Hospitals creating redundant units for doctors - Not for patients

PESHAWAR- According to a new trend emerging in the autonomous health care institutions, influential doctors are unnecessarily establishing new units to gain their vested interests, without showing any concern for improving patient care.

According to media reports; This trend started developing over the past few years and became a burden on the meagre resources of KP. According to the officials of the Finance Department, each new unit costs Rs1.5 million, including salaries of professor, associate professor, assistant professors, senior registrar, nursing staff and paramedic staff.

Like other government departments, the Health Department was politicized by the previous political governments. Policies were usually made to serve the personal interests of influential doctors, instead of the poor patients.

Certain powerful doctors didn’t allow second units in their specialties despite the fact that their units remained overburdened throughout the year. Others created unnecessary units to get promotions and become professors.

Most of such new units were established at the Lady Reading Hospital (LRH) and Hayatabad Medical Complex (HMC) in Peshawar.

In teaching hospitals attached to medical colleges, new units are established as per Pakistan Medical and Dental Council criterion.

According to PMDC rules, for every 100 students there should be two medical and surgical units/wards, with one professor, associate professor, etc, for each ward. There should be one gynaecology, paediatric, eye, and ENT wards for similar number of students. As per PMDC rules, for 200 medical students the strength of wards should be double.

The Khyber Medical College (KMC) is the prime example. It started with four medical and surgical units and two gynaecology, paediatric, eye and ENT units for its affiliated Khyber Teaching Hospital (KTH) for the 200 medical students it could admit each year. This has slightly changed to accommodate the increased number of students at KMC.

A senior Health Department official said that; In other hospitals, the creation of new units is required according to patient load. “If the bed occupancy rate, say in gynaecology or paediatric ward is reaching over 100 percent, than new unit should be established to cater to increased workload. This would mean new blocks are made and beds are increased,” the official said, adding that not a single bed was increased while establishing new units in LRH and HMC in the past.

He said another reason for establishing the new unit should be a long waiting list of patients.“For this reason, temporary or permanent new staff is employed. In developed countries, this is called Waiting Lists Initiative. In the public sector autonomous hospitals, there has been a trend recently to make new units at the expense of already established units. The beds of existing wards are divided, but no new beds are added for patient benefit,” he said.

A prime example of this is the surgical block in LRH. “This used to have two surgical units. These were split into four surgical units but not a single bed was added for the patient benefit. So in whose interest is this being done,” the official asked.

This resulted in millions of rupees expenditure without any real benefit to the patients. “I had suggested that no new unit should be established without annual master plan of the hospital. There should be an audit of all such units created over the last 10 years,” the Health Department official said.

The current bed strength of LRH is 1,600, which used to have 1,800 beds before medical, dermatology and urology wards were demolished to start work on the new multi-storey medical block in 2012.

This has a tentative completion time in 2018. Even when the medical block is completed and approximately 400 more beds are added to the LRH, the existing medical B, C, D wards, nephrology and pulmonology are likely to be demolished. So probably the total bed strength of LRH will stand at 1800.

Over the last three to four years, new and unnecessary units, created at LRH by squeezing them into the already established units, are orthopedic ward split into two units to accommodate orthopedic B.

Urology ward was divided to accommodate skin unit. Surgical C was split to accommodate surgical D; male medical C was split to accommodate male medical D and female medical A was divided to house female medical D.

Gastroenterology was accommodated in private rooms of Eye block, endocrinology was housed in private rooms of Eye block and partly in Eye and ENT wards for females.

Interestingly, the endocrinology unit was established for an assistant professor in LRH, who happened to be close relative of former health minister. It is astonishing that no beds were added for the patients’ benefit.

Like the previous governments, the Pakistan Tehreek-e-Insaf-led KP government didn’t carry out needs- assessment survey to find out what is required for patient benefit and not for the staff.

Also, why annual statistics are not being generated by the administration and clinical audit and service evaluation carried out in these institutions. Despite directives by the Health Department asking for not creating new units and making induction and promotions, some of the influential doctors managed to get approved new units at the LRH and HMC primarily to gain promotions.