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Nagaraja.M.R.. Vol.17....Issue. 21...........23/05/2021
Editorial : Private
Hospitals Robbing Patients
-
PIL Appeal to Honourable Supreme Court of India
Now crores of
Indians are facing life threatening
covid disease. Even in these trying times private hospitals linked to
politicians are fleecing money from patients. Politicians in power are part of
this loot and not enforcing government
mandated price caps and bed reservations.
Many affluent
persons having lakhs of rupees property and income have got BPL ration
cards using their connections. By virtue their BPL card those rich people get free medical treatment in hospitals, free
ration, etc. Whereas poor , needy persons without any connections don't have
BPL card they neither get free medical treatment or free ration. They either
die by hunger or lack of medical care.
Government declare it does not have enough money to buy oxygen,
ventilators , to build emergency
hospitals. Whereas it is spending crores
of rupees on unnecessary projects like
central vista , flyovers, etc.
Government is failing in prioritising
spending.
Above two movie clip web links aptly describes hospital scenario.
Hereby we request Honourable Supreme Court of India to order central and state governments :
1.
To reimburse medicals Bills of Ministers , judges , MLAs , MPs towards covid treatment or other ailments
only if admitted in government hospitals.
2.
To
scientifically fix prices of ICU
beds, ventilators , medicines, medical
care charges specifically for COVID treatment and immediately enforce it on private hospitals.
3.
To order government to take control of erring private hospitals under
NDMA Act forthwith.
4.
To allot hospital beds in both
government and private hospitals on scientific basis not on the basis of recommendations by powers
that be.
5.
To order central and state governments
to immediately stop low priority projects
and to divert that money for covid care.
6.
To order Ram Janma bhoomi trust , TTD ,
Malankara church and Jamia Masjid ( who
have collected crores of rupees public donation ) to lend money to government as loan towards covid care.
7.
To strictly maintain accountability of covid expenses by governments.
8.
To initiate criminal prosecution of rich people with BPL cards.
9.
To extend free health care , free ration
facilities to needy even if they don't have BPL card.
10. To
admit all patients even if without money to pay for admission, treatment. To initiate criminal prosecution of doctors , hospitals who refuse treatment of
poor.
With Regards
Nagaraja Mysuru Raghupathi
Cruel Greedy COVID
Hospital
On June
24, when Mayanka Sanghotra learned that her mother, Narender Kaur, had tested
positive for COVID-19, she was naturally alarmed. She could not get through to
any of the government helpline numbers listed online, but she did discover that
Shanti Mukand Hospital, located about ten minutes away from her home, was dedicated
to patients infected by the novel coronavirus. Within hours, Sanghotra had her
mother admitted to the hospital.The doctors at Shanti Mukand said the
52-year-old Narender’s condition was critical. She had very unstable oxygen
levels. Sanghotra was prepared to do anything to ensure the best possible
medical intervention, so when she was told that the hospital offered a COVID
package for Rs 4 lakh and they would start the treatment immediately when she
deposited the amount, she agreed.The package included Rs 36,500 per day for a
bed without a ventilator (Rs 30,000 for the bed and Rs 6,500 to provide PPE
kits to the hospital’s staff). Everything else, depending on the number of days
Narender Kaur would spend in the hospital and the type of medical services she
would require, would be calculated upon her discharge. Since Sanghotra could
not withdraw more than Rs 50,000 per day from her bank, she paid the Rs 4 lakh
in instalments.The doctors assured Sanghotra that her mother’s condition was
slowly improving. But there were problems. Within two days, Narender had to be
put on non-invasive ventilation (NIV) oxygen support. On July 1, Sanghotra was
informed that her mother did not have a pulse and now needed a ventilator.
“The doctors
still said that at least her condition was not deteriorating,” Sanghotra
recalled.She was asked to arrange for three injections, each for Rs 40,000.
Then she was asked to procure the anti-viral drug remdesivir. It was apparently
out of stock at the hospital pharmacy.“It was only available on the black
market for prices ranging from Rs 30,000 to Rs 80,000. The doctors had asked
for six vials,” said Sanghotra. She managed to get four vials from the hospital
pharmacy itself. About a week later, on July 10, she received the other two directly
from the manufacturer, whom she was able to call thanks to some of her
contacts.The bill that Mayanka Sanghotra was asked to clear.Soon after this,
she received a call from the hospital’s billing department. As of July 5, they
told her, her bill had exceeded Rs 7.5 lakhs.“I was confused. If there was a
package for Rs 4 lakhs, how was the bill Rs 7.5 lakhs?” she said.The billing
department gave her an elaborate breakup of the costs. “This included costs for
everything, including sanitisers, all in lakhs! Did the COVID package include
nothing needed for COVID treatment?” Sanghotra wondered.Sanghotra had seen a
small notification somewhere that the Delhi government had put a price cap on
the treatment of COVID-19 in private hospitals. When she asked the hospital
about it, they would not give her a direct answer. So she went home and started
looking for help online.She got in touch with Malini Aisola, the co-convenor of
the All India Drug Action Network (AIDAN). Together, they navigated several
rounds of negotiations with everyone involved.Amresh Kumar, a member of the
ruling Aam Aadmi Party (AAP) in Delhi, got in touch with Sanghotra and promised
to help her. “But instead of intervening, the government representative
actually abandoned Mayanka to negotiate on her own,” said Aisola. “The role of
the government representative was to step in and ensure the hospital followed
the government rules. But all he told Mayanka was, ‘try and negotiate and maybe
they will give you a 10% discount’.’’Acting on Kumar’s suggestion, Sanghotra
went to Dr Tejender Pal, a physiotherapist at Shanti Mukand, that very day for
help. Pal directed her to Dr Mohan Dube, the hospital’s director of medical
services (DMS).
In a supposed
display of altruism, Dube assured her that if she deposited Rs 5 lakh with the
hospital by the following Monday, he would help convince the management to
decide in their favour.“How was it in my favour when a government price cap
existed?” Sanghotra asked.Also Read: We Need to Consider Nationalising Private
Hospitals if We Are to Avert a Total DisasterAn order ignoredOn June 20, the
Delhi government had issued an order capping prices for COVID-19 treatment in
private hospitals. The order said: “…All COVID beds would be at rates given by
the Committee subject to upper limit of 60% of the beds of total hospital bed
capacity.”The order explicitly specified the rates. All National Accreditation
Board for Hospitals and Healthcare-accredited hospitals, such as Shanti Mukand,
could charge no more than Rs 10,000, Rs 15000 and Rs 18,000 respectively for a
bed in the isolation ward, a bed in the ICU without a ventilator and a bed in
the ICU with ventilator support.Although the order exists on paper, many
private hospitals work their way around it and charge patients much more than
the specified limits.“No one at the hospital ever told me about the existence
of this order!” Sanghotra observed.On July 11, Sanghotra wrote a complaint
letter with the subject: “Grievance regarding billing of patient Mrs Narender
Kaur for COVID-19 treatment in violation of Delhi Government Order of 20 June
2020” and sent it to the hospital authorities as well as the Delhi
government.In response to this letter, Amresh Kumar and Dube told her over a
conference call that ‘things could have been resolved with discussions’.On July
14, Aisola accompanied Sanghotra to the hospital to meet Dube
Dube told them that Sanghotra should write an
application regarding her financial constraints with respect to the payment of
the hospital bill. He instructed Dr Samrul Hoda from the billing department to
ensure that Narender Kaur’s case was dealt with at the prices set by the
government.A poster released by Shanti Mukand. Photo:
Facebook/shantimukandhospitalHoda went through Sanghotra’s application in
detail. He told her and Aisola that they could escalate the matter all they
wanted, but the pharmacy bills of almost Rs 3 lakhs had to be paid separately,
irrespective of the government cap.When the two women reminded Hoda of the
conversation with Dube, he said he was following Dube’s instructions. When the
women asked to confirm this claim, Hoda said Dube’s phone was unreachable at
the moment.“We said our primary concern was just to get Mayanka’s mother the
medical attention she needed. We were there for a resolution, not a fight,”
said Aisola.There was no sense to the pharmacy bills. “Most tests and
treatments I was billed for were already included in the package!” said
Sanghotra. By then, she had deposited about Rs 3.5 lakhs with the hospital and
saw no reason to pay the pharmacy bills separately.On July 17, Hoda called
Sanghotra and said: “Either arrange the payment or you can take the patient out
of this hospital.”Sanghotra was shocked. “This was so unethical. How can a
person from a hospital say things like this? I was depressed and helpless,” she
said.On the evening of July 17, however, the billing department of Shanti
Mukand Hospital asked Sanghotra to settle her bills according to the
government-specified rates. She paid Rs 4.22 lakhs and they asked her to deposit
an advance for the next few days. She paid Rs 18,000 in advance for one
day.Photograph of the final bill. Photo: By arrangementTwo hours later,
Sanghotra received a call from the hospital. Her mother’s oxygen levels were
unstable, she was told. A few minutes later, she received another call.
Narender Kaur had gone into a cardiac arrest. By the time Sanghotra got to the
hospital at 9:30 pm, her mother had been declared dead.Questions, but no
answersOn July 26, I asked Hoda about the COVID-19 packages at Shanti Mukand
Hospital. He gave me the figures specified in the Delhi government order of
June 20 and assured me that the hospital abided by these rules.Then I asked him
to confirm if this practice had been adhered to completely since June 20. “I am
afraid I cannot discuss these details,” he said, adding that charges go higher
when patients insist on better facilities, such as an air-conditioned single
room.I asked if this was what had happened with Narender Kaur.He said he could
not recall such intricate details. “There’s always an undertaking, though,” he
added.Also Read: Majority of Politicians Who Contracted COVID-19 Have Preferred
Private HospitalsBut the hospital refused to provide a copy of the undertaking
to Sanghotra, even though the AAP’s Amresh Kumar had told her that patients and
their relatives have the right to demand such documents from hospitals. So far,
this too remains unresolved.When I got in touch with Amresh Kumar of the AAP on
August 3, he took two days to respond to my queries. On August 5, he told me:
“I do not recall the particular details of this case. There are far too many
cases that we have to oversee. But from what I recall, this was a case of
overcharging and as is usual in such cases, I put them in touch with the DMS.
The patient and the DMS take it [forward] from there.”Kumar added that the last
time he had communicated with Sanghotra was during the conference call on July
11, when he spoke with her and Dube. However, though that conference call took
place after Sanghotra had sent her complaint letter to the hospital authorities
and the Delhi government, Kumar denied any knowledge of the letter.When I told
him that Sanghotra’s mother, Narender Kaur, had been declared dead after the
bills were finally settled, Kumar said: “That conference call was the last
communication I had with them. I have no information after that. You can send
me the patient number if the issue has not been resolved yet, and I can then
try to help.”Not an isolated caseSanghotra’s story is unfortunately not an
isolated case. In a virtual press conference on June 25, several civil society
groups, including AIDAN, Anveshi Research Centre for Women’s studies, and 18
others, highlighted the failure of the government’s price cap in private
hospitals. With no transparent information system for the public and not much
effort by the authorities to enforce the order, COVID-19 patients not only
suffer from the illness but also to pay for treatment.When patients approach
hospitals for immediate medical requirements, there is already a serious power
difference between the two parties, said Inayat Singh Kakar of the People’s
Health Movement at the virtual press conference. “It becomes very difficult to
challenge the hospital or the government under such duress. It is like trying
to fight with your hands tied!” she said.Representative image of a COVID-19
hospital. Photo: PTI“These stories are still just the tip of the iceberg,”
Jashodhara Dasgupta from Sahayog said. “It is expected that at least in times
like this, the private sector will keep its ideas of profiteering aside and
stand in solidarity with people who are suffering. It is unfortunate that we
find such unabashed and unethical ways of profiteering and exploitation.”“It is
unethical and it is mental harassment,” said Sanghotra. “Private hospitals have
a fixed mindset: we need money by hook or by crook.”
It has been more than a month since the Delhi
government issued its order capping prices of treatment, but grievances like
Sanghotra’s have not been resolved. The civil society groups at the press
conference released a letter to government authorities such Delhi chief
minister Arvind Kejriwal and Lt Governor Anil Baijal. The letter urged them to
take action on complaints, establish a formal grievance redressal system, ensure
transparency on rates, provide real-time information on fixed-rate beds
capacity, extend price caps to all ICU beds and check on the indiscriminate use
of drugs like remdesivir and favipiravir.“Over 80% of our doctors are in the
private sector; 93% of hospitals are privatised and 64% of hospital beds are in
the private sector. So, given a pandemic, it is impossible for the people of
this country to limit their healthcare requirements only to the public sector,”
said Dasgupta.However, Sanghotra, who is now dealing with her mother’s last
rites, said: “I have learnt the biggest lesson of my life: to never, ever go to
a private hospital.”Sweta Dash is associated with the Right to Food campaign.
How Indian doctors and private
hospitals are fleecing patients and corporates
-
Ritesh Kumar Singh
Most Indians consider doctors as next to God if not
God. We still have many doctors with impeccable ethical records. However, there
are many others - not so ethical, and their number is on the rise who don’t
think twice before taking their patients for a ride.
The arrest of top doctors (including the CEO of
Hiranandani Hospital Dr. Sujit Chatterjee) in connection with a kidney
transplant case on August 9 is not a rare incident of unethical (and maybe
illegal) business practice at big private hospitals in Indian cities.
Some of the common tactics used by money-minded
Indian doctors to cheat or fleece gullible patients of their hard earned money
are:
Prescribing more tests than necessary - to be done
at preferred labs (whether in-house at big hospitals or outside labs) for hefty
commissions. Sometimes these tests are not even conducted on the samples taken,
and fake results are given. By the way, have you heard about sink tests?
Keeping you admitted at hospital rooms when you’re
fit to be discharged. A doctor attempted this trick with my son at a hospital
in Andheri.
Prescribing expensive medicines/vaccines when
cheaper and quality substitutes are available. Often many such
medicines/vaccines are available only at prescribed chemist shops. That
benefits pharma companies and the doctors who prescribe them but inflate the
bills for patients.
Charging patients at different rates for the same
treatment. Top private hospitals are charging according to the room a patient
selects even for the same operation by the same doctors in the same operation
theatre.
Fake operations – this is how it happens. A doctor
can assess that you can be made to pay. He will say that you need an urgent
operation when you don’t really need it. If you’re still not convinced he’ll
say that he needs to send a tissue from your throat for testing whether it has
a cancerous cell. Most of us don’t argue with our doctors. So you’ll agree.
He’ll admit you and give you anaesthesia.
Unconscious you will be wheeled into operation
theatre where your conscious relatives will be not be allowed. After few hours,
you’ll be taken out drowsy. After you wake up the doctor will come and say that
he has sent your tissue for testing though he doesn’t think you got cancer but
he wants to be doubly sure. Can you argue? This again has happened with one of
my relatives. After the operation, the doctor simply forgot that he has to
discuss the test results before the operation he was very concerned. When my
relative approached him to discuss the results of the test even without looking
at the reports he smiled and said nothing to worry.
Use of stent in heart disease treatment even if not
needed – 1 stent may cost a patient anything between Rs. 60,000 -100,000 or
more depending upon the status of hospitals or pockets of gullible patients.
It's not uncommon to give stents to patients at 3 times the import price.
Worse, it may be harmful and may cause death yet doctors take bribes to
recommend stents.
Gynaecologists at private hospitals are well-known
to force pregnant women to go for C-section which pays better than normal
deliveries.
Last but not the least, is luring poor and
uneducated people for agreeing to donate organs, kidney in particular, for
which there is no dearth of high paying customers as highlighted by the arrests
at Hiranandani Hospital in Mumbai and Appolo in Delhi.
Genesis of the problem
With profit making being their main motive, private
hospitals are pushing doctors through a system of incentives and disincentives
to over-bill using whatever means – ethical or unethical – they can think of.
With seats in the subsidized government medical colleges being limited, many
medical aspirants opt for private medical colleges that charge hefty capitation
fees. This makes doctors vulnerable to the whims of private hospitals that pay
good money to their empanelled doctors – needed to recover high investments in
medical education.
With seats in the subsidized government medical
colleges being limited, many medical aspirants opt for private medical colleges
that charge hefty capitation fees. This makes doctors vulnerable to the whims
of private hospitals that pay good money to their empanelled doctors – needed
to recover high investments in medical education.
This makes doctors vulnerable to the whims of
private hospitals that pay good money to their empanelled doctors – needed to
recover high investments in medical education.
Implications
Most of the readers of this post are likely to be
the salaried professionals. We all get health cover provided by our employers
who pay the premiums to insurance companies.
Insurance premiums are negotiated almost every year
and rates are decided on the basis previous years claims. The more the claims
in the current year, the higher the premium would be next year.
Thus, patients or their employers (in the case of
salaried people) have to indirectly bear the rising cost of healthcare in the
form of high and rising insurance premiums. Since it’s the patients or their
employers who’re really bearing the rising cost of health care, insurance
companies don’t object to rising medical malpractices unless the net claim
payments exceed the premiums received.
Worse, they may try to benefit from that by raising
insurance premium rates for unorganized individual cover seekers. If you don’t
believe me…please try to check what premium your employer is paying for Rs.
500,000 cover and how much you’re paying for your self-financed plan. Premium
could be as high as 300-400%.
Not only this. Cashless facilities - which most of
us prefer but most of the insurance don't - again attract very high premium
rates. Reimbursable claims are preferred by the insurance companies because
they often reject some of the charges by saying that those are not covered.
To cut the long story short, doctors, private
hospitals, pharma companies and often insurance companies are having fun at the
cost of individuals, and corporates.
The way forward
MCI is not effective in checking malpractices and
corruption in medical field, a system of the standardized treatment protocol or
SOPs may help check some abuse but may constrain doctors in treatment. In some
cases, it may raise the cost of treatment. Preferred hospital network system
though has improved convenience, but is enough to check unscrupulous doctors.
Can economics provide any insights to help
addressing the growing menace of medical malpractices? We’d like to submit that
tweaking the system of incentives and disincentives, and improved access to
information and a more transparent healthcare market more transparent will
help.
Incentives
Increasing the supply of seats in govt. medical
colleges and capping capitation fee will reduce the investment cost of medical
students and hence their vulnerabilities to give in to uncontrolled pursuit of
profit by private hospitals that pushes them to cheat and overbill.
Access to information and transparency
Mandatory recording, archiving and sharing of the
recording with patients or their representatives
At present, private hospitals do publish the
credential of its specialist doctors like education and past experience. How
about adding the following information as well say about its gynaecologists:
Total deliveries in the last 3 years
Normal deliveries
C-section
Such information will help patients take informed
decisions about which doctor to go to for a treatment. Maybe, the doctors
(especially those who're ethical and there are still many) should come forward
and provide the above information whether asked or not.
Rating and ranking of top specialist doctors in
fraud prone specializations such as kidney transplant, gynaecology and heart -
by a third party independent agency and the ratings to be made available online
– without any restrictions
Rating of hospitals based on basic infrastructure,
charges, indicators of ethical business practices like how many medical
malpractice suits filed against...
Disincentives
The above measures can check most of the
malpractices but not all. For serious deviant, stringent punishments including
permanent disbarment and imprisonment will be needed.
Individual actions by patients
Aggrieved patients should take their grievances to
consumer courts which are cheaper, faster and don’t require lawyers for
representation. Some nice suggestions on how to approach consumer courts for
medical malpractice/negligence can be found here. In addition, given the
pervasiveness of the internet and social media, it's important that we share
our experiences - good as well as bad with doctors and hospitals. If we do,
unethical doctors and hospitals will start losing patients that will force them
to change their ways. Similarly, good doctors and hospitals should be promoted.
What corporate can and should do?
Indian corporates are cutting corners to survive in
a sluggish economic environment. Yet they are paying hefty insurance premiums
that keep on rising almost every year. How about studying your last 5 years’
insurance bills?
Corporates, especially the bigger ones with bigger
insurance bills are advised to hire in-house doctors and medical lawyers to
investigate being taken for a ride by unethical doctors, hospitals, and take
remedial actions.
Post Script: And the above is about better off
sections of society. Just imagine how vulnerable the workers of unorganized
sector are before such doctors and hospitals since they don’t get health cover
facilities from their employers…so most of them go without insurance cover as
individual health covers are very expensive.
COVID Care Fundamental Right
https://dalit-online.blogspot.com/2021/05/covid-care-fundamental-right.html?m=1
FIR against COVID Hospitals
https://dalit-online.blogspot.com/2021/05/fir-against-covid-hospitals.html?m=1
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