ESI's ad campaign

Over the past fortnight, I have been noticing a massive ad campaign by ESI over press as well as TV making me wonder what new venture they are onto. Going by their past track record (refer letters below, addressed by me to the press), they can’t be up to much good.

Just last evening, I was parked beside the ESI hospital in Indiranagar for a while. It looked as desolate as ever. What a colossal waste of public money!


decadent ESI (sent on 25/02/05)

Congratulations to Karnataka Labour Minister, Mr Tanveer Sait, for his bold announcement of the intention to privatise the ESI hospitals and dispensaries. The extent of decay in the organisation is evidenced by the deplorable quality of construction of its own staff quarters across the road from the Indiranagar (ESI) hospital, whose own notoriety was epitomised by the incident of rats chewing up a new born baby, not too far in the past.

Open recognition of the reality that government ownership is the root cause of inefficiency and corruption is when a politician turns to becoming a true leader from being a mere politician. May Tanveer Sait's tribe increase.


parasite ESI (sent on 5/05/05)

It was none less than the veteran trade unionist and MP, Mr Gurudas Dasgupta, who described the ESI quite aptly as the parasite that lives off the sweat of the blue-collared worker. He could as well have added "that eventually kills him", the latest of its victims being Ambarish Hugar, the garment factory worker from Koramangala. It is surprising that his friends were unaware of ESI's notorious track record. Most are, and as a routine, they just bribe the staff to get a certificate (required for the purpose of lodging claims) that they are not equipped to handle the case, and move the patient to a private hospital for treatment. As such, the bed occupancy in a hospital like the one in Indiranagar never ever crosses some 10 percent at best. And this, in a country where the other government hospitals have on an average some three patients to a bed any given time. Not that there isn't any corruption there, but compared to the ESI, they shine out as paragons of virtue.

The Karnataka Labour Minister, Mr Tanveer Sait, had recently made bold to say that he was going to pursue the privataisation of the ESI hospitals & dispensaries. He will be doing a great favour to the working class if he actually succeeds in the pursuit.

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.

misplaced anxieties

text of the letter sent to the Indian Express on 12th April:

Mr U R Ananthamurthy has reportedly expressed great anxiety over healthcare and education sectors getting privatised, vide the report in your City Express columns on the 9th April, under the caption 'Ananthamurthy's Rujuvathu released'. But, how come this same Mr Ananthamurthy does not express similar anxiety when newspapers, including yours, repeatedly come up with reports about the deplorable conditions in both the government hospitals as well as schools.

The conditions in the hospitals are so bad that it is only the real desperate lot who ever go there, to come out far worse of, if they come out alive at all. So much so, even the poorest of the poor choose to go to a St John's or a Manipal, somehow finding the means to pay off the bills and without much complaints, or availing the various beneficiary schemes that the hospitals organise for the real needy.

And, it will shock anyone to know that the BBMP run schools have been spending on an average, per annum, per child, far higher than what a parent spends to send his child to say, a Bishop Cotton's, to eventually report pass percentages barely in double digits. And even this, sequel to a recent intervention by an NGO. As to the conditions prevailing before the intervention, particularly of the toiletary facilities (rather lack of it), the less said the better.

Would Mr Ananthamurthy like to attempt to redeem the situation on the ground, instead of pontificating from his ivory tower? If not, would he let the ones who are doing a good job, and are prepared to do more, just do it, please?

The only cure for hospitals on deathbed

text of the letter sent to Times of India:

I refer to your Times City report of March 11th, about 'hospitals on deathbed'. Similar reports have appeared in your paper as well as the others, on a regular basis, from times immemorial. The only difference you notice now is the glass and steel facade (in Bowring hospital), provided at a cost (to the public) of close to Rs 10 crores, a good portion of which would have gone into various new pockets, apart from the old ones which have been collecting their portions from the everyday operations as well for ages. Without this new facade, these buildings atleast had their heritage value. Now, even that is lost.

There is no redemption for these institutions as long as their management remains with the government, and the loot in various forms will only continue to grow in the years to come. The only way out is for their operations to be made over totally to any of the many reputed institutions existing in the field, like St John's, St Martha's, St Philomena's, Chinmaya Mission, Mata Amrutanandamayi trust, etc, etc, possibly monitored by a Healthcare services and Education Regulatory Authority, set up replacing the state Health Ministry.

Unshackle (vimochana), please!

text of letter sent to The New Indian Express:

On the 28th of the last month, there was an article in your columns (on the front page) on dowry deaths in Bangalore. Quoting volunteers from ‘Vimochana’, a city based NGO, the article went on to describe the deplorable conditions in the burns ward of the Victoria hospital. The question that arises here is how come the Vimochana’s of this world continue to tolerate these kinds of conditions in the government hospitals.

In response to a survey conducted by a leading daily, last year, with a view to finding solutions to the wide-scale corruption plaguing government hospitals, a significant percentage of the respondents had suggested privatisation as a possible way out. Particularly in an area like healthcare, however, a check against unhealthy practices could perhaps be provided by strengthening the NGO/missionary institutions in the field, like St Johns, St Martha’s, St Philomena’s, Chinmaya, Ghousia, Rotary Trusts, etc, who all seem to be doing excellent work. The government would do well to hand-over the running of Victoria, Vanivilas, Bowring as well as all the ESI hospitals and dispensaries, to these institutions. May be a supervisory / regulatory authority could be simultaneously instituted to oversee all the related functions, while also scrapping the ministry.

Perhaps Vimochana would like to support this view? They are doing good work and they have a powerful voice.

not for the poor; only for the desperate

Yesterday, again, I was with the children (read 'building awareness' in the 'Gyaan guru' blog). One of them came up with how, when his aunt was taken for delivery to the Vani Vilas hospital, the staff there played around till they were paid some Rs 1,000/- collectively, by way of bribes, before they got down to attending to her. For all that, it was a nightmarish experience. So much so, they have sworn never to step into a government hospital ever again.

In fact, on a subsequent occasion, when another family member needed to be hospitalized, they chose to go to St Martha’s hospital, and in spite of the fact that it cost them dear, nobody was complaining.

I asked the rest if they corroborated the view. They were unanimous in agreement. And, mind you, these are all from really poor sections of the society.

User charges and government hospitals

letter sent to Indian Express on 24th June, ‘05:

"User charge is nothing compared to the huge sums we have to spend to bribe the hospital staff to ensure proper care for our loved ones. If it is a case of a surgery or even a delivery, the amount to be spent here on the staff is almost the same that would be spent in a private hospital". This quote by the government hospital patient's relative, who was asked by your reporter for his opinion on Mr Siddaramaiah (Dy Chief Minister)'s order of withdrawal of user charges, clearly sums up the actual position obtaining. Is it any surprise then that a visit to any of the Corporate hospitals in the city today will show you throngs of even lower middle class people patronising them. At least, they can be fairly sure that they will return home cured. As compared to that, in the case of the government hospitals, one needs to have a lot of luck to manage that given the callous attitudes, insanitary conditions, and the all pervading corruption.

In response to a survey conducted by a leading daily, a few months back, with a view to finding solutions to the wide-scale corruption plaguing government hospitals, a significant percentage of the respondents had suggested privatisation as a possible way out. Particularly in an area like healthcare, however, a check against unhealthy practices could perhaps be provided by strengthening the NGO/missionary institutions in the field, like St Johns, St Martha’s, St Philomena’s, Chinmaya, Ghousia, Rotary Trusts, etc, who all seem to be doing excellent work. The government would do well to hand-over the Victoria, Vanivilas, Bowring as well as all the ESI hospitals and dispensaries, to these institutions. May be a supervisory / regulatory authority could be simultaneously instituted to oversee all the related functions, while also scrapping the ministry.

Mr Siddaramaiah should realise that times have changed, and that his chances of re-election would be better served by more meaningful approaches.

Muralidhar Rao