Medical malpractice is robbing the Indian population hollow. ANANYA BORGOHAIN writes about the current healthcare system and how it might redeem itself
According to the World Health Organization (WHO), in the past few years, approximately 3.5 per cent of the population per annum (which is around four crore people) is below the poverty line in India, owing to expenditures incurred by them on private medical services alone. The irony cannot be missed here as since the 1990s, the country’s healthcare sector has climbed upwards in the era of globalisation, liberalisation and privatisation.
It’s understandable that health is beyond compromise for almost everyone and this is what compels the Indian middle class (and others) to shell out lakhs of rupees on clinical assistance which are, many times, not even required in the first place. Multifarious malpractices collaborated by private hospitals, laboratories and pharmaceutical companies take a toll on people as many times needless surgeries are conducted to meet sales targets.
Two doctors, Arun Gadre and Abhay Shukla, have come up with an enlightening commentary on the country’s healthcare sector in their book, Dissenting Diagnosis (Random House). Interviewing numerous doctors who have spoken about the issue of medical ethics being compromised by greed and inhumanity, the book reveals shocking details. The way patients are robbed needs urgent attention and scrutiny.
To cite a minor example, hospital owners charge Rs50-75 lakh to allot space to a pathology lab and a pharmacy. In this way, the owners do not even require a loan from bank to set up the hospital. Also, no regulation of the pathology lab or pharmacy is done, as they are paying enormously anyway. Now, their deposit money is eventually covered from the patients’ pockets. This is reportedly done through a series of scams. There have been instances of manufacturing fake pathology reports of diabetes when the patient’s sugar level was normal. Or to mention another example, in the dengue season, the blood platelet count drops with any viral fever. Only one in a thousand such people need to be admitted in the hospital. And yet in certain instances, well-off patients are sent straight to the ICU, charging them Rs25,000-30,000.
likewise, some level of jaundice among newborns is normal and physiological but exaggerated reports make it sound like mayhem. In the book, the doctors mention cases where hernia surgeries are recommended to perfectly normal patients and Gadre has also earlier mentioned in an interview about an abortion being suggested to a woman who is not even pregnant. Blood samples of another patient were shown to the teenage girl to persuade her for an abortion.
Pregnant women, in fact, bear the brunt of this mismanagement with more gruesomeness. There have also been reports about putting stitches in the womb of a pregnant woman and faked ultrasounds to convince them for immediate hospitalisation.
In fact, the commissions or cuts are so predominant that ambulance and autorickshaw drivers also enjoy them for the patients they bring in. laboratories, too, have started paying a cut of 50 per cent to doctors for sending patients to them. Dr Punyabrata Goon, a GP in Kolkata, says, “They don’t even check the patients, they just write a list of investigations. In our area, the commission rates are 25 per cent for X-rays, and 33 per cent for MRIs and CT scans.”
On the other hand, Dr Rajendra Malose from Chandwad in Nashik says, “Nowadays, one gets Rs30,000-40,000 just for referring a patient for angioplasty.” A pathologist from a metro city says, “In case of typhoid, if the blood test is done before the fifth day, it does not reveal anything. But it’s carried out every alternate day from the first day. The more expensive a test, the more it is prescribed. A sputum examination is generally sufficient to detect TB in the lungs; no test can detect it if it’s anywhere else in the body, but expensive tests like TB Gold, TB Platinum are prescribed. More expensive the test, more the commission.”
Terminally ill patients are kept on ventilation, which further incurs electricity bills worth thousands. But sometimes, it turns worse and farcical. A GP from a small town says, “There was a death in a corporate hospital in the nearby city. A bill of Rs16 lakh was prepared for a simple case of heart attack. The relatives didn’t have the money, so the hospital hid the body. Finally, the DSP had to raid the hospital.”
A deeper malaise lies as medical practitioners are lured by pharmaceutical companies with sponsored foreign vacations, luxurious items, and other privileges. Medical representatives and their myriad schemes offer the finest of material pleasures to doctors to get their products prescribed by them. Arranging fully sponsored trips to exotic destinations in the name of medical conferences is a common occurrence. Apparently, in these ‘conferences’, doctors are required to wear a tie provided by the company that is funding the trip. Requirement to meet sales target accelerate the unethical practices. Moreover, private medical colleges charge lakhs to over a crore per student. Over the years, these doctors try to earn their money back through the patients.
While the facts that have been revealed are disillusioning, many principled doctors who have come out in the open discussing this pertinent issue also suggest a series of solutions that could work in curbing these inhuman practices. Dr Vijay Ajgaonkar, senior diabetologist from Mumbai, says that the Clinical Establishment Act authorises the Government with power over the health sector, which is probably better than the Medical Council of India (MCI) running the show since it is influenced by political elections.
He also mentions that the cost of medicine could and should be lowered. It will be further effective if doctors prescribed generic medicines. Fees for any diagnosis should be pre-determined and a rate structure chart, which details where every penny of the patient is going, should be created to ensure more transparency.
While regulating the private medical sector is crucial in this regard, an alternative is to add a participatory, democratic regulatory system. In it, as Gadre and Shukla emphasise, representatives of various stakeholders concerned — elected representatives, public officials, representatives from the medical profession, consumer organisations, patients’ right groups — would interact in committees at district/city and State levels. They should be trusted with overseeing the work of inspectors and officials.
Another way out is to establish citizen-doctor forums that could channel debates and discourse among patients and healthcare practitioners. Any doubts raised by either party could be discussed and monitored through these forums.
Gadre and Shukla highlight that Universal Health Care (UHC) systems exist in Canada, Australia, Brazil, Thailand, the UK, and several European countries where public health services, trust hospitals and private hospitals engage in a publicly managed system, which provides free healthcare to the entire population. It’s debatable whether it could be facilitated in India but public participation could certainly be a catalyst in preventing medical misconduct.
Government schemes like Rashtriya Swasthya Bima Yojana should be supervised with more competence. They could go a long way in assisting the poor as their rates are fairly low. At the same time, teaching hospitals can do better than corporate hospitals if they are supported well by both the Government and other forces. Above all, and this goes without saying, cultivating a clear conscience could come to the rescue of humanity.
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