JANKIDEVI BAJAJ INSTITUTE OF MANAGEMENT

STUDIES

A Project on

ESI HOSPITAL
Submitted By:
GROUP NO – IV (MPMIR-II)

Trupti Bane - (03)

Manali Bhakta - (05)

Niharika Choudhary - (07)

Kashmira Kerawalla - (19)

Shreya Patil - (26)

Anureet Soni - (40)

 ACKNOWLEDGEMENT

It is often said, ‘Many hands makes work light ’. Indeed, it is true in our case for, without the
kind support and help of many people; our project would not have been so interesting. We would
like to extend our sincere thanks to the ESI Hospital, Andheri for giving us an opportunity to
work on a challenging project as this.

Our deepest appreciation to Mr. A.M. Patil (Medical Superintendent) who gave us a benefit to
learn by sharing his own thoughts and experiences.

Special thanks to Mr. Dineshprashad. Gupta (Dy. Medical Superintendent) and Mr. Narsingh
(Dy. Director, Finance) for helping us broaden our vision in our approach to the project and also
for their sincere efforts to take time out of their busy schedule for guiding us.

We also take this opportunity to thank Mrs. Suchita S. Bane (Retired Employee – ESI Hospital,
Andheri) for extending her kind support and encouragement in working to the betterment of our
project. .

Our earnest gratitude and sincere thanks to Mr. A. Navalkar(Professor)

of Industrial Relations course for giving us an opportunity to take up such a challenging project ,
and get exposure to the practical aspects of Industrial Relations at large.

And also our special thanks to our family and to all those people who have directly or indirectly
contributed in the completion of our project

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 Contents

1 Employees State Insurance Scheme Of India 4

Introduction
2 ESIC Hospital, Andheri 13

Underneath it all
3 Committees 20

4 Departments 24

5 Medical Care 25

6 Budget Planning 29

7 Purchase Of Materials 30

8 Kitchen Department 33

9 Training 35

10 Common problems 36

11 Observations & Suggestions 38

12 References 40

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 Employees State Insurance scheme of India

Introduction

STATEMENT

To provide for certain benefits to Employees in case of sickness, maternity and employment
injury and to make provisions for related matters.

INTRODUCTION:

Employees State Insurance scheme of India is an integrated social security scheme tailor to
provide protection to workers in the organized sector and their dependents in the organized
sector and their dependents in contingencies, such as, sickness, maternity or death and
disablement due to an employment injury or occupational disease. Towards this objective the
scheme of health insurance provides full medical facilities to insured the person and their
dependent, as well as, cash benefit to compensate for any loss of wages or earning capacity in
times of physical distress.

APPLICABILITY OF THE ESI ACT:

The ESI Act, (1948) applies to the following categories of factories and establishments in the
implemented areas:-

• Non-seasonal factories using power and employing ten(10) or more persons

• Non-seasonal and non-power using factories and establishments employing twenty (20)
or more persons.

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The “appropriate Government” State or Central is empowered to extend the provisions of the ESI
Act to various classes of establishments, industrial, commercial, agricultural or otherwise in
nature. Under these enabling provisions most of the State Governments have extended the ESI
Act to certain specific classes of establishments, such as, shop, hotels, restaurants, cinemas,
preview theatres, motor transport undertakings, news paper and advertising establishment etc.,
employing 20 or more persons.

ORGANISATION:

As provided under ESI Act, the Scheme is administered by a duly constituted corporate body
called the Employees State Insurance Corporation (ESIC). It comprises members representing
Central and State Governments, Employers, Employees, Parliament and the medical profession,
Union Minister of Labour functions as Chairman of Corporation where as the Director General,
as its chief executive, discharges the duty of running the day-to-day administration.

A Standing Committee representing all stake holders is elected from the body corporate for
managing the affairs of the scheme and monitoring the progress of implementation of various
corporate decisions and policies etc. from time to time.

The Medical Benefit Council, a statutory body advises the corporation on matters related to
administration of medical benefit under the ESI scheme.

INFRASTRUCTURE

The central headquarters of the Corporation is located at New Delhi. For purpose of coverage,
revenue collection, extension of the scheme to new classes of establishments, implementation of
the scheme in new areas, coordination’s the Corporation has established Regional and Divisional
Offices across the country mostly located in the state capitals.

Given the huge number of beneficiaries- about 354 lakhs now the Corporation has set up a wide
spread network of service outlet for prompt delivery of benefits in cash kind that includes full
medical care.
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Medical facilities are provided through a network of 1422 ESI Dispensaries, over 2000 Panel
Clinics, 307 diagnostic centers besides 144 ESI hospitals and 42 hospital annexes with over
28000 beds. For providing super-specialty medical care the Corporation has tie up arrangement
with advanced medical institution in the country, both in the public and private sector. The
medical benefit is administered with the active cooperation of the State Governments.

The payment of cash benefit is made at the grass roots level through as many as 825 Branch
Offices and Pay Offices that function under the direct control of the corporation.

CONTRIBUTION

The ESI Scheme is mainly financed by contributions raised from employees covered under the
scheme and their employers, as a fixed percentage of wages. As of now, the rates of contribution
are:-

I. Employee’s Contribution : 1.75 percent of wages

II. Employer’s Contribution : 4.75 percent of wages

• Employees earning up to Rs. 50/- a day as wages are exempted from payment of their
part of contribution.

• The State Government bear one-eighth share of expenditure on Medical Benefit within
the per capita ceiling of Rs. 900/- per annum and any additional expenditure beyond the
ceiling.

WAGE CEILING

Employees of covered units and establishments drawing wages upto Rs. 10.000/- per month
come under the purview of the ESI Act, 1948 for multi-dimensional social security benefits.

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AREAS COVERED

The ESI Scheme is being implemented area-wise by stages. The Scheme has already been
implemented in different areas in the following States/Union Territories

STATES
All the States except Nagaland, Manipur, Tripura, Sikkim, Arunachal Pradesh and Mizoram.

UNION TERRITORIES
Delhi, Chandigarh and Pondicherry

BENEFITS PROVIDED BY ESI

Medical Benefit:

An insured person and his dependent family member become eligible t claim medical facilities
under the E.S.I. Scheme from day one of entering insurable employment.

For availing the medical facility for self or any of the declared dependents an insured person has
to produce the temporary identification certificate issued by the E.S.I.C Branch Office on taking
insurable employment. This temporary identity certificate is thereafter replaced with a family
photo identify card that caries the photographs and other particulars of the family member and
the insured person. Failure to obtain the permanent card or its non production at
dispensary/hospital can result in deprivation of medical care.

It is also to be born in mind that dispensary is the base point for availing medical facilities. The
reference for specialist treatment of diagnostic investigations is made by the ESI dispensary itself
to the concerned hospital. It is only in extreme emergency or at odd hours when the dispensary is
closed that the insured person can report at the emergency dept of an ESI hospital directly but
should not fail to produce his/her photo identity card.

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All medicines are issued free of cost by the dispensary to which an ISP is attached. However, in
case of non-availability of prescribed drugs at the hospital an insured person can purchase the
medicines from local market if so advised and submit such claim to the dispensary for
reimbursement.

Sickness Benefit:

A claim for sickness benefit can be made only on the basis of Medical Certificate issued by the
authorized doctors under the Scheme. In exceptional cases alternative evidence of sickness or
temporary disablement is accepted by the Corporation.

1. An insured person is required to deposit his medical certificate in the box provided at the
dispensary. Or he should ensure that the certificate is presented to the branch office
within 3 days of its issue.

2. He/She should fill-up claim form from sickness benefit printed on the certificate itself,
when she/he goes to branch office for collecting payment or while submitting the
certificate at the pay office, as the case may be.

3. Branch office staff will assist in the filing the claims if so required. In case of pay offices,
Dispensary staff will assist in filing the claims.

4. If the claim is accepted, the same shall be paid immediately by the branch office and if
not found eligible a regret slip will be issued in ESI-15. In case of Pay-offices the cashier
visits the pay office on an appointed day and disburses the payment. Insured person can
also get payments through money order if they do desire and send a written request to the
Branch Office.

Extended Sickness Benefit:

Same procedure is to be followed as is applicable for claiming Sickness Benefit. However, in
this case the insured person is supposed to appear before the medical referee when referred by

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the Branch Officer Manager for the purpose of confirmation of the examination for allowing
Extended Sickness Benefit from 124 to 309 days. Further an insured person is required t appear
before the Board for deciding the case beyond 400 days but upto a maximum period of 2 years:

Temporary Disablement Benefit:

1. Procedure regarding submission or Regulation Certificate and claiming the

benefit remains the same as shown above against sickness Benefit.

2. In addition, an insured person who sustains employment injury to give a notice to

such injury to the employer immediately either in writing or orally and also ensure that the
employer has given the accident report to the concerned Branch Office will in time in the
prescribed form-16.

Permanent Disablement Benefit:

1. An Insured person should submit an application for reference to the Medical

Board on plain paper to the branch office manager after the termination of temporary
disablement benefit. This may be done at the time of submitting the final certificate or
within 12 months from the termination of temporary disablement.

2. He should ensure that he also gives his age proof to the Branch Office Manager
along with the application.

3. Form B.11 (a) indicating residual incapacity will be issued by the I.M.O./I.M.I. at
the time of final certificate. It is required to be submitted along with an application for
appearing before a Medical Board. If it has not been obtained at the time of issue of final
certificate it should be obtained at the time of applying for Medical Board.

4. The Medical Board sends its decisions to the ESIC Regional Office directly or
through branch office as the case may be and the regional office issues the sanction for
periodically payments of P.D.B. One copy of the sanction order is endorsed to the insured
person also. After receipt of this sanction the insured person should submit the claims form
in the branch office for payment of P.D.B. This payment will be made to him every month
as long as he is alive.

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 5. In case his rate of P.D.B. is Rs.5/- per day or less an insured person can apply for
lump sum communication of the payment provided that the total commuted value does not
exceed Rs.3000

6. An Insured Person should apply for commutation within a period of 6 months

from the date of possible option. Then only branch office manager shall be able to send the
request to regional office immediately. Otherwise the insured person will be referred to the
medical referee for certifying normal expectancy of life, and only after such certifying is
obtained, the insured person’s case will be processed for sanction of communication.

7. The original sanction order of communication is send to the insured person with a
copy to the branch office. The insured person should produce the original copy at the
branch office at the time of payment.

Dependent Benefit:

1. Dependents of a deceased insured person should contact the branch office for claiming
the dependents benefit. The claim clerk will receive them and supply them necessary
forms and furnish all information needed by them. He will also assist them in filing the
claim form-18
Dependents are required to submit:

a) The evidence of death of the insured person having occurred due to an

employment injury.
b) Evidence that claimants are dependent.
c) Evidence of age of claimant.
d) Evidence that female dependent (widows/daughters) has/have not remarried or
married after the death of an insured person.

2. These claims after scrutiny are forwarded to the regional office and the Regional Officer
communicates its decision to all the persons who claim the Dependent Benefit. To those who
are not found entitled, a letter in form ESIC-146 will explain why their claim has been

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 rejected. The letter in form ESIC-147 will indicate the daily rate of benefit of each
dependent. For minor dependent the information is sent through the guardian.

3. The dependents should approach the Branch Office with the letter (ESIC-147) for
claiming the first payment.

4. Subsequently they can collect dependents Benefit on first of each month either in person
or by money order by submitting claims in form-18 A.

5. If dependants are staying in far off places, they can opt for payment from the nearest
Branch Office. The Branch Office Manager will transfer all the records to the concerned
Branch Office from where payment has been desired to be made by the beneficiary.

6. At the time of claiming Dependent Benefit for the month of June and December every,
the claimant should submit a declaration in form-27 duly attested by the authorities
mentioned there in.

Maternity Benefit:

An Insured woman claiming Maternity Benefit during the employment is to submit following
documents either personally or by post:

a) A certificate of expected confinement form-21. Issued by an authorized doctor.

b) A benefit claim in form-22 duly completed.
c) In addition to above, she has also to submit a certificate of confinement in form-23
within 30 days of date of confinement.

In case of claiming payment after confinement insured women has to submit a certificate in
form-23 along with the claim form in form-22.

In case of miscarriage she has to submit a certificate of miscarriage along with claim in form-
22. Certificate of miscarriage has to be submitted within 30 days. Insured woman can draw

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 Maternity Benefit on weekly basis. At the time of final payment she should submit form-28
duly completed by her employer which will be issued by the Branch Office Manager.

Funeral Expenses:

Claim in form 25 (A), duly attested by the competent authority as mentioned in the claim
form itself, be submitted to the branch office along with the death certificate for claiming the
funeral expenses on the expenses up to a maximum of Rs.2500/- is admissible.

Other Benefits:

a) Unemployment Allowance payable for up to 6 months to those insured persons, who face
involuntary unemployment due to closure of factory/establishment, retrenchment or
permanent invalidity arising out of non-employment for last 5 years.
b) Old age medical care for self and spouse at a nominal contribution of Rs.120/- per
annum.
c) Physical rehabilitation with free supply of artificial appliances.
d) Vocational rehabilitation on permanent disablement.
e) Immunization, family welfare services besides pre-natal and post-natal care in respect of
female beneficiaries.

Employees State Insurance hospital, Andheri

Underneath it all
ESI Hospital, Andheri, was constructed by ESI Corporation as a 600 bedded hospital and
commission by State Government of Maharashtra on 1.5.1977. It was later reduced down to 400
beds and again on recommendation of review committee to 300 beds w.e.f. 1.10.07. As a matter
of policy of taking over 1 hospital from each State to run as a model hospital, this hospital was
taken over by ESI Corporation on 14.4.08, in presence of Honorable Chief Minister of

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Maharashtra, honorable Union Minister of State for Labour and employment and officers of ESI
Corporation and State Government. The hospital has been upgraded to 500 beds.

Specialist Services:

This hospital caters OPD Services in General Specialties viz. General Medicine, General
Surgery, Orthopedic, Gynaecology, and Obstetrics, Pediatrics, Ophthalmology and ENT.
Medical Officers with Post Graduate Qualification run the Pediatric and Gynaecology
Department. Appointment will be done in August 2008. One Dentist is also posted.

The Specialties other then in OPD Service are Pathology, Anaesthesia (PG Qualifies Resident
Anaesthetist) and Radiology (Medical Officer with PG Qualification) SR. Specialists in this
Departments will be appointed in August 2008. For super specialty treatment, tie-up arrangement
is available with J.J. Hospital, KEM Hospital, Nair Hospital, Sion Hospital and Tata Cancer
Hospital.

The hospital has a Counseling Center for HIV/AIDS with a Counsellor from MDACS. A DOTS
Centre is also functioning. There are no Skin, Psychiatry and Chest Department at present.

Daily attendance in OPD is approximately 300 patients. OPD services are catered during
working hours of 9.00 a.m. to 4.00 p.m.

Emergency Services:

Round the clock services are available in Casualty, Indoors, Pathology, X-Ray, and O.T.
Casualty medical officers are posted in casualty along with another staff compromising staff
nurse, ward boy, Sweepers, Barber etc. Medical officers are also posted in shifts for indoors.
Specialists remain on call to attain any emergency either in casualty or in wards. Technicians are
posited in shift duties in X-Ray and Pathology Department.

The maintenance agency has provided man power round the clock to run Central AC and
package unit of kitchen.

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Ambulance Services are available round the clock. A tie up arrangement has been made for super
specialty investigations and purchase of medicines, which are not available in the hospital.

Indoor Services:

There are 300 beds distributed for different departments viz. Medicine 90, Surgery 60,
Gynaecology and Obstetric 60, Paediatrics 30, Orthopaedics 30, Casualty 5, Pooled beds 15 and
5 beds each for Eye and ENT. Pooled beds can be utilized later for other departments to be
established viz. Skin, Chest, Dental, Psychiatry, ICU/ICCU etc. The present occupancy of the
hospital ranges between 180 to 190.

Diagnostic Services:

These services are catered through Pathology and X-Ray Department. A full time Pathologist is
posted a Semi Autonalyser, Cell Counter, Centrifuge, Hot Air Oven, Incubator, Auto pipettes,
Blood Storage Refrigerator are available in Pathology Department. All routine investigations are
done here. Since there is no tissue processor, tissue blocks and slides are got prepared through a
tie-up arrangement.

X-ray Departments has won 725 MA X-Ray machine, One Portable, 60 MA Machine and One
Ultrasonograph. Medical Officer with PG Qualification is looking after X-Ray Department. Both
Pathology and X-Ray Department function round the clock.

Operation Theatre:

There are two Operation Theatre complexes in the hospital viz. on 2 nd and 3rd floor. However,
only the one on 2nd floor was in use and has been closed for repairs. A minor O.T. on ground
floor is converted to Major O.T. as a makeshift arrangement. All major and minor Operations of
all departments are done here. There are two Resident Anaesthetists posted here. The equipments
available are Boyles Apparatus, Suction Machine, Cardiac Monitor with Defibrillant, Pulse

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Oximeter, Multipara Monitor, Operating Microscope (Ophth.) etc. Number of operations
performed is annexed.

Kitchen:
Through Kitchen diet as required for various patients is provided as per ESIC Norms. Morning
breakfast, Lunch and Dinner are provided. Diet Committee makes the planning of diet. Apart
from Steward, Head Cook and Cook mates, a Dietician is posted here. One Medical Officer is
the in charge.

CSSD:

There are two High Pressure Horizontal Sterilizers in the department out of which one is
working and other needs repairs. Suppliers of Sterile material is made from here to OPD, Indoor,
Pathology, X-ray and other department. One Medical Officer is incharge of the department, apart
from Staff Nurses and other Staff.

Linen Department:

This department has a staff including Linen Keeper, Tailor and group D Employees. There is
sufficient stock of blankets, bed covers/sheets, and other surgical linen. Procurement was done
through PSU Textile Industry.

Labour Ward:

This section runs round the clock with Staff Nurses and Group D Employees. Medical Officers
with PG Degree in Gynaecology and Obstetrics remain on call. Deliveries conducted in the past
are annexed.

Maintenance of the Buildings:

The hospital building is on ground and five floors and there are 324 Staff quarters in the
Premises. The maintenance at present is being done through Private Contractors. Hospital
Building and Residential Quarters are undergoing special repair works. However, there is a
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proposal to renovate the hospital completely and provide modern facilities with Central Air-
Conditioning.

Family Welfare Activities:

There is a family Welfare Section run by the State Government with a Staff of a Medical Officer,
Staff Nurse, One Clerk and Group D Employees. This Department conducts Antenatal
Checkups, vaccination and distribution of Contraceptives. Operative part is looked after looked
after by the hospital.

Future Plans:

1. A Dialysis unit will be started soon.

2. ICU/ICCU units will be opened.
3. New equipments will be purchased for all the departments.
4. ESI Corporation has already floated global tender for installation of CT Scan/MRI
machine in ESI Hospital Andheri.
5. Hospital building is being completely renovated, refurnished and centrally air
conditioned. New construction of building after demolition of old nurses hostel and on
the vacant plot a PG hostel will be constructed.
6. There is a plan to start an Evening OPD.
7. There will be regular CME and training programmes for doctor and paramedical staff.
8. Procedure for starting of blood Bank will be taken soon.

Composition:
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Person In charge:

• Mr. A. M. Patil – Medical Superintendent

• Mr. Dineshprasad Gupta - Deputy Medical Superintendent

• Mr. Narsingh – Deputy Director, Finance

The medical superintendant is directly appointed by the government. The deputy medical
superintendant and the deputy director, finance is recruited from the UPSC (Union Public
Service Commission) based on their qualifications.

The minimum qualification for the medical superintendant is M.B.B.S degree.

There is no fixed tenure for the officers. They can be transferred from one location to another
location periodically as per the requirement.

Statistical Data:-

HEADS FIGURES *
Sanctioned beds 300
Previous date patients 180
New patients admitted 27
Discharged patients 43
Death 1
Present number of patients 163
*Figures as on 12-11-2008

Staff Position Govt. of Maharashtra & E.S.I.C. as on 31.08.08

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 Category POSTS From ESIC Staff
Sanction Filled Vacant
Specialists 17 07 06 04
Administrative --- --- --- 05
Medical Officer 28 20 02 06
Class III Clerk 44 28 11 05
Class III Para medical 40 30 02 12
Class III Sister I/c 15 09 05 01
Class III Staff Nurses 90 83 01 06
Class IV Ward boy 100 98 02 ---
Class IV Sweeper 04 75 75 --- ---
92 88 04
Class IV Others ---
501 438 63
Total 39

Organization chart:

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 1
Committees

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It has been decided to constitute committees for various purposes for smooth functioning of the
hospital, ensure supply of drugs, diet, stationary and other articles and also see for
implementation of new proposals to update the hospital services. Such committees will work out
annual requirement on the basis of consumption of last 3 years and taking into consideration
future planning and development. After sanction from the medical Superintendent limited/open
tenders, as the case may be, shall be limited and finalized in consultation with accounts and
approval of the medical superintendent. Emergency requirement may be fulfilled by local
purchases from hospital contract for drugs and dressings and Kendriya Bhandar/NCCF for
stationery and other articles. Dietary articles if required may be purchased by inviting limited
tenders. Linen and liveries should be purchased from government agencies. It should be ensured
by all committees that adequate stock is kept at hand before placing the orders.

The committees are as follows:

1. Medical scrutiny committee:

After the tender is passed this committee first checks the quality of the medicine and then
it uses for the patients. This committee mainly looks after the quality of drugs and
medicines supplied in the hospital.

Composition:

• Deputy Medical Superintendent

• Medical Officer Purchase

• Representatives of 3 Departments

• Deputy Director Finance

• 2 Pharmacists

2. Tender/Purchase committees for Non-Medical equipments:

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 In this committee, all the suppliers get a chance to quote their price in a sealed envelope
and then all the tenders are opened in front of all the committee members and the tender
with lowest quotation is finalized.

Composition:

• Deputy Medical Superintendent

• Medical Officer Purchase

• Representative of user department

• Joint director (Administration) / Deputy Director (Administration)

• Deputy Director (finance)

• Care taker of hospital

3. Technical Evaluation Committee for Equipments:

This committee evaluates the equipments that are brought into the hospital.

Composition:

• Deputy Medical Superintendent

• Medical Officer Purchase

• Representative of user department

4. Committee of General/Stationery Purchase:

This committee looks after the stationary items that are used in the hospital.

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 Composition:

• Deputy Medical Superintendent

• Joint director (Administration) / Deputy Director (Administration)

• Deputy Director (finance)

• Representative of nursing staff.

• Medical Officer Purchase.

5. Technical Committee (purchase of medical equipments):

This committee purchases medical equipments like X-Ray machines, C T Scan machine,
and Ultra Sound machine.

Composition:

• Deputy medical Superintendent

• Specialist of concerned department

• Doctor (may or may not be from the same department)

• Medical Officer (Purchase)

• Deputy Director Finance (For all committees)

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6. Committee of Dietary and Grocery items:

This committee looks after the food items for the patients. The quality and quantity of
food items is decided by this committee.

Composition:

• Deputy medical Superintendent

• Joint director (Administration) / Deputy Director (Administration)

• Deputy Director (finance)

• Dietician

• Store in charge

7. Committee of Linen Purchase:

This committee looks after the uniforms of the patients as well as bed sheets, napkins,
pillow covers.

Composition:

• Deputy medical Superintendent

• Joint director (Administration) / Deputy Director (Administration)

• Deputy Director (finance)

• Representative of nursing staff

• Medical Officer (Purchase)

• Linen keeper

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8. Committee of Purchases of Liveries:

This committee looks after the uniforms of the staff. Every year three uniforms are
provided to each staff member.

Composition:

• Deputy medical Superintendent

• Joint director (Administration) / Deputy Director (Administration)

• Deputy Director (finance)

• Store Keeper

• Union Representative

**********

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 2
DEPARTMENTS

i. Medical

ii. Surgery

iii. Gynaecology

iv. Orthopaedics

v. ENT (Eyes ,Nose and Throat)

vi. Ophthalmic

vii. Psychiatrist

viii. Pathology and X-Ray

ix. Anesthesia
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 **********

3
Medical Care

The hospital takes care of its patients in three different ways. They are:

1. Primary care

2. Secondary care

3. Tertiary care

 Primary care :- The doctors (Insured Medical Practitioners) give the primary
treatment

to the patients at the various dispensaries of ESI Hospital . They examine them by
holding check ups and treat them for minor injuries.

 Secondary care: - The IMPs’ at their dispensaries diagnose the severity of the
disease and accordingly advise them for further treatment in the ESI hospital. The
patients are advised to visit the hospital for blood testing, urine and stool testing, and
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other prescribed tests such as Ultra sound Sonography, Eco-cardio gram (ECG),
Magnetic Resonance Imaging (MRI), Computed Tomography (CT) scan and thereby
provide the reports to the patients for their further treatment.

 Tertiary care: - The tertiary care includes the super specialty treatment which
is given by the doctors to their patients. Any major surgery or a transplant which has to
be performed on the patient comes under this category.

The tertiary facilities given in this case includes the knee joint replacement, the hip joint
replacement and such other replacements or transplants. There are various tied up
hospitals viz. Balaji hospital at Byculla, Sion hospital, JJ hospital, and KEM which
provide the tertiary treatment to the insured patients.

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PROCEDURE FOR CASE PAPER

The patients having major health problem are recommended to visit the other tied up hospitals
like KEM, J.J., MGM, Balaji hospital for undergoing superspeciality treatment. The patient is
again investigated for that particular disease and if required is admitted for his treatment.

A report is sent to the ESI hospital thereafter for sanctioning his estimated expenses for medical
treatment.

The Medical Superintendent issues the sanction order for the patient after complete study of his
medical report provided by the tied up hospital.

A demand draft is made accordingly, and sent to the concerned authority of the respective
hospital.

A copy of the medical and expenses report along with the form stating the period of his
treatment is sent to the ESIC. The patient is paid his wages for the period of his medical
treatment from the ESIC.

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The most common found occupational health diseases in the industrial workers are as follows:-

Silicosis

Silicosis is a preventable disease. Silicosis (also known as Grinder's disease and Potter's rot) is a
form of occupational lung disease caused by inhalation of crystalline silica dust, and is marked
by inflammation and scarring in forms of nodular lesions in the upper lobes of the lungs.

This respiratory disease was first recognized in 1705 by Ramazzini who noticed sand-like
substances in the lungs of stonecutters. The name silicosis (from the Latin silex or flint) was
attributed to Visconti in 1870.

Preventive occupational safety measures include:

• controls to minimize workplace exposure to silica dust

• substitution of substances—especially in sandblasting—that are less hazardous than silica
• clear identification of dangerous areas in the workplace
• informing workers about the dangers of overexposure to silica dust, training them in
safety techniques, and giving them appropriate protective clothing and equipment

Asbestosis

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Asbestosis is a chronic inflammatory medical condition affecting the parenchymal tissue of the
lungs. It occurs after long-term, heavy exposure to asbestos, e.g. in mining, and is therefore
regarded as an occupational lung disease. Sufferers have severe dyspnea (shortness of breath)
and are at an increased risk regarding several different types of lung cancer.

Prevention to be taken:- Prevention measures, such as wearing a protective mask with a supply
of clean air, and strictly following recommended methods to control asbestos fibres and dust,
can be adopted by the high-risk work force.

In industries, substitution with a less harmful variety of asbestos, dust control measures, periodic
medical examination of the employees, rotation of workstation for the employees and good
ventilation facilities can help to minimize the risks.

Byssinosis

It is a lung disease, caused by exposure to cotton dust in inadequately ventilated working

environments.

Prevention to be taken: - The workers working in cotton manufacturing or textile industries

should always wear the mask provided as safety equipment which covers their nose and mouth
and prevents them from inhaling the extremely minute cotton particles and cotton fibers.

Hearing impairment

A hearing impairment or hearing loss is a full or partial decrease in the ability to detect or
understand sounds.

Loss of the ability to detect some frequencies, or to detect low-amplitude sounds that an
organism naturally detects, is a hearing impairment.

Factories which produce noise above 90 decibels (db) leads to hearing impairment in the workers
which thereby leads to hearing impairment.

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Prevention to be taken: - The workers working in such high noise producing factories should
wear the earplugs, which are provided to them as safety equipment.

**********

4
Budget Planning

For the smooth functioning of the hospital there has to be smooth flow of funds for the various
expenditures for the purchase of drugs, medical and non medical equipments, food for the in
-house patients and also for improving the infrastructure and administrative affairs of the
hospital. For this purpose, the budget is sanctioned every year by the central government. The
budget allocated by the government for the fiscal year 08-09 is 25 crores. However, the Deputy
Director, Finance has proposed a budget of 52 crores.

The funds allocated for the medicines and treatment of the insured employees is the collective
contribution of the employers (4.75%) and the employees (1.75%).

The budget can be invariably sanctioned by the Deputy Director, Finance as and when there
arises a requisition for drugs, medical/non medical equipments, stationeries, groceries, etc.

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 **********

5
Purchase of materials

The ESI Hospital purchases drugs , equipments (medical/non medical), diet, stationery &
printing, linen & liveries as per the requirements of various departments.

The committees responsible for the purchase of their respective materials, meet as per their
need in the presence of the Deputy Medical Superintendent and Deputy Director , Finance and
Medical Officer Purchase to take collective decisions regarding the floating of the tenders. These
tender notices can be given as global or local tender notice.

Sealed bids are invited and finally the committees meet up again for finalizing the quotations.
The least biding parties are selected for the purchase of their required materials.

Purchase of drugs:

Purchase of drugs and dressings is done under the E.S.I. Corporation centralized rate contract
no.130 for additional drugs. A copy of the Centralized rate contract for additional drugs finalized
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for supply of drugs and dressings under the ESI Scheme in the country is sent to the director
general of E.S.I. Corporation (ESIS-ALL STATES AND Medical superintendent ESIC Model
Hospitals). All the medicines, drugs, dressings come under the rate contract.

Purchase of equipments (Medical/non medical):

For the purpose of purchase of equipments the hospital has a committee known as technical
committee. This committee looks after the purchase of the medical as well as non medical
equipments. They often meet as and when the need arises and decides upon the further actions to
be taken regarding the purchase of the materials.

The purchase of the equipments usually occurs due to the following reasons:

1. Purchase against the contamination

2. Purchase of new equipment.

Procedure for purchase of equipments:

• Advertisement is given in news papers in the form of tenders with specifications.

• The tender with the lowest quotation which meets the requirements and standards is then
finalized.

• After the finalization of the tender, order is passed to that particular agency.

• The supply of the material is done within 3-4 days (for emergency within 24 hours)

• The hospital receives the equipments and checks for the quality of the material supplied.

• After the quality checking of the material, it is approved for installation.

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 • As and when the installation is finished payment is made (90% of the payment is made
before the supply and the remaining 10% is done after the installation )

Purchase of raw materials:

The purchase of the raw materials for the kitchen is managed by the committee of Dietary and
Grocery items. This committee meets up to decide upon yearly purchase of the raw materials.

In meetings, the dietician and the along with other members involved decide upon the quality of
the raw materials to be purchased. Once the specifications are decided upon, the committee
members float the tenders in the newspapers stating the required specifications.

The tender is passed for the supplier whose quotation is the lowest. And after the complete
quality checking and approval form the dietician the payment is done.

**********

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 6
Kitchen department

 The kitchen department comprises of 6 persons working in a general shift from 9 am – 5

p.m out of which 3 persons work as cook, assistant cook, 1 Dietician & 1 Assistant
Dietician .

 The raw materials & the food grains is purchased for the 15 days & is brought from the
tender in Vashi. This contract is maintained for 1 year & it keeps on changing according
to the need.

 The rate of entire meal for per patient is Rs. 17.95 paise/day & Rs. 38.86 paise/monthly.
Thus the entire budget of the meal comes at around 1 lakh 42,000 monthly.

 There is a provision of a refrigerator for storing the food items & the store room in case
of an emergency.

 The Diet Sheet is prepared one day in advance according to the patients need & the
scaling is done by the Dietician for proper measurement of nutrition in the food.

 The meal comprises of: BREAKFAST- 1 Glass of Milk, 2 Bananas;

 LUNCH/ DINNER- As per prescribed & it consists of 1 vegetable which could be

repeated twice a week for sedimentary workers.

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  The following terminology is used for the diet sheet as mentioned below :-

• AD - FULL DIET

LD - LIGHT DIET

MD/BMD - MILK & SUGAR

ADD - DIABETIC VEG -DIET

AFD - PEDIATRIC DIET ( SMALL)

BFD - NON –VEG FULL DIET

BMD - BUTTER MILK DIET

BREAD - 60 GRMS - 2 SLICES/ PATIENT

MILK - 70 ML MILK IS CUT FOR MAKING TEA

**********

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 7
Training

The Medical Superintendent of the ESI Hospital, Dr A.M. Patil firmly believed in the power of
Karma and satisfying his customers who are in the form of patients. Hence in order to avoid
hindrance in the smooth functioning of the hospital, conducts training for his staffs. These
training are mostly for improving the behavioral aspects of his staffs and nurses.

The staffs and nurses who are employed in the hospital are underprivileged. Thus they tend to
aggravate at times while serving their patients. This will in turn escalate a sense of dissatisfaction
among the patients.

Thus to instill a sense of tranquility within these class III and class IV employees, he holds
training where he advocate about means by which patients can be served and satisfied. The staff
tends to believe in spirituality. And hence he explains the sacredness involved in helping and
serving people by way of treating them.

There are no external training conducted as of now. But, they have future plans to give external
training in technical as well as behavioral areas.

**********

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 8
Common problems

The Medical Superintendent of the ESI Hospital, Dr A.M. Patil firmly believed in the power of
Karma and satisfying his customers who are in the form of patients. Hence in order to avoid
hindrance in the smooth functioning of the hospital, conducts training for his staffs. These
training are mostly for improving the behavioral aspects of his staffs and nurses.

The staffs and nurses who are employed in the hospital are underprivileged. Thus, they tend to
aggravate at times while serving their patients. This will lead to unsatisfied customers.

Thus to calm these people he holds training where he preach about ‘satisfying one patient also,
will satisfy god. And if a patient is not served properly or not attended proper manner will be
punished by god.’

Nevertheless, he also believes that there is no organization which doesn’t have problems. Even in
this hospital there are certain problems which do occur among the patients, the staffs, the nurses
and the doctors.

The common problems, which occur among them, are as follows:

Patients

• There are no equipments for major surgery viz. angioplasty, heart operations, and kidney
transplantations available in the hospital. Hence asked to go to other hospitals namely
Balaji Hospital , Byculla; J. J. Hospital, Sion; KEM Hospital, Tata Hospital, etc. which
are tied up with ESIC.

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 • The out going patients have to wait for long hours for the doctors which in turn results in
hypertension and anxiety among them.

• The doctors being from the state government tends to become proud and arrogant at times
with the patients. Due to their arrogant behavior they at times delay or avoid operating
the patients.

• No doctors for lifestyle diseases like depression and heart ailments.

• Over-crowded wards

Staffs

• No proper laundry facilities provided for nurses and staffs

• Adequate number of uniforms not provided to them with no proper stitching facilities
provided.

• Canteen is not in a proper hygienic condition with very few seating arrangement.

• Confusion in the minds of the state government staffs after the take over of the
corporation as to whose policies to follow.

Doctors

• Doctors are less in numbers hence; they have to attend more patients at a time.

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 • No adequate equipments available for super specialty treatment.

• The state government doctors have a fear of loosing their jobs due to the take over of
corporation.

**********

9
Observations & suggestions

Observations

1. The officials were very co operative as well as helpful, and provided as much
information as they could.

2. The Hospital building is under renovation for the purpose of constructing a “Model
Hospital”.

3. All the wards were clean and well ventilated.

4. New equipments with the latest technology such as Incubator, X-ray machine and USG
machine were newly introduced.

Suggestions

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• The procedure of filling the forms for getting the patients admitted can be simplified, as it
is time consuming and difficult for the patients and their relatives to understand as they
are less educated.

• Seating arrangements for the visitors of the patients needs more attention as some of the
visitors were found to be sitting on the floor due to less inadequate space.

• The stretchers used to carry the patients need to be in good working conditions as the
backrest of the stretcher was found to be slight curved and the stretcher was rusted.

• The complaint box must be kept in an isolated place so that the patients are able make use
of this facility freely, without any hesitation or any fear.

• Rest room for the staff should be adequately furnished.

• The staff canteen needs has to have a good infrastructure and has to be hygienic.

• The area around the doctors’ residential quarters within the premises needs maintenance
as the area was found to be littered.

• Drinking water facilities must be well maintained.

• Water coolers need to be assigned at proper places, and the area surrounding it has to be
well maintained.

• An in-house laundry facility for the staff must be set up.

• There is a need for the dustbins to be kept at various places in the hospitals, so that the
patients as well as visitors can avail them as and when required thus contributing to the
maintenance of cleanliness of the hospital.

• More appropriate care and attention to the patients is required and clarification of the
doubts if any in the minds of the patients should be answered.

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 **********

References

• Employees’ Sate Insurance Scheme

Citizen’s Charter

Revised edition: January 2007

• Social Security Benefits

Under The ESI Scheme

(Brief procedures of Claim)

• ESI Hospital Rate Contract Manual

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