Private hospitals across Tamil Nadu continue to refer critically-ill COVID-19 patients to government hospitals at the eleventh hour. Many of these patients, referred at the last-minute, have died within a few hours of arrival at government hospitals.
Last week, Health Minister C. Vijayabaskar warned that notices would be issued to private hospitals that resorted to such late referrals. Yet, at least five to seven critically-ill patients were referred from corporate hospitals, medium-level private hospitals and nursing homes to the Rajiv Gandhi Government General Hospital (RGGGH) and the Government Kilpauk Medical College (KMC) Hospital every day, according to official sources.
A majority of these patients were sent to government hospitals at midnight, creating difficulty for healthcare providers to make arrangements for emergency cases. “Patients with oxygen saturation levels of 40%-60% and lung involvement of 70%-90% are referred to government hospitals. One or two patients survive, while the remaining die within two to three hours of arrival. Many are aged between 40 and 50. Even nursing homes have started admitting COVID-19 patients now, and once the patient becomes critical, they refer them to a government hospital. At times, shifting a critically-ill patient can make them sicker,” a senior government doctor said.
Another senior doctor said there were one or two institutional deaths a day at the RGGGH, while the remaining deaths recorded were among patients referred late from private facilities. A doctor said even patients who were intubated were referred, once they knew that he/she could not be weaned from support.
Government doctors in Tiruchi, Pudukottai and Ariyalur had similar complaints. While many such patients were aged over 65, some had severe co-morbidities, including diabetes and uncontrolled blood pressure, and had complaints of breathlessness and severe chest congestion.
Increasing burden
These last-minute referrals have increased the burden on government hospitals. “Patients with a high risk of fatality are often referred to government hospitals. In most cases, CT scans show severe lung infection,” a doctor at the Ariyalur District Headquarters Hospital said. While the hospital treats them as COVID-19 patients, some of them are not included in the Health Department’s COVID-19 numbers. These patients are among a large section of those transferred to government hospitals, he added.
“They do not want to take the risk and ask them to go to the nearest GH,” a senior doctor at the Mahatma Gandhi Memorial Government Hospital, Tiruchi, said.
However, treatment coordinator of the COVID-19 specialty hospital at the Government Rajaji Hospital in Madurai, K. Senthil, initially said that there were a high number of late referrals when there was a spike in COVID-19 cases. “We would get at least four or five late referrals each day when there was a rise. Now there are fewer such cases,” he said.
A Health Department official said the district administration held meetings with heads of various private hospitals and urged them to ensure that late referrals are avoided.
In Coimbatore, following complaints that certain private hospitals were sending out critically-ill COVID-19 patients to government hospitals, Collector K. Rajamani appointed five government officials who can be contacted to report grievances. They were tasked with monitoring treatment, facilities and expenses at 20-odd private COVID-19 hospitals.
Some deaths listed as “brought dead” in the bulletin are cases of late referrals from private hospitals, an official said.
A health official said they were in the process of issuing notices to private hospitals on complaints of late referrals to government facilities.
(With inputs from Kathelene Antony in Tiruchi, Wilson Thomas in Coimbatore and Sanjana Ganesh in Madurai)
