Chandigarh, March 13 -- In stroke care, delay is damage. But in Chandigarh, a family noticing the warning signs of a brain stroke may do the right thing - rush the patient to the city's primary district hospital, Government Multi -Specialty Hospital, Sector 16 - and still lose the narrow window in which life-saving treatment can prevent paralysis or death. Since 2022, the hospital has not been administering the clot-dissolving drug Alteplase (Tissue Plasminogen Activator or TPA), which must be given within three to four hours of the onset of an ischemic stroke. Instead, stroke patients are being referred to Post Graduate Institute of Medical Education and Research (PGIMER), losing critical time while the brain continues to suffer irreversible damage. Of the two types of strokes - Ischemic and Haemorrhagic - the former, the most common, occurs when a blood clot blocks blood flow to the brain, depriving brain cells of oxygen. The latter occurs when a weakened blood vessel in the brain ruptures and bleeds, disrupting normal blood circulation. Both can be fatal and need immediate treatment. When administered within the crucial treatment window, Alteplase can dissolve the clot in case of an ischemic stroke, restore circulation and significantly reduce the risk of permanent brain damage, paralysis or death. However, once that window closes, the chances of recovery diminish sharply. Despite being a secondary-level healthcare facility capable of treating stroke cases, GMSH-16 has not been thrombolysing stroke patients since the Covid-19 restrictions were lifted in 2022, according to doctors familiar with the hospital's earlier stroke management programme. Meanwhile, unaware that the treatment is not available there, families continue to rush stroke patients to GMSH. Emergency department staff, including an emergency medical officer, said the TPA injection was not being administered at the hospital. However, UT director health services Dr Suman Singh maintained that the drug was given when required. When asked for data on when a stroke patient was last administered TPA at GMSH-16, no clear record was provided. Stroke treatment follows a strict "golden window", where every passing minute results in the death of brain cells. Experts say secondary care hospitals such as GMSH-16 play a crucial role in preventing such delays. Under the hub-and-spoke model adopted for stroke management, since 2016, PGIMER functions as the hub while surrounding hospitals act as spokes that identify stroke patients, conduct urgent brain scans and administer clot-busting medication when appropriate, referring only complex cases to the tertiary centre. Dr Dheeraj, professor in the neurology department at PGIMER, said the institute treats around 1,200 stroke patients annually and has seen an increased burden in recent years. "After Covid-19, GMSH-16 has not been thrombolysing stroke patients and is sending all cases to us," he said. "Secondary care hospitals play a crucial role in making treatment accessible to stroke patients by doing immediate scans and administering the TPA injection if required. This saves valuable time. If all patients are referred to PGIMER, the rush here can compromise treatment time," he added. Before the pandemic, GMSH-16 had an active stroke management system in place, with a dedicated nodal officer, resident doctors, nursing and paramedical and emergency staff trained for stroke management. Dr Naresh Sharma, a former doctor at the hospital who served as the nodal officer for stroke management, said, "We used to keep four to five TPA injections in the emergency complex and administer them for free." "The idea of hub and spoke model is to give treatment as early as possible. Once a stroke patient was identified, urgent scans were performed. If the clot was suitable for thrombolysis, we administered the injection immediately. Only complex cases were referred to PGIMER. In many cases, we were able to reverse paralysis and limit brain damage within hours," he added. Dr Sharma retired in 2020, after which the stroke management programme at the hospital gradually declined. Sources said the hospital earlier procured the injections through the Rogi Kalyan Samiti fund, but the procurement has since stopped. While neighbouring states have been expanding stroke care services at district hospitals, Chandigarh appears to have fallen behind. Punjab, for instance, runs a state-wide stroke management programme in which district and sub-divisional hospitals provide treatment with guidance from Christian Medical College in Ludhiana. Between March 2025 and January 2026, district hospitals in the state managed 58 stroke patients through the programme, of whom 39 received thrombolysis....