Twins' death, wrong surgery, what's ailing Manjeri Medical College?

Malappuram: The recurrent complaints and lapses involving the staffers of the Government Medical College Hospital, Manjeri, are turning out to be a blot on the institution.

The facility, in the state's most-populous district Malappuram, was inaugurated in September 2013, as the sixth medical college in the government sector.

Several people, mostly beneficiaries of the hospital's services, had complained of 'poor infrastructure' and 'negligence' on part of the authorities.

The hospital, established by converting the District General Hospital, is yet to get a full-fledged medical college status.

The latest in the series of allegations is the death of a woman's twins on September 27 at the Medical College Hospital, Kozhikode, after reported denial of initial treatment and life-saving support at the Manjeri hospital. (The babies were reportedly stillborn). It was reported that the woman, in labour, was admitted to the Manjeri hospital. As the Manjeri medical college was declared a COVID-19 hospital, the doctors there referred the woman to the Woman and Children Hospital, Kottaparamba, Kozhikode. Later, the woman was admitted to the Kozhikode Medical College, where the death of the twins was confirmed.

In January, the family of a 39-year-old man who died at the medical college preferred a police complaint stating that medical negligence caused his death. He was admitted to the hospital for the treatment for ear pain and he died allegedly after being administered an injection for pain relief. The relatives said the hospital was severely wanting in emergency care.

In another incident, in May 2019, a doctor of the hospital allegedly performed a wrong procedure on a seven-year-old boy. Later, Health Minister K K Shylaja ordered an inquiry and the doctor was suspended from service. It was alleged that the doctor performed a surgery for hernia when the patient wanted a nasal surgery.

Actual plan

The hospital was thought of and conceived as a vital facility which could cater to a wide range of healthcare needs of the people of Malappuram and nearby districts.

According to a report prepared by the Kerala Government Medical Officers' Association (KGMOA) in 2019, the population-bed ratio of Malappuram district in government sector is one bed for 1,643 people, which is highest in Kerala.

A medical council team, which inspected the medical college two years ago, said in a report the out-patient rooms were overcrowded and the 'patient population' at the facility was 'very high.' They had also pointed out that the beds in the wards were 'congested' and there was 'insufficient space' for patients. These issues remain unaddressed even now.

KGMOA state committee member A K Raoof said the facilities at the medical college were still at the level of a general hospital or taluk hospital. But the number of patients was higher than that of any other medical college in the state. Dr Raoof said this was the main reason for the recurring complaints.

"The task of a medical college should be tertiary care. But the Manjeri medical college is being forced to attend to even primary- and secondary-level patients, like in a taluk hospital. It is not practical to provide proper and timely medical care to patients without having sufficient staff and facilities," he said.

He said the dual administration, under the Department of Medical Education (DME) and the Department of Health, was another major factor which worsened the situation. "A section of staff including the principal of the college are under DME. At the same time, the hospital is under the control of the superintendent who functions under the Director of Health Services (DHS). There is a lack of communication and coordination between DME and DHS staff who work in the same wards," he said.

The Manjeri District General Hospital was one of the best general hospitals in the state. There were no major complaints regarding the medical service of the hospital on part of patients. Complaints started pouring in when the hospital was converted into a medical college. Dr Raoof said doctors and other staff were under severe stress and it was the responsibility of the government to avoid such situations.

M Ummer, Manjeri MLA, told Onmanorama that medical negligence was a major issue. "We cannot blame only the patient-staff ratio for the complaints on part of the patients and relatives. Wrong procedure on a patient is not due to lack of infrastructure facilities. It is the duty of doctors and other staff to verify the details of patients," he said.

He said referring a pregnant woman in advanced labour to another hospital, without proper examination and observation, was not due to lack of facilities. "These are issues of common sense and willingness," he said.

The MLA admitted that lack of infrastructure and staff shortage were major issues, too. "The government should be ready to complete the pending projects and start a separate district general hospital in Manjeri, as the land is available in the city itself," the MLA said.

A large number of doctors at the hospital was redeployed to other government medical colleges across the state after the Manjeri Medical College received approval from the Medical Council of India (MCI) in 2018.

Staff shortage in the gynaecology department was in news after the death of the twins. The staff of the department was transferred to non-COVID hospitals after Manjeri Medical College was declared a COVID Care Centre.

There was a recommendation to start a critical care department two years ago. Many private hospitals have agreed to support to this initiative. But the government is yet to take a decision on this. Six major projects for the construction of new OP, radiology, and investigation blocks, residential quarters, mortuary complex and store were pending with the Public Works Department (PWD) for the past three years. This is in spite of the fact that Rs 22 crore had already been allotted for initial works.

Dr M P Shashi, Principal of the Medical College, said the government provided staff only for a hundred students of the college and this was not proportionate enough to treat the patients who turn up at the hospital each day.

"We have only 80 ICU beds. We have to increase the number to at least 110 to meet the demand. The medical college is a 450-bed facility. But the number of beds has now been increased to 650 and almost all these are taken. The government should be ready to set up a separate COVID hospital and medical colleges should be used only to attend to COVID-19 patients who are in a critical stage," Dr Shashi said.

A seminar jointly conducted by the KGMOA and the Kerala Government Medical College Teachers' Association (KGMCTA) last year had urged the government to delink the general hospital from the medical college. It had also sought a referral system in the medical college to avoid increased patient load.

(Nijeesh Narayanan is an independent journalist based in Kozhikode)