Srinagar, Feb 28: Four years back, the health and medical education department issued Standard Operating Protocol (SoP) for instituting answerability in healthcare institutes in case of referrals but these are not followed in hospitals and there is no end to unnecessary referrals.
Khursheed Ahmad, patient at SDH Tangmarg said that at most of the times patients, who would be easily managed at the hospital, are referred to Srinagar and Baramulla.
“Even children who have minor ailments and patients who have minor ENT issues are also referred. This must end. If this is SDH then it should have at least basic facilities,” he said.
The patient said the hospital receives patients from more than 50 villages and expressed concern said despite that the basic healthcare facilities have not been improved.
Nasir Ahmad, a patient at SDH Pattan complained all the trauma cases are referred to Srinagar hospitals for treatment after due to lack of proper facilities.
A senior doctor who is posted at SDH Tangdar in Kupwara said there is shortage of specialist doctors and patients are referred to Kupwara and then to Srinagar for treatment.
“The local doctors do not want to work there. Many posts of doctor are also vacant as many doctors declined to work there. If there are no specialist doctors how can patients be treated in rural hospitals,” he said.
Naveed Ahmad, a resident Uri said the sub-district hospital in Uri lacks all the basic facilities and majority of the patients are referred to Baramulla and Srinagar hospitals.
Patients face hardships while undergoing even minor surgery in SDH Uri. Pregnant women suffer badly during pregnancy period due to lack of Blood Bank and Sonologist. “If a patient needs blood there is no option other than shifting the patient to Baramulla,” he said.
The resident said even during minor complications and due to the non-availability of resources, hospital authorities are forced to refer patients. The non-availability of facilities has made life of people tough and troublesome.
In Jan 2021, J&K government publicised Standard Operating Procedures (SoPs) for instituting answerability in healthcare institutes in case of referrals.
As per the SoP, prepared by GMC Srinagar, a doctor who decides to send a patient to a higher institute had to ensure that the patient reaches the hospital safely.
For this, the doctor had to follow an inventory before deciding that a case could not be handled at the level wherefrom the referral was taking place.
In addition, the referrals as well as the investigation were mandated to have name, registration number, seal and signature of the doctor on duty.
The SOPs were then issued after a roadside delivery case of a Kupwara woman in Srinagar to regulate patient referrals and burden on tertiary care institutions.
However, doctors in tertiary care hospitals complain that the SOPs are not being followed as they continue to receive patients who can be easily managed at peripheral hospitals.
“There is no impact of SOPs and these aren’t followed everywhere. We still receive unnecessary referrals and most of these come after 5 p.m. I see cases where there is no medical attendant or ASHA worker with the patient,” said a doctor at LD hospital.
Similarly, the SMHS hospital also receives unnecessary referrals in bulk with doctors pitching for strict implementation of norms before referral.
“As per the norms issued earlier, when a patient is referred, a WhatsApp message should go to nodal officer of the concerned hospital from on duty-doctor to make necessary preparations but it is not being done,” said a senior doctor at SMHS.
Administrative Secretary, Health and Medical Education (H&ME) Department, Bhupinder Kumar, said broadly, the referrals have been streamlined as the regular referrals audits are being carried out to avoid unnecessary referrals.
“Mainly the referrals happen because of the non-availability of some specialist/facilities in the rural set up which are difficult to create and maintain,” he said.
“The department is in process for setting up of CTs upto the level of District and MRIs to the level of all New GMCs with reporting through Tele-radiology to reduce load on tertiary care hospitals,” Kumar said.
Spokesperson Directorate of Health Services Kashmir, Dr Mir Mushtaq said the directorate are working to ensure the minimum possible referrals to tertiary care hospitals.
“Specialist doctors have been posted in the sub-district hospitals. Infrastructure and machinery has also improved. However, referrals can’t be stopped altogether. The referral is in the interest of patient care,” he said.
“Though there is a concern we should try to minimize the burden on tertiary care hospitals. Often time there are such cases where we have to make the referral. A patient can’t expect everything to be take care of at the primary or secondary care level,” he said.
