As the strike is temporarily stayed pending a meeting of the hospital’s trustees, hospital staff have been talking about what goes on behind the scenes.
‘This building may look beautiful and impressive from the outside, but inside it feels like a cage or prison.’ – Nurse on strike.
‘Not a single member of the eleven trustees on the Board are gas-affected. They could not care less how patients are treated.’ – Junior doctor on strike.
Bhopal gas survivors have been coming out of BMHT for years with horror stories of the treatment they have received inside. But for the first time, we are getting confirmation of those stories from employees themselves, who are speaking out on the corruption and the abuse of lower-level employees and patients. We spoke to various senior and junior residents, nurses and technicians, and recorded these testimonials.
Discrimination against gas-victims is institutionalised within BMHT.
The hospital was built by order of the Supreme Court for the benefit of gas-victims, but the management appears more interested in private patients, and appears to treat the gas-affected as a nuisance to be suffered until they can take the hospital completely private.
– According to junior doctors and nurses, when they first register, gas-affected patients are given a code number starting with ‘1’ while private patients are given a code number starting with ‘9’. From then on, no matter where they go in the hospital, patients are treated differently according to their code number.
– Nurses said that they receive direct orders from their superiors to prioritise private patients and that they get rebuked and punished if they do not.
– Private patients are guaranteed to receive medical reports signed by senior doctors within 24 hours, while gas-affected patients have to wait for days and even months for reports and test results. For MRI reports for example, private patients receive results in 24 hrs while gas-affected patients have to wait for 5-6 months.
– Employees receive absolutely no training or information about the gas tragedy or how specifically to treat people who were affected by gas.
– Although the hospital was built in order to care for gas-affected patients, the number of in-patient and out-patient private patients have been increasing steadily year by year. For example, the percentage of private patients receiving outpatient services in 2001 was 4.5% while in 2004 it was 11.1%. In the last 2 years alone, the number of private patients has gone up by 30%.
The Board of Trustees and Management are corrupt.
Various large sums of money remain totally unaccounted for by either the Board of Trustees or Management (who have yet to publicly release any financial statements).
– BMHT received 6.5 crores in cash last year from individual private patients, with no record of where this money went.
– BMHT has also been treating employees of Air India, Indian Airlines, Gas Authority India Limited, Steel Authority India Limited as well as patients from the Chief Minister Relief Fund (fund to treat any special guest of the Chief Minister) on credit, with no record of how this money has been collected or used.
– One junior doctor described the excessive number of expensive and rarely-used machines being bought by management – that are sitting around unused without any technicians to run them. The doctor suspects that management is receiving some kind of commission from the medical equipment companies from which they are purchasing the machines.
– There is also a large amount of interest being collected from the original Trust Fund, but again, there is no information as to where that money is going or how it has been spent.
– While the board and management complain of shortages of money to adequately fund and staff the hospital, we have collected numerous accounts of the lavish lifestyle of management/board being funded by BMHT money, including expensive cars, pool/workout room/clubhouse reserved for senior staff/management only, international flights for board meetings, etc.
There are severe shortages of staff at BMHT
There is a severe shortage of qualified staff at BMHT. While the number of patients have increased drastically over the last few years, the number of staff has been slashed, resulting in extremely poor care for gas-affected patients.
– In 2000, there were 198 nurses, 63 senior residents and 21 junior residents; and in 2004, there were 98 nurses, 25 senior residents and 28 junior residents. During the same time period, the number of admitted patients increased 11 times.
– The shortage of senior doctors has been especially critical – for example, in the Cardiology Ward, there is not a single senior doctor. But instead of hiring and paying for more experts and senior residents, junior residents (whose number has gone up slightly) have to take on more and more burden of care that they are not qualified for. In day-to-day practice, this has resulted in poor care and fatalities for gas-affected patients. With the expert doctors not available, less qualified residents are forced to treat and operate upon patients without proper knowledge or practice, which in effect has resulted in medical experimentation upon gas-affected patients. It also results in patients being constantly referred outside the hospital because of the lack of special expertise inside.
– To illustrate the above point, a junior doctor described a situation 3 weeks ago where a patient who was admitted for gastro-surgery started complaining of chest pain. Because there was no consultant/doctor available in the Cardiology ward, a junior doctor in gastro-surgery examined the patient and failed to find the source of the problem. As a result, the patient died of heart failure shortly thereafter.
– BMHT claims to have the philosophy of one nurse to one patient, but reality is starkly different. The ICU itself has a ratio of only 1 nurse to 3-6 patients, and nurses have described other wards where there is only 1 nurse for 30 patients. Nurses have told us that they often have to abandon critical gas-affected patients in their ward because they are told by their superiors to cover other areas of the hospital or attend to private patients.
– Even in the face of such shortages, the management has made no move to attract qualified doctors with good salaries and benefits. Instead, they have been driving people out by slashing salaries, benefits, and creating a miserable work enivoronment.
BMHT fosters inhumane working conditions
– Employees receive inadequate pay:
Employees of all job descriptions complained of low pay that has either been reduced or kept the same since 1998. Although management has been claiming that nurses are paid 5,000 Rs./month, nurses we spoke to said they only receive 2,800 Rs. Junior residents are receiving 8-10,000 Rs., which is half the amount they would receive at comparable institutions in India.
– Employees are overworked without compensation:
Time and time again, employees complained of being forced to work extra hours and shifts without receiving pay or days off. One nurse we spoke to said she works at least 2 unpaid hours extra every day, and at least 2 extra unpaid shifts every week. Other employees including doctors, pharmacists, etc have complained of routinely working 12 hour shifts (instead of 8 hrs) and working 7 days a week when there is no one to cover their position on days off.
– Appropriate medical leave not given:
Employees also complained of not receiving proper medical care or sick leave as promised to them in their contracts. When sick, employees must be examined by the Chief Medical Officer, and no matter what the illness – viral fever, malaria, etc – everyone receives only one day off. But by the time the sick employee completes the examination and then goes through 4-5 levels of bureaucracy to get sick leave papers signed, most of their day off is used up without rest or recovery. Other times, supervisors outright refuse to let their employees leave, threatening termination. For example, one nurse developed a tooth infection that she had to treat with her own money after her supervisor refused to let her get immediate dental care after chipping a tooth at work. Another nurse complained that she was not given maternity leave and that she was working shifts right up to the moment of her delivery. When employees take more than one day for sick leave, pay is usually docked.
– Vacation promised but not given:
All employees are promised paid days off in their contracts, but in reality, when they take time off, pay is routinely docked and supervisors threaten to fire them.
– Employees complain of intimidation, harassment and emotional abuse from supervisors:
Nurses complained bitterly about their superiors, recounting stories of many colleagues who routinely leave work crying because of the abuse they receive at work. The employees to whom we spoke refused to repeat in public the swear-words that their supervisors shout at them. Employees are routinely threatened with the sack, and are accused of making up illnesses and excuses to get out of work. If supplies are missing or equipment malfunctioning, employees are often asked to pay for replacements/repairs out of their own pocket.
4th class workers sign blank contracts:
4th Class workers, including 90 security guards, 150 attendants and 90 cleaners are contract workers who receive no benefits, no share of Provident Fund (retirement plan), and are not even entitled to medical treatment in the hospital. They literally sign blank contracts upon joining the BMHT staff, and are entirely at the mercy of their supervisors regarding work conditions.