STNM Hospital

Gangtok: A day after testing positive for COVID-19, Sikkim health minister MK Sharma was rushed to Central Referral Hospital, Manipal for a CT scan on his own, allegedly with no aid from STNM Hospital, the compound where he resides. The reasons for the urgency remain unknown, but sources in STNM Hospital reveal that ‘CT Scan machines in the STNM Hospital are not working since June’.

On the contrary, sources in CRH Manipal also reveal that the minister was the first COVID positive patient to have his CT scan conducted at CRH Manipal. So far, Sikkim has witnessed 1,336 COVID positive cases, with three fatalities on record as on August 21.

The glaring concerns that have come to light are, were CT scan conducted for every other ,1336 patients so far? Did the three fatalities miss out on the CT scan for their lungs? The scan presumably asserts on the severity of COVID and its effect on the patient’s lungs. So far, STNM has been conducting X-rays of patient’s lungs to assert on the severity, with a portable machine at its disposal on the 8th floor of the hospital, a designated COVID wing of STNM.

EastMojo digs deep on why the CT Scan machine is not functional at STNM Hospital.

Why is the CT scan machine at STNM Hospital not functioning?

Upon a question by EastMojo to a senior doctor, ‘fearing pressure from higher up’, who requested anonymity, stated, “CT scan at STNM has been facing problems for 2-3 months. Our fealth administration has known about this issue, with correspondence having happened from the hospital’s end many a times. In February, most of the machines lost their warranty, it was on a year-long warranty. Once the warranty expires, the government must sign a comprehensive maintenance contract with the company providing equipment like a CT scan machine. The same must have happened from March, for CT, MRI, Cath Lab, Ultrasound, X-ray, for all such high end machines”.

What happens when you sign a contract?

With the contract signed, the company in contention would need to come for servicing of the equipment. In March, the company sent a contract package to the STNM Hospital and State Health Department, wherein it highlighted the amount to be paid to the company, which the senior doctor refused from revealing. “It was a heavy contract, that is all I can assure. Once the contract is signed they will carry out AMC servicing, which is annual and a routine procedure. The company quoted the price, we also sent the correspondence to the Department. The same must go to the State government with further correspondence to Union Health Ministry, for the amount quoted to be passed. Once the contract is signed, the services will be carried out by the company, as per the norms for one year. Any complaint we make, the company must send individuals for servicing”.

Why has the contract not been signed since March?

The hospital knows very little about whether the file sent to the health department has reached the State Cabinet or not. “It does not stand on our part to follow the contract; it is between the corporate and the Health Department. Our concern lies on the treatment of the patient, wherein the CT Scan machine as mentioned, is in dire need for the patient’s diagnosis. We have pressed on the urgency from March, and months have passed since then. We have been facing the brunt from the patients as to why a simple CT Scan cannot happen in STNM Hospital”, said another senior doctor.

What is the company’s stand on the same?

It appears, the company in contention for the CT Scan had carried out extra servicing, beyond the annual contract. “Based on the verbal assurance from the Health Department, which did happen, the company did replace parts of the machine, which marks equivalent or more than servicing. In March, the CT Scan machine did suffer a malfunction, they added couple of lakhs worth part to the CT Scan machine. Even after the parts were replaced, the file in contention for the signing of the contract, was not released by the Health Department. When the signing of contract didn’t happen, the company felt insecure on the lines of whether the contract would be continued in the future or not. Will it be given to someone else? Seeing the same, the company took an affirmative stand on not continuing servicing until the contract is signed”, said the senior doctor.

Can the contract not be signed virtually?

Since it is COVID 19 and lockdown protocols are strong on entry on technicians to the State, Can the contract not be signed virtually? Asked EastMojo. To which the doctor in anonymity, mentioned, “The contract does not need presence of individuals, they can send the quotation as a soft copy, the same can be signed and sent back to the company by the State Health Department. Whenever, they sent the quotation, which the company has, they have already signed and sent the same. The only remaining part is for the State government to sign it. If it was private, the head of operations would decide on the same and sign and send it, but with STNM being under the government, the file has to reach every nook and corner, before approval. Hence, the process takes time, but it is the responsibility of the State Health Department. The Hospital merely has to send the quotation”.

Is there only one CT Scan Machine in STNM Hospital?

“If we have more than one CT Scan machine, it would be a huge cost for the State Government and STNM Hospital. One machine is heavy costing, in one year, the machine servicing cost ranges around Rs. 40 lakhs, just for the contract. Hence, multiple machines cannot happen, there is only one CT Scan machine in STNM Hospital. There is another machine in old STNM Hospital, but we left it there itself. It was considered for repair work later, as the transition of the machine is another big cost to bear, as these are heavy machines. It was kept as a backup machine for Geyzing District Hospital, but till now in a span of one year, that machine must be redundant. With new parts, it may come in handy in Geyzing District Hospital, but right now it is non-functional”.

There are reports of CT Scan machine functioning till April in STNM?

“The CT Scan machine has been nonfunctional since June, it was the warranty that expired in February. Immediately after warranty expires, it is not the machine starts dis-functioning, it runs. If it runs, it is in our benefit, that the company need not be called. Also, minor problems to the machine, can be aided by the technicians at our disposal, they can rectify in correspondence with the company over phone. Minor problems shoot up every week. But the problem currently with the machine does seem major”.

What exactly is the problem on the CT Scan machine?

“The tube head has a problem, so that is something we cannot correct nor do we have the adequate tools or technicians who can understand that problem. It is beyond our technicians, even if we do open and put it back, it will result in a counter case upon us by the company. Since April a major part has been spoiled. Based on a verbal assurance by the Health Department, with a promise for contract continuity being signed, urging for the replacement, we took a permit during lockdown to invite such technicians, who replaced the said part. It was functional after that with the machine functioning till mid June. After that, even the Department didn’t sign the contract while company officials also maintained they will not come, claiming it is not cost effective.”

Did the government lack in commitment for CT Scan machine review?

“If such a case were to arise in the future, the government should have thought about it, had a vision. The same has proved to be true with the Health Minister needing to be rushed to CRH Manipal instead of getting the same CT Scan in STNM Hospital. It should have been thought that the machine is a dire need for public who cannot bear the high cost of a CT Scan. Me being a doctor, if a case came when I cannot carry out the same process of CT Scan for my father or anyone close, it would be so disheartening for me. Hence, now we have a problem”.

Since June are the CT Scan technicians not working?

CT Scan, MRI, X-Ray have technicians who rotate every 6 months. CT Scan has 9 technicians, MRI has 6 technicians. There are around 15-16 old technicians, but last year as part of new recruitment we STNM procured 13-14 new technicians. Some are from Geyzing, some are under contract, some are from National Health Mission and 5-6 are from CRH Manipal.

“Since June, the machine is not functioning, so all the technicians under CT Scan have been shifted for COVID duty. They are carrying out portable X-ray at the 8th floor of STNM Hospital. As per protocol, if the patient comes in ICU, it is preferred that CT scan must be conducted. There are new drugs that are being tried to follow up on the same along with research activities, based on which the Health Minister must have been put under CT Scan at CRH Manipal. Today, if the CT Scan was conducted, based on which the drug will be given and tested what kind of improvement may have happened. As, CT Scan is clearer in diagnosis of COVID than an X-ray. Even if people test negative for COVID, CT Scan is also seen as an alternative for diagnosis, even against RT PCR testing. CT Scan is almost confirmatory, as there is no 100% reliability”.

Why does COVID need CT Scan?

To begin with COVID 19 is an issue of the lungs. “The entry point for COVID is throat and nose, but it most affects the lungs. With a CT Scan, they check up on the chest and lungs. The virus enters with breathing, so lungs are undoubtedly the most affected. But the same is not 100%, some have mild symptoms and some are asymptomatic, so there is no finding in the lungs. In severe cases or with co-morbidity, it affects fast and lungs is involved. It is one of a kind viral pneumonia”.

Has CT Scan been conducted for COVID patients in Sikkim?

“We have not conducted any CT Scan, we are only conducting X-ray with portable machine in the COVID ward. X-ray is conducted on 50% of all cases so far. So even for those who had fatalities, there may not have been a CT Scan, which I am unsure of. We had COVID since May 23, so when the CT Scan machine was functional, we had a meagre number of COVID cases, which was yet to cross 100 and with no fatalities. CT machine also went dis-functional and the cases also started getting severe”.

Does any other government district hospital have CT Scan?

In a recent development, when a patient died of brain haemorrhage at CRH Manipal’s door step. Namchi District Hospital’s Medical Superintendent Dr SN Adhikari asserted on carrying out a CT Scan for the patient, which delayed the process for the referral to CRH Manipal. There is only one radiologist in STNM Hospital in Dr KN Sharma, who serves as the only radiologist for Government Health Sector. “Namchi District Hospital does have CT Scan machine, in between when the machine at STNM was malfunctioning, we did send patients to Namchi for CT Scan. There is only one radiologist, so despite the technicians carrying out the CT Scan, the radiologist at STNM has to carry out the diagnosis of the report or the film”, said the senior doctor.

CRH Manipal on the CT Scan for health minister

CRH Manipal refused to comment on the Health Minister paying a visit to the hospital for a CT Scan. But a senior official maintained that the process was carried out as per protocols with technicians in PPE suits. The CT Scan machine has since been sanitized and if there is concern about the exposure, the same could be sealed for 72 hours.

However, another doctor in anonymity maintained, “A day ago, CRH Manipal was questioned on its stand on negligence by political leaders and a legislator. We were slammed ‘if we are unable to carryout functioning to give the hospital to the State government’. It must be known that CRH Manipal is still under private public partnership. We have come in handy for the Health Minister today, and we will carry on with our public service, irrespective of all the criticism. He was the first COVID positive patient to visit CRH Manipal for a CT Scan, posing a threat to the entire hospital, which still has to carry out its non-covid duties”.

STNM on minister opting for CRH Manipal

STNM Medical Superintendent Dr. CS Sharma upon being questioned about the lack of CT Scan maintained, “The CT Scan machine has been dis functional only for a week. The Minister did not consult with the hospital and commuted on his own. There was no ambulance sent, he facilitated his own transition to CRH Manipal”.

Health Dept unaware about Health Minister’s visit to CRH Manipal

Health Director General Dr Pempa Tshering Bhutia maintained he was unaware about the visit to CRH Manipal made by the Health Minister Dr MK Sharma. “He is a minister, he may have contacted the hospital and reached on his own”.

On being questioned about the transition of a COVID positive Health Minister from his residence in STNM premises to CRH

Manipal, Dr Bhutia suggested the STNM Medical Superintendent to know better about the same. “Ambulance are a concern of the STNM Hospital, which I would not know of?”

The Health Official also admitted on the CT Scan machine not functioning at STNM Hospital. “The CMC contract has not happened, once it does it will work out. It is an internal issue, which I cannot comment on. CMC has not been approved, hence the issue. It malfunctioned once before, it has once again malfunctioned. A better understanding can be drawn from the Medical Superintendent or the Radiologist. I would not know details of STNM Hospital, I cannot have an idea about the entire State. The concerned person would know from STNM Hospital. We are waiting for Government approval, it needed approval from the Health Minister himself. Let us see, how it goes from here on. Once the contract is approved, the repair will happen. Why malfunctioned so early, is in the hands of the GE company. It is a very expensive machine, it is one of the best CT Scan and MRI machine in the entire Eastern India, it is one of the latest machines”.

The Health Director General did admit that the file for the Contract to have reached the Cabinet. “We have sent the file but it has not come back to us. It has been quite some time and it must be with the Minister. I would not know when it was forwarded”.

Health Principal Secretary Srinivasan Sulu on the unavailability of CT scan machine and the Minister opting for CRH Manipal, stated, “Our CT scan needed a spare part which needs to arrive from Mumbai, which will reach us in the next few days. The Minister went in his personal capacity, it’s similar to him reaching anywhere for treatment. He went for the test to CRH Manipal, and is back in isolation. Manipal Hospital has been decontained. He had wore PPE to masks and so he went. Him being Minister, he can go. Minister has access to go anywhere. We are in agreement with Manipal, 25 bedded have been earmarked for CoViD. Not just a Minister, but any other person can also go to Manipal if they are COVID poaitive. Manipal has also been declared as a COViD hospital. I have signed the agreement with the Medical Superintendent Dr. Gautam Dey, which has been a month now. We are also finalizing a floor of the Hospital for COViD, taking into account the rising COVID cases as out patients cannot go to Siliguri”.

The Principal Secretary also asserted on issue of a vaccine for COViD which the State Health Department has retrieved. He also asserted on making the CT Scan functional in a week at STNM Hospital. “The parts are

in Mumbai, with rains the flight is not taking off. There are also materials in Delhi which needs to reach here, but we are unable to retrieve. STNM Hospital is new and it takes time”.

“I assure you that what has happened with Health Minister, will not be repeated for other COViD patients. The deaths in Sikkim so far have been of co-morbidity barring one which was genuinely COVID death. No one has died of respiratory distress, hence we are bringing new vaccine which has been retrieved from USA and not even available in India. All are common, in good faith we have signed an agreement with CRH Manipal”.

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