CAG report on Uttarakhand hospitals: Inoperative ICUs, X-ray machines without licence

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CAG report on Uttarakhand hospitals: Inoperative ICUs, X-ray machines without licence

A report filed by the Comptroller and Auditor General of India (CAG) on the outcomes of Uttarakhand’s district hospitals covering the period 2014-19, which was tabled in the state Assembly on Saturday, has been extremely critical of the state-run institutions, pointing to a lack of operation theatres for emergency surgeries and inoperative ICU facilities, X-ray machines running without license, and of ambulances running without fitness or pollution certificates, among other shortcomings.

Chief Minister Trivendra Singh Rawat, who resigned on Tuesday, holds the Health portfolio.

For the audit, six hospitals across four districts were selected – the district hospital and district female hospitals in Almora and Haridwar, and the joint hospitals in Udham Singh Nagar and Chamoli.

The audit found that operation theatres for emergency surgeries were not available in any of the test checked hospitals in 2014-19. An ICU facility was available in only two hospitals – which were non-functional due to a lack of essential equipment and specialised manpower.

The trauma centre at the Chamoli hospital was inaugurated by the then chief minister on February 20, 2009 but remained non-functional till March 20, 2020 due to non-deployment of required specialist manpower and non-availability of essential equipment such as CAT scan.

At a visit of the drug dispensing counter, the audit found that only 41 per cent patients were provided prescribed drugs in full. In Chamoli, the figure was as low as 17 per cent. “Thus, the core objective to provide drugs free of cost could not be achieved as 59 per cent of the OPD patients had to purchase drugs from their own pocket,” the CAG report says.

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The report noted that none of checked hospitals had obtained the requisite license for an X-ray machine, pointing out that as per Section (3) of the Atomic Energy (Radiation Protection) Rules, 2004, a license from the Atomic Energy Regulatory Board (AERB) is necessary to establish X-ray and CT Scan units.

“In the absence of AERB certificate, the test checked hospitals not only violated the prescribed regulatory requirements but also compromised the safety of patients and staff in the Radiology departments of these hospitals,” CAG report says.
It added that monitoring equipment like TLD badges and pocket dosimeters were not provided to the X-ray technicians in three of the test checked hospitals. “The safety of these technicians was therefore compromised,” it says.

The audit observed that all the hospitals failed to provide accident and trauma or psychiatry services during the period of the report. Dialysis services were available in only one of the hospitals, while a burn ward was available only in two of the institutes.

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It was observed that none of the test-checked hospitals had three ambulances with Basic Life Support (BLS), and none of the ambulance had ALS systems. The available ambulances were running with expired fitness, insurance and pollution certificates. Oxygen cylinders were available in eight out of nine running ambulances but were operated by the drivers instead of technicians. Also, the logbooks in some of the hospitals showed that these were used for multiple purposes such as postal deliveries, electricity bill payments and attending court cases.

It was also noticed that bedsheets were not changed on a daily basis in any of the test checked hospitals. The patients were thus not provided hygienic and clean bed linen in these hospitals, putting them at risk of further infection.
The audit also observed that the provider of dietary services was not providing diet as per agreement and the patients were distributed non-packed milk in lieu of agreed packed milk; the quantity of milk as agreed was also not served; breakfast was served without fruits and lunch without curd, fruit, rice, etc. However, full payment was made to the contractor.

With regards to maternity services, the audit noted that IFA (Iron folic Acid) tablets were available in all the test checked DFHs/JHs except in Chamoli where the IFA tablets were not available during the period 2014-17 and were out of stock for 223 days during the year 2018-19.

A scrutiny of records on sampled days disclosed that baby wrapping sheets were available in only one of the test checked hospitals, cetrimide solution and thread for suture were not available in any of the hospitals, and sanitary pads and gowns for women in labour were not available in the Haridwar and Chamoli hospitals. “Non-availability of essential consumables in test checked DFHs/JHs adversely impacted the achievement of the objective of providing a clean and safe environment for mother and newborn in labour room and ward,” the report says.

The audit further reported that no gynaecologist was posted in the Chamoli and Udham Singh Nagar hospitals during 2014-19 against the sanctioned post whereas a gynaecologist was posted as Principal Medical Superintendent (PMS) in DH Haridwar between June 25, 2016 and December 13, 2018 despite this service not offered by the hospital.

A scrutiny of labour room records pertaining to five sampled months during 2014-19 disclosed that 253 out of 4,105 deliveries were recorded as preterm deliveries based on the gestation period and thus the women were to be administered corticosteroid injection for safe delivery. The audit noticed that the required injection was not administered to 204 women before deliveries, despite availability of the drug in three out of four hospitals. It was also observed that in Haridwar and Almora, 16 (of preterm deliveries) and four who had stillbirths, were not administered the betamethasone/ dexamethasone injections before deliveries.

The audit also observed that a centralised oxygen supply system was not installed in five test checked hospitals to ensure uninterrupted oxygen supply. Adequate arrangements for oxygen cylinders were not available and the buffer stock was also not identified DFH and DH Haridwar.

The report says that in the State, against the requirement of 418 primary health centres (PHCs) and 105 community health centres (CHCs) as per applicable population norms, 259 PHCs and 86 CHCs had been established as of March 2019.

When asked about the shortcomings pointed out in the CAG report, state minister and government spokesperson Madan Kaushik said, “The CAG has drawn attention on certain things but that is for the year ending 2019. A large number of medical and paramedical staff and infrastructure have been increased in the hospitals after 2019.”