 doctors, had died across India from covid-19 up to 11 September, based on the claims it had received under a special covid-19 insurance plan.

The insurance plan does not cover healthcare workers in the private sector. The association itself has already counted over 400 covid-19 deaths among doctors and has pointed out that private doctors, including general practitioners, remain the first point of contact for many covid-19 patients.

A senior physician and faculty member in a government hospital treating covid-19 patients, who requested not to be named, told The BMJ, “It’s not difficult for the government to collect such data—we need to know how the infection is impacting our healthcare workforce.”

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