A majority of the state government-run dialysis units operating under the Pradhan Mantri National Dialysis Programme (PMNDP) in Karnataka are functioning in blatant violation of guidelines.
Medical professionals held the public-private partnership — or PPP — model being followed to run the units responsible for the callousness that has, according to a nephrologist from Ballari, even resulted in several deaths.
“Patients undergoing dialysis have died of complications developed during the procedure. This is due to the mismanagement and negligence of the state government and the outsourced company,” the nephrologist, who did not want to be identified, told South First.
“The private company (responsible for operating the units) has not recruited MBBS doctors to manage the dialysis centers. The non-availability of qualified doctors and nephrologists is the reason for most deaths in our unit,” a senior doctor from Chikkamagaluru said.
Yet another nephrologist South First spoke to said the deaths “are not reported as dialysis incompetence”, and hence no specific data would be available. “The casualties are high,” he added.
South First can confirm that 70 percent of the 167 dialysis units in the state do not have nephrologists. Of the 70 percent, a majority of units are functioning even without medical officers.
The PMNDP has issued a set of guidelines to operate the units. The respective states are responsible to ensure that the units adhere to the norms.
Repeated requests ignored
According to a senior nephrologist at the government hospital in Ballari, several letters were sent to authorities, highlighting the irregularities in dialysis units. The irregularities, he underlined, could amount to criminal negligence.
“If a patient has a heart attack, medical procedures such as angioplasty will be performed under the supervision of a cardiologist. If a pregnant woman needs a C-section, a gynaecologist takes over the patient. Dialysis should be done under the supervision of a nephrologist. But here, the patient will be at the mercy of a 12th-pass technician, who had done three years’ paramedical course — some even one year,” the doctor explained the state of affairs at the dialysis units.
None of the doctors wanted to be identified. They requested anonymity for fear of reprisals.
Meanwhile, several representations were made to the authorities concerned to appoint the necessary medical staff.
“A physician and duty doctor were appointed after we made several requests. But we are yet to get a nephrologist. This is against the rules. The rule book mandates the presence of a nephrologist from renowned government institutes or a physician holding an MD and one-year dialysis training, a dietician, a nurse, and a dialysis technician,” Syed Arif of the Ballari dialysis unit told South First.
Chetan R, the president of the Karnataka State Dialysis Workers Union, said, “Several dialysis units are functioning even without duty doctors. It was with much difficulty that we got a physician to be present during dialysis.” He is a technician attached to the dialysis unit at HD Kote in Mysuru.
The PMNDP, rolled out in 2016 as part of the National Health Mission, is primarily meant to provide free dialysis to the poor. Patients from the above poverty line families, too, can avail of the service at a discounted rate.
On average, the 167 units in Karnataka are conducting 30,000 dialyses every month, sources said.
Dysfunctional machines
Dialysers — or dialysis machines — in several centres, including those in Chikkamagaluru, Arasikere, and T Narasipura, are either dysfunctional or require servicing.
“We have repeatedly informed the agency coordinators, but they told us to ‘adjust’. We use the machine that is working, but we have to slash the time allotted to each patient,” a technician from Sakleshpura informed.
Recently, patients in Ankola held a protest after they were redirected to another centre nearly 35 kilometres away in Karwar since the machines were defunct.
Meanwhile, Medical Reverse Osmosis (RO) plants at many centres are also bogged down with several issues. They have a high Total Dissolved Solids (TDS) value which is unfit for dialysis.
“It is important to monitor the RO plants and check the TDS values. Several centres are even using water unfit for dialysis, causing severe health issues. Additionally, there are instances in which patients were asked to buy the medicines, which they were entitled to get free of cost,” the doctor added.
Patients with end-stage kidney failure require dialysis to remove waste and excess water.
Related: Doctor warns of kidney damage from Covid-19
Viable model?
The centres in Karnataka have been operating under the PPP model. Two companies — ESKAG Sanjeevani Pvt Ltd and BR Shetty Healthcare — were initially roped in to run the centres.
In January 2020, BRS Healthcare opted out, citing bankruptcy, and the state government took over the responsibility of operating the 122 centres. The government has now asked the Kolkata-based Sanjeevani to take over the centres that had been under BRS. A tender has not been floated.
“Even after coming under the state government’s control and direct supervision of deputy director of health and family welfare, no nephrologist or doctor holding MD degree and with one-year training in dialysis has been appointed,” a Tumakuru-based nephrologist told South First.
Minister admits ‘issues’
Admitting to issues dogging the dialysis centres, Dr K Sudhakar, Minister for Health and Medical Education in Karnataka, said, “I have received several complaints from MLAs across the state. This was a temporary arrangement made after BR Shetty Group had gone bankrupt. The tendering process has been finalised and in another two months it will be completed.”
The minister added that he had held a meeting with all stakeholders. “Another round of meeting with Sanjeevani will be held soon. All the issues will be addressed,” he added.
When contacted, a representative of Sanjeevani, who attended the meeting the health minister had convened on Thursday, 20 October, refused to comment.
“They (Sanjeevani) have been giving the best for many years. I do not want to comment on this issue,” he said, requesting anonymity.
Employees on strike
Adding to the woes, around 600 employees from 122 government-run dialysis units across Karnataka are now on strike, affecting nearly 4,000 patients.
The employees gathered at the Freedom Park in Bengaluru — the second time in three months — on Thursday, 20 October, protesting against the mismanagement of the centres by the state government and Sanjeevani. The protesters said they had not been paid for the past three months.
Union president Chetan said they were being paid a lesser amount now. The state government, which took over the centres from BRS, reduced their salaries from above ₹20,000 to ₹13,800. The employees have been denied benefits such as provident fund, he said.
After operating the centres for eight months, the government handed them over to Sanjeevani.
“I was earlier earning ₹25,000 a month. The salaries were fixed based on experience. But, after the new agency took over my salary was reduced to ₹13,800. They slashed the salaries of all employees,” Chetan added.
The authorities have now promised to meet their demands at the earliest. The protesters, however, refused to budge.
“We don’t want fake promises and those that would remain only on paper. Last time, health minister Sudhakar met us and promised to fulfill the demands, but nothing happened. So this time, we will not call off the strike until our demands are met,” he said.
