Daijiworld Media Network - Mangaluru

Mangaluru, Jan 26: Poor patients struggling with severe illnesses are unable to access treatment in intensive care units (ICU). The ICUs at the district government Wenlock Hospital remain full throughout the year, and private hospitals are not offering treatment under the Ayushman Bharat Arogya Karnataka scheme.

At Wenlock Hospital, an ICU bed for one patient means either transferring an existing patient to the ward or a tragic loss of life. Patients from over 15 districts, including Dakshina Kannada and neighboring areas, are left scrambling for ICU access, often influenced by political pressure.

File photo

The new state-of-the-art Wenlock building has 95 ICU beds, including 30 for children and 65 for adults, all of which are full. To complement the hospital's 905 beds, an additional 100 ICU beds would require 100 nurses and Group D staff to work across three shifts. The current nursing staff shortage exacerbates the situation, officials report.

Ayushman emergency procedures: Untapped potential

Under Ayushman Bharat's 4A emergency procedure, impoverished individuals can receive free treatment in private hospitals, even in ICUs, for 55 designated illnesses. This includes conditions like pneumonia, asthma, head injuries, and poisoning. For instance, 4A code M100067 ensures free ICU treatment in private medical college hospitals for breathing-related emergencies caused by such conditions.

Code 4A-67 is divided into categories: A for high-dependency units, B for non-ventilator ICUs, and C for ventilator-supported ICUs. The government reimburses private hospitals at rates 30% higher than those in public hospitals. Diseases like severe malaria, dengue, brain stroke, and others also have streamlined codes for government reimbursement.

Despite these provisions, many private hospitals avoid adhering to them. Patients poisoned by organophosphates, snake bites, or other toxic substances are often rushed to Wenlock to avoid private hospitals' exorbitant bills, leading to treatment delays and ICU shortages.

ICU bed shortages in Mangaluru

The city and its surrounding areas have seven medical colleges. According to NHC guidelines, 10% of total hospital beds must be ICUs, meaning there should be at least 350 ICU beds available. However, are patients receiving free treatment under the 4A code?

Challenges in Ayushman Bharat implementation

Under the Ayushman Bharat scheme, BPL cardholders are entitled to free treatment without advance payments. Private hospitals are expected to provide medicines at pre-approved rates. However, patients admitted to private hospitals are often forced to pay an advance of Rs 10,000 and daily ICU charges, along with exorbitant medication costs. Bills ranging from Rs 1-2 lac over 10 days compel families to exhaust their savings, sell jewelry, or take loans. After being discharged, many then seek admission at Wenlock, with about 90% of its patients having already drained their financial resources in private hospitals.

Free treatment for accident victims

Anyone injured in an accident on Karnataka's roads, regardless of their state of residence or income status, is entitled to 48 hours of free treatment. This does not require a referral letter. The government covers treatment costs under 75 accident victim (AV) codes. The aim is to provide emergency care and save lives, but implementation remains a challenge.

The claim that Wenlock's ICU is perpetually full needs reevaluation. District in-charge ministers must urgently address the need for more ICU beds and nursing staff. Clear directives must also be issued to private hospitals to ensure free treatment for the underprivileged, said Gerald Towers a social worker.