Losses, chaos on 26/7 compel Mumbai hospitals to relook into contingency plan

Rita Dutta - Mumbai

Mumbai’s relentless and historic downpour on 26/7 which claimed lives, wrecked property worth crores of rupees and rendered many homeless had private hospitals at their wit’s end. Besides being a mute spectator to breakage of equipment and damage of infrastructure due to flooding and water seepage, hospital authorities had to grapple with power cut, a dwindling stock of food, water scarcity and provide accommodation for hundreds of stranded employees.

The power cut and damage of engineering equipment at Guru Nanak Hospital at Bandra even led it to a temporary closure. The mayhem and losses have compelled the hospital authorities to re-think their sketchy contingency plan.

Revenue also had plunged by 25 to 30 per cent in private hospitals for a week starting from 26/7. Asian Heart Institute (AHI), which rakes in Rs eight crore in a week’s time has been slapped with a financial loss of over crores of rupees in that dreaded week. Said Dr Ramankant Panda, CEO, AHI, “We have incurred a loss of revenue of over Rs two crore.”

The hospital has estimated another Rs 2 to 3 crore over damages of instruments and infrastructure due to water seepage. Said Dr Mitul Thakker, general manager, marketing, AHI, “After doing a proper estimate, we would make our claims to the insurance company.”

The loss of revenue is attributed to low patient trickling in the OPDs and health check-ups and cancellation of surgeries. Similarly, Raheja hospital is reeling under a loss of 25 per cent revenue, with almost no patient for health check-ups, less than 50 per cent patients in OPDs and 25 per cent reduction in in-patient flow in that week. Same with Lilavati Hospital, which besides losing 30 per cent revenue also lost old patient records and medicine stock.

At P D Hinduja Hospital, the OPDs wore a forlorn look for three days from 26/7 with around 30-40 people. Said Anupam Verma, director, administration, Hinduja Hospital, “Business improved a little after 28th with around 200 people in the OPD. On a sunnier day, the OPD teems with around 1000 patients.” Of the over 40 scheduled surgeries, around 20 could be conducted, the rest postponed because of low patient turnout, he added.

Challenging time for healthcare providers

It was a litmus test of patience, diligence and dedication for hospital administrators, doctors, nurses and staff, who slogged for 24 to 48 hours incessantly confronted with an array of problems. Firstly, the authorities had to provide accommodation and food not only for the hundreds of patients, but also to their relatives and hospital staff, stranded in the hospital on 26/7. The situation was chaotic with most hospitals not having in-house staying facility for staff. Hospitals used unutilised spaces, like departments, conference rooms and auditoriums and made arrangement in nearby hotels.

What was even more arduous was whipping up culinary dishes from a fast depleting stock of food. Says Brig Joe Curian, CEO, Raheja Hospital, who was stranded in the hospital for two days, “We did not have so much of a problem with the food stock on the first day. But from the second day, we were forced to ration our meals.”

For AHI, it was challenge twice over as apart from feeding 1000-odd stranded patients and staff, the hospital had to provide food for 500 people who took shelter in the hospital on 26/7 from a nearby area. “How we could have said no to the hungry souls who came here on the first day? But on the second day, we were afraid whether we will be able to continue with our benevolence. We started rationing our food and gave instructions to look after our own patients and staff first,” recounted Dr Panda. Beset with water shortage on the second day, AHI had to get water from BMC tanker, which was chlorinated before use.

Alarmed by the presence of a posse of 450 staff, 250 relatives of patients and 40 consultants on 26/7 who took shelter at Lilavati hospital, the hospital management took immediate measures in procuring 100 litres of extra milk and dispatched ambulance to get loadfull of vegetables. Said Dr N D Trivedi, vice president, Lilavati Hospital, “We provided free food to all our employees during those critical hours and requested them to stay back in hospital.”

Post-26/7, hospitals had to struggle with skeletal staff, with employees who had trudged home not making it back to the hospitals for a day or two.

Says Col B S Khimani, executive officer, Jaslok Hospital, “We dealt with manpower shortage by rotating our staff, but ensured that work was not crippled.” Other hospitals too, paralysed by 60 to 70 per cent absenteeism, adopted a similar strategy.

Trying to save paperwork, equipment and medicine stocks from the flood was another uphill task. Many hospital lost their storage items housed in the basement. Said Dr Vivek Desai, CEO, HOSMAC, a hospital consultancy firm, “Most of our hospital do not have a proper storm water drainage system. Even engineering staff are ill-trained in switching off machines in such situations.” The closure of Guru Nanak Hospital is an apt example of this failure, he added.

But despite the travail, what kept the morale high and work going were encouragement from the management, generosity of medicos who stayed back to offer their services willingly and helpful attitude of hospital staff who worked incessantly, without grumbling.

Revealed Dr R K Anand, medical director, Jaslok Hospital, “We cheered our staff to give that extra bit and decided to give them overtime. I was surprised to see how people smiled and worked, without cribbing.” Lilavati Hospital has decided to give monetary incentives to staff affected by the flood, said Dr Trivedi.

Playing the Good Samaritan

Neither loss nor the harrowing time deterred some of the hospitals in rendering yeoman’s service. Over three days, AHI reached out to over 25,000 slumdwellers by distributing cooked food and also medicine, when required.

Said Dr Aasish Contractor, head, preventive cardiology, AHI, who participated in the relief work, “We handed over food to slumdwellers of Kalina, Tunga and Vakola, pockets severely affected by the flood.”

Hinduja Hospital sent their mobile team of doctors for four to five hours every day to residents of Malad, Santacruz, Borivili and Kalina to attend to medical calls and distribute medicine, including tetracycline. “The mission was successful, with as many as 150 residents approaching our team everyday,” Verma recounted.

Jaslok also launched a helpline in Marathi, Hindi and English for hassled parents of children affected during the flood. Even Association of Hospitals (AoH) also asked hospitals to constitute a special committee attending such duties, said Curian.

We have incurred a loss of revenue of over Rs 2 crore. Additionally, we have estimated the damages caused to instrument and infrastructure to another Rs two crore Dr Ramakant Panda CEO, Asian Heart Institute, Mumbai	We did not have so much of a problem with the food stock on the first day. But from the second day, we were forced to ration our meals Brig Joe Curian, CEO, Raheja Hospital	Hospitals should have a buffer stock of non-perishable items, including food and medicine for three months as part of contingency plan Dr Shakti Gupta, dept, hospital admin, AIIMS, New Delhi

How sound was contigency plan of Mumbai hospitals

Mumbai hospitals have attended to blast victims, participated in relief work of earthquake-ravaged Bhuj, but the mayhem following the unprecedented rainfall took them unawares, also raising questions about the inadequacy of their contingency plan, if any.

While some hospitals claim to have such a disaster management plan, it is mostly on paper, claim experts. Neither do hospitals document their disaster management plan, nor the staff trained for it on a regular basis For hospitals which have a contingency plan, it only encompasses medical emergencies. “AHI is prepared for tackling epidemic outbreaks, accident victims, but not for such natural calamity,” revealed Dr Panda.

Admitting the absence of a contingency plan for combatting with disasters at Lilavati hospital, Dr Trivedi says, “This disaster was unprecedented. In such critical times, it is important to refrain from panicking, use intelligence and plan accordingly.” He however added that a contingency plan from a body like AoH would be welcome. While Raheja hospital was prepared to tackle such a huge patient flow for a few days, it was not ready for a week’s span, admitted Curian.

But why do hospitals need a contingency plan? According to Dr Shakti Gupta, author of “Emergency Medical Services and Disaster Management: A Holistic View” published in 2000, “Every hospital should have a contingency plan as it ensures better mobilisation of resources during critical times.”

Modifying contingency plan

The recent adversity have hospitals pondering on modifying their contingency plan, with emphasis on inventory management, improving medicine and food stock, have better drainage system and increase in-house accommodation. “We also need to constitute an in-house emergency medical team, which would swing into action during disasters,” said Curian.

The contingency plan of hospitals should be detailed to include crisis related to various sorts of strikes, road accidents, earthquake, floods, said Dr Gupta, also additional professor, department of hospital administration at AIIMS, New Delhi. On inventory management, he emphasised on the importance of having a buffer stock. “Hospitals should have a stock of non-perishable items, including food and medicine for three months. Even vegetables can be stocked at –20 to –40 c at cold storage for over a month, ” he said. The golden way to deal with shortage of food during trying times is to have a simple menu, said healthcare management consultant Dr K C Ojha. According to Dr Desai, “We need proper planning of hospitals, with greater emphasis on which department to be housed in which floor and better storm water drainage facility right at the conceptual stage.”

Said Dr Kanchan Mukherjee, department of health services studies, Tata Institute of Social Sciences, “Its time for hospitals to do a SWOT analysis and improve its service based on the survey.”

Hospitals also need to train their staff in disaster management with rehearsals and mock drills every three months, added Dr Gupta, who has assisted the government of Pondichery, Karnataka and J&K to form a disaster management plan for hospitals.

rita_dutta@rediffmail.com