So far, the encephalitis death toll has reached 112 for children from Muzaffarpur.
On 18 June, Aaj Tak reporter Anjana Om Kashyap, along with her camera crew, brazenly walked into Muzaffarpur’s Sri Krishna Medical College Hospital’s (SKMCH) wards and even the intensive care unit (ICU) to report on these deaths.
The incident caused a storm on twitter, with people criticising her for accosting a weary-looking doctor in the middle of his very busy shift and disrupting essential healthcare services.
Among these valid criticisms, comes another – it is well known that in any hospital, special clearance is needed even for the relatives of patients admitted to enter the ICU, so how and why was Kashyap allowed to enter and film her segment? More importantly, is this medically sound for the admitted patients?
ICU Ethics – What’s Allowed and What’s Not?
To power up a story, reporters do go to extreme lengths, but what are the protocols of entering an ICU for everyone?
Bihar’s Health Department has released a set of guidelines which clearly state that patients with encephalitis should be kept in a peaceful environment, devoid of any loud noises.
FIT spoke to Dr Vishakh Varma, a consultant of critical care medicine at Akash Healthcare Hospital, who gave us the low-down on ICU ethics for doctors, patients, relatives and everyone in between.
The universal protocol across the country is that the ICU is a very secure area and there are multiple checks and clearances at various levels to enter. For example, at our hospital even an attendant needs to be granted access from two guards, one at the hospital reception and one outside the ICU door. Then, one must take precaution to control the spread of infections by using a hand drug and changing footwear. The same applies to visitors.Dr Vishakh Varma
Dr Brij Mohan, a professor in SKMCH's Department of Pediatrics, added,
According to hospital rules, entry into an ICU like this is not allowed. This is a known fact, and not something we should have to explicitly mention – it should be understood that once cannot just enter anywhere.Dr Brij Mohan
For example, according to Fortis Hospital’s ICU Visiting Guidelines, all ICUs come under ‘restricted areas’, where visitors have to follow certain protocols.
Isolation gowns, masks, gloves, shoe covers are to be used, along with hand sanitizers before entering and while leaving the ICU.
Cameras in the ICU? Not Okay!
Dr Brij Mohan said that coming in front of the camera or in contact with other equipment like lights, even in the patient ward, can increase the risk of infection. This could also lead to cross-infection in children.
“Visitors, like journalists perhaps, need to be granted special permission to enter, and this is rarely given by the hospital management,” said Dr Vishakh Varma.
Many times when we have had VIP patients in the ICU, and journalists have wanted to enter, they have been denied permission by the management.Dr Vishakh Varma
He adds that even if permissions are granted for the journalists and their teams, shooting a live video inside the ICU is problematic.
It is not correct ethically as it violates the patient’s privacy, many times they are in compromising, [vulnerable] positions. Besides, the patients need to give written consent before the video goes out.Dr Vishakh Varma
After this, there is only a limited time slot of 30 minutes to an hour per evening and morning that is allotted as visiting time.
“Even then, a guard usually regulates the movement of visitors to avoid chaos.”
Dr Varma did acknowledge that during a crisis or an epidemic like the one in Bihar, any hospital’s ICU will be under stress and would see a lot of over-crowding.
However, it would be over-crowded in terms of patients, not relatives and families, and the visiting hours would generally remain the same to regulate the additional crowd of visitors.
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