A year on, a number of protocols announced to make patient referrals safe stand unimplemented in Kashmir.
Experts said the unaccountable and unnecessary shuttling of patients continues to worsen the survival chances of critical cases.
On November 20 when Muddasir Ali, Greater Kashmir senior editor, was referred from Sub-district Hospital Charar-e-Sharif to SMHS Hospital, his family was neither provided a copy of the prescription nor was a referral note sent along to help the next doctor assess him faster.
He was declared “dead on arrival” while his attendants had not been provided anything to indicate what medicines or procedures had been administered at the hospital they had been referred from.
Ali’s is not the lone case where the referral has been done in a shoddy manner, without necessary documentation.
Many doctors at tertiary care hospitals in Kashmir have voiced concern over the unnecessary referrals while many more have expressed dismay over the inadequate efforts to handle emergency cases before “bundling them in an ambulance for dying on the way”.
A senior specialist working at SMHS Hospital said that it had become a norm to refer patients, even with minor ailments, after 4 pm.
He said that such “unnecessary referrals” added to the load in tertiary care hospitals and worsened access to facilities for patients who “actually needed specialist care”.
However, he said the worse impact was on emergency cases. “Referral of trauma cases, heart attacks and other medical emergencies without following the basic protocol often results in deterioration of patients. Sometimes, they lose the battle en route,” he said.
In January last year, J&K government publicised a Standard Operating Protocol (SoP) for instituting answerability in healthcare institutes in case of referrals. As per the SoP, prepared by GMC Srinagar, a doctor who decides to send a patient to a higher institute had to ensure that the patient reaches the hospital safely. For this, the doctor had to follow an inventory before deciding that a case could not be handled at the level wherefrom the referral was taking place. In addition, the referrals as well as the investigation were mandated to have name, registration number, seal and signature of the doctor on duty.
The health department had also ordered “Referral Audit Committees” to review the process and outcomes of patients being sent from one set up to the other and take action on cases where the protocols had not been followed.
However, these committees are yet to take off, a health official said, blaming the pandemic.
“The committees were never operationalised and there has been no question raised in the past year over the hugely unsafe referrals,” the official said.
Financial Commissioner Health and Medical Education, AtalDulloo said the department had set in motion the process to revive the SoPs for referrals.
“In the past months, healthcare underwent a drastic change and it wasn’t possible to run hospitals in the manner they had been running,” he said.
Dulloo said he had sought report from medical colleges as well as the directorates of health in Kashmir and Jammu over the status of the Referral Audit Committees.