Is PIC losing excellence?

LAHORE : The Punjab Institute of Cardiology (PIC) has become a shadow of itself as declining standard of services coupled with high rate of infection contributes to an alarming rise in mortality ratio of serious cardiovascular patients in the hospital.

Punjab Institute of Cardiology – Pakistan’s premier institution for heart diseases situated in the heart of Lahore – which had provided state-of-the-art treatment to cardiac patients from across Pakistan for three decades, but now seems visibly departing from its glorious history with many patients and families leaving the hospital ‘either unsatisfied or devastated’.

“My mother’s chest wound is still open three weeks after her bypass surgery and one can see heart pumping inside the body with a naked eye,” said Ms Fareeha Arshad, daughter of a private female patient at ICU-4 of Ali Surgical Block in PIC headed by consultant cardiac surgeon Prof Dr Zafar Tufail. “Had it been just our patient, it may have been dubbed one odd case, but here every second or third patient’s chest is open due to unskilled manner of stitching being consumed by infection,” she claimed, saying that the patients had become guinea pigs for experimentation in the hospital.

“Having seen patients on neighbouring beds losing lives one after the other, we are compelled to take our mother to some other hospital lest we lose her too to such glaring negligence being committed by doctors and nurses,” she said, lamenting that their patient remained admitted for more than three weeks and we spent almost a million rupees and eventually leaving the hospital after an aggravated operation with ensuing multiple complications and an uncertain fate.

A doctor in ICU of Ali Surgical Block, on condition of anonymity, told The News that the high rate of infection is eating away the stitches to leave the chest wounds of the patients open beyond repair. “The patients, who catch infection, eventually die in hospital, if they are paying, and at home, if non-paying,” he said, while hinting towards the practice of making money out of people’s misery.

Meanwhile, the patients’ files in ICU of Ali Surgical Block suggest longer stay of up to 57-58 days among ICU admissions, which not only reflects the miseries of patients caught in infection but also unnecessary occupying of ICU beds in a public sector hospital for nearly two months in a country with highest prevalence of cardiovascular diseases. The doctors are of the view that the absence of measures to eliminate infection had caused increase in mortality rate up to 15 per cent, as opposed to global ratio of 1-2 percent mortality, during admission post-bypass surgery. Besides, the morbidity rate (the deaths occurring within 30 days of admission) is also very high – a claim they say is easily verifiable through study of average expiry rate among ICU admissions. “Any independent body of doctors may confirm authenticity of the statistics,” they asserted. The doctors also confirmed an unprecedented use of antibiotics as reflective of high ratio of infection. “It optimises per week usage of Inj. Collistin to 1,072, Inj. Rocephin to 1,549, Inj. Vancomycin to 4,065 and Inj. Tygacil to a large extent in an attempt to control the infection. The intra-aortic balloon pump is also being used in one in every four patients, which brings usage to 25 per cent,” the doctors said, terming it all an unnecessary burden either on families of private patients or the government spending from tax-payers’ money on poor patients. The doctors informed that the head of the department does not hold OPD clinic for poor patients, hence remains unaware of his patients’ condition in the absence of follow up.

A doctor said that the middle and lower middle class patients are the biggest losers in the current government. “The head of the department, who performs four bypass surgeries per day, prioritises two patients each from the categories of paying and the poor possessing health card,” he said, adding the middle and lower middle class patients do not fall in either category, hence suffer the most. “The waiting list of patients, requiring bypass operations, has exceeded one-and-a-half year, yet there is never a follow-up of those on the waiting list and bypass surgeries are done on the basis of a reference or a capacity to pay. This is where the Buzdar government has come to in just two-and-a-half years,” he lamented.

“We are seeing the country’s premier cardiac hospital crumble with substandard quality of health services due to inefficiency of administration and lack of government’s attention,” the doctor said, while maintaining that the current administration in PIC was completely indifferent to the matters of public interest as there was neither any measures to control infection nor any official meeting or a workshop to discuss the mortality and morbidity ratio in the hospital.

With the state of healthcare at PIC stated to be in a dismal condition, the doctors and patients’ families have demanded a clinical audit of the all indicators to gauge the actual ratio of infection and mortality rate, which must include a comparative study of the difference of service standard and data of vital indicators of two surgical blocks under one roof.

Dr Azhar Hussain, who himself is a doctor and a brother-in-law of a private male patient in the ICU in Ali Surgical Block, said, “Our patient, despite being a non-diabetic patient sans any complications, developed multiple complications of lungs and kidneys after the surgery, forcing the cash-strapped family to hire doctors of multi-specialties from an adjacent private hospital.” He said there was no extra care for private patients except that the familis of private patients had to bear all expenses of tests, medicines and specialists’ fees for each visit. “The private patients’ unused medicines are administered to the patients of free category, which should be the responsibility of the hospital or the government,” he added.

He said that the attitude of th e doctors and nurses was extremely rough whenever attendants inquire about the condition of their patients. “Who shall explain the condition of the patients when attendants of all patients are evacuated during the professor’s round in the ICU,” he questioned. “For the doctors and nurses, our loved ones may just be patients but they mean world to us.”

Saqib Azeem, a son of a male patient, said that the protocols of intensive care, like changing shoes, wearing gowns, caps, gloves and shoe-coverings for visitors, were not being followed in the ICUs in the hospital. He said, according to consultant cardiac surgeon’s own claim, even operation theatres were not disinfected before two months.

“The bathrooms attached to the ICU are untidy and stinking and wash basins are choked with bottles and tobacco spits,” he said while portraying a sordid picture inside an ICU whose windowpanes were also broken. He further informed that there is no partition with fleece curtain between the ICU beds as the patients are coughing and sneezing openly amidst COVID19 pandemic.

Many attendants of the patients outside the ICU complained that the paramedical and allied health staff and janitorial and security staff were fleecing the people if anyone needs them to perform some task. “Every member of the auxiliary staff in the hospital demands Rs 100 as “bakhshish” for each task performed, while outside the hospital, the parking mafia is charging Rs 50 per day and Rs 100 per night per visit,” they complained. “There can be several visits in a day,” they said.

It was also witnessed by this correspondent that the attendants of the patients, waiting outside the ICUs, created a huge rush without observing the standard operating procedures (SOPs) amid the second wave of coronavirus. There is no concept of social distancing and hand senitizing outside the ICUs, although a few people do wear masks, which may easily spread coronavirus among the people sitting and lying outside the ICUs.

When contacted, Head of the Cardiac Surgery Department of PIC Prof Dr Zafar Tufail vehemently denied the reports of unusual rise in rate of infection or mortality, saying that the activists of Young Doctors Association (YDA) were playing up on the issues to personally target him for holding them to account. “Out of 100 patients, about 4 to 5 patients may get infection with 5 to 6 may die as well,” he said, adding that YDA tries to cash in on the families’ emotions to incite them. “I have no objection to holding of an inquiry into the alleged anomalies.”

Regarding the high ratio of infection, he said that, according to global practice, the department has to be closed if the rate of infection shoots up unusually. “At PIC, we do not confront such situation right now,” he added. For instance, he said, if three out of 100 patients are admitted with aggravated wound, they remained admitted from 6-8 weeks and up to 3-4 months, which does not account for to represent the current rate of infection. However, he said, “We do all we can to prevent infection – a major killer in cardiac surgery, yet it cannot be completely eliminated.

Regarding an unprecedented use of antibiotics, he said that there was no unusual increase in usage of antibiotics as it had remained constant for many years. However, he said, mortality may vary in each month. In September, there was one mortality out of 100 cases; in October, four patients died out of 90 cases; while the deaths were slightly more in the month of November. “The mortality rate has to be gauged over a period of one year or five years rather than seeing it in a certain isolated month,” he added.

He said that every cardiac surgeon operates with a risk of minimum of three per cent mortality in a bypass surgery. In some cases, the risk may be up to 10 per cent. “The fact is we at PIC can’t refuse even the terminal-stage patients referred by private hospitals, which naturally contributes to increase in mortality rate,” he said, saying that there was no such a concern of patients and their families but of those who want their control over the system in the hospital.

PIC Executive Director Prof Dr Saqib Shafi did not respond to the repeated calls and messages to seek his comments on the matter.

Talking to The News, Specialised Healthcare and Medical Education Department (SHC&MED) Secretary Barrister Nabeel A Awan said that if the data confirms such a high figure of mortality rate in the PIC, he would have the needful audit done in a few days in public interest.