Tuesday, August 15, 2017

Nothing, nothing, nothing - The response to repeated reminders on oxygen dues

Lucknow, Aug. 14: Documents The Telegraph has seen contradict the Yogi Adityanath government's claim that it became aware only on August 4 about the dues owed to the gas vendor to the Gorakhpur hospital where 30 children died on Thursday and Friday after supplies were stopped.

The government has blamed the delayed payment on Rajiv Mishra, principal of the Baba Raghav Das Medical College, and suspended him before accepting his resignation.

Here's what the records of the state's medical education department say (represented in the form of a calendar):

March 22: Mishra writes to the director-general of the medical & health department, which functions under health and family welfare minister Siddharth Nath Singh, to clear the vendor's dues.
He has attached a copy of a payment reminder he has received from the vendor, Pushpa Sales Pvt Ltd, the same day. Mishra forwards copies of his letter to medical education minister Ashutosh Tandon and Siddharth Nath.
Result: Nothing.

April 3: Mishra sends a similar letter to the additional chief secretary of the medical education department, with copies to the directors-general of the medical & health and medical education departments. He attaches the latest reminder from the vendor, received the same day.
Result: Nothing.

April 17: Mishra writes again to the additional chief secretary, with copies to the directors-general, attaching the latest reminder, received the same day.
Result: Nothing.

April 24: Mishra writes again to the additional chief secretary, with copies to the directors-general, attaching the latest reminder.
Result: Nothing.

May 2: Mishra writes again to the additional chief secretary, with copies to the directors-general, attaching the latest reminder.
Result: Nothing.

May 6: Mishra writes again to the additional chief secretary, with copies to the directors-general, attaching the latest reminder.
Result: Nothing.

May 29: Mishra writes again to the additional chief secretary, with copies to the directors-general, attaching the latest reminder.
Result: Nothing.

June 28: Mishra writes again to the additional chief secretary, with copies to the directors-general, attaching the latest reminder.
Result: Nothing.

July 6: Mishra writes again to the additional chief secretary, with copies to the directors-general, attaching the latest reminder.
Result: Nothing.

July 18: Mishra writes again to the additional chief secretary, with copies to the directors-general, attaching the latest reminder.
Result: Nothing.

(At least five of the reminders from Pushpa Sales that Mishra has attached to his letters threaten stoppage of oxygen supply.)

Aug. 1: Mishra writes again to the additional chief secretary, attaching the latest reminder, signed by Pushpa Sales executive Dipankar Sharma, which says the dues have grown to Rs 63.65 lakh and must be paid immediately to ensure "uninterrupted supply" of oxygen. A copy is marked to minister Tandon.

Aug. 4: Tandon receives a letter sent by Mishra and learns - for the first time, according to the minister - about the dues and the threat.

Aug. 5: Tandon orders Rs 2 crore transferred to the Gorakhpur treasury towards the payment of the dues, according to the minister. Money reaches the treasury the same day, according to the government.

Aug. 7: Money arrives in treasury, according to Mishra.
Aug. 8: Mishra sends college accountant to treasury to get a token clearing the payment.

Aug. 9: The vendor writes directly to Tandon, sources in Pushpa Sales say.
The letter from company director Maneesh Bhandari says the six-month dues have risen to Rs 68.65 lakh despite the principal being informed "many times through letters, orally, telephone, email and a legal notice".
"We personally handed this letter to the minister on August 9 morning. He and (chief minister Yogi) Adityanath went to the medical college the same afternoon to hold a review meeting," an executive of Pushpa Sales said.
"We came to know from hospital authorities that they had told the chief minister about the problem and he had looked questioningly at Tandon. After that, Adityanath apparently stayed silent."

Vendor still unpaid. No work possible because the chief minister was at the medical college and "we were busy with him", Mishra says. Doesn't explain why a Net-banking transaction that should have taken the accountant just a few minutes was not done.

• Vendor stops supply in the evening after Adityanath leaves.
Aug. 10: After 23 babies die,Adityanath tells reporters he hadn't known about the delayed payment or oxygen crisis at the hospital, located in the parliamentary constituency he has represented continuously since 1998.
Vendor still unpaid. Mishra doesn't explain why.

On August 14, Mishra does not take calls from this newspaper, which wanted his reaction to reports that he had been away in Rishikesh on August 10.
Aug. 11: A sum of Rs 52 lakh is finally transferred to the company's account through RTGS. Vendor begins steps to resume supply.

Aug. 12: Siddharth Nath announces suspension of Mishra, accusing him of delaying the payment. But even before a probe starts, the government insists that lack of oxygen didn't cause the deaths. Late at night, government accepts Mishra's resignation.

Aug. 14: Siddharth Nath tells reporters in Allahabad that the oxygen supply was disrupted because "some people wanted kickbacks". He does not say who they are.
(A health department source had told this newspaper on August 12 that the medical college's account had a balance of Rs 3.86 crore on August 9, and that the vendor had gone unpaid because he had "failed to oblige some senior members in the government".
("No such business operates without kickbacks," the source said. "But the principal had recently received orders from Lucknow to stop the payment.")

• Adityanath, who used to call Gorakhpur bandhs against "misrule" by the Bahujan Samaj Party and the Samajwadi Party, faces a shutdown against him in his hometown for the first time in his political career.
Most Opposition parties participate in the protest. So do the Hindu Samaj Party and Nagrik Manch, two social welfare organisations once closely associated with Adityanath.

Monday, August 14, 2017

Supreme Court tells Singh Bros to maintain shares in Fortis

Supreme Court tells Singh Bros to maintain shares in Fortis

NEW DELHI: The Supreme Court on Friday told Fortis promoters Malvinder and Shivinder Singh to maintain the current status of shares held by one of their companies in Fortis Healthcare Ltd. The order, a result of DaiichiSankyo’s latest petition at the apex court, is expected to block the brothers from selling any shares in their flagship hospital chain until arguments are heard in about a month.

A bench comprising Justices Ranjan Gogoi and Navin Sinha told RHC Holdings Pvt Ltd and Oscar Investments Ltd to maintain “status quo” of Fortis Healthcare Holding’s shareholding in Fortis Healthcare Ltd. The Singhs control RHC and Oscar, which jointly own Fortis Healthcare Holding—the company that holds their stake in the hospital group.

The court also issued notice to the companies, which are expected to submit a response before the next date of hearing likely in four weeks.

The Singhs are currently locked in litigation initiated by Japanese drug maker Daiichi Sankyo, which is trying to enforce an arbitration award that would require the brothers to pay the company Rs 3,500 crore in damages and interest. A Singapore tribunal had granted this award last year after Daiichi alleged the Singhs concealed information of wrongdoing at Ranbaxy while selling it for $4.6 billion in 2008.

Daiichi has moved the Delhi High Court several times since January following reports that the Singhs may strike a deal to sell their controlling stake in Fortis. Last Friday, it approached the Supreme Court to appeal a June 21 high court that would potentially let the Singhs enter corporate transactions provided they maintained the value of the unpledged assets they disclosed earlier this year.

The high court had sought the value of these unpledged assets so that they could be considered to pay Daiichi’s award if the Japanese firm won its ongoing case to enforce it.

Since June, Fortis Healthcare Holdings has pared its shares in the hospital chain to around 37% from 52.20%, Daiichi's counsel had argued at the Delhi High Court on Thursday. The Japanese company fears the move would make it difficult to realise its award if it wins its ongoing case at the high court.

Ahead of Yogi Adityanath’s visit Gorakhpur hospital gets a makeover

In 24 hours the Baba Raghav Das Medical College hospital at Gorakhpur underwent a makeover, ahead of the visit of Chief Minister Yogi Adityanath, along with Union Health Minister J.P. Nadda.
Police personnel deployed inside the sprawling campus of the hospital on Saturday were stationed even inside the wards on Sunday to regulate relatives of patients and visitors.
The narrow corridor connecting the “100-bed encephalitis ward” with the canteen in the middle of the hospital was sprinkled with bleaching powder and four colourful dustbins were put in a row. At the glass door of the ward some young policemen and women were on their toes and not allowing anyone to go inside.
At one far corner of the corridor Baby Kumari of Chauri-Chaura was in tears as she was not allowed to see her son Sangam Kumar inside the ward. On the intervention of The Hindu the woman was allowed in.
The tiled floors and walls had been washed; the gurneys and trolleys to carry sick patients neatly arranged in a row; the ill-lit places lit up; the smell of urine and stale food filling the air had vanished and plastic bags of patients’ relatives scattered all over had been removed.
Even the canteen area, where one plate of food is available for ₹15 for patients’ relatives, was in order. The army of stray dogs had been chased away and the milling caretakers of the patients not to be seen.
The doctors appeared extra attentive, the nurses running from one bed to another and the ward boys, wearing plastic caps and rubber gloves, were busy ensuring that everything looked neat and clean. “CM saheb aa rahe hain, sir…kuch bhi gad-bad hua to sidhe napa jayenge (CM is coming, sir…if anything goes wrong, dismissal will follow next)”, said a ward boy.
At one bed in the encephalitis ward two-three nurses were seen attending to the children, with doctors giving them necessary instructions from the prescriptions. “Where were all these amenities a day back? It seems we’ve come to some big private hospital today,” grandfather of a child admitted in the ward told The Hindu.
However, death of children continued. Bhikhari Yadav of Bhatni in U.P. came out of the ward with the body of his four-year-old son Sumit Kumar in his arms. Seeing it his wife broke down.

Gorakhpur's creaky health infra: Tragedy was waiting to happen

The death of over 60 children within the span of a few days at Gorakhpur's BRD Medical Collegehas caused ripples of shock and anger across the country and abroad too. As state and central government ministers and officials scramble to find out what actually happened, ground reports seem to indicate that, as suspected, oxygen supply to the children's ward and the ICU had indeed run out.

But the moot question is: Was this tragedy just waiting to happen? Preliminary investigations suggest it was certainly deemed to occur. BRD Medical College is one of the few tertiary care public hospitals in this heavily populated region of Uttar Pradesh that caters to over 3.5 lakh outpatients and 40,000 inpatients every year.

While BRD's creaking infrastructure and mismanagement have played a role in the deaths, a larger question may again be bypassed - Why is BRD Hospital a "big centre" to which patients, not only from Gorakhpur but others districts around it, come in thousands? After all, many of their diseases (including Japanese Encephalitis) and treatment procedures do not require super-specialty level medication. So, why is it that a person has to go to BRD only to be treated for Japanese Encephalitis?

A look at Gorakhpur's health infrastructure reveals the chilling state of affairs. Just 11 primary health centres out of 68 in the district function 24x7 - which is what they are mandated to do. There are just six first referral units in the whole district which has a population of nearly 45 lakhs. There is just one sick new born care unit and only three new born stabilization units in the whole district.

In fact the reach of the much-vaunted mother and child health programmes of the government is also severely limited. Although estimated deliveries in 2015-16 were 1,29,429, based on the past trends and number of women in child-bearing age, the reported live births in the district were just 58,674 - that is, 45% of the total. Clearly 55% of the children were born outside the whole institutional framework .

A glance at Gorakhpur's National Health Mission district-level approved budget for 2016-17 reveals some bizarre and misplaced priorities of the officials. Of the Rs 82.46 crore allocated to Gorakhpur district, child health and the Rashtriya Bal Swasthya Karyakram (National Children's Health Program) together account for a measly Rs 1.89 crore - that is, just over 2% of the total.

In contrast, family planning is allocated Rs 1.61 crore, and health personnel get Rs 10.6 crore.

But simply allocating more resources is of course not the solution because as another report shows, health personnel in the state are distributed in the most imbalanced way with Lucknow division having 187% of its requirement of obstetricians and gynecologists while Goraphpur has 83% and neighbouring Azamgarh just 50%.

Similarly, while Kanpur has four general surgeons for every sanctioned position, Gorakhpur has about one for two sanctioned posts. So, while the oxygen supply issue needs a quick and just resolution, a deeper look at what plagues Gorakhpur’s healthcare system is urgently needed.

Thursday, August 10, 2017


A division bench of Hon’ble Justice Mr. B.C. Gupta and Dr. S.M. Kantikar in the National Consumer Forum (NCDRC) admitted a major complaint of “medical negligence” and issued show cause notice against a private nursing home “Extent Medical & Surgical Center” in Chandannagar near Kolkata for the wrongful death of Ms. Sanchita Khan, US-trained IT specialist and only 32-year old daughter of a ENT specialist, Dr. Manik Chandra Khan. Sanchita died following treatment by one Dr. Amit Saha (owner of the Extent nursing home) after suffering from a simple cough and fever for only 4 days. Ironically, Dr. Saha was found to be practicing with a fake M.D. degree in medicine as he claimed himself to be a “critical care specialist” even though he was found to have only post-graduate (M.D.) degree in Preventive and Social Medicine (PSM).
PBT president, Dr. Kunal Saha, appeared on behalf of Dr. Khan and argued that the treatment provided to the victim was abysmal as no attempt was made to correct the obvious medical problems like anemia and hypoxia as the patient was left virtually unattended to die after only 4 days. A claim of Rs. 3.95 crore compensation has been made in this complaint in view of the young age and high status of the victim as well as the unethical conduct of the accused doctor and hospital.
PBT president also successfully argued before the same bench the case of a second victim of alleged medical negligence in which a 62-year old lady, who was suffering from a heart attack, was refused admission at an ESI Hospital in Kolkata. The patient died within 15 hours without treatment after she was taken back home. In this case, MCI has already found the accused doctor, Darpanarayan Datta, guilty for medical negligence and directed the West Bengal Medical Council (WBMC) to cancel his medical license for a period of 1 year. Unfortunately, WBMC still refused to abide by the MCI’s order and did not take any measure to cancel license of Dr. Datta. A compensation of Rs. 1.05 crore has been claimed in this matter. Both matters will come up for further hearing in November. Over the past more than one month since Dr. Saha came from USA, he has been appearing for different victims of medical negligence (on behalf of PBT) in consumer courts across India without ever taking any money from any of the victims only to help them find medical justice.

Difference between Haryana and Chandigarh police

Chandigarh, Aug. 6: Police in Haryana's Hisar town were accused of ignoring a complaint about a woman's possible abduction in a car hours after their Chandigarh colleagues were publicly thanked by a woman for responding promptly to her distress call during an alleged stalking-cum-kidnapping attempt.

Umesh Sharma, a trader in his 40s, today told The Telegraph he had heard a woman's cries through the open window of an Alto while driving over the Dabra flyover in Hisar, 242km from Chandigarh, around 5pm yesterday.

He said he had pulled up alongside the Alto and peered in to see three young men and a woman, who was screaming that she was being kidnapped.

"I honked and asked why she was screaming. The man seated beside the driver pointed to the word 'police' inscribed on the rear windshield. The Alto then accelerated and vanished," Sharma said. "The men were in plainclothes."
Sharma said a policeman on traffic duty near the flyover refused to hear his complaint.

"I called the police control room several times but there was no response. Then I decided to go to the Civil Lines police station and file a complaint," he said.
Sharma said he gave the police the number of the Alto. The police lodged a general diary but appear not to have taken any action so far.

"We have noted what the man had to say. There was nothing much to go on in this case," a senior police officer in Hisar told this newspaper on the condition of anonymity.

"There is no missing persons complaint with us matching the description given by the man."
The officer evaded the question whether the police had investigated the car number Sharma had given them. Calls to the mobile number of Hisar superintendent of police Manisha Chaudhary were not answered.

Chandigarh police had promptly intercepted and arrested Haryana BJP chief Subhash Barala's son Vikas and a friend after receiving an emergency call from a young woman driver at Friday midnight saying two men were stalking her in a car.
In a Facebook post yesterday afternoon that described her ordeal, she thanked the Chandigarh police profusely "for unparalleled efficiency and attention to a distress call from me", saying they "almost restore my faith in the system".

Allegations that weak charges had been invoked today prompted Rahul Gandhi's office to tweet: "Condemn attempt to kidnap & outrage modesty of young lady in Chdgrh. BJP Govt mst punish the guilty; not collude W/culprits & mindset they represent."

CPM leader Sitaram Yechury tweeted: "Clearly someone is helping the accused here. Why are the PM and BJP President so silent about stalking of women?"
Congress spokesperson Manish Tewari said the Chandigarh police had already succumbed to political pressure and diluted the case.

"The police facilitated Vikas Barala's bail and did not apply non-bailable sections, though the victim had clearly stated that an attempt was made to kidnap her," he said.

Haryana Congress chief Ashok Tanwar tweeted: "The BJP runs anti-Romeo squad in Uttar Pradesh and its leaders turn Romeo to chase girls on the streets of Haryana."

Lucky not raped and lying in a ditch

That being said, I'd like to take a moment to commend and thank Chandigarh Police for unparalleled efficiency and attention to a distress call from me. They almost restore my faith in the system.
Here's what went down:
I was driving home from the Sector 8 market at about 12:15am, and crossed the road into Sec-7, where the petrol pump is. I was also on the phone with a friend at the time, and realised about a minute later that a car was following me.
It was a White SUV, and as I noticed it, it pulled up and started driving alongside my car. I was now in Sec-7, heading towards the lights next to St. Johns' in 26.
There were 2 guys inside the SUV, and they seemed to really be enjoying harassing a lone girl in the middle of the night, judging by how often their car swerved, just enough to scare me that it might hit me.
By now I was totally alert and mildly panic-y, so I decided to turn right from the St. Johns' traffic lights towards Madhya Marg (a more crowded, seemingly safer road).
I tried to turn right from the lights but the SUV blocked my way, forcing me to go straight into Sec-26.
At the next turn, I tried to turn again, but this time they went a step further.
Right at the turn, they blocked the road in front of my car, and the guy in the passenger seat got out of the car and started walking towards me. I reversed as fast as I could and went straight and took the next right turn before they could catch up again.
I used this time to also call the cops at 100, and explain to them the situation and my exact location and where I was headed.
The cop who answered my call, intuitively sensed the urgency in my voice, and promised me that help would be along very soon.
I hung up and had now reached the main road, and hadn't seen the SUV for about 15 seconds, so I hoped, that they'd seen me calling the cops and disappeared. I was wrong.
I was now on a straight road for about 5-6km (Madhya Marg), and that entire time, the SUV stayed alongside my car, trying to bully me into stopping every 10-15 seconds LITERALLY.
I was in a full-blown panic attack by now because they would keep trying to corner me, and I'd somehow manoeuvre my way out and keep moving.
My hands shaking, my back spasming from fear, half in tears, half bewildered, because I didn't know if I'd make it home tonight.
Who knew when, or if, the cops would show up.
These guys INCESSANTLY bullied me all the way to Solitaire (end of 6kms), and at the traffic lights, blocked my car for the final time. This time they meant business, because they left me absolutely no space to move or escape, and the passenger JUMPED out of the car and moved towards mine.
I don't know how, but I reversed my car and moved to the right where there was space, all this while constantly honking so the few vehicles around would know something was wrong.
At this point, the guy had reached my car, banged loudly on my window, AND TRIED TO OPEN THE DOOR HANDLE!
Just as he did this, I saw a PCR pull up at the lights, quite possibly in response to my call. They heard me honking, and saw the SUV swerving left and right in an attempt to block me, and a couple of cops ran out towards the SUV, nabbing it just in time, because they were blocked in by traffic.
I, still shaking from fear, drove straight home, and told... (father) what happened, getting him back with me to file the complaint.
The 2 boys, who of course, are from influential families with political connections, have been arrested and the complaint has been filed.
At the risk of sounding redundant, I need to mention and thank Chd (Chandigarh) Police again because had it not been for their timely response, I might not be writing this status today.
If this is what women deal with in one of the safer cities in the country, where are we going?
I find it shocking, that in a place with cameras at every light and cops every 200 metres, these boys thought they could either get into my car, or take me into theirs, just because they're from an influential background.
I'm lucky, it seems, to not be the daughter of a common man, because what chance would they have against such VIPs?
I'm also lucky, because I'm not lying raped and murdered in a ditch somewhere.
If this can happen in Chd, it can happen anywhere.
LADIES! Please be proactive about your own safety;
DON'T BE AFRAID to call the cops, The minute it starts!
Call your parents, if possible, and let them know where you are and the situation you're in.
Try and run away, in the safest way possible.
YOUR LIFE IS PARAMOUNT! If he walks towards you, use whatever you can as a weapon.
I was never a big fan of weapons, till last night.
Whether it's a gun or mace or taser or a golf club or a knife, it's going to make you feel safer and more confident.

Teen stalked and slain by BJP leader's son

Lucknow, Aug. 9: A BJP leader's son murdered a 17-year-old schoolgirl by repeatedly slashing her throat on a busy road in Uttar Pradesh in front of at least 50 people, her sister has said.

The alleged assailant was on the radar of the now-disbanded "anti-Romeo" squad in Uttar Pradesh five months ago for stalking the same girl but had been let off with a warning, her father said.

Ragini Dubey, who was on her way to school along with her younger sister yesterday morning, was declared dead on arrival at a health centre in Ballia district, 400km east of Lucknow.

The accused has been identified as Prince Tiwari, the son of local panchayat chief and BJP leader Kripashankar Tiwari. Prince, a Class XII dropout and jobless, has been arrested along with Raju Yadav, an alleged accomplice.

Ragini had spurned Prince's offer to marry her as she disliked him and also wanted to study to become a doctor. However, Prince allegedly continued harassing Ragini for the past four months.

Ragini and her sister Siya were cycling to Sanskar Bharati School in Salempur block from their home in Bajahan village yesterday morning when Prince and an associate, Sonu Tiwari, hit the sisters' cycle from behind with their motorbike on the busy Bansdih Road.

"We fell off our cycle. Prince dragged my sister to the middle of the road, took out a knife and kept slashing her throat. There were at least 50 people on the road but none of them came forward to help," Siya, 13, said.

Ragini's father, farmer Jitendra Dubey, has named Prince, Kripashankar, Sonu and Prince's friends Niraj Tiwari and Raju in the FIR. While Prince and Sonu, who were identified by Siya, are the main accused, the others have been named as accomplices.

"My sister used to dislike Prince. But he and his friends continued harassing her," Siya said.
Jitendra alleged that all the five accused were in the village for several hours after the crime. "Had the police acted fast, all of them could have been arrested," he said.

Vijay Pal Singh, the additional superintendent of police, said search teams had been formed and attempts were being made to arrest the others.

Jitendra, who has five children, said he had complained to Kripashankar about Prince in March but the father took no steps to rein him in. In March, Jitendra had approached policemen who were members of the local anti-Romeo squad.

"The anti-Romeo squad personnel warned Prince to stay off Ragini and let him off. But he continued to stalk and harass my daughter. He wanted to marry Ragini but she had refused. She wanted to continue studying and become a doctor," Jitendra said.

Wednesday, August 9, 2017

RBI surveys a wake-up call for the Narendra Modi government

The RBI survey for June 2017 shows the percentage of people who said their income growth was lower than in December 2013 and March 2014, when the disenchantment with the UPA government was at its peak. Graphic: Mint
Perceptions matter. The government of the day will be able to garner more support if people feel their incomes are increasing or their employment prospects have improved. True, non-economic factors matter a lot and, throughout history, the ability to stage circuses has been as important for governments as providing bread. But economic factors play a big role in people’s sense of well-being and the latest Reserve Bank of India (RBI) surveys should be a wake-up call for the central government.
For example, shouldn’t the government be concerned that in the June 2017 RBI survey on consumer confidence, the percentage of respondents who said that their incomes had decreased from a year ago was more than in September 2013, during the depths of the balance-of-payments crisis? Should it not worry them that the percentage of people polled who said their incomes had increased from a year ago was lower than in December 2013 and March 2014, when the disenchantment with the United Progressive Alliance, or UPA government, was at its peak? As Chart 1 shows, the net response, or the percentage of people in the survey who said their incomes had increased compared to a year ago minus the percentage who say their incomes have decreased, is the lowest in many years.
The consumer confidence survey is conducted by RBI in the six cities of Bengaluru, Chennai, Hyderabad, Kolkata, Mumbai and New Delhi. It, therefore, reflects perceptions among the relatively well-off, who have been staunch supporters of the present government. Conditions in less developed areas are likely to be worse. Chart 2 shows the perceptions about employment in the survey. In June 2017, the percentage of households who said their employment conditions had worsened from a year ago was much higher than in March 2014, just before the last general elections. More importantly, the net responses (the percentage of households saying their employment conditions have improved minus the percentage saying conditions have deteriorated) have been negative for six consecutive quarters now. Surely that is a warning sign?
There is, however, one important area where the current government, aided by RBI, has done exceptionally well—it has succeeded in taming the inflation monster. That is why households’ perceptions of overall current economic conditions are still nowhere as bad as they were in 2013 or early 2014. Chart 3 shows the perception of current economic conditions from RBI’s consumer confidence survey. Note, however, that “net responses” have turned negative in the last two quarters, which means that the proportion of those surveyed who thought current economic conditions were worse than a year ago is higher than the proportion who think conditions have improved. It is not a good sign that the percentage of people who think that economic conditions have worsened in the past year is just a bit higher than in March 2014.
Let’s move on to another RBI survey—the industrial outlook survey, which covers the manufacturing sector. Chart 4 gives the employment assessment of the manufacturing sector. Once again, the survey shows the situation is not as bad as it was during the days of the taper tantrum in 2013. But it cannot be a comfort that the percentage of manufacturers who think that employment is increasing in June 2017 is lower than what it was in March 2014.
Perhaps people think their current travails are temporary and things will get better soon? At first glance, that seems likely. In the consumer survey, for example, a net 37.7% of those polled in June 2017 think their incomes will be higher a year ahead. That’s in contrast to the net 1.4% who felt their current incomes were higher than a year ago. But then, people always feel the future is going to be better. For instance, in December 2013, a net 37.2% felt their incomes a year ahead would be higher. That’s not too different from the June 2017 number.
We have a similar situation in regard to employment prospects too. A net 28.4% now think their employment prospects will improve a year ahead. Contrast that with June 2014, in the first flush after the election, when the net percentage was as high as 54.9%. Those early hopes have been dashed.
Every economist has said that for the economy to really start looking up, we need to see a turnaround in investment demand. Is capital formation going to improve soon? Look no further than the latest RBI survey of professional forecasters. The median forecast of gross fixed capital formation (GFCF) for 2018-19 is 29% of gross domestic product (GDP) at current market prices. For comparison, GFCF in 2013-14 at current prices was 31.3% of GDP. Investment demand will get better, but it’s likely to be a slow uphill task.
The current government has done a lot by way of structural reform. A lower fiscal deficit, low increases in minimum support prices, removing petroleum subsidies, the introduction of the goods and services tax (GST), the bankruptcy law and the law regulating the real estate sector are examples. Analysts have pointed out that some of these reforms, while being beneficial in the long run, may have a negative impact on the economy in the short run. That is very likely. It is also possible that the short-term disruptions are resolved by early 2019, before the next elections, and perceptions improve dramatically.
But what if that doesn’t happen? The government should take the results of the RBI surveys as an early warning signal.
Manas Chakravarty looks at trends and issues in the financial markets. Respond to this column at manas.c@livemint.com.

Tuesday, August 1, 2017

US hospitals set record for fast heart attack care

There's never been a better time to be treated for a heart attack. U.S. hospitalshave set a record for how quickly they open blocked arteries, averaging under one hour for the first time since these results have been tracked.
More than 93 percent of patients now have their arteries opened within the recommended 90 minutes of arrival.
"Things have definitely improved" from a decade ago, when less than half of heart attack patients were treated that fast, said Dr. Fred Masoudi, a University of Colorado cardiologist who led a recent report examining response times.
It's based on records from about 85 percent of U.S. hospitals that do the artery procedure, angioplasty . Through a blood vessel in the groin or an arm, doctors guide a tube to the blockage causing the heart attack. They inflate a tiny balloon to flatten the clog, and leave behind a mesh tube called a stent to prop the artery open.
The sooner blood flow is restored, the less chance of permanent damage.
"It's one of the few things in medicine where time, literally seconds, is of the essence. It's where the phrase 'time is muscle' comes from," said Dr. Ajay Kirtane, director of the lab that performs angioplasties at New York-Presbyterian/Columbia University Medical Center.
The risk of dying goes up 42 percent if care is delayed even half an hour beyond the 90 minutes that U.S. guidelines say patients should be treated after arrival.
In 2005, this "door-to-balloon" time averaged a dismal 96 minutes, and the American College of Cardiology led a drive to get hospitals to improve. The report shows it plunged to 59 minutes in 2014.
It was only 24 minutes for George Smith at UConn John Dempsey Hospital in Farmington, Connecticut. The 82-year-old woke up on March 31 with intense jaw pain, the same kind he had during a heart attack two years ago. His wife called 911. An ambulance whisked him to the emergency room, and "they were all waiting for me" at the door, he said.
An hour later he was sitting up in bed with a new stent. "I was amazed," he said. "Such a blessing."
One reason UConn is so fast - its median door-to-balloon time was 56 minutes last year, and only 39 minutes during one recent quarter - is the work it has done to make its emergency responders part of the cardiac care team, said the hospital's EMS coordinator, Peter Canning.
"We used our paramedics to extend our hospital into the patient's home," where they do an extensive electrocardiogram of the heartbeat and call results ahead to the hospital to get the angioplasty room ready, he said. "Calling from 25 minutes out instead of 5 minutes out can be a savings of 20 minutes of heart muscle."
But all that speed by the hospital won't do much good unless patients act fast, too, and call 911 if they think they might be having a heart attack.
The warning signs:
-Discomfort in the center of the chest lasting more than a few minutes, or that goes away and comes back. It can feel like pressure, squeezing, fullness or pain.
-Pain or discomfort in one or both arms, the back, neck, jaw or stomach.
-Shortness of breath, which might include breaking out in a cold sweat, or feelings of nausea or lightheadedness.
"For women, the symptoms may not be the same. It may not be the typical chest pain" but rather abdominal pain, nausea or unusual tiredness, said Dr. Annapoorna Kini, a cardiologist at Mount Sinai Hospital in New York City.
What to do? "Get medical help," she said. "It's better to worry after" about whether it was really a stomach problem rather than a heart attack.
Angioplasty also is done for non-emergency conditions, to treat chronic chest pain caused by arteries that are clogged but not severely blocked, and its use in that setting is more questionable. Often medicines and other things can be tried first, and angioplasty can be avoided or delayed.
The report shows that fewer people are getting these procedures inappropriately. In 2014, about one third of angioplasties were elective, for non-emergency situations. Just over half were deemed to be done for clearly appropriate reasons and another one third were classified "may be appropriate" under guidelines from the cardiology college and others. About 14 percent were deemed "rarely appropriate" - less than other research has found in the past.