DHANGADHI, AUGUST 12 Private hospitals in Sudurpaschim Province licensed to provide general healthcare are increasingly being found offering specialised treatment and complex surgeries beyond the scope of their approvals, exposing gaps in health-sector monitoring and enforcement. Recent cases involving Atariya Hospital General Hospital in Kailali and KG Hospital in Dhangadhi have highlighted the mismatch between authorised services and actual practice. Atariya Hospital General Hospital, which operates as a general hospital, was found to be running a cardiac catheterisation laboratory (cath lab) without the required approval, according to an inspection by the Health Office, Kailali. Health Office Kailali chief Ramesh Kunwar said the hospital was licensed only as a general hospital and therefore could not operate a cath lab or provide specialised cardiac surgery without separate approval. 'This is only a general hospital. Separate approval is required to provide specialised services, including cardiac surgery,' Kunwar said. The inspection followed the death of Hemanta Bhandari, a teacher from Patan, Baitadi, who died after undergoing surgery at the hospital in June. Bhandari had been taken to the hospital after experiencing chest pain and was later taken to India for further treatment after he did not regain consciousness following the surgery. His relatives said Indian doctors told them there had been a problem with a blood vessel leading to the brain during the heart surgery. However, the actual cause of Bhandari's death has not been established and requires medical investigation. Following its inspection, the Health Office recommended action against Atariya Hospital General Hospital to the Health Directorate. Acting director of the Health Directorate, Dipayal, Dr Khagendra Bam, said specialised services require approval from the federal Ministry of Health and Population. He said the directorate had received a report from the Health Office regarding the hospital's operation of the cath lab and was discussing the matter. Concerns over monitoring The case has also raised concerns over whether the agencies responsible for licensing and monitoring private health institutions are effectively coordinating. Under the existing system, hospitals with up to 200 beds are licensed by provincial authorities or bodies designated by them, while hospitals with more than 200 beds require approval from the federal Health Ministry or its designated agency. The provincial government has authorised local governments to issue licences for 15-bed hospitals and health offices to issue licences for 25-bed hospitals. However, health-sector observers say regular monitoring to determine whether hospitals continue to meet the required standards after receiving licences has not been effective. Hospitals are required to meet standards covering beds, human resources, equipment, specialist doctors and emergency services. Authorities have the power to take action, including revoking licences, when institutions operate services contrary to approved standards. In practice, however, enforcement has remained weak, according to sector observers. Dr Bam said health institutions found operating services against prescribed standards would be investigated and subjected to necessary action. 'If a health institution is found to be operating services against the standards, it will be investigated and necessary action will be taken,' he said.