The plight of patients in private ICU-ICCU hospitals in the city of Mumbai is pathetic. This fact provided reason enough to study the subject. An examination of the conditions of these specialist units demonstrates that they violate the most fundamental human right — the right to life — and the directive principle of the right to health care. The phenomenal mushrooming of these private ICU-and ICCU-hospitals in Mumbai parallels the commercialisation of the medical profession and is fast destroying its ethics and morals.

There are no standards or regulatory bodies for private nursing homes, or for the private ICCUs which cater to almost 85 per cent of the city’s population. The terms ‘intensive care unit’ and ‘intensive cardiac care unit’ conjure up a picture of a struggle to survive; the most vulnerable and unfortunate of humans, in need of the utmost care.

Critical care is a high-technology specialisation in medicine. People admitted are often dangerously ill on admission. They can also be high-risk cases — ill and with associated medical problems — stable but admitted for observation because they could develop a life threatening situation at any time. Proper critical care with timely diagnosis can save their lives. This second category benefits most from proper and scientific critical care.

There are four categories of ICU-ICCU hospitals: government and municipal which are free, subsidised charitable trust hospitals, private trust and corporate hospitals, and totally private single or partnership ventures. This study examined 40 ICU-ICCU hospitals in the last category.

Medical nursing homes in Mumbai tend to label a few beds ‘critical care beds’ and proclaim themselves to be an ICU-ICCU hospital. The only uniformity one could note in these units was a big hoarding; 50-70 square feet for each bed and the attached gadgets; an ECG machine; a cardiac monitor (in slightly over half of the units surveyed); a defibrillator, a suction machine, oxygen cylinders, an Ambu bag with tubes, and some injections. The RMO was often non-allopathic, the nurse often unqualified, and a qualified specialist was rarely present at the time of the visit.

Critical care requires the presence of a team of qualified specialists on the premises round the clock, and of a knowledgeable director who coordinates the team of specialists managing the case.

However, in the private critical care hospitals visited, it was found that relatives were asked to observe the cardiac monitor and alert changes in cardiac rhythm to the sleeping RMOs and nurses. They were also asked to provide nursing care such as sponging, feeding, making beds, giving medicines, and giving bed pans.

The 40 ICUs-ICCUs visited (all were in the suburbs) admitted cases referred by family physicians and specialists as well as by doctors who may have a stake in the unit. Patients also came directly for emergency admissions.

The doctor on duty was rarely an allopath. Round-the-clock critical care, monitoring, and assessment of the progress or deterioration of the patient were all left to a non-allopathic doctor on duty, and to unqualified nurses.The specialists were rarely in the hospital, often choosing to order treatment by telephone.

Charges varied from Rs 600 to Rs 1,500 per day for a cot and use of the cardiac monitor. All 40 hospitals surveyed offered a referral commission ranging from 30 per cent to 60 per cent. This would result in compromised services, unwarranted admissions and treatment, and even death.

In terms of the hospitals’ functioning, there was no evidence of standard protocol for critical care, no teamwork amongst the treating specialists, no holistic approach, no mortality auditing, no evidence that the doctors keep themselves up to date on medical developments. The absence of essential drugs such as injectable streptokinase and nitroglycerine is deplorable.

Patients’ relatives evidently accept as destiny the unnecessary deaths that must occur from such negligent treatment. They are helpless, the laws outdated, litigation prolonged and expensive, and there is no other system to redress their grievances. Nor is support of any kind forthcoming from the medical community, nor from defunct medical councils which protect the profession, nor from apathetic governments , municipal corporations, medical associations which include the Indian Society of Critical Care. This apathy and lack of support at all levels will certainly have contributed to the shoddy functioning of these so-called ‘critical care units’.

Apparently it is impossible to run a critical care unit with minimum standards. The purpose of a critical care unit is to save lives. However, this does not happen in these units. When you call an ICU-ICCU hospital, it should give that care. Precious lives should not be extinguished because you advertise something that you don’t give.

(Based on a thesis in the departi,lent of civics and politics, University of Mumbai)