misconceptions about Corporate hospitals

I am appending below three letters (listed 1 to 3) that appeared recently in a Yahoo-group, of which I am also a member, which bring out clearly the misconceptions about today’s Corporate Hospitals.

The hospital involved in the present instance is the Manipal Hospital, Bangalore, which incidentally, has been rated the “most patient-friendly hospital” in a country-wide survey conducted recently by Voluntary Organisation in the Interest of Consumer Education (VOICE) in collaboration with Indian Council for Medical Research (ICMR).

One thing that needs to be understood is that they have their costs, including decent levels of salaries for their doctors and staff, who with their qualifications do not exactly come cheap. The challenge before these hospitals therefore is to manage their operations efficiently in order to provide state of the art healthcare, but at costs that are affordable to the common man.

More and more their approaches are beginning to reflect this outlook, as evidenced the recent write-up by Ramesh Ramanathan about Dr Devi Shetty, the chief of Narayana Hrudayalaya (listed at 4 below).

There are of course the ones that are targeting the well-heeled sections of the market altogether, which may be resorting to questionable practices. But, clearly, in the future world, unless you can provide good value for money, you do not have far to go. And, sooner than later, the questionable practices will have to be answered for.

Whatever, what is becoming increasingly clear that the organized private sector players in the healthcare sector have today come of age, and are in a position to take care of the needs of even the poorest of the poor in the country. On the other hand, the (dis) services provided by the government hospitals are becoming increasingly costly, in terms of negligence, apathy, mamools (no longer small as the term may imply), fresh infections due to unhygienic conditions, and not in the least life itself on account of these and many other factors.

It is time the government re-looked at its role.

Muralidhar Rao

1) Letter purportedly written by a relative of an accident victim, and circulated in a Yahoogroup by a member in the 1st week of Jan,’08

Dear All,

I would like to get one of the incident happened this weekend to your notice.

One of my co-brother met with an bike accident and expired on Friday night.(A BMTC bus came in wrong side and hit him)

This accident happened around 6.30 PM near whitefield and initially he got admitted to a hospital called Vydehi near whitefield.
Later it was proposed by Vydehi doctors to take him to either Nimhance or Manipal.
So we took him to Manipal around 8.00 PM since NIMHANS is very far and also by considering traffic at that time. To reach even Manipal it took too much time, Most of the delay caused because of Heavvy Traffic in airport road. As soon as we took him to the Manipal hospital doctors said his state is very critical and 95 % he is out. Still they said they will do CT-Scanning and then they can clearly confirm the status.

Then around 10.30 PM they arranged for CT-Scanning ( Too much of delay ). Soon after the CT-Scanning one of the doctor reported his BRAIN is damaged , 2 kidney's and small lever also was damaged for which he needs to be operated for a head surgery and a stomach surgery, during the operation he may die also or at any moment he may die. Soon after they took him to ICU instead of taking him to Operation Theatre. There was around 1 hr delay in answering us back from this point. They didnt allow any of us to see him when he was in ICU until we demanded and shouted on them. When we demanded and asked them to discharge so that we will take him to NIMHANS, Then the answer from them was they will operate immediately but we need to Admit and pay around 2 lack Rs. Since we didnt had that much of cash and also we doubted on whether he is still alive or simply these doctors playing a game..., But still since they demanded around 2 lack rupees for the operation before they start it, I went ahead to fill up the forms and pay money immediately with using credit card , But when our uncle had a look at him in ICU noticed that he is already dead (this was around 11.30 PM). Then immediately he asked me to not to make any payment. We went to doctor in-charge and asked(when we shouted) about his status and chances of he being saved. Doctor informed that chances are less than 1 percent, then only we realized that MANIPAL Administration guys playing a game, and trying to fool us to collect some money in the name of operations to operate a dead body !!!

We took it seriously and tried to contact TV9 on the same day but could not get the contact numbers...,
Since we were strong enough fight back on Manipal Hospital they agreed that he is dead and asked us to pay Rs. 30,000 to release dead body.

As we know they didnt give any treatment other than doing a CT-Scan and keeping the dead body in ICU for 2 Hrs.. We shouted on them and demanded to release the dead body with CT-Scan charges only. Finally we were able to fight and take the body with out paying any money as they were trying to cheat us.
Some how we escaped from being paid for dummy operations being planned by Manipal Doctors. But if it was some other innocent poor people they would have ended up with paying full money and cheated by MANIPAL.

The whole idea behind my write-up is : we all know MANIPAL is one of the big and well known Hospital in Bangalore. But these people cheat innocent people by colleting huge money to operate even dead body!!! and try to fool as if they are going to save the patient. I request you all to forward this mail to all your friends and inform every one on how BIG Private Hospitals can cheat .. and to Beware of these..

For more details you can reach me on_____ . email:______

Thanks & Regards
R


2) Letter addressed by a consultant surgeon at Manipal Hospital, also a member of the Yahoogroup

Please find below the statement issued by Manipal hospital regarding the charges made by a certain gentleman.

What is really surprising is that a totally unsubstantiated mail was forwarded by many citizens. That in itself is to be questioned. However, I insist on people knowing what actually transpired, hence the mail.

I myself have operated on seriously sick and injured patients, some of who have sadly succumbed to their injuries. NOT ONCE has the hospital demanded any money prior to
taking the patient to the theatre.

Regards, Dr R

Letter written by Manager, Customer Relations, Manipal Hospital

Ref.: Your E-Mail regarding treatment provided to Late Mr A

We have seen your E-Mail on the captioned subject matter, which E-Mail you have indiscriminately floated, twisting the facts, deliberately concealing the truth and defaming Manipal Hospital. Please do be notified that we have taken a very serious note of your E-Mail and reserve our right to act in accordance with law.

You have made some serious and damaging allegations against Manipal Hospital, conveniently omitting to state the fact that Manipal Hospital provided all life saving initial treatment without collecting any money and the attendants accompanying Mr A manhandled our staff, were unruly and in fact Police had to be called in to handle them and that they walked away from the Hospital without paying the actual expenses incurred by the Hospital.

All allegations made by you are baseless, malafide and we vehemently deny the same. Your E-Mail is nothing but a sad attempt to sensationalize the unfortunate death of a young man.

Manipal Hospital has over the years created and maintained a reputation of being one of the finest healthcare providers and we are committed to protecting our reputation no matter what.

For benefit of all, we would like to place on record the facts as under:

1. Mr A was brought to the Casualty of Manipal Hospital on 4th January 2008 at about 8.50 PM from Vydehi Institute of Medical Sciences & Research Centre in a very critical condition. Even you have admitted the criticality and remote chances of survival.
2. Mr A had been involved in a Road Traffic Accident and had sustained severe head and injuries in other parts of the body. He was given immediate life saving medical attention and stabilized in the Causality so that certain important investigations to assess the extent of the injuries sustained by him could be performed. All this was done even without receiving a single penny. He was intubated and mechanically ventilated and immediate steps were taken to stablise him for further medical management.
3. Mr A was haemodynamically unstable and was given fluids and blood transfusion to stablise his condition. Please remember no money was paid but service was provided.
4. At about 9.30 PM, Mr A was shifted for a CT scan after stabilization and all throughout he was being continuously being monitored.
5. Immediately after the CT Scan the patient was shifted to the ICU at about 10 PM to maintain his condition till further decisions are done on clinical management.
6. Please note that all of the above was done with the sole intent of providing immediate and effective medical care in the best interest of the patient. No money was asked for and no money, except the registration charges (Rs.150/- [Rupees One Hundred Fifty Only]), was paid till the time the patient was shifted to the ICU.
7. Throughout this time the critical condition of the patient was explained to the attendants of the patient. It was clearly explained that the patient was critical, badly injured and his chances of survival were bleak, however, the doctors assured that they would do all possible things for the patient
8. It was further explained to the attendants of Mr A that the patient may require surgery at later stage but first the patient will have to be kept in the ICU and further stabilised before being operated upon.
9. It was only after the patient was shifted to the ICU, the attendants were asked to complete the admission process as it is mandatory legally to admit the patient for further management and more particularly as this was a medico-legal case.
10. At this stage it is important to state that as per Hospital policy we need to inform the patient party of the approximate cost of the treatment. So an estimated cost of treatment was provided to the attendants of the patient. This amount was Rs.200,000/- (Rupees Two lakhs Only) for ICU care, a probable surgery and post surgery care. This estimate is provided to all patients to enable them to plan and make necessary arrangements well in advance. But we never demanded this amount to be paid immediately or denied any necessary treatment due to lack of this.
11. Rs.200,000/- (Rupees Two lakhs Only) was an estimated amount and what was asked to be paid for admission of the patient was only Rs. 30,000/- (Rupees Thirty Thousand Only) as admission charges. When the attendants expressed their inability to pay the admission amount of Rs. 30,000/- (Rupees Thirty Thousand Only) and agreed to pay only Rs. 20,000/- (Rupees Twenty Thousand Only), the Hospital agreed. However, even this amount was also not paid.
12. Please note that Mr A was treated in the Casualty, all necessary medications and treatment was give, CT Scan was done and he was admitted to the ICU without asking for any money.
13. Unfortunately, Mr A succumbed to his injuries while admission process was going on and this was promptly informed to the attendants.
14. Since the case of Mr A is a Medico Legal Case, the Manager on Duty asked the attendants of the patients to complete the admission formalities as per legal requirements and to enable the Hospital to release the body to the Police.
15. It was at this stage that the attendants of the patient abused and physically manhandled the Manager on Duty and screamed that they would pay only if the patient survived otherwise they would not pay for the treatment provided. Assistance from the Police had to be sought to bring about order. It is unfortunate that such kind of behaviour was exhibited inside a hospital without any concern or respect for other patients in the Hospital.
16. The body was released to the police and no demands were made for release of the body.
17. At the time the body was handed over to the Police, the Hospital did not even insist on payment of the bill considering that the fact the attendants and family members were understandably distressed by the death of a dear one. The said amount of Rs. 27,078/- (Rupees Twenty Seven Thousand Seventy Eight Only) is still due and payable to Manipal Hospital.

If you have any concerns as regards the services rendered by Manipal Hospital, you are free to take re-course under law, however, in light of the facts and circumstances above stated, we hereby call upon you to immediately retract your baseless and malafide allegations and desist from sending such irresponsible and derogatory communications, failing which we shall be forced to seek legal appropriate re-course.

Thanking You,
Dr S,
Chief Operating Officer & Medical Director,
Manipal Hospital, Bangalore


3) Apology letter sent by the relative to Manipal Hospital, and posted in the Yahoogroup

Dear All,

I had sent an e-mail dated 07-Jan-2008 regarding death of my co-brother, Mr A and had accused Manipal Hospital of trying to operate on a dead person.

After obtaining the details of the events from Manipal Hospital, now I realize that estimation was provided while my co-brother was alive and Hospital did not even demand full money to be paid for the services. While the admission process was in progress my co-brother died. Due to the grief and tension I misunderstood the whole thing and sent the e-mail damaging reputation of Manipal Hospital, which in fact had provided all life saving measures without demanding any upfront payment.

I sincerely regret this emotional outburst and distress caused to the Hospital and I would request all of you to please ignore the earlier mail and its contents. Also please do inform the same to your friends to whom you have forwarded my earlier mail. For your information please read reply from Manipal in below mail.
Thanks & Regards
R

4) Dr Devi Shetty, one of the country's leading heart surgeons is also focused on bringing affordable health services to the poor. He talked of the need for innovation and scale in healthcare, based on our unique challenges in India.

Using the example of a CT scan, which costs Rs 5,000 - 10,000 per patient, he said, "We have a few hundred CT scan machines in India, each doing 3-4 scans a day, although the capacity is over 100/day. These machines are like planes that earn money only when they fly. We need to increase the flow of patients through these centres. But this is related to other issues like hospital bed capacity and inpatient/outpatient ratios. Today, most hospitals make their money from inpatients. We need to reverse this relationship where thousands of outpatients who each pay a few hundred rupees for tests can subsidize the operating costs of the hospital."

Imagine if we could get a CT scan cost down to Rs 500, offer a heart surgery for a few thousand rupees or a gall bladder surgery for under a thousand. This requires a fundamental redesign of all the parts of the healthcare delivery system - from re-engineering individual components like the CT scan, to embedding these into scaled health "cities" that can get a critical mass of 10,000 outpatients a day.