Millennium Post

Kidney chameleons

Dialysis saves thousands of lives each year but many patients who suffer from kidney failure are at risk due to the unregulated and unaccountable growth of stand-alone centres across the capital defying most protocols for standardised treatment.

A few dialysis centres in central Delhi are functioning in narrow streets. To reach the place, the driver of the ambulance or car has to negotiate a narrow street behind a market with sweet shops, a dhaba, a cloth shop and similar establishments. Loose electric wires dangle dangerously over entrances and shops. There is no parking available, since cars and two-wheelers have taken up all available space. To take the patient up, there is no automatic chair attached to the banisters- in fact, there are no banisters at all. Patients are carried up on chairs by drivers and relatives, and in some cases have also slipped down stairs, sustaining injuries.

These clinics exploit the fact that the Act passed by the parliament has not been made into a law by Delhi’s lawmakers. Says Minister of Health and Family Welfare Harsh Vardhan: ‘I understand some dialysis centres are operating in unhygienic conditions and I agree they should be hauled up.’

The scary fact is that unlike other medical facilities that need government licences or monitoring by health bodies to function, dialysis centres do not require even registration with Delhi’s Directorate of Health Services. Though the lawmakers are aware of the mushrooming of these centres, they are helpless in tackling the problem. ‘I am aware that many dialysis centres indulge in malpractices. We are tackling many problems at the moment and this too will be looked into. We just request for some time as this is a new government,’ says Vardhan.

In Delhi, around 6,000 patients undergo dialysis every day, but there are very few registered specialised units. Most big private hospitals have specialised units, which are registered under the Delhi Nursing Homes Registration Act, 1953. ‘Dialysis units running inside hospitals do not require registration,’ says Dr R N Das, in charge of nursing homes, Directorate of Health Services. There are around 150 big hospitals, both government and private in Delhi. ‘On an average, 80 such hospitals have specialised dialysis units,’ says nephrologist Dr Uma Kishore.

He further says that in Delhi, existing dialysis centres cannot meet the demand, which has led to the opening of unregistered clinics. ‘There are around 40 stand-alone centres operating across Delhi and we still need more,’ adds Kishore. However, he states that the units must follow the protocols for standardised treatment and that the state government should adopt the Clinical Establishments Act, 2010 without wasting any time.

‘If not, people’s lives are surely at risk,’ he adds. Hence, the lack of standards like sanitation, hygiene, elevator, escalator and ramp facilities cannot be challenged.

The reality is revealed, when patients visit stand-alone dialysis centres only to save money while compromising safety and hygiene. The cost of dialysis at hospitals is between Rs 3,000 and Rs 5,000 per session. The bills at such centres are, however, around Rs 1,500. Most of these centres do not follow minimum standard protocols and offer treatment to mint money. They conduct around 70 to 100 dialysis’ per day with minimum number of staff and specialized hands.    

Das says according to the guidelines set by the Indian Medical Association and Nursing Homes Registration Act, 1953, if a dialysis centre operates round the clock and has more than two indoor beds, it needs a licence. ‘Many of the stand-alone ones do not need licences as they don't operate full time,’ adds Das.

Many top nephrologists of Delhi state that unhygienic conditions of many dialysis centres are dangerous for the health of patients. Dr Sanjiv Jasuja of Apollo Hospitals says all patients needing haemodialysis should visit a hospital thrice a week for blood-cleansing. ‘The dialysis is done under strict ‘Infection Control Protocols’ only by trained personnel. However, haemodialysis patients are vulnerable to infections that can be transmitted through unscreened blood products or bad hygiene conditions,’ says Jasuja.

Special accreditation agencies like NABH have inspection protocols for standardised delivery of dialysis. All private and corporate hospitals recognised by these agencies deliver standard quality dialysis procedures. In case of other private operators, the negligence of Delhi’s MLAs is a heaven-sent opportunity to make money, no matter what the cost to patients might be.

The Act Matters
The Clinical Establishments (Registration and Regulation) Act, 2010 has been enacted by the central government and notified on 1 March, 2012, to provide for registration and regulation of all clinical establishments in the country with a view to prescribing the minimum standards of facilities and services provided by them. The Act has taken effect in four states- Arunachal Pradesh, Himachal Pradesh, Mizoram, Sikkim and all Union Territories.

The Act is applicable to all medical establishments of both public and private sectors, including single-doctor clinics. Since health is a state subject (except in the above-mentioned states), it is incumbent on the assemblies to pass this order to make it a law in their own states. The only exception will be establishments run by the Armed Forces. So far, only Uttar Pradesh, Rajasthan and Jharkhand have adopted the Act under clause (1) of Article 252 of the Constitution.
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