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This article is written by Shikha Pokhriyal from school of law, Delhi Metropolitan Education, GGSIPU. This article talks about the revised guidelines on admission in hospitals and why it became the need of the hour.

Introduction

As novel coronavirus continues to increase in India, the number of patients with serious illness is also growing because of the emerging new variants of coronavirus.  Due to negligence or non-availability of hospital beds, many people are losing their loved ones.

In the middle of all this chaos, the requirement of the hospital beds consisting of ICU beds and oxygen beds, medicines and injections required to treat coronavirus increased, and because of this patients are not able to get the treatment on time. 

Even when the patients can procure beds in the hospitals, before admission there are some formalities the hospitals lay down in front of the patients. By the time the patient gets admitted and treatment starts, sometimes it gets too late.

Given this situation, the Supreme Court of India, suggested the Center revise its National Policy on admission in hospitals. The Court suggested the center frame common guidelines for the hospitals. This came after, when a person who was covid positive staying in Delhi NCR, was denied admission in the hospital because he was having an Aadhar card as his valid identity card which stated his residential address in Mumbai and not of the place where he was currently seeking admission.

Therefore the court ordered the central government to lay down some rules and regulations; so that a patient who requires urgent treatment cannot be denied admissions in hospitals based on the required identification documents or the positive RT PCR reports or nonavailability of the beds cause most of them are procured by the patients who do not require them.

National policy on admission guidelines of hospitals: The Central Government’s take 

The Ministry of Family and Health Welfare, by following the order of the Supreme Court, established some new national policies on admissions in the hospitals. 

To ensure that the patients get admitted and get effective and comprehensive covid facilities, the Union Government adopted a patient-centric approach.

In this patient-centric measure, the Central Government laid down some new rules and regulations which are mandatory to be followed by the hospitals under Central government, State government, and union territories including the private hospitals administering the covid treatments to the patients

Revised national policy on admission in hospitals 

To get admitted to the hospital for the treatment of novel coronavirus, the patient is not required to acquire a positive covid RT PCR test report. The doubtful case of coronavirus shall be admitted to the Covid care center(CCC), Dedicated COVID Health Centre (DCHC), or Dedicated COVID Hospital (DHC), whatever the case seems to be.

The Ministry of Family and Health welfare established a three-tier health infrastructure to tackle the novel coronavirus situation in the country, which are listed below:

  • Covid care center(CCC):  these covid centers are formed for the mild covid cases. These are established in hotels, schools, hostels, lodges, etc. 
  • Dedicated covid health center(DCHC): these covid centers are formed for the patients which are clinically assigned as moderately ill. Such covid centers are established in the whole hospital or the separate block of the hospital having the separate entry/exit and the parking. The availability of beds with oxygen support shall be available in these hospitals.
  • Dedicated covid hospitals(DHC): these covid centers are formed for the patients who are clinically assigned a severely ill. These centers can be established in the whole hospital or the part of the hospital having a separate entry/exit and parking. Availability of the beds with oxygen support, ICU, and ventilator beds should be there in this kind of covid care center.
  1. If the patient’s residential address belongs to some different city, such patient shall not be denied admission in the hospital-based on the inability to produce any valid document of the place where such patient is seeking admission. 
  2. Any medical services such as oxygens or medication, shall not be denied to any patient on the account of any reason.
  3. The patient who is in urgent need of hospitalization should be given priority. The authority has to keep a check that the patients who do not require hospital beds, that is the patients who are asymptomatic or with mild symptoms, shall not occupy the beds unnecessarily. Also, the discharge of the covid patients should be strictly done according to the newly revised discharge guidelines. 

The Union ministry has recommended the Chief Secretaries of the states and the Union Territories to frame required rules and regulations for the implementation of the above policies within three days.

The need for the national policy on admission guidelines to hospitals

Commenting on the new guidelines, Dr. Ravi Wankhedkar, Chairman, IMA Covid Registry said, “Though this late, but much-needed welcome guidelines; will benefit patients who have all the signs of COVID, but a negative test, and also prevent him/her from becoming a super spreader. Moreover, problems of inter-city/inter-state patients will be solved.” India required this kind of national policy to tackle the situation of the increasing number of coronavirus cases. Though if this kind of policy should have been established earlier, a lot of severe illnesses and deaths due to novel coronavirus could have been prevented.

The whole chaos for the requirement of the oxygen cylinders and the injections like Remdesivir and others used for treating severely ill covid patients gave a stronger reason for the revision of the old national policy on admission in the hospitals.

The second wave of coronavirus made the people of India running to and fro for basic health equipment like oxygen cylinders and hospital beds. In this scenario, there were formalities, required by hospitals like having the positive coronavirus report or having the valid identity to get admitted into the hospital and these kinds of formalities take up a good amount of time.  Due to these requirements many patients lost their lives due to novel coronavirus outside the hospital or in the hope of getting a bed in the hospital.

Also, the Supreme Court observed that because of the new emerging variants of the coronavirus, even the RT PCR was not able to detect the coronavirus in a few cases. The RT PCR test was showing negative results but the symptoms are indicating the coronavirus. This also caused a lot of problems as people neglected the symptoms which resulted in very severe illnesses like lung damage or pneumonia which became very difficult to overcome.

Many patients procured beds in the hospital either with very mild symptoms or patients with no symptoms at all. This caused a huge problem for the admission of the patients who required all the health equipment and the hospital beds. This also resulted in an increased number of deaths.

The Supreme Court asked the Central Government to revise the old policies of admissions in the hospital, primarily because of the case where a patient has declined a bed in the hospital because his aadhar card was from the different city where he was seeking to get admitted.

Many hospitals were asking for a huge unreasonable amount of funds to give admissions in the hospital. There were cases where the hospitals denied discharging the patients if the huge amounts were not deposited. In some cases, hospitals also refused to give the dead body to the family after charging them with an unreasonable amount of money.

These kinds of problems gave rise to change the existing national policy of admission in the hospitals. There was a need for one universal policy that should be adhered to by all the hospitals coming under center, state, or any union territory, even the private hospitals.

Implementation of the new policy: If done right 

The guideline states that no patient shall be denied any medical supervision including oxygen and any other treatment. This is also helping all those patients who are not being admitted at all. All the four guidelines which the central government passed, will help the country to curb the cases of coronavirus and will ensure that effective, proper, and comprehensive treatment is given to the patients so that they can be saved on time. These policies will also ensure that hospitals work according to one guideline and not arbitrarily. 

Also, these policies will help people to raise their voices and ask for help on the internet freely. By sharing the verified lead for the hospital beds or the oxygen cylinders or the required injections, many lives can be saved. Management of the hospitals will also improve in handling an increasing number of cases. Though now, situations are getting a little better in some states still some states are still handling this storm in huge numbers.

The health ministry is urging people to get vaccinated as soon as possible if they find a slot. Now, as the vaccination drive is open for people above 18 years, everyone is hoping that things will get better. The union ministry also stated that the vaccine is the only medication available for the novel coronavirus which will help to reduce the rates of infection and if the infection happens after the vaccination that will be very mild and there will be no requirement of hospitalization.

The country Seychelles vaccinated most of its population against the novel coronavirus issued a guideline after there were cases confirmed of coronavirus, that the majority of the cases are mild or asymptomatic and there are maybe few cases of severe illness due to coronavirus.

Conclusion 

The second wave of coronavirus shook the whole country and especially the health system. This wave of new variants of coronavirus made the people of India running here and there to save their loved ones. This time India recorded the highest number of novel coronavirus cases since the pandemic began crossing four lakh. Almost everyone was inquiring about a hospital bed for someone or was trying to get hold of oxygen cylinders or the prescribed injections.

The requirement of hospital beds was so high that even the approaches were not able to help. The huge amount of coronavirus positive reports created a lot of problems. RT PCR test was not able to detect the new mutant of coronavirus and the result was negative even though the patients had all the symptoms, and without a report, no hospital was ready to admit. Because of the increasing number of cases, it has become so difficult to book a coronavirus test in any lab be it government or private. Even if someone were able to get tested then also the test reports at least took 3 days to arrive. This time gap also caused a lot of pain to the patients.

Revised national policy on admission in the hospital established by the Union Ministry, came as a relief in these distress times. The requirement of any identity was not made mandatory to get admission in the hospitals which helped the patients to get admitted in the place they were staying even having the valid identity of any other state.

References


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