The Kidney Warriors Foundation has filed a complaint with the Karnataka Medical Council (KMC) and the State Human Rights Commission highlighting the fact that most state-run dialysis units operating under the Pradhan Mantri National Dialysis Programme (PMNDP) are functioning without nephrologists.
The foundation has attached with its complaint a copy of South First‘s investigative report titled ‘Undergo dialysis at your own risk in state-run units in Karnataka’.
The foundation has alleged that this amounts to the denial of the Right to Life and is also a violation of basic human rights.
The Mumbai-based foundation is a large network of kidney patients, healthcare professionals, caregivers, and social workers who have signed up to make a difference in the lives of people affected by kidney disease.
Speaking to South First, Kidney Warriors Foundation Founder and CEO Vasundhara Raghavan said: “Based on the South First report and our own investigations, we have found that dialysis in at least 145 of the 167 centres in Karnataka is being done without the presence of a nephrologist.”
“We had written to the KMC two months back bringing to their notice the gross negligence in the dialysis centres of Karnataka. There has been no action taken against this even till date,” she added.
What is the issue?
It was the Union government’s Ministry of Health and Family Welfare that launched the PMNDP dialysis centres, with each of them doing anywhere between 100 and 1,000 dialysis per month.
When South First, based on complaints from dialysis patients and technicians at some of these centres, investigated the matter, we found there were no nephrologists at a majority of the centres in the state, and dialysis was mostly being done by technicians who are not qualified to do them.
South First also found that many of the dialysis centres were managed by untrained nursing staff and technicians whose job is only to operate the machines.
The technicians themselves conceded this and even had met with state Health Minister Dr K Sudhakar, complaining about problems related to the company to which the job was outsourced, including non-provision of nephrologists at the centres.
The Kidney Warriors Foundation, in it’s independent investigation, found that 122 dialysis centres, which were maintained by BRS Health Care from 2017, had not appointed nephrologists.
But later, as the company went bankrupt, it stopped operations at these centres and the state Health Department had taken over the responsibility of running them.
After BRS Health Care went bankrupt, the contract for the scheme was awarded to Kolkata-based ESKAG Sanjeevini.
However, despite several protests by the technicians over irregularities in payment of salaries, defunct dialysis machines and gross negligence at the centres — as also the ending of company’s contract — the state is yet to decide on handing over the centres to a new company.
Health Minsiter Dr K Sudhakar had earlier told South First that tenders have been floated and a decision would be taken soon in this regard.
What does the complaint letter say?
In it’s 100-page complaint to the KMC and the Human Rights Commission, the Kidney Warriors Foundation has stated: “For the last two years (1/1/20 to 31/3/2022) those centres were directly run by the Department of Health and Family Welfare, Karnataka, including recruitment of staff. Shockingly, even during these two years, no concerned specialists (i.e, qualified nephrologist/MD medicine with one-year dialysis training from recognised centre) was recruited by the Health Department,”
“Dialysis machines are faulty most of the time and particularly the RO plants… dialysis duration is only 2-3 hours which is less than four hours that is recommended; meanwhile, dialysis patients are having premature death at many centres,” the foundation’s complaint has alleged.
“With no nephrologists appointed at these centres, without supervision, and dialysis being done without prescription, not looking into the patients’ health condition, will lead to comorbidities like cardiac arrest, stroke and other conditions, resulting in death too,” KWF’s Raghavan told South First.
Pointing to the defunct machines at many centres, the KEF complaint makes the same point: “Since machine is not properly serviced and same dialysis treatment being applied to all, (it) can lead to improper and insufficient dialysis leading to the death of the patient.”
The complaint pointed out that allowing a caesarian section to be done by a non-obstetrician would amount to an offence and be called out as medical negligence. The foundation demanded that the same yardstick be applied to the dialysis centres being managed without a specialist.
“Unavailability of concerned specialist is a serious crime committed even today and for years together in government hospitals in PMNDP, Karnataka.”
A PMNDP document issued before the programme was started details how it should be run.
The document clearly states that service providers should provide medical human resource, dialysis machine along with RO water plant infrastructure, dialyser, and consumables.
It also details minimum standards and staffing patterns for the dialysis unit under which it mandates recruitment of a qualified nephrologist or MD medicine with a year’s dialysis training from a recognised centre, and clinical review for all patients, said Raghavan.
“We are shocked to see this sad scenario in dialysis centres in a situation where surplus concerned specialists are available in Karnataka. From the foundation we checked to see if the state lacked nephrologists and we found that the very few nephrologists have been contacted by the state government or the private company to supervise PMNDP centers,” the complaint said.
What the complaint demands
The foundation has demanded action against ESKAG Sanjeevani and officials of the Karnataka government who has committed/allowed this criminal medical negligence.
Also, the complaint demanded compensation be given to all the patients who have undergone dialysis in those centres where concerned specialists were not available. As also compensation for patients who died due to non-availabililty of specialists.
Despite the complaint being sent to the KMC chairman, principal secretary of the Health and Family Welfare Department, and chairperson of Karnataka State Human Rights Commission, in November, there has been no response from them.
“This is concerning,” said Raghavan. “Dialysis is a very critical treatment that needs support from a good nephrologist who has to see that every individual is getting the type of treatment that he or she deserves. The government can’t be so careless about people’s lives.”
Meanwhilem when South First contacted the officials from the KMC they said that a meeting is being held on Saturday, 21 January, when they will discuss this issue.
“We will discuss this in our Saturday meeting and then comment on the issue,” a senior official said.