Referee Referrals

Sikkim has two big hospitals - STNM Government Hospital and Manipal Central Referral Hospital - but as far as treatment for patients ailing from critical diseases or serious accidents is concerned, both fail to deliver on expectations. Meanwhile, the district hospitals and primary health centres are only equipped to treat minor ailments like flu or to dress wounds.
The STNM Hospital, which is still the more trusted institution for most here in Sikkim and is also a referral hospital, is facing acute shortage of beds. If a patient in critical condition is taken to the emergency ward of the hospital, he or she will immediately be forwarded [not referred, mind you] to the CRH with a note on the hospital card that says “patient sent to CRH due to unavailability of bed”.  The patient is then required to be taken to the CRH.
At CRH, registration is done after paying Rs. 100 as card fee and a minimum of Rs. 5,000 has to be deposited at the billing counter as security deposit followed by various other expenses for tests and medicines. Although the newly launched insurance policy ‘Swasthya Suraksha’ does provide some respite, many have expressed their dismay over the high cost of medicine at the CRH pharmacy.
Though CRH is a referral hospital, it does not meet the criteria of a referral hospital. For instance, it lacks specialists in various departments for which patients must be taken to nursing homes in Siliguri or to other states. In some cases, families have been forced to take their patients outside the state after prolonged treatment at CRH did not help in recovery.
Here starts the most agonizing part. Whether it is because of lack of coordination between the authorities of these two hospitals or ego problems among the babus, the patients and their relatives face serious problems during this stage.
Recently, one of my relatives suffered a brain haemorrhage. We first took him to STNM Hospital. After a CT Scan, the doctors advised us to take him to CRH because STNM Hospital did not have a spare bed for the patient. We did so and kept him under medical supervision at CRH for a little over a month. Looking at the lack of any signs of recovery and deteriorating health of the patient we asked the doctor to refer him to a private hospital in Siliguri. The doctor denied our request insistent that they could treat the patient and told us that if we remained insistent, we would have to take the patient at our own risk. We agreed and asked for the patient to be discharged. The discharge paper clearly said, “discharged on patient party’s decision against medical advice”.
Someone told us that a patient discharged against doctor’s advice won’t be provided ambulance service in CRH. So we approached the STNM Hospital with a request as it was providing the facilities till a couple of days back. But to our surprise, the authorities there said that they had recently stopped providing ambulance service to CRH patients. It was already noon when the message reached us. Some relatives close to the authorities at CRH approached the management and we were not only provided the ambulance but also a male nurse to attend to the patient on the journey.
Our patient being a senior citizen as well as a Sikkim Subject, we tried to approach the Health Department for benefits provided by the Government to a referred patient. Here too we faced problems as the paper given by STNM Hospital to take our patient to CRH does not mention the word ‘referred’. This, despite the assurances of officials at STNM Hospital of helping after the treatment was over.
Similar complications arose in the case of a journalist friend who is undergoing treatment in CRH and was advised by the doctor to seek treatment outside the state. When some of our friends approached the concerned authorities in the Health Department for assistance under the Government’s referral benefits, they were told that there is no such provision for patients admitted in the CRH.
These issues must be resolved by authorities of both the hospitals in order to provide better service to patients in the state.