Unaddressed and unchanged: Telangana doctors blame govt for absence of protocols after rat-bite recurrence

Such incidents will continue if you don't stop adding medical colleges without enacting reform, irked doctors tell the Telangana government.

ByChetana Belagere

Published Feb 13, 2024 | 9:00 AMUpdated Feb 13, 2024 | 9:07 AM

Unaddressed and unchanged: Telangana doctors blame govt for absence of protocols after rat-bite recurrence

Dr Kiran Madhala, the vice-president of the Telangana Teaching Government Doctors Association, is irate. And he has his reasons.

He told South First: “The same rat bite in hospital case, the same vulnerable patients, the same ICU setting under the same government’s watch, and the same lacklustre response: Suspension and making doctors, nurses, superintendents the scapegoat. What exactly has changed over these two years?”

His words resonated with a piercing clarity as he reflected on the disturbing recurrence of the rat bite incident at Warangal’s Mahatma Gandhi Memorial Hospital in March 2022.

Fast forward to today, and we are faced with a grim repeat of the past: A patient, in a vegetative state, subjected to the same nightmare in another government hospital in Telangana.

Madhala’s frustration was palpable as he questioned the absence of meaningful action: “Have we implemented any reforms, any standard protocols? Have we issued visiting passes to patients, restricted food in ICUs, or addressed the glaring issues of sanitation? Apparently, none!”

His assertion underscored a glaring indictment of the systemic inertia that continues to jeopardise patient safety and trust in the public healthcare system while scapegoating doctors and nurses.

Also Read: Rural Telangana struggles with shortage of doctors, paramedical staff

The previous incident

In March 2022, a 38-year-old man in critical condition — with multi-organ failure and in an unconscious, vegetative state — was shifted from a private hospital to MGM Hospital in Warangal. He was admitted to the respiratory ICU of the hospital.

He was under treatment by physicians when one of his relatives reportedly noticed bleeding around his ankles and heels — apparently due to rat bites.

Unfortunately, the patient — who was now being treated at Nizams Institute of Medical Sciences — died a few days later.

The incident prompted immediate administrative action: The head of the respiratory ICU unit was suspended, the hospital superintendent was transferred, two duty doctors — whose contracts were nearing expiration — were relieved of their duties, and the sanitation contractor was blacklisted.

As a deja vu of the incident, a 43-year-old patient admitted to the ICU at the Government General Hospital (GGH) in Kamareddy was found bitten by rats on Saturday.

The patient had undergone head-and-throat surgery at Nizam’s Institute of Medical Sciences in Hyderabad and was then admitted to GGH.

Family members of the patient found rat bites on the right-side fingers and toes of the patient’s body.

The state government immediately issued orders to suspend the on-duty doctors and a staff nurse. Also, the district coordinator of hospital services (DCHS) resigned from her services to the government.

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‘Are necessary steps being taken?’

“If the narrative remains disturbingly similar even after two years, isn’t it a systemic failure to address root causes that undermine patient safety and trust in public healthcare?” asked Madhala.

Irked doctors at government hospitals have decided to raise their voices against the poor management of not just government hospitals but also medical colleges in the state.

Speaking to South First, paediatrician and Secunderabad-based researcher Dr Madap Karuna questioned the condition of most of the government hospitals in the state.

She said, “The government must also look around the state of hygiene and maintenance in government hospitals such as Osmania Medical College and Niloufer. It begs the question: Are the necessary steps being taken to ensure cleanliness and prevent overcrowding? Unlike private institutions where regular pest control is a given, government medical facilities seem to lag in these crucial areas.”

Doctors also recalled the incident of rat infestation at the mortuary of the Bhongir Government Hospital in August 2023, when the family of a deceased alleged that rats had bitten off the nose, forehead, and ears of the body.

Another senior doctor recalled the reports of the presence of snakes inside the Mancherial Medical College.

Citing an example she said a dog chased a medical doctor inside the premises of the Erragadda Government Chest Hospital in 2022 and attacked her.

She added that the doctor might have died if the patients around had not saved her.

This dog attack was just the tip of the iceberg, said Madhala. “If you randomly visit some of the medical colleges in Nizamabad, there is no guarantee you will come out without a dog bite,” he said.

“There are nearly 100 stray dogs inside government hospitals. Food is strewn around everywhere. Have we ever thought of a policy around these things? Any reforms?” he asked.

These issues must be dealt with seriously as administrative failures, and the state government must bring reforms instead of suspending medical doctors or nurses for these incidents, he said.

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‘There is a huge gap’

This situation also calls for a closer examination of new medical colleges and hospitals to ensure they meet the necessary standards for hygiene and safety.

The matter requires immediate attention and action from the authorities to safeguard the well-being of both patients and healthcare workers.

Doctors are irked that there are absolutely no protocols in the government hospitals to prevent crowding, getting food into the ICUs, issuing identity cards, and passes for visiting hours.

The doctors said that instead of the government ensuring all this is done, the speed at which medical colleges were coming up was not at all welcome.

“With one medical college, Osmania we have 10 attached hospitals. Likewise in Warangal. Like this, Telangana has 26 state-run medical colleges with 40-odd hospitals,” noted Madhala.

Given the speed at which the government was increasing the number of medical colleges, such accidents were bound to happen, he added.

“The state has the third-highest number of government medical colleges, but have we created proper infrastructure, manpower, administration, and the number of doctors and nurses to run them? There is a huge gap,” said Madhala.

He said faculty shortages, gaps in specialists, and overall doctor availability were huge challenges.

He noted: “Establishing a medical college in an underresourced area doesn’t assure patient care. In fact, we must be looking at strengthening the existing medical colleges and hospitals. Look at factors like basic medical facilities and sanitation conditions, waste disposal, and doctor availabilities.”

Also Read: How officials in Telangana are identifying fake drugs

Where are the policies?

Irked by the suspension of two doctors and a nurse in the Kamareddy case, the doctors questioned the non-existence of policies for attendants and caregivers.

“Are attendants given instructions to keep hospital surroundings clean? Overcrowding, lack of hygiene, and regular pest control at institutes are entrusted to private-sector organisations,” said a senior doctor from Kamareddy.

Meanwhile, Telangana Health Department officials told reporters that the presence of rodents in the Kamareddy hospital was due to dismantling activities near the ICU for renovation of the dialysis unit.

They accused the patient’s attendants of throwing food in and around the hospital, which they said increased the rodent menace.

“It is understandable that the patients who come to hospitals are mostly poor and a ban on bringing food into the hospital premises may be problematic. But attendants eating food inside wards, ICUs, or corridors of the hospitals must be stopped. A designated canteen area must be given for them to eat food,” said the doctors.

Meanwhile, Madhala asked why patient attendants were allowed to crowd into government hospitals, and not given visitor passes and allowed in limited numbers for a limited duration during the day.

“When will these reforms and policies come into being? Each time an incident occurs, it is we, the doctors, who are made the scapegoats. The government must stop announcing new medical colleges and set these things straight,” he said.

Also read: Resident doctors assaulted by patient’s attendants in Hyderabad hospital

‘How will people trust govt hospitals?’

The doctors noted that the government was on one hand asking people to shift to government hospitals to prevent out-of-pocket expenditure. On the other hand, doctors are held responsible for when incidents like these occur, they noted.

“How will people trust government doctors and hospitals?” asked the doctors.

Madhala demanded structural reforms such as restriction of patient attendants inside the hospital, effective sanitation and security, filling of all vacancies, financial backup for hospitals, a strong redressal mechanism, clear job charts for doctors and staff, and proper infrastructure.

“It is an administration issue. Rats come due to a lack of sanitation. How are teaching doctors responsible?” asked Jalagam Thirupathi Rao, the state general secretary of the Telangana Teaching Government Doctors Association (TTGDA).

“This is the sanitation staff’s concern, which belongs to the sanitation agency. It is monitored by the superintendent of the resident medical officer (RMO),” Rao told South First.

“Our teaching doctors are in no way concerned [with sanitation]. They are only concerned with patient care and the teaching of MBBS and MD students. They have been unnecessarily suspended,” he added.

Condemning suspensions in the Kamareddy case, the Telangana chapter of the Indian Medical Association said that the duty of all medical officers was to treat the patient till discharge, and that they had no role in searching for rats in wards.

“The ICU is meant to extend treatment to patients in a serious condition, to save precious lives. It is not meant to keep vigil on rats. Sanitary and other staff must keep wards neat and clean,” said Dr Kali Prasad Rao, the president of IMA Telangana.