COVID-19 Risk: Kolkata Hospital Fails to Protect Staff, Test Patients

Kolkata Apr 25: The West Bengal government is playing catch up after a week of mismanagement in the Kolkata Medical College and Hospital (KMCH), at the end of which one senior doctor, four postgraduate trainees, six interns and at least six cleaners and attendant staff tested positive for COVID-19 after coming into contact with patients without adequate protective gear.

A pregnant woman had been admitted to KMCH’s obstetrics and gynaecology department on April 8. She tested positive for COVID-19 but only after she delivered her baby, having slipped through KMCH’s screening process at the time of admission.

Another patient had been admitted in the general medicine emergency room (ER) in the early hours of April 13, after having been forced out of a private nursing home, and was severely ill from chronic kidney disease. She died after a night of treatment. Hospital staff would later discover that her family members didn’t reveal she also had the coronavirus.

The screening procedure in the general medicine ER had thus failed to catch patients who had COVID-19 but didn’t know it or weren’t open about it – so much so that one intern currently at home said under condition of anonymity that it seemed like the KMCH authorities had “no intention of conducting COVID-19 tests”.

Improper care

As a result, three sets of carers were exposed to the highly contagious virus over multiple shifts ranging between two to 12 hours.

To make matters worse, hospital authorities took a whole week to quarantine and test their doctors even though they knew they had treated patients with COVID-19 just two days after exposure.

An intern at KMCH said in a desperate voice note that the authorities, after promising to take proper care of staff members exposed in the obstetrics department, later forced them to share dormitories, each with three to four beds and one washroom, in a rundown hotel in north Kolkata. Four of these doctors would test positive for COVID-19.

He called the crisis management in the college-hospital a “hopeless mess”.

Interns at medical colleges are not considered to be staff and are denied the protection ‘regular’ staff members receive as government employees. Indeed, many interns were on duty during the lockdown while senior doctors were asked to stay at home unless the hospital had an emergency.

KMCH’s interns have agitated against their alma mater’s apathy before. In 2018, for example, MBBS students went on a hunger strike demanding better residential accommodation. It was many months before the administration agreed.

On April 23 (this year), representatives of final-year students at the college placed a number of demands before college authorities, including for 240 N95 masks and for students to be allotted separate rooms instead of being forced to share.

In the hostel, a student in his 20s said he was “depressed” at being away from his family, while many of his classmates were at home, and because of the authorities’ callousness towards his and his coworkers’ plight.

More than that, he was anxious that most of them weren’t being tested enough for COVID-19 – or at all.

Interns have also demanded that rosters be rewritten such that only healthy interns are posted for duty, and that too only when absolutely necessary – in much the same way senior doctors  are treated.

Repeated calls, emails and messages to KMCH principal Dr Manjushree Ray and deputy superintendent Dr Jayanta Sanyal went unanswered.

Allegations of misconduct

KMCH is also in trouble on another front, this one potentially more worrisome.

One postgraduate trainee in quarantine said hospital authorities were keen to release the body of deceased patients to their families even if attending doctors strongly suspected them of having died of COVID-19.

As a result, the hospital had modified the standard operating procedures (SOPs) for drawing up death certificates, a straightforward format that doctors treating patients are required to follow.

“The deceased patients’ families, afraid they would not be able to claim the body of their loved ones, often refused postmortems,” the trainee said, “and death certificates were signed off with the underlying health condition written down as the only cause of death” – and not COVID-19 itself.

The college administration has refused to either accept or deny these allegations.

Proper death certification serves several purposes. The first is that bodies with the virus need to be handled according to fixed protocols. The most overarching is that death certificates help keep track of the relative contributions of different diseases to mortality.

Incorrect certification can distort the information a government needs in order to make the right decisions to protect people during an emergency – and make the ground reality seem rosier than it really is.

As hospital staff become more dissatisfied, growing attention and pressure from the Centre seems to have prompted the West Bengal health ministry to post a flurry of updates to its website. In a short span, there are calls for private bids for equipment and new placements for officers and nurses in ‘hotspots’ in the state.

Following the allegations of improper conduct, among others, the Centre also recently sent a team of medics to check what West Bengal is and isn’t doing to deal with the coronavirus epidemic.

Their visit didn’t go down well with chief minister Mamata Banerjee and her cabinet. Her party colleague, Rajya Sabha MP Derek O’Brien, dubbed the visit “adventure tourism”.

Emails and phone calls to the chief minister’s office, the director of health services and the director of medical education in the state health department went unanswered.

For now, West Bengal’s testing rates remain low: 62.7 per million people, better only than Jharkhand (52.2, both figures as of 9 pm on April 24). Many observers have expressed disappointment at this figure, and suspect the state could be in for a nasty surprise in future.

Divya Guha is an independent Kolkata-based journalist.