We demand 'Safe ICUs for ALL' insulated from any negligence.
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Shout Out....
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Speak Up !!
To begin with, we are NOT against medical community, rather we salute all those sincere medical people who work with full integrity to save human lives. However, there are many incompetent, irresponsible people, processes in our Indian medical system who becomes the cause of negligence and thus claim uncountable human lives.
All these below 'negligence instances' are quite common in any hospitals or medical institution. So, our demand is not from one doctor/one nurse/one hospital rather whole medical system of India. There are things which should be demanded as standard of ICU care to avoid such lapses/misses and negligence altogether for each citizen of India. And while you are reading this page, there are things that are happening right now also inside the ICUs which are taking away life of our loved one. We don’t know when any of us be next to fall under the trap of these ICU walls and mistreated and ignored to let die. And our family will hear the news 'cardiac arrest' or 'multiple organ failure'. |
Please share your comments(at bottom of page) about the medical negligence faced by you/your family/contacts. So, this can be collectively viewed by responsible authorities for corrective actions.
For full negligence case details of our Father’s stay in COVID ICU ( Wed 5th Nov - 10th Nov 2020) ....Click here. (few points mentioned in Pt 21.)
1-14) See the section at bottom of the page, written in 2015.
15) ICU negligence, patient fall – One of the day during 2010, when one of us were standing in Mumma's ICU(35+ bedded single hall with partitions), noticed that a patient fall from her Bed. No-one was there near to that ICU bed partition. 3-4 nurses did rush after hearing the ‘bang’ and picked her up to place on Bed again. Her vitals were fluctuating. I was asked to leave immediately and come back after an hour. Next day, ICU staff disclosed the news of multiple organ failure to patient's family.
You will never know whether your loved ones did fall, improperly positioned, facing some choking or difficulty when no-one was around them when they needed it most.
16) ICU negligence, unattended patient during doctor's round and critical situation- During 2010, we took special permission to be at Mumma's bedside (as she can't speak, completely paralysed, however with one hand partial movement and our board we were able to understand what she needs), so they allowed me or my sister, except during 'doctor rounds', '11 PM- 4 AM' or any other time when they request us to leave.
One such time when 'doctor rounds' were happening in that 35+ bedded ICU, I happened to convince ICU Guard that this particular medicine needed to be confirmed from Nurse and that's how I reached near Mumma's bed. I saw her oxygenation dropped to 74 and she was gasping for breath (definitely this was such suction plug or Bipap Mask issue which should have been noticed if someone is at her bedside at right time ). But no staff was there as they were involved taking rounds with various doctors for their assigned patients. No-one was there at nursing station as well, then I ran shouting, Mumma needs help, oxygen dropping and called the immediate available Nurse I found- she straightaway declined that "this bed number is not my patient", I shouted and rushed again to the group of Nurses talking, where Nurse In charge was also standing, who immediately attended Mumma but by that time oxygenation already dropped to 54. He forced me to move outside with help of guard. 5 minutes after, doctor asked for our consent for intubation as soon as possible, otherwise she will die. We were left with no other option but to give consent. Later got her tracheostomy as well to ensure that we will never visit these dreaded ICUs anytime after that.
Just imagine, if I had entered that ICU 10 mins later instead of when I reached, I am sure we were also been told of cardiac arrest/multiple organ failure on that day.
15) ICU negligence, patient fall – One of the day during 2010, when one of us were standing in Mumma's ICU(35+ bedded single hall with partitions), noticed that a patient fall from her Bed. No-one was there near to that ICU bed partition. 3-4 nurses did rush after hearing the ‘bang’ and picked her up to place on Bed again. Her vitals were fluctuating. I was asked to leave immediately and come back after an hour. Next day, ICU staff disclosed the news of multiple organ failure to patient's family.
You will never know whether your loved ones did fall, improperly positioned, facing some choking or difficulty when no-one was around them when they needed it most.
16) ICU negligence, unattended patient during doctor's round and critical situation- During 2010, we took special permission to be at Mumma's bedside (as she can't speak, completely paralysed, however with one hand partial movement and our board we were able to understand what she needs), so they allowed me or my sister, except during 'doctor rounds', '11 PM- 4 AM' or any other time when they request us to leave.
One such time when 'doctor rounds' were happening in that 35+ bedded ICU, I happened to convince ICU Guard that this particular medicine needed to be confirmed from Nurse and that's how I reached near Mumma's bed. I saw her oxygenation dropped to 74 and she was gasping for breath (definitely this was such suction plug or Bipap Mask issue which should have been noticed if someone is at her bedside at right time ). But no staff was there as they were involved taking rounds with various doctors for their assigned patients. No-one was there at nursing station as well, then I ran shouting, Mumma needs help, oxygen dropping and called the immediate available Nurse I found- she straightaway declined that "this bed number is not my patient", I shouted and rushed again to the group of Nurses talking, where Nurse In charge was also standing, who immediately attended Mumma but by that time oxygenation already dropped to 54. He forced me to move outside with help of guard. 5 minutes after, doctor asked for our consent for intubation as soon as possible, otherwise she will die. We were left with no other option but to give consent. Later got her tracheostomy as well to ensure that we will never visit these dreaded ICUs anytime after that.
Just imagine, if I had entered that ICU 10 mins later instead of when I reached, I am sure we were also been told of cardiac arrest/multiple organ failure on that day.
17) ICU negligence, vitals failing, tubes detached? One of the Dec day in 2010, inside ICU around 10 PM (generally this time, all medicine and food have been given to patients and most of the staff is either sleeping or chit chatting at Nursing station or watching TV), I noticed an old lady whose monitor screen was showing sudden drop in the vitals. As I knew how to read these and sensed, that may be oxygen tubing or something got detached and this is to be immediately acted upon, rushed to nursing station where only 2 nurses were present in head-down sleeping position. I woke them and asked them to check that lady. I was again forced to leave ICU at this instance. Next day I could not see that lady in her chamber, later in afternoon in waiting area- we got to know that her family already left as they were informed about cardiac arrest early morning.
I doubt in my heart that there was some tubing detachment which led to that, however as nothing currently in ICUs can be available to validate later, numerous such instances remain unnoticed/hidden.
18) Doctor's incompetence to resolve 'bluish body' issue linked with Ventilator settings- One of our new member in ALS C&S family member from Jaipur shared that his Father on trache+ ventilator were facing hands getting bluish and similar patches all across the body in 2019. He consulted popular pulmonary doctor in his region, however issue continued and increased. I discussed in detail and from the image/video clips he shared, found out that his Father was discharged from ICU of hospital on ST mode during May 2019 with fixed pressure settings. As lung breathing effort getting decreased, with fixed pressure, current tidal volume was reaching only around 200-220 currently. I suggested AVAPS mode and various other altered associated settings. Within a day, his father's bluish tint fade away from all across the body.
So is it wise to believe certified knowledge is always right ?
I doubt in my heart that there was some tubing detachment which led to that, however as nothing currently in ICUs can be available to validate later, numerous such instances remain unnoticed/hidden.
18) Doctor's incompetence to resolve 'bluish body' issue linked with Ventilator settings- One of our new member in ALS C&S family member from Jaipur shared that his Father on trache+ ventilator were facing hands getting bluish and similar patches all across the body in 2019. He consulted popular pulmonary doctor in his region, however issue continued and increased. I discussed in detail and from the image/video clips he shared, found out that his Father was discharged from ICU of hospital on ST mode during May 2019 with fixed pressure settings. As lung breathing effort getting decreased, with fixed pressure, current tidal volume was reaching only around 200-220 currently. I suggested AVAPS mode and various other altered associated settings. Within a day, his father's bluish tint fade away from all across the body.
So is it wise to believe certified knowledge is always right ?
19) Incompetent doctors and ignorant staff inside ICU- During Jan 2020, one of our ALS C&S family member from Delhi requested to visit her husband at ICU in Delhi hospital as he wasn’t able to sleep since 2-3 days, also they like to shift him on portable Trilogy 100 Ventilator. We met and discussed first with in-house prominent Neurologist of that hospital in his room, who suggested strongly to shift him on SIMV-PS mode. Me along with other senior ALS C&S member who went with me to ICU got inside and setup the Trilogy-100 with settings we know are best coming under the mode ST-AVAPS(not SIMV-PS) and configured it. Within 5 mins, restlessness from the patient face was gone and he fell asleep so calmly. Duty doctor was amazed to see that change in patient's response and asked for details of changes we did. We explained them which he listened positively and thanked us for sharing.
I sat additional 2 hours in this ICU to ensure values are working perfect. Thinking I am just an unaware attendant sitting and watching, a Nurse came for schedule trachea suction, did two pass from trach and wiped the suction tube with gauze and used the same for oral suction. I was shocked to see the same piece of suction tube getting used for trache and oral both. I raised concern on which both duty doctors came to rescue the situation. I questioned, why they don’t have separate 'Oral yonkur suction set'. Surprisingly, they have never heard of such thing. I showed an internet image for their reference and requested them to use it separately for each patient and change it every alternate day. Doctors accepted and said they will do the needful and we left the ICU. I also gave my number for any queries in future.
And this as well is a respectable private hospital. Duty doctor who is medial degree holder wasn’t aware of such things and we are helping them learn- this looks so indifferent- isn’t it ?. However, this was positive that they did not showed their ego rather listened and understand things. However, I am still not sure whether their practice of using same tube for oral and trache is continued till date or have they really implemented any change. If not(which is more likely the case), patients getting dying out of the infection causing pneumonia with no faults of theirs. And who knows many other ICUs also follows the same ?
20) Multiple instances of faulty settings during 2015-2020- There are numerous instances of incorrect ventilator settings done by pulmonary doctor/ device specialists for our ALS C & S group. When these members brought this to my/group knowledge through video recordings in ICUs or/and later from their home, settings were modified. With that breathing issues which were troubling patients for long time got resolved in just few minutes. And let me tell you some of these settings were done by the most respectable and top medical professionals in India who can impress you in their talks/webinar/discussions/interviews, however at ground level while managing patients on ventilator, they are not able to understand need of patient to configure ventilator accordingly. This is not a fault of ventilator devices, rather issue is with these system on how to utilize these devices for the benefit of patients. It is an irony that Families pays lakhs of rupees inappropriate/incorrect treatment at hopsitals, while their real resolution is getting done in few minutes by us without spending a single rupee.
Why such doctors treat themselves as experts and see common man as illiterate. Why can’t these Doctors see the gaps in themselves (may be due to less user experience ?) and be forthcoming to learn from people like us. Like in IT industry, we IT professionals were forced to keep upgrading ourselves to be in industry, such culture must be build in medical field which is the main profession who are there to save our life.
21) Not Covid, Medical negligence and casual approach tortured our father for 6 days and finally with inhuman cruelty took away from us.- For full case details of our Father’s stay in COVID ICU ( Wed 5th Nov - 10th Nov 2020) ....Click here.
21A) Emergency dept, just for name sake, no action is taken on emergency basis:
It was around 1:00 am on 5th November, 2020 when we shifted Papa from Govt hospital to this big private hospital. Govt doctors who came with us to transfer the patient shared to receiving doctor, that he is stable on NRBM with supplemental oxygen and responding well to treatment given in last few hours there. He was taken in the emergency for checking the vitals and other important details before shifting to ICU. We saw at that time of shifting, Papa got fully wet because of excessive urine. They ignored the entire condition of cleanliness. In those 2 hours of stay there, we requested for around 5-6 times to all the staff including GD, Nurses, on duty doctors for changing Papa’s clothes OR allow us to change as we were having diaper/extra pair of clothes but we were not allowed to do, stating only staff is authorized to do. They asked us to move out but we stayed there. No staff was coming in between to see whether Papa is ok or not.
We were monitoring Papa ourselves. Then we checked the capacity of oxygen cylinder which was at last 10 points, alerted the staff for cylinder replacement. Then after a while, Oxygen cylinder capacity was close to 0. As Papa was on NRBM(non-rebreathable) mask, he became restless quickly, we took out our own pulsoxymeter from our pocket to monitor and observed saturation was coming down. We screamed for oxygen cylinder but the reply from 2-3 available staff was, “there is no more cylinder available”. Here, Papa was getting extremely restless, saturation dropped to 88 by then. After lot of of persuasion, he was shifted to another bed having Oxygen line and there he got stable. (CCTV footage of 5th November between 2:00AM to 3:00AM can show this negligent behavior much more clearly).
Thank God we didn’t move from his bed when staff was asking us to move out, otherwise we may have lost him in emergency only by hearing manipulated words that condition got critical or cardiac arrest happened.
21B) Casual approach towards treatment and care for elderly patient.
ICU Staff shared that patient is not eating himself and that’s the big problem for them. Papa was like a child for us, who needs assistance in everything whether its bathing, feeding, urinals from last few years. We kept requesting time and again to allow us to be inside in PPE kit and we can make him eat like we were doing at home. We conveyed that we know ICU management as well but they still refused. We instructed, that give him food by keeping 1-2 bites in plate and keep another when that is finished and it may take 30 mins for him to eat. They said we don’t have that much time. We requested that as he has passion for tea, please give him atleast biscuit dip in tea which will take just 5 mins. But these inhuman creatures didn’t have that much patience to feed him this much as well. We complained this to treating doctor(HOD) who said in staff favour. Staff shared later, as Papa was restless so they had tied his hands and legs since the day he was admitted. As per information, they attempted Ryle Tube 2-3 times on different days which he removed (how come when his hands and feet tied heartlessly). Besides high dosages of medicines, they kept giving him 100ml NS/hour continuously whenever we talked to ICU staff to check his fluid/food intake. This starvation has led to acidosis, increase in Urea, creatinine and as well hypernatria (sodium increased day by day crossing all limits). In covid, there is no reference of hypernatria rather hyponatria is commonly observed as per data available.
They also kept incorrect breathing support settings -where one day bipap machine parameters were kept according to covid lungs(low Vte around 265), next day parameters were changed to normal lungs(Vte kept at 465) which we observed during video call. We got to know later from non-medical personnel, that the staff for ICU hall of 30 patients was managed by hardly 2 nurse, 1 GD and one doctor at any given time. ICU staff/doctors were visiting patients only during their schedule medication/activities otherwise remained seated at their nursing station or in TV room. This clearly indicates, that most of time patient remain unattended. At regular intervals, we were getting the news of demise of one or other patient from Covid-ICU due to covid related symptoms/cardiac arrest/multiple organ failure. Rather these outcomes were provoked due to negligence leading to untimely deaths of patients.
Really very sad, pathetic situation at ground level in major hospitals despite artificially they tend to look quite polished. Do you think this is anyway Intensive Care Unit..NOT AT ALL!!!
21C) Incompetent/ ignorant doctors taking care of critically ill patients.
The main act that led to the traumatized death of our loving Father: During the daily discussion with treating doctor(HOD) at his room, he conveyed, that he is coming from Covid ICU only and tried for the betterment of Papa’s condition. He has tried again Ryle tube which didn’t pass the path as there were dry flakes coming out in pathway. On which I asked- whether humidifier is being used with Bipap- he said NO (so that is clearly the reason of those flakes). Next, he shared that he has inserted an Airway to avoid tongue fall and gave instruction to staff for lateral side turning. That time only, me and my sister looked at each other with a surprise that if they have given lateral side turning, anytime Papa will cough, can get hurt by airway and could be chocked. This is mentioned under the guidelines by NCBI in one of his paper that if the person can generate cough, then it is one of the major contradiction for placing airway. And as anticipated that actually must have triggered the situation as this HOD Dr. received a call from ICU at next moment, that they are doing CPR of Papa as his heart beat is gone. (We are sure no-one was there with Papa when he choked and when they would have seen pulse gone on monitor, they had reacted). That moment, we were easily allowed to go and visit him in ICU with PPE kit worn, but the state of bleeding gums, jaws and whole mouth was clearly showing the proof of cause was due to negligence.
I sat additional 2 hours in this ICU to ensure values are working perfect. Thinking I am just an unaware attendant sitting and watching, a Nurse came for schedule trachea suction, did two pass from trach and wiped the suction tube with gauze and used the same for oral suction. I was shocked to see the same piece of suction tube getting used for trache and oral both. I raised concern on which both duty doctors came to rescue the situation. I questioned, why they don’t have separate 'Oral yonkur suction set'. Surprisingly, they have never heard of such thing. I showed an internet image for their reference and requested them to use it separately for each patient and change it every alternate day. Doctors accepted and said they will do the needful and we left the ICU. I also gave my number for any queries in future.
And this as well is a respectable private hospital. Duty doctor who is medial degree holder wasn’t aware of such things and we are helping them learn- this looks so indifferent- isn’t it ?. However, this was positive that they did not showed their ego rather listened and understand things. However, I am still not sure whether their practice of using same tube for oral and trache is continued till date or have they really implemented any change. If not(which is more likely the case), patients getting dying out of the infection causing pneumonia with no faults of theirs. And who knows many other ICUs also follows the same ?
20) Multiple instances of faulty settings during 2015-2020- There are numerous instances of incorrect ventilator settings done by pulmonary doctor/ device specialists for our ALS C & S group. When these members brought this to my/group knowledge through video recordings in ICUs or/and later from their home, settings were modified. With that breathing issues which were troubling patients for long time got resolved in just few minutes. And let me tell you some of these settings were done by the most respectable and top medical professionals in India who can impress you in their talks/webinar/discussions/interviews, however at ground level while managing patients on ventilator, they are not able to understand need of patient to configure ventilator accordingly. This is not a fault of ventilator devices, rather issue is with these system on how to utilize these devices for the benefit of patients. It is an irony that Families pays lakhs of rupees inappropriate/incorrect treatment at hopsitals, while their real resolution is getting done in few minutes by us without spending a single rupee.
Why such doctors treat themselves as experts and see common man as illiterate. Why can’t these Doctors see the gaps in themselves (may be due to less user experience ?) and be forthcoming to learn from people like us. Like in IT industry, we IT professionals were forced to keep upgrading ourselves to be in industry, such culture must be build in medical field which is the main profession who are there to save our life.
21) Not Covid, Medical negligence and casual approach tortured our father for 6 days and finally with inhuman cruelty took away from us.- For full case details of our Father’s stay in COVID ICU ( Wed 5th Nov - 10th Nov 2020) ....Click here.
21A) Emergency dept, just for name sake, no action is taken on emergency basis:
It was around 1:00 am on 5th November, 2020 when we shifted Papa from Govt hospital to this big private hospital. Govt doctors who came with us to transfer the patient shared to receiving doctor, that he is stable on NRBM with supplemental oxygen and responding well to treatment given in last few hours there. He was taken in the emergency for checking the vitals and other important details before shifting to ICU. We saw at that time of shifting, Papa got fully wet because of excessive urine. They ignored the entire condition of cleanliness. In those 2 hours of stay there, we requested for around 5-6 times to all the staff including GD, Nurses, on duty doctors for changing Papa’s clothes OR allow us to change as we were having diaper/extra pair of clothes but we were not allowed to do, stating only staff is authorized to do. They asked us to move out but we stayed there. No staff was coming in between to see whether Papa is ok or not.
We were monitoring Papa ourselves. Then we checked the capacity of oxygen cylinder which was at last 10 points, alerted the staff for cylinder replacement. Then after a while, Oxygen cylinder capacity was close to 0. As Papa was on NRBM(non-rebreathable) mask, he became restless quickly, we took out our own pulsoxymeter from our pocket to monitor and observed saturation was coming down. We screamed for oxygen cylinder but the reply from 2-3 available staff was, “there is no more cylinder available”. Here, Papa was getting extremely restless, saturation dropped to 88 by then. After lot of of persuasion, he was shifted to another bed having Oxygen line and there he got stable. (CCTV footage of 5th November between 2:00AM to 3:00AM can show this negligent behavior much more clearly).
Thank God we didn’t move from his bed when staff was asking us to move out, otherwise we may have lost him in emergency only by hearing manipulated words that condition got critical or cardiac arrest happened.
21B) Casual approach towards treatment and care for elderly patient.
ICU Staff shared that patient is not eating himself and that’s the big problem for them. Papa was like a child for us, who needs assistance in everything whether its bathing, feeding, urinals from last few years. We kept requesting time and again to allow us to be inside in PPE kit and we can make him eat like we were doing at home. We conveyed that we know ICU management as well but they still refused. We instructed, that give him food by keeping 1-2 bites in plate and keep another when that is finished and it may take 30 mins for him to eat. They said we don’t have that much time. We requested that as he has passion for tea, please give him atleast biscuit dip in tea which will take just 5 mins. But these inhuman creatures didn’t have that much patience to feed him this much as well. We complained this to treating doctor(HOD) who said in staff favour. Staff shared later, as Papa was restless so they had tied his hands and legs since the day he was admitted. As per information, they attempted Ryle Tube 2-3 times on different days which he removed (how come when his hands and feet tied heartlessly). Besides high dosages of medicines, they kept giving him 100ml NS/hour continuously whenever we talked to ICU staff to check his fluid/food intake. This starvation has led to acidosis, increase in Urea, creatinine and as well hypernatria (sodium increased day by day crossing all limits). In covid, there is no reference of hypernatria rather hyponatria is commonly observed as per data available.
They also kept incorrect breathing support settings -where one day bipap machine parameters were kept according to covid lungs(low Vte around 265), next day parameters were changed to normal lungs(Vte kept at 465) which we observed during video call. We got to know later from non-medical personnel, that the staff for ICU hall of 30 patients was managed by hardly 2 nurse, 1 GD and one doctor at any given time. ICU staff/doctors were visiting patients only during their schedule medication/activities otherwise remained seated at their nursing station or in TV room. This clearly indicates, that most of time patient remain unattended. At regular intervals, we were getting the news of demise of one or other patient from Covid-ICU due to covid related symptoms/cardiac arrest/multiple organ failure. Rather these outcomes were provoked due to negligence leading to untimely deaths of patients.
Really very sad, pathetic situation at ground level in major hospitals despite artificially they tend to look quite polished. Do you think this is anyway Intensive Care Unit..NOT AT ALL!!!
21C) Incompetent/ ignorant doctors taking care of critically ill patients.
The main act that led to the traumatized death of our loving Father: During the daily discussion with treating doctor(HOD) at his room, he conveyed, that he is coming from Covid ICU only and tried for the betterment of Papa’s condition. He has tried again Ryle tube which didn’t pass the path as there were dry flakes coming out in pathway. On which I asked- whether humidifier is being used with Bipap- he said NO (so that is clearly the reason of those flakes). Next, he shared that he has inserted an Airway to avoid tongue fall and gave instruction to staff for lateral side turning. That time only, me and my sister looked at each other with a surprise that if they have given lateral side turning, anytime Papa will cough, can get hurt by airway and could be chocked. This is mentioned under the guidelines by NCBI in one of his paper that if the person can generate cough, then it is one of the major contradiction for placing airway. And as anticipated that actually must have triggered the situation as this HOD Dr. received a call from ICU at next moment, that they are doing CPR of Papa as his heart beat is gone. (We are sure no-one was there with Papa when he choked and when they would have seen pulse gone on monitor, they had reacted). That moment, we were easily allowed to go and visit him in ICU with PPE kit worn, but the state of bleeding gums, jaws and whole mouth was clearly showing the proof of cause was due to negligence.
Our biggest mistake that despite we were aware of cruelty of ICUs in India, we continued him to stay as that is reputed hospital and prominent HOD in critical care is handling this. Living in guilt that we believed them, instead of ourselves and our care. As soon as we got the clarity of things ongoing, we planned to procure things on rent to build ICU@Home again (as ICU setup we had for Mumma-was already donated) and it was reaching us by next day so we could transfer Papa back home but these Doctors faulty actions didn't gave us that chance.
22) Casual approach of ICU staff and inconvenience to patients - It was again during Mumma’s stay in that ICU, where we used to give her a Rattle toy in that phase, as she was still having some strength in one arm and she could hold and shake if she needs anything. However, most of the time, when we used to enter ICU in the morning, have noticed that rattle was kept on the table, placed far away from Mumma’s reach. And, when we tried to check the reason from Mumma with the help of alphabetic/word card board that we were using to communicate with her, she shared that these nurses have taken it away so they cannot hear its noise. Nurses as well complained, that she kept on shaking this rattle all the time which disturbs them. But we know that Mumma never used to shake that without any reason but we lived in pity of those kind of staff for the few hours of our absence from ICU.
23) Famous and impressive talks, but incompetent doctors running ICU- Recently a prominent anesthesiologist(HOD) of one of the reputed private hospital at Delhi was treating our ALS C & S family member's loved one. I was regularly being updated from ICU by that family member who as well took special permission to stay inside (like we did in 2010).
This doctor(HOD) has transferred the patient from hospital ventilator to the widely used Trilogy 100 home Ventilator machine, rented by the family. After the setup was done, family member sent me the pic of trilogy screen to verify, if that is fine, As soon as I saw that image, I was shocked!. Leak was showing zero in that image for the 'passive' circuit. I raised an alarm and asked to share the video so that the whole circuit setup can be seen from patient's tracheostomy to Ventilator. During this video call, I noticed there was no placement of 1) Catheter mount, 2) HME filter and most importantly 3)'whisper swirl'(for exhalation) piece was absent. 4)Oxygen tubing was wrongly attached at the junction of tracheostomy tube, while it should be attached to the back of Trilogy Ventilator. I wonder how come patient was exhaling the air inhaled? Then I noticed that Vent leak was jumping from 0 to 5 to 7 to 0 to 3 values. So luckily, somewhere exhalation was happening either through the looseness of tracheostomy balloon or minimally through the point where the oxygen tube was attached(not properly). While Leak should be around 25-30 as per the guidelines of the device for proper exhalation. This setup may looked OK temporarily, however will risk the life of patient if continued for few more hours.
After my discussion with that Family member, he raised this concern in ICU. Later, he made me speak to the ICU's duty doctors on call- who said everything is fine.. "Sir has personally setup that device, so no worries". Now when I raised specific queries politely- why whisper swirl was not attached ? or why HME wasn't placed? and pls tell me where you feel patient is exhaling(?) as you have kept single limb circuit - there was no clue with anyone on my questions, then this lady doctor shared her weird knowledge that HME is to be placed in NIV(non-Invasive Ventilation) circuit only. Surprised, I asked to double check her information, so she asked a fellow duty doctor who also said the same which I overheard on phone. It was really a sad situation, so I suggested to transfer patient back to hospital Ventilator. Thank God that family member took correct decision and got her reverted to hospital's Ventilator till the time 'whisper swirl' arrived next morning. Next day, doctors agreed to place it where we wanted in circuit, so things were under control.
I don't know why these so qualified degree doctors are not aware of - what is active/passive circuit, what is concept of single limb and double limb circuit, significance of HME (in invasive is more than non-invasive), role of catheter mount, role of whisper/exhalation valve. When the doctor (HOD) was not aware of how to setup that circuit-then why he has not pointed out and called device specialist from where the device was procured. Exhalation valve, single limb circuit is a standard concept, he should have been aware of these irrespective of device. Moreover, team were blindly following their seniors due to lack of basic respiratory concepts with them as well. Seriously, I am amazed how come this ICU is running by these hands of ignorant doctors(including HOD) and lives of patients are being played by them everyday!! .. and none of general public or family came to know about these issues.
23) Famous and impressive talks, but incompetent doctors running ICU- Recently a prominent anesthesiologist(HOD) of one of the reputed private hospital at Delhi was treating our ALS C & S family member's loved one. I was regularly being updated from ICU by that family member who as well took special permission to stay inside (like we did in 2010).
This doctor(HOD) has transferred the patient from hospital ventilator to the widely used Trilogy 100 home Ventilator machine, rented by the family. After the setup was done, family member sent me the pic of trilogy screen to verify, if that is fine, As soon as I saw that image, I was shocked!. Leak was showing zero in that image for the 'passive' circuit. I raised an alarm and asked to share the video so that the whole circuit setup can be seen from patient's tracheostomy to Ventilator. During this video call, I noticed there was no placement of 1) Catheter mount, 2) HME filter and most importantly 3)'whisper swirl'(for exhalation) piece was absent. 4)Oxygen tubing was wrongly attached at the junction of tracheostomy tube, while it should be attached to the back of Trilogy Ventilator. I wonder how come patient was exhaling the air inhaled? Then I noticed that Vent leak was jumping from 0 to 5 to 7 to 0 to 3 values. So luckily, somewhere exhalation was happening either through the looseness of tracheostomy balloon or minimally through the point where the oxygen tube was attached(not properly). While Leak should be around 25-30 as per the guidelines of the device for proper exhalation. This setup may looked OK temporarily, however will risk the life of patient if continued for few more hours.
After my discussion with that Family member, he raised this concern in ICU. Later, he made me speak to the ICU's duty doctors on call- who said everything is fine.. "Sir has personally setup that device, so no worries". Now when I raised specific queries politely- why whisper swirl was not attached ? or why HME wasn't placed? and pls tell me where you feel patient is exhaling(?) as you have kept single limb circuit - there was no clue with anyone on my questions, then this lady doctor shared her weird knowledge that HME is to be placed in NIV(non-Invasive Ventilation) circuit only. Surprised, I asked to double check her information, so she asked a fellow duty doctor who also said the same which I overheard on phone. It was really a sad situation, so I suggested to transfer patient back to hospital Ventilator. Thank God that family member took correct decision and got her reverted to hospital's Ventilator till the time 'whisper swirl' arrived next morning. Next day, doctors agreed to place it where we wanted in circuit, so things were under control.
I don't know why these so qualified degree doctors are not aware of - what is active/passive circuit, what is concept of single limb and double limb circuit, significance of HME (in invasive is more than non-invasive), role of catheter mount, role of whisper/exhalation valve. When the doctor (HOD) was not aware of how to setup that circuit-then why he has not pointed out and called device specialist from where the device was procured. Exhalation valve, single limb circuit is a standard concept, he should have been aware of these irrespective of device. Moreover, team were blindly following their seniors due to lack of basic respiratory concepts with them as well. Seriously, I am amazed how come this ICU is running by these hands of ignorant doctors(including HOD) and lives of patients are being played by them everyday!! .. and none of general public or family came to know about these issues.
24) Substandard knowledge of Ventilator modes with treating doctors : One of our ALS C & S family member's patient was discharged on ST mode with fixed pressure settings. Less tidal volume was getting achieved with the given pressure which created uneasiness with patient for next few hours of reaching home. During the video call from home I noticed, Vte was coming around 200, BR was going 30-35(very uncomfortable similar breathing from last few hours) and Inspiratory time was set to 1.8 for BR of 15. I suggested their home nurse to change the Ventilator settings as per my experience. Within 5 mins things started settling down: BR getting better at 16-17, Vte- 350-380 and inspiratory time also corrected. In few minutes, patient looked peaceful and calm.
This is sad to see that the qualified degree doctors are not aware of different Ventilator modes and do not understand breathing issues of patient. They are incompetent to adapt the configuration of the device as per the patient.
25) Hasty decisions to Intubate, claimed life.
A member from our ALS C & S family called me one day to see my opinion for critical condition of her Father. She shared that his Father felt respiratory distress 4 days back (for the first time which clearly shows that it was initial/ temporary issue ) and was rushed to nearby hospital. In few hours, he was put on Ventilator and in next two days, his vitals and every test started coming fine. On third day, doctors decided and weaned him off from Ventilator. He stayed fine for two days and on observing another episode of respiratory issue- they again intubated him. I was disturbed to hear this kind of hasty decisions by doctors. It seems, none of the doctors were knowledgeable enough to understand lung condition in MND disease. In my opinion, along with few supporting medicines temporary, they may have tried non-invasive quite comfortably for him in beginning/second episode of issue. Assuming, they have visualized that his condition is very bad and may require invasive again. In that case, they should have discussed with family about tracheotomy decision which is quite obvious for a MND patient who may choose to continue long term on machine support. This would have helped to let option of Ventilator continued intermittently whenever it is required, depending on the patient’s condition at hospital/home later.
We lost another precious life due to unskilled doctors managing ICUs here.
Today, at this point, I feel saved and satisfied that we took the decision of getting Mumma at home on Ventilator and setup ICU at home in the year 2010. That's how we were able to self-research, learn, implement, improvise iteratively and built an holistic approach to run ICU@home ourselves(without any doctors and nurses). And this is what is required in Hospital’s ICU- a complete holistic approach. This is a job which require sincerity, dedication and compassion towards each and every life admitted in ICU – whereas the actual scenario is, that visiting doctors are unaware of whether instructions followed properly or not; Nursing staff just executing jobs without understanding the patient's sickness or the treatment given; junior doctors blindly follows senior's advice even if that is wrong.
Hence, it was very much important to collate all our learnings and experience for others to utilize it for their loved ones and this became the reason of creating repository www.alslifemanagement.weebly.com and "ALS care & support" – a WhatsApp group in the year 2015. Continuously growing knowledge of this big family found its path to flow through various channels to hundreds of its members to walk this journey with care and support.
I wish, Govt should treat Healthcare as a 'Service' and not as any other flourishing 'business industry' which it is currently built into!
This is sad to see that the qualified degree doctors are not aware of different Ventilator modes and do not understand breathing issues of patient. They are incompetent to adapt the configuration of the device as per the patient.
25) Hasty decisions to Intubate, claimed life.
A member from our ALS C & S family called me one day to see my opinion for critical condition of her Father. She shared that his Father felt respiratory distress 4 days back (for the first time which clearly shows that it was initial/ temporary issue ) and was rushed to nearby hospital. In few hours, he was put on Ventilator and in next two days, his vitals and every test started coming fine. On third day, doctors decided and weaned him off from Ventilator. He stayed fine for two days and on observing another episode of respiratory issue- they again intubated him. I was disturbed to hear this kind of hasty decisions by doctors. It seems, none of the doctors were knowledgeable enough to understand lung condition in MND disease. In my opinion, along with few supporting medicines temporary, they may have tried non-invasive quite comfortably for him in beginning/second episode of issue. Assuming, they have visualized that his condition is very bad and may require invasive again. In that case, they should have discussed with family about tracheotomy decision which is quite obvious for a MND patient who may choose to continue long term on machine support. This would have helped to let option of Ventilator continued intermittently whenever it is required, depending on the patient’s condition at hospital/home later.
We lost another precious life due to unskilled doctors managing ICUs here.
Today, at this point, I feel saved and satisfied that we took the decision of getting Mumma at home on Ventilator and setup ICU at home in the year 2010. That's how we were able to self-research, learn, implement, improvise iteratively and built an holistic approach to run ICU@home ourselves(without any doctors and nurses). And this is what is required in Hospital’s ICU- a complete holistic approach. This is a job which require sincerity, dedication and compassion towards each and every life admitted in ICU – whereas the actual scenario is, that visiting doctors are unaware of whether instructions followed properly or not; Nursing staff just executing jobs without understanding the patient's sickness or the treatment given; junior doctors blindly follows senior's advice even if that is wrong.
Hence, it was very much important to collate all our learnings and experience for others to utilize it for their loved ones and this became the reason of creating repository www.alslifemanagement.weebly.com and "ALS care & support" – a WhatsApp group in the year 2015. Continuously growing knowledge of this big family found its path to flow through various channels to hundreds of its members to walk this journey with care and support.
I wish, Govt should treat Healthcare as a 'Service' and not as any other flourishing 'business industry' which it is currently built into!
Above content published on Jan 14th 2021.
Thoughts written in 2015:
1) Attention required by Indian Govt. - Despite hundreds on ongoing researches in various countries, still there is no definite cause or cure found till date which can reverse ALS. Only option available with Family is quite expensive management of this disease which is different in different stages. Many countries grant reimbursement of complete medical supplies including cost of two ventilators-primary & secondary especially for MND (ALS) patients as its management is very expensive. Indian Govt should also understand the precious life support for these disease patients and allows to manage our elders in home conditions if there is proven proper care team available.
2) Exploitation of patients and their earned money in their difficult times by private Hospitals- We observed that all medical supplies (gloves, suction catheter, cotton or anything used on the patient which is included in your hospital bill) provided in the hospitals are given to patients at the MRP rate while the actual cost which hospital purchased those items actually around 25-45% of the actual cost from suppliers. E.g. Suction Catheter MRP is 41 Rs/piece while supplier give hospital @11 Rs/piece. There is lot to be corrected for such malpractice happening in Hospitals.
3) NelCath Catheter – Usage of NelCath catheter (rounded tip) for trache suction should be made mandatory in hospitals. Also NS bottle should be cut from top instead from sides. May look very unimportant stuff, however have big impact.
4) PEG Feed - Do not believe that food which come to you in hospitals for feeding patient on PEG is made hygienically. We kept our critical streak intact and visited that reputed private hospital’s canteen. We were shocked to see how filthy way, PEG feed was being made ...how can they administer such feed to patients ??. We started preparing our own PEG feed from home despite, hospital staff was quite against it.
5) Bed Sores – We have seen in less than 10 days on that ICU hospital bed, mumma developed Bed sores which doctors and nurses kept on treating for rest of the stay, to show they care but actually there was no improvement. It happened with every other patient who stay immobile at hospital bed generally. We are sure that every other hospital you may also heard about the same thing. We came back home with those bed sores, needed 2 months of complete care to get that completely healed and its almost 5 years immovable on bed after that and there is NOT A SINGLE BED SORE formed. So now what is the cause?.. its all negligence by hospital staff.
6) ICU room do not stand for intensive care- We observed that there is lot of ignorance and negligence happens with the patients in ICU room. While on the other hand family keep thinking outside that their loved ones are continuously under strict monitoring of medical staff inside. Real picture is 1 nurse is given 2 or more patients and most of times your patient is sitting alone as nursing staff always have excuse(or really busy attending) of seeing the other patient.
1) Attention required by Indian Govt. - Despite hundreds on ongoing researches in various countries, still there is no definite cause or cure found till date which can reverse ALS. Only option available with Family is quite expensive management of this disease which is different in different stages. Many countries grant reimbursement of complete medical supplies including cost of two ventilators-primary & secondary especially for MND (ALS) patients as its management is very expensive. Indian Govt should also understand the precious life support for these disease patients and allows to manage our elders in home conditions if there is proven proper care team available.
2) Exploitation of patients and their earned money in their difficult times by private Hospitals- We observed that all medical supplies (gloves, suction catheter, cotton or anything used on the patient which is included in your hospital bill) provided in the hospitals are given to patients at the MRP rate while the actual cost which hospital purchased those items actually around 25-45% of the actual cost from suppliers. E.g. Suction Catheter MRP is 41 Rs/piece while supplier give hospital @11 Rs/piece. There is lot to be corrected for such malpractice happening in Hospitals.
3) NelCath Catheter – Usage of NelCath catheter (rounded tip) for trache suction should be made mandatory in hospitals. Also NS bottle should be cut from top instead from sides. May look very unimportant stuff, however have big impact.
4) PEG Feed - Do not believe that food which come to you in hospitals for feeding patient on PEG is made hygienically. We kept our critical streak intact and visited that reputed private hospital’s canteen. We were shocked to see how filthy way, PEG feed was being made ...how can they administer such feed to patients ??. We started preparing our own PEG feed from home despite, hospital staff was quite against it.
5) Bed Sores – We have seen in less than 10 days on that ICU hospital bed, mumma developed Bed sores which doctors and nurses kept on treating for rest of the stay, to show they care but actually there was no improvement. It happened with every other patient who stay immobile at hospital bed generally. We are sure that every other hospital you may also heard about the same thing. We came back home with those bed sores, needed 2 months of complete care to get that completely healed and its almost 5 years immovable on bed after that and there is NOT A SINGLE BED SORE formed. So now what is the cause?.. its all negligence by hospital staff.
- Its air bed which hospital staff just monitor from the sides which is generally looks inflated and they ignore un-noticed minute holes which will not let lift patient from the heaviest portion.
- One should never apply cream on back for bedridden patient.
- They place diaper on patient and replace that after set hours (8-12 and sometime 24 hours!!!!). While in home care -we monitor diaper every hour for even a single urine output and replace after sprinkling antifungal powder at surface of fresh diaper. Also we place lavatory PAN 2-5 times during the day as required and do complete urinal area cleaning via that.
- We have seen for every cleaning from lavatory PAN or Diaper, cleaning staff utilize complete 500 gm. roll of cotton and still patient urinal and back area did not get clean which aggravates bed sores development. In our case- we portion the one cotton roll into over fifty plus 2’/3’ pieces and damp with water droplets, use 2-4 such pieces in each cleaning as it depends, so same cotton 500 gm cotton roll can be used for week of usage.
- Do regular exercise- we do regular 10-15 minutes of exercise for mumma hands and legs
- Proper sponge-Never do sponge with cotton as hospital staff does. Instead use clean hand towel dipped in water, strain it and clean the body using that. And take repeat soak of towel for each body part and do not continue with single soak. Please give dry massage at the back while apply “moisturex” cream in small quantity on rest of the body. Moreover, for long term bedridden case, one should also do soap sponge after every fortnight.
6) ICU room do not stand for intensive care- We observed that there is lot of ignorance and negligence happens with the patients in ICU room. While on the other hand family keep thinking outside that their loved ones are continuously under strict monitoring of medical staff inside. Real picture is 1 nurse is given 2 or more patients and most of times your patient is sitting alone as nursing staff always have excuse(or really busy attending) of seeing the other patient.
7) BiPAP tied to patient are NOT on uninterrupted power supply- We observed in ICU, whenever power goes off, nursing staff keep running for patients on Bipap machine to remove their tied face mask as avoiding them could suffocate the patients. Its shocking practice - First there should be uninterrupted power supply to all equipment at least in ICUs if they charge so much hefty amount from patients and their families. Secondly, there are many advanced Bipap masks available in market which are equipped with auto-detection of such condition and open the outlet immediately based on pressure changes.
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8) Daily tests are definitely NOT required- Just to increase your bills, doctors follow the practice of daily TLC, daily X-RAY (very bad practice) and other tests which can easily be decided on requirement basis or alternate day. E.g. if TLC is 24 K, you started antibiotics, after a day that TLC is reduced and medicine working, there is no need to continue performing TLC tests daily. While we have seen many such tests were repeated daily unnecessarily. We requested (literally pleaded ) doctors so as to relieve mumma from daily X-Ray(that too which used to happen at 1 AM at chilly nights) and such painful tests during last few weeks of stay at hospital and they relieved us by atleast keeping those at alternate days (so we came out from hospital with 35 X-Ray sheet for 1.5 month of stay. All this is completely exploitation of money of patients and also exposing their body to unnecessary radiations. While at home, we hardly get into situation of requiring tests unless there are challenging days. (after few months). During last 5 years on Ventilator at home - we called X-ray machine at home only 4 times and got the blood tests done <15 times. Only thing which is frequently required is the trache suction culture (generally once every 2 months).
9) Unknowledgeable medical staff in ICU for managing Ventilators- ICU doctors must be aware of Ventilator settings and various parameters and its inter- dependencies between other parameter and total effect on patient's breathing cycle. While we observed they just switch between ventilator modes which disturbs the breathing cycles of patient, rather than changing parameters in the same mode. e.g. in ICU of 35+ room, a very relaxed lady having sip of coffee doing chit-chat with nursing staff –a single doctor sitting at night whom I questioned (as I was learning Ventilator settings from internet those times) about max Inspiratory value- she said there is max 18 mmH2O can be kept in hospital Ventilator, there are 3 modes- CPAP, SIMW and CV mode which she knows. And if patients showing signs of discomfort -she is there in ICU to switch the modes. With all knowledge which we gained till now, we really believe such medical staff is disastrous threat to life of patients in ICUs and we feel shaken by thinking how many lives were taken away by such irresponsible, unknowledgeable (so called certified practitioners !)doctors which remained unnoticed to everyone.
10) Another case came to our knowledge recently, where a certified specialist (who is authorized to set ventilator setting for patients), has set ventilator with tidal volume(Vt) setting with ***and Breath rate(BR) equal to *** for a patient weighing just around 42 KG. This is quite dangerous setting combination as tidal volume is kept quite high(along with BR to make minute ventilation quite high) and gives very little time to exhaling air and in turn will lead to CO2 pile up in body and ultimately life of patient put on stake and actually taken. And when one life goes away like this -its definitely was NOT God's wish.. its because of such irresponsible people who do such mistakes and surprising all things remain undetected, as no body questions or investigate at this angle. People were given reason that 'BP kept dropping' and that was reason(or terms like 'multiple organ failure', 'cardiac arrest' which is very commonly given reason).. its pathetic feeling to know such instances...And shocking as well -how can one set such kind of settings considering he is certified specialist. Are these people forgetting basics..is there no value of life for them? .....why there is no action taken on such cases?
11) I request all hospitals to take routine yearly exams of their doctor and nursing staff (like in IT industry, we should regularly upgrade our skills to remain in industry) to keep them updated with their knowledge.
12) Leak concept and circuit type understanding - Moreover, all staff were surprised to see our installed portable Ventilator(Trilogy 100) and they were literally inflating trache cuff (can lead to dangerous situation) so to avoid LEAK value (which will always be there in single limb passive circuit to expel expiratory air). It was really unfortunate to see such un-knowledgeable staff in critical care. Why hospitals don’t train their staff regularly to remind them of their concepts and make them knowledgeable about latest medical equipment and associated technologies?
13) Seriousness towards their profession is missing in most of medical staff.- As it happens with every other person, people tend to give less importance and became lazy, less attentive towards their job in routine, However, if person has taken such a noble professional where such attitude might claim or affect life of an individual then definitely such attitude must not be allowed.
14) There should be facility to allow CCTV camera in your patient room – How would anyone ensure that their loved one is actually under monitoring inside those closed walls of ICU or falling trap of negligence of irresponsible medical staff. Despite the fact you are been charged of hefty medical bills, one cannot guarantee that justified treatment and proper attention was given inside that ICU room.
This is unending topic however we would like to stop here (unless something really important comes in our mind which we will update later).
9) Unknowledgeable medical staff in ICU for managing Ventilators- ICU doctors must be aware of Ventilator settings and various parameters and its inter- dependencies between other parameter and total effect on patient's breathing cycle. While we observed they just switch between ventilator modes which disturbs the breathing cycles of patient, rather than changing parameters in the same mode. e.g. in ICU of 35+ room, a very relaxed lady having sip of coffee doing chit-chat with nursing staff –a single doctor sitting at night whom I questioned (as I was learning Ventilator settings from internet those times) about max Inspiratory value- she said there is max 18 mmH2O can be kept in hospital Ventilator, there are 3 modes- CPAP, SIMW and CV mode which she knows. And if patients showing signs of discomfort -she is there in ICU to switch the modes. With all knowledge which we gained till now, we really believe such medical staff is disastrous threat to life of patients in ICUs and we feel shaken by thinking how many lives were taken away by such irresponsible, unknowledgeable (so called certified practitioners !)doctors which remained unnoticed to everyone.
10) Another case came to our knowledge recently, where a certified specialist (who is authorized to set ventilator setting for patients), has set ventilator with tidal volume(Vt) setting with ***and Breath rate(BR) equal to *** for a patient weighing just around 42 KG. This is quite dangerous setting combination as tidal volume is kept quite high(along with BR to make minute ventilation quite high) and gives very little time to exhaling air and in turn will lead to CO2 pile up in body and ultimately life of patient put on stake and actually taken. And when one life goes away like this -its definitely was NOT God's wish.. its because of such irresponsible people who do such mistakes and surprising all things remain undetected, as no body questions or investigate at this angle. People were given reason that 'BP kept dropping' and that was reason(or terms like 'multiple organ failure', 'cardiac arrest' which is very commonly given reason).. its pathetic feeling to know such instances...And shocking as well -how can one set such kind of settings considering he is certified specialist. Are these people forgetting basics..is there no value of life for them? .....why there is no action taken on such cases?
11) I request all hospitals to take routine yearly exams of their doctor and nursing staff (like in IT industry, we should regularly upgrade our skills to remain in industry) to keep them updated with their knowledge.
12) Leak concept and circuit type understanding - Moreover, all staff were surprised to see our installed portable Ventilator(Trilogy 100) and they were literally inflating trache cuff (can lead to dangerous situation) so to avoid LEAK value (which will always be there in single limb passive circuit to expel expiratory air). It was really unfortunate to see such un-knowledgeable staff in critical care. Why hospitals don’t train their staff regularly to remind them of their concepts and make them knowledgeable about latest medical equipment and associated technologies?
13) Seriousness towards their profession is missing in most of medical staff.- As it happens with every other person, people tend to give less importance and became lazy, less attentive towards their job in routine, However, if person has taken such a noble professional where such attitude might claim or affect life of an individual then definitely such attitude must not be allowed.
14) There should be facility to allow CCTV camera in your patient room – How would anyone ensure that their loved one is actually under monitoring inside those closed walls of ICU or falling trap of negligence of irresponsible medical staff. Despite the fact you are been charged of hefty medical bills, one cannot guarantee that justified treatment and proper attention was given inside that ICU room.
This is unending topic however we would like to stop here (unless something really important comes in our mind which we will update later).
We request hospital authorities, trustees and owners to take measures which should keep a check on all such mis-happening and equip their hospitals with best of care comparable to amount they charge to patients. Despite costs, this profession is a noble profession and requires dedication, knowledge, care and attention as one such mistake or laziness can put patient's life at stake....which is not there in any kind of profession. One life gone do not effect one but complete family and hopes for many dies.
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If any of the points are taken for correction by authorities, we will be happy and our purpose of sharing this information feel worthier……….
Disclaimer: For points which are against medical fraternity in this page, Our intend here is NOT to generalize these opinions , as there are many in medical field who are honest, maintain their integrity and expertise in their skills and hold compassion for sufferings of people. There are many Doctors for whom we hold high regards ; and other Doctors, nurses and ventilator clinical specialist whom we are thankful, and not to forget all those medical suppliers who deliver medical supplies at discounted prices at our doorstep. Thanks All !
Disclaimer: For points which are against medical fraternity in this page, Our intend here is NOT to generalize these opinions , as there are many in medical field who are honest, maintain their integrity and expertise in their skills and hold compassion for sufferings of people. There are many Doctors for whom we hold high regards ; and other Doctors, nurses and ventilator clinical specialist whom we are thankful, and not to forget all those medical suppliers who deliver medical supplies at discounted prices at our doorstep. Thanks All !
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