By John B Monteiro
Mar 10: Karnataka chief minister Siddaramaiah launched in Bengaluru on March 8, the state government’s ambitious "Santwana - Harish Scheme" to provide immediate medical treatment as well as relief to victims of road accidents during the "Golden Hour". This innovative scheme is thoughtfully named after 23-year old Harish Nanjappa who in February 2016 had his body sliced into two in a horrible road accident; but could not be saved for lack timely medical aid. Yet, he asked, when being ferried by ambulance and on the verge of death, that his eyes be donated for transplantation. It may be recalled that when he asked for help in his dying moments, lying on the road, onlookers insensitively busied themselves clicking his photos and videos on their mobiles.
This scheme is based on the premise that accident victims should receive the most competent medical service within the shortest time called the "golden hour". In emergency medicine, the golden hour refers to a time period lasting about one hour, or less, following traumatic injury being sustained by a medical emergency, during which there is the highest likelihood that prompt medical treatment will prevent death. It is widely accepted that the patient's chances of survival are greatest if they receive care within a short period of time after a severe injury.
Cases of severe trauma, especially internal bleeding, require surgical intervention. Complications such as shock may occur if the patient is not managed appropriately and expeditiously. It, thus, becomes a priority to transport patients suffering from severe trauma as fast as possible to specialists, most often found at trauma centres of full-fledged hospitals, for definitive treatment. Because some injuries can cause a trauma patient to deteriorate extremely rapidly, the lag time between injury and treatment should ideally be kept to a bare minimum (the golden hour) after which time the survival rate for traumatic patients is said to fall off dramatically.
Time was when people were afraid of helping accident victims because, when admitted to hospital, they became medico-legal cases, with the Good Samaritan helping a patient to be admitted to the hospital becoming witnesses in such cases with police and courts requiring their presence which often degenerated into harassment. Now the authorities have repeatedly assured such helpers that they would not be troubled for their involvement in shifting accident victims to hospitals.
While this Good Samaritan problem is neatly solved, the question of settling hospital bills came centre-stage. If earlier hospitals were reluctant to handle accident cases lest they get enmeshed in medico-legal cases, now their main concern is how to collect the hospital bills. This is where the new scheme is god-sent. The scheme takes care of the immediate hospital expense, to the limit of Rs 25,000 per case, no matter who is the accident victim – rich or poor, Kannadiga or non-Kannadiga or even a foreigner. And there is no condition that the victim should reimburse the amount even if he can bear the expense.
Readers will recall accident reports in the media noting that the victim was admitted to XYZ hospital which is nearest to the accident spot and can be reached without being restrained by traffic jams common to inner-city roads. So, generally they are admitted to what I would call Highway Hospital which is high-end in service and fees. I was wondering how such a hospital would collect its bill from the patient who may have even been unconscious when admitted to its ICU or MICU (Medical Intensive Care Unit) by third parties.
The Karnataka Government had good reason to cover road accident victims because the statistics in this sector cry out for such action. According to National Crime Records Bureau, Ministry of Road Transport statistics, in 2013, 137,000 persons were killed in India in road accidents. Daily 20 children under the age of 14 years die in road accidents in India. There is one death every four minutes due to road accidents in India. Among the top ten cities in India with the highest number of road crash deaths Bangaluru comes fourth.
In this age of quick audio-visual coverage of road accident and their broadcast in the electronic media with gory spot coverage, road accidents have great emotive impact on the minds of media viewers and readers. Therefore, it is not surprising that "Santwana-Harish Scheme" covers road accident victims. Consequently many other sectors needing "golden hour" treatment are left out of the scheme; but need to be included. These include heart/stroke attack victims, attempted suicide victims, drowning cases and snake-bite cases – among many others eligible for "golden hour " treatment and the financial shelter of the scheme. Let me start with true-life incidence from the attempted suicide category.
Ramakka, a forty-three-year old illiterate woman living in a village near Mangaluru lost her husband due to cirrhosis of the liver two years ago. When alive, this alcoholic harassed his wife into parting with money she earned by rolling beedies. All her hope for the future was reposed in her 16-year-old son, Thimma, whose education in the high school was financed by her. He got into bad company and brought in bad reports. One day she questioned him over this and severely scolded and threatened to withdraw him from the school. That evening Thimma was found unconscious and frothing from the mouth. One person driving by in his car took the boy to the Highway Hospital. Informed of this, Ramakka rushed to the hospital; but could not see her son as he was in the MICU. But, she was regularly presented bills which by the end of second day had crossed the Rs 30,000 mark. Ramakka could not comprehend how to face the situation. She begged to relatives and neibhours and collected a few thousands. She also pleaded with the hospital which reduced the total bill for a week, Rs 80,000-plus, by Rs 9000.
This is the rationale of extending the "Santwana- Harish Scheme" to cover survivors of suicide attempts. But, our immediate reaction to suicide is negative forgetting the fact that often family and society drives people to suicide. It may be noted that worldwide 800,000 people commit suicide yearly of whom India accounted for 135,000.There are, of course no statistics on survivors. Also, suicide was illegal in India with the survivor meted out jail term up to one year under Section 309 of Indian Penal Code. Mercifully, this Section was repealed in 2014. But, the need to cover the survivors under the Scheme survives.
Coming to heart attack, another candidate for "golden hour" treatment, it is widespread in India. Coronary heart disease, involving not necessarily only the fatted rich, is the most common type of heart disease killing 370,000 people annually in India. In 2013, stroke was the second most frequent cause of after coronary artery disease accounting for 6.4 million deaths worldwide. Snake-bites and drowning cases also call for "golden hour" attention and financial support as envisaged under the "Santwana- Harish Scheme".
So, why cover road accident schemes exclusively and not heart/stroke attacks, suicide survivors, drowning cases and snake-bite victims? Those involved in car crashes, by common understanding, are rich people who can bear the expenses of high-end, corporate-type hospitals. But the bridge-finance facility for the initial Rs 25,000 is visionary. By the same token there should be a mechanism for the victim to voluntarily reimburse the initial bridge-finance so that the state can extend the available resources to cover sectors beyond road accidents.
Veteran journalist and author, John B. Monteiro now concentrates on Editorial Consultancy, having recently edited the autobiography of a senior advocate, history and souvenir to mark the centenary of Catholic Association of South Kanara and currently working on the history/souvenir to mark the platinum jubilee of Kanara Chamber of Commerce & Industry.