Waiting in the Q: Mumbai’s kids with serious heart ailments

Not so long ago Kolkata and Srinagar that witnessed many infant deaths and the authorities merely ordered enquiries whose reports are suppressed. This should not be allowed to happen to the heart-lung machines of Mumbai’s KEM Hospital

The tabloid Mumbai Mirror, belonging to the Times group, first reported on 25 March 2013 and its sister TV channel Times Now has since then been continuously broadcasting the story of the breakdown at the KEM Hospital, Mumbai, of one of the only two heart-lung machines which was functioning for 29 long years—more than 19 years beyond its best-before-date. The only one that is presently in use for the last 13 years stands reserved for emergencies only. This aging machine that ought to have been replaced in its 10th year is likely to malfunction any time. It is patched up often, just to keep it going to breathe its last any day!
As on today, while waiting their turn in the queue, since January 2012, 20 kids on the open-heart surgery list have lost their lives with the waiting list today is 700, with nearly 80% in the 1-5 years age bracket. All of them have no choice because they cannot afford the starred hospitals catering to health tourism. Mumbai’s Kokilaben Ambani and Seven Hills are the only other dedicated centres for such surgeries. Paediatric surgeon Dr Suresh Rao laments that Mumbai lacks team based practice, “Such surgeries need cardiologists, surgeons, intensivists and anaesthesiologists and specialized infrastructure all in one place.” Bengaluru and Hyderabad have paediatric heart programmes. A Times of India headline read, “City lags in kids’ cardiac care.”
Media reports quote the well-known cardiac surgeon Ramakant Panda, “All such programmes in the US are supported by public or private funding. Hospitals need to be funded for such surgeries.” According to Dr Devi Shetty of the Bengaluru-based Narayana Hrudayalaya they are ignored simply because they are not profitable. “In a bypass graft a grown up is out of the ICU in a day and fit for discharge in a few days, a child is required to be kept in the ICU for longer time,” he said.  
Within days of the public outcry, the civic Leader of the House says BMC is in talks with private hospitals—Kokilaben Ambani, Fortis, Seven Hills and Jaslok—to clear the backlog to treat 288 critically ill kids with congenital heart defects by footing the entire bill. Earlier a trustee of the Guru Teg Bahadur-Apollo told the media that it would take some kids. 
On 8th March 2013, following a series of reports in the print and electronic media, the Maharashtra State Commission for Protection of Child Rights taking suo moto cognizance of the matter held a first hearing and ordered the hospital to file an affidavit to explain. Its secretary AN Tripathi is on record to say “It is sad that the children are dying before reaching the operation table. We have to get to the root cause of the problem.” Report in the Times of India dated 8 March 2013.   
One of the six paediatric surgeon at Paediatric Surgery Department sadly throws up his hands lamenting to the Mirror reporter, “It kills me to see little boys and girls who I know have very little time. If I could, I would operate upon all 700 today. It is very frustrating.” Ironically the 700 kids on 24/7 danger list needing immediate attention are not considered to be emergencies.
The Mumbai Municipal Corporation has to answer why the KEM hospital, despite being the premier hospital of India’s richest civic bodies, has just one out-dated heart lung machine. It has a budget larger than that of any smaller states of the Union of India. Yet it has been an abysmal failure when it is utterly insensitive to the health concerns of its seriously ailing little citizens. The delay in their surgery is attributed essentially to the shoddy upkeep of the heart-lung machines, the precious life-saving equipment.
Unlike other Indian metros, Mumbai’s civic administration has extremely large funds to run, among others, three renowned medical colleges with attached hospitals manned by dedicated specialists whose services can match those of any super speciality hospitals. It is mired by red tape when it comes to the acquisition of absolutely essential life saving support equipments like the heart-lung machines.
 Four years from 2009, when the proposal was first submitted to replace one heart-lung machine at KEM Hospital to save precious lives of little kids with serious heart ailments, it is still stuck.  The fact of the matter remains that the tender floated in 2009 for a new heart-lung machine received just two bids—one from Sorin, an Italian and another Gentinge Group, a German. It underwent a two-year bidding and screening process that ended in awarding it in 2011 to Sorin. Subsequently the BMC suspended the order when Sorin wanted to supply an upgraded machine at no extra cost because the company had phased out the model quoted Earlier.  It was no longer available. But the BMC neta-babus would have none of it. They still insisted on the supply of the discarded model that was not on manufacture. This tender was then cancelled and another floated, with Sorin again being the sole bidder. BMC waited for other bidders for another six months. There being no other bidder, this too was cancelled. In the next tender Sorin being the sole bidder and this again suffered the same fate—cancelled. 
According to Additional Municipal Commissioner, Manisha Mhaiskar, another tender with no “minimum three bidders” clause was to be issued in the month of March 2013. She is quoted to say, “BMC is doing everything it can to make sure the new machines are in within the next three months. If the suppliers don’t bid for this tender, we will acquire them directly.” The medical director for all BMC-run hospitals, Dr Suhasini Nagda, admits that the situation is critical. “The process of acquiring a new machine is expedited. Steps are now being taken to create paediatric surgery departments in other civic hospitals. Of the new tender for four machines, KEM will get two, Sion and Nair Hospitals one each,” she said. Further delay for the hapless suffering kids! 
Mayor Sunil Prabhu, Mumbai’s First Citizen, could not provide any valid reasons, other than “tenders are invited” when cornered on camera by an electronic media correspondent. Now will the mayor explain?   
Why all this action of emergency acquisition not carried out much earlier when they could have saved many lives? Particularly when Sorin happens to be the only bidder all the time. It is said that the cost of the heart-lung machine is just Rs85 lakh, not a big sum;  
Why is precious time and energy still being wasted on repetitative bidding exercises that only result in consequential delays and loss of more innocent lives? 
Dr Shivkumar Uttare, an executive member of the Maharashtra Medical Council, shocked that the situation is allowed to reach this critical stage, laments: “Over 700 kids on the waiting list are just not acceptable. With the resources at its disposal, the BMC ought to have dealt with this matter a long time back.”  
The questions that demand explanation from civic authorities remain:  
Do the precious lives of the suffering little kids not matter to your neta-babus? 
• Why are all such urgent cases of BPL patients not referred to other state-run hospitals and/or the many large private   hospitals, including an exclusive Asian Heart Institute? 
More particularly when all Mumbai’s private hospitals operate from precious lands allotted to them by the state on which they have structures that are granted additional/extra FSI. Besides enjoying a host of other concessions as well.  
Under the existing laws governing charitable trusts, these private hospitals are mandated to keep 10% of their beds for poor patients. These hospitals need to put in the public domain how many such patients they have treated.
The uncle of a kid who lost his precious life has this to say, “Eight month old Ayush was struggling to breathe. We rushed him to the KEM Hospital. They put him on a ventilator. But it was all over in less than three hours, even as his mother and I watched helplessly.”
This is the experience of many more. Like the oft repeated quote—corruption is a universal phenomenon—similar sad state of neglect especially of little kids that was seen not long ago happening in the mal-administration of hospitals in Kolkatta and Srinagar that witnessed many infant deaths and the authorities merely ordering enquiries whose reports are suppressed. This should not be allowed to happen to the heart-lung machines of Mumbai’s KEM Hospital.
With additional inputs from the Mumbai Mirror, Times of India and Times Now TV
(Nagesh Kini is a Mumbai based chartered accountant turned activist.)
Thomas Kuruvilla
9 years ago
I too feel the BMC is extremely insensitive to such important issues. Another question which I would like to ask is why is the BMC not taking a strong position with regards to its dealings with SevenHills Hosp., which is a PPP, built on BMC land? As per the PPP, the hospital has to reserve 20% of its beds for the poor. But the hosp. has taken the matter to court. SevenHills has a good pediatric cardiology Dept. & should be forced to comply with its obligations.
9 years ago
These corrupt netas will understand the value of life only when their whole family and kids are at critical stage in hospital,and this people will have no option other than see their family die, even after paying looted money. SHAME on this netas.
Thomas Kuruvilla
9 years ago
In this context I would like to specially point out how Seven Hills Hospital, Marol, which has been built on BMC land as a private-public-partnership has failed to live up to its obligation to treat 20% of its in-patients at rates applicable in municipal hospitals. The hospital has been functioning since the last 3 years & is yet to sign the MOU, citing one reason or the other. The matter is now in the High Court. This is clearly a delaying tactic by the hospital as it has itself admitted that had it started off on a smaller scale it could have easily met its obligations with the BMC. The hospital has a very competent paediatric cardiothoracic surgeon. In fact, there was a full team of paediatric cardiologists, cardiac surgeons & anaesthesiologists when it started functioning 3 years back but some have left out of disillusionment. The BMC & the HC should ensure that this hospital fulfils its obligations to the poor at the earliest.
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