Doctors cite two reasons why Ahmedabad Civil Hospital has a high Covid mortality rate

A Gujarat HC order termed Ahmedabad Civil Hospital “as good as a dungeon". As of 22 May, the hospital recorded 377 deaths, accounting for over half of city’s total Covid deaths.

People wait at the Ahmedabad civil hospital | Praveen Jain | ThePrint

New Delhi: The Gujarat High Court Friday rapped authorities at the Ahmedabad Civil Hospital — the city’s largest hospital and nodal Covid-19 facility — for its high mortality rate, calling it “as good as a dungeon, may be even worse”.  

The civil hospital is emblematic of the floundering response to Covid-19 in Gujarat, and Ahmedabad in particular. As of 22 May, the hospital accounted for over half of the city’s total Covid-19 deaths.  

Ahmedabad is the city worst affected in Gujarat by the pandemic and has recorded a total of 9,849 cases and 662 deaths as of 22 May. Of the deaths, 377 have been at the civil hospital. 

The hospital, however, has been in controversy since the beginning of the pandemic.  

In mid-April, there were reports that Covid-19 patients had to wait outside the hospital for hours before they were admitted and given beds. More recently, reports of family members not being informed of the deaths of patients have come to the fore.  

Just last week, the body of a Covid-positive patient who was admitted in the hospital was found in a bus stop, 10 km from the hospital, after he was discharged. 

Doctors working in the hospital say they are overburdened with Covid-19 patients but that may not be the only reason for the high mortality here.  

ThePrint contacted the officer on special duty (OSD) for the hospital, Dr M.M. Prabhakar, but he said he was “not authorised” to speak on the matter, and declined to comment further. 

ThePrint also contacted Gujarat Health Commissioner Jaiprakash Shivahare, as well as District Magistrate K.K. Nirala but they did not respond to phone calls and messages. This report will be updated when they reply. 

A high mortality rate

Two resident doctors ThePrint spoke to, who wished to remain anonymous, cited two reasons behind the hospital’s high rate of mortality. They said most Covid-19 patients in the city are being referred to this hospital, and among them most are coming at the very last stage of the illness, when “even a ventilator cannot help”.  

“Most of the patients who are dying die because they have comorbid conditions, or come to the hospital at the very last stage of the illness. When a patient experiences extreme shortness of breath, even a ventilator cannot help,” said the first resident doctor. “The other issue is that the civil hospital cannot deny anybody healthcare, even if our beds are full, so it puts a strain on existing resources.” 

The doctors said the 1,200-bed Covid hospital is packed, and patients are given beds as and when deaths and discharges occur. 

According to the Ahmedabad Municipal Corporation website, however, the civil hospital has 736 active cases of the novel coronavirus.  

Earlier this month, a resident doctor wrote an anonymous letter saying the hospital was “mismanaged” as patients were placed in wards with no spacing, and were being monitored by junior doctors as opposed to senior ones. The Gujarat High Court cited this letter in its order Friday. 

The resident doctors ThePrint spoke to Sunday said since the letter was first drafted, however, a meeting between junior doctors, senior doctors, and the administration had led to some of the problems easing up.  

“It’s true that senior doctors were not consistently doing the rounds, but now they have started. A lot of our other problems with supply of medication and equipment have also been resolved. Now we’re facing more problems with logistics and coordinating between patients and their families,” said the second resident doctor.  

A member of the Gujarat branch of Indian Medical Association, meanwhile, alleged that hospital staff until last week were negligent towards patients on ventilators.  

“As per my knowledge, until a week ago, there were no portable commodes. So a person on a BiPap machine, the stage before being on a ventilator, needed to be taken to the toilet without oxygen, at which point they collapsed,” said the doctor. “Secondly, patients on ventilation are not even put on a Ryles tube, the nasogastric tube we put for feeding. The IV drip is also not on. Three days the patient is on a ventilator and then they die. You have to give them nutrition. You can’t just give them oxygen. This is negligence.”

‘Late response to burden in civil hospital’

An analysis by the think-tank, Observer Research Foundation, found that the high mortality was a result of “failure to implement basic containment policies”. It said, “…the ill-preparedness of civil authorities has exacerbated the problem and weakened the state response.”  

While the report did not elaborate on basic containment policies, it said: “Prior to the designated COVID-19 hospital (civil hospital) becoming functional, patients were admitted to the Old Civil Hospital. In the absence of formal procedure, there was no exclusive differentiation between the COVID-19 ward and the general ward. Health workers came in contact with both sets of patients.”

It added that the Ahmedabad Municipal Corporation (AMC) “expanded the number of COVID-19 designated hospitals (now 42) only on May 16th” though the the civil Hospital had been overwhelmed for some time.  

“A timely intervention would have eased the burden on the Civil Hospital,” the report said.

With inputs from Angana Chakrabarti.