“I have a renal condition that requires me to undergo dialysis. I’ve been coming to the Nishtar Hospital for my treatment for two years. I know for a fact that the doctors here often overrule the standard operating procedures which dictate that all patients need to be tested for HIV and hepatitis before being sent in for dialysis,” said a middle-aged patient, speaking on the condition of anonymity.

The woman told the media that two months ago, when she was at the hospital for her dialysis treatment, she met a boy who told her he had tested positive for HIV. He also said the doctors were reluctant to conduct dialysis. “Later, I learnt that that boy had died,” she said.

According to the standard operating procedure (SOP) set by the Punjab Healthcare Commission, each dialysis patient needs to be tested for HIV every six months and for hepatitis every three months. The testing is mandatory.

These are the rules on paper. In Nishtar Hospital, however, negligent staff has allegedly been flouting the SOP.

Gross violations of SOPs have been observed at the hospital’s Nephrology Ward which became the epicentre of an HIV outbreak earlier this month when it was revealed that a patient who underwent dialysis there had contracted HIV during the treatment and passed away.

After 25 more patients, 11 women and 14 men, tested positive for HIV at the ward, it was revealed that the same dialysis machine was being used for the treatment of HIV positive and negative patients.

An undercover visit to the ward and conversations with patients revealed that some doctors were performing dialysis without conducting blood screening. Until recently, the hospital had also lacked a separate machine for the dialysis of HIV-positive patients.

Doctors on duty during the visit claimed that blood screening of each patient – including HIV and hepatitis tests – was mandatory. When asked for test results of patients over the last six months, the doctors said that the reports were ‘classified’ and could not be made public.

This is the second incident of alleged medical negligence reported from Nishtar Hospital in two and a half years. Earlier, in October 2022, it was revealed that the hospital staff had dumped some putrefying bodies on the rooftop and left them there to rot, in violation of the hospital protocols.

“The head of nephrology has also assumed charge as registrar at the hospital. His primary responsibility should be to oversee renal care,” said Nazir Ahmed, a council member of the Human Rights Commission of Pakistan. “This is what happens if the division of labour is unfair and multiple portfolios are handed to the same person,” he said.

Nishtar Medical University’s administration has constituted a three-member institutional committee to probe the HIV outbreak and determine its scale. According to a report released by this committee, the staff of the dialysis unit was unable to provide full data of patients who had tested positive for HIV or hepatitis.

The institutional investigation committee also found that 220 dialysis patients had been tested for HIV, out of which 25 were found to be HIV positive. However, the three-member committee did not deem medics negligent. It only issued an advisory to prevent such occurrences in the future.

The hospital administration shelved the committee’s report, its findings and the notification issued to constitute a committee when the Punjab government constituted a high level fact-finding committee headed by the Punjab Human Organ Transplant Authority director, Prof DrShahzad Anwar. This committee included the Punjab Aids Control Programme project director, the head of Nephrology Department at the Services Hospital, Lahore, DrZahidRafique and deputy secretary (technical) of the Health Department.

Senior doctors, who spoke to TNS on the condition of anonymity, said that the extent of negligence could be gauged by the three blunders the hospital administration had made after it was reported that the patients, who had previously been negative for HIV, were testing positive for the infection after their dialysis appointments. The medical staff initially did not inform the medical superintendent. They also did not reach out to the Aids Control Programme Centre established at the Shahbaz Sharif District Headquarters Hospital. They also did not immediately isolate the infected patients.

The nephrology unit tried to cover up the matter. Insiders told TNS that attempts were still being made to scapegoat the junior staff and pin the blame only on them. Some members of the lower staff have been reportedly served notices and asked for explanation. This has resulted in panic in the ranks of the support staff.

“We were assigned to care for dialysis patients. We did our level best but we were unable to protect them from HIV infection. We are sorry. We promise 100pc compliance with the instructions and SOPs in the future,” read one of the notes submitted by the staff members to the associate professor of nephrology.

Commenting on the note, a senior doctor observed that, in fact, it was the sole responsibility of doctors to conduct blood screening and HIV test instead of the lower staff. “The lower staff is being scapegoated,” said the doctor.

On Friday, Chief Minister Maryam Nawaz paid an unscheduled visit to the Nishtar Hospital. She suspended five senior doctors including the medical superintendent, DrKazim; Nephrology Ward head, Prof Dr Ghulam Abbas; Assistant Professor Dr Jahangir; Associate Professor Dr Poonam; and Senior Registrar DrAlamgir. The licences of these doctors were also suspended.

During her visit, the chief minister was given a detailed briefing at the vice chancellor’s office on the issue of HIV/ AIDS transmission among 25 patients at the Nephrology Ward of Nishtar Hospital. She expressed outrage at the negligence.

Insiders said the chief minister had also sought resignation from the vice chancellor, Prof DrMehnazKhakwani. However, this could not be confirmed independently.

A former Nishtar Hospital medical superintendent, DrKazim Khan, said that the hospital had been conducting regular screening of all its patients. He said that the recent incident involved a patient who had “…previously tested negative for HIV but was later found to be positive.”

“29 machines are fully operational in the dialysis unit. A dialysis machine for hepatitis B positive patients has been damaged and awaits repair. 13 machines are rendering Hepatitis C service. Two machines are reserved for HIV-positive patients. More than 240 dialysis patients are registered currently,” said Khan.

The writer is the bureau chief of The News in Multan.He may be reached at trisign69@yahoo.com