PESHAWAR: The restrictions placed on admission of patients to Khyber Teaching Hospital from private clinics of consultants have beset senior doctors, who argue that it is against the law to deny hospitalisation to patients.

Since long, it had been a standing practice that consultants referred patients from clinics to the hospital where they were admitted to their respective wards for surgeries and clinical management etc. However, last month, the Board of Governors (BoG) of KTH decided that the consultants couldn’t admit patients from their clinics directly.

The board allowed the doctors doing institution-based practice (IBP) to admit patients in their respective wards.

Following the implementation of Medical Teaching Institutions Reforms Act (MTIRA) 2015, the management of 10 teaching hospitals has been the domain of their BoGs concerned. Prior to enforcement of MTIRA, the health secretariat managed these hospitals.

BoG chairman denies ban on referral from private clinics

The MTI-covered hospitals had recruited consultants on contractual basis. They don’t do private clinics but attend IBP in hospitals in the evening. Part of the income generated from the IBP goes to the hospitals while the MTI consultants get consultation fee. They also perform duty in MTIs in wards, operation theatres and elsewhere and get lucrative salaries.

The consultants, who worked in the MTIs before enforcement of the law, are doing morning duty in the institutions and attend their private clinics outside the hospitals in the evening.

Now, consultants are not referring patients on clinic chit but on white paper to the hospitals.

“Acutely serious patients are referred to a tertiary care hospital for admission into emergency unit on call. But it is the discretionary power of hospital whether to admit or refuse,” said a senior consultant.

On the other hand, IBP consultants were allowed to admit even a stable child on non-emergency days to his/her unit, he said. “This whole exercise is contradictory to MTIRA 2015 where government has agreed that IBP will not be compulsory but optional for old faculty members,” said the senior consultant.

IBP is an integral part of MTIRA and all the newly-hired consultants do it. While the non-MTI consultants don’t do IBP and continue their private practice as usual.

“There is no ban on referral from private clinics. The ban is that the referred patient will not be admitted for the referring consultant under his/her name but will be hospitalised under the name of the respective consultant on call for that day,” Prof Nadim Khawar, the BoG chairman of KTH, told Dawn.

He said that that any general practitioner or specialist could refer patient to KTH. However, sources said that patients sent by Prof Nadim Khawar from his clinic were being admitted to the hospital.

Prof Khawar, a former head of child health department at KTH, said that his patients were not admitted under his name. “Nor am I involved in their care,” he added.

The BoG meeting held last month also decided that there would be no admission of patients from private clinics of the consultants and only the IBP consultants had the privilege to hospitalise patients from their clinics located inside the hospitals.

The meeting had informed all the consultants of the hospitals that there would be no admission on the clinic chits and in case of referral, the patients would be evaluated in accident and emergency department of the hospital to decide about their hospitalisation or otherwise.

The non-MTI consultants argue that they had been assured by architects of MTIRA that they would continue to do private practice as well as send patients to their wards for admission as was the practice prior to enforcement of the new law.

“The hospital is not ready to admit our seriously-ill patients in our wards whereas those referred by IBP consultants are readily admitted,” they said.

However, Prof Khawar said that admission was not denied to any emergency patient. “Under the admission policy, all the patients sent from outside clinics would be examined by MTI consultants at the hospital. We cannot deny admission to the patients,” he said.

Published in Dawn, July 20th, 2021