Have our hospitals become heartless?

Surya Hospital demanded money from a 45% burns victim of the February 13 terrorist attack at the German Bakery. This was in spite of clear instructions from the state government that victims of the blast were not to be troubled for payment. Incidents where hospitals have been refusing to treat emergency patients without advance payment have been on the rise throughout the country. Driven by the single-minded objective of recovering investments and making profits, have our doctors and hospitals lost their conscience and morality? DNA explores.

We have paid more than Rs32,000 to Surya Hospital
I was in bad shape and was one of the seriously injured victims. When I was taken to Surya Hospital for treatment, they denied admission, asking us to pay first. On this condition, one of my best friends sold his car and wristwatch to get me admitted. We have paid more than Rs32,000 to the hospital authorities for my treatment. 

I have approached the hospital’s administrator, Mahesh Kulkarni, for a refund several times in the past eight months. He only makes promises and ignores my phone calls. He never tells me when the refund would be made. I am being harassed by the hospital.

Saqr Al-Bethany, a 28-year-old Yemeni, who suffered 45% burns in the German Bakery blast

The victim was charged for staying in a deluxe room
We charged the victim because we did not know that he was a German Bakery blast victim. Our doctors were not aware about the terrorist attack when the patient came in at 8.30 pm.  Besides, after admission, the victim himself insisted on staying in a deluxe room with the facility of an air-conditioner, for which he was charged. The government does not refund the cost of deluxe rooms and pays for the general ward. If the government agrees to pay us the amount for deluxe rooms we will immediately refund Al-Bethany’s money. We have submitted a compensation claim of Rs1.91 lakh to the district collectorate for treating Al-Bethany.

Sadanand Bapat, director of Sahyadri Hospitals Ltd

Refund will be given only after the government clears our claims
The victim should have come to us and given us a written complaint, which he has not done yet. The hospital administrator was right in stating that the refund will be given only after the government clears our claims.

Dr Charudatta Apte, chairman, Sahyadri Group of Hospitals

The need to care and be honest has to be the norm in society
There is an element of truth in the statement that the medical profession is  becoming uncaring and commercial. An uncaring attitude, lack of morals and greed are the symptoms of an affliction that has not spared any profession in this country . What is needed is an attitudinal shift. The need to care, help and be honest has to be the norm in society as a whole and not restricted to certain professions. Only then can we expect to see similar changes in Indian society and in the medical profession.

Dr Shyam Kagal, physician

When you run a hospital, you cannot have a fixed set of rules
It is difficult to say whether hospitals have  become commercial and insensitive. Whenever there is an emergency, the first one hour is the golden hour to save the patient’s life. The hospital is required to provide immediate treatment, which may include expensive medication.

About three months ago, the Pune Municipal Corporation had come up with a scheme, wherein it had earmarked a certain amount in its budget for medical emergencies.  If the patient is not in a position to pay the fees, the hospital could be given some amount under this scheme. The ministry of health must come out with more such parameters.

When the patient is unconscious, we do not know if he can afford the treatment  or if he has  medical insurance or not. Many corporate hospitals are becoming commercialised as they follow a given set of rules. But when you are running a medical institution, you cannot have a fixed set of rules.

Dr Mahesh Kotbagi, chairman, Kotbagi Hospital

In the case of a calamity, the doctor must not charge fees
If there is an emergency, it is the moral duty of a doctor to provide immediate medical treatment without thinking of the fees. Only when the patient is brought out of danger, should the doctor ask his/her relatives if they can afford to pay the fees or to shift him to a government hospital where treatment is subsidised. In the case of a bomb blast or any other calamity, the doctor must be courteous enough not to charge fees.

There are many corporate hospitals which offer five-star services just like a hotel. Last Tuesday, I was in Hyderabad to see a friend at his hospital. As soon as I entered, a couple of people rushed towards me to take my bag, thinking I am a patient. This is when it becomes commercialised. Hence, these days, even patients have started expecting such kind of treatment at all hospitals. Other things are beginning to get more importance instead of the treatment. This needs to be brought under control.

Dr Kantilal H Sancheti, founder, Sancheti Hospital

Denial of emergency care to needy patients is exploitative commercialisation and failure of regulating mechanisms (if at all one exists) of private health services.
While there is a huge uproar whenever doctors or medical establishments are attacked by enraged relatives of the patients, which of course needs to be condemned and all necessary protection should be given to the private medical establishments, there seems to be little pondering on eliminating the root cause of these manifestations.

Unless there is an improvement in communication between doctors and patients, unless patients’ rights are protected, unless there is standardisation of the cost and rationalisation of medical treatment, the present scenario of ‘trust deficit’ between patients and doctors will continue.

In the Maharashtra Medicare Service Persons and Medicare Service Institutions Act, 2009, there are explicit references to protect doctors and medical establishments from violence and damage or loss to property. This Act has been  passed by the state government, largely owing to the legitimate security concerns of the medical practitioners. However,  specific clause (clause 7) of this Act which has a provision of establishing authority to aid and advise victims of medical negligence has not been created till date.  

Though there are a number of doctors who are doing good ethical practice within the professional boundaries, needless to say a few have taken a principled stand on these issues publicly. Given this larger background, there is dire need for active forums like patients’ rights committees and mechanisms of dialogue between doctors and patients.

Similarly, on the legal side, draft rules under the Bombay Nursing Home Registration Amended Act (BNHRA), 2005, and provisions as mentioned in clause 7 of the Maharashtra Medicare service persons and Medicare Service Institutions Act, (2009), need to be approved.

Dr Dhananjay Kakade, associate coordinator, Sathi (Support for Advocacy and Training to Health Initiatives)

Hospitals are pocketing their profit for business expansion
Poona Hospital is looked after by the Rajasthani and Gujarati community. We don’t run the hospital on a profit-and-loss basis. Such negligence from the administration will never happen at Poona Hospital.

These hospitals, who are running their businesses for pure commercial gains, are pocketing all the profit for individual benefits and business expansion. They are not ready to invest in the benefit and welfare of the patients.

The Bombay high court (HC) passed an order in 2006 that all the hospitals running as a trust, whose profits are over Rs5 lakh per year should treat patients whose incomes are below Rs25,000 per year, for free. The other benefits are 50% discount on bills pertaining to pathological investigations and no charges for the bed and medicines.

Under the high court directives, 10% beds are to be reserved for such low-income group patients. The hospitals cannot deny medical care or ask to transfer the patients to  other hospital, under any circumstances.

Hospitals and medical care have become a big business; there are no ethics followed anymore. The charity commissioner, who has been entrusted with the duty to keep a check if hospital administrations are following the HC directives, is completely neglecting the problem.  

Chandmal Parmar, founder trustee, Poona Hospital

Hospitals make people bow to their demands during road accidents
We run a home for underprivileged and terror-hit children at Fulgaon in Pune. Recently, one of our children was bitten by a snake and we had taken him for treatment to Sassoon Hospital.
As Sassoon Hospital did not have the anti-venom injection, we shifted him to various hospitals till we could locate one hospital on Ahmednagar Road that had the cure. The hospital refused to go ahead with the treatment until we paid Rs6,000. It is sad that even in such an emergency the hospital insisted on a deposit. We arranged the cash and the boy was saved, but the question is what if we could not arrange for the money?

The insensitivity of hospitals is experienced especially in  cases of road accidents. In such situations, people don’t carry big amount of money. They are made to bow down to hospitals’ demands because saving the patient becomes a priority, and the patient’s relatives are in no mood to protest against such ill treatment. It is nothing but taking advantage of the situation, where the patients are in a difficult situation.

It is surprising when hospitals admit patients and insist on cash payments and don’t accept a cheque.

If you look at big city hospitals and educational institutes, all are expanding their businesses and have undertaken huge expansion projects. Where is the money coming from? These hospitals get land at cheaper rates, more floor space index (FSI), bank loan at lesser interest, various tax exemptions, duty exemptions on imports, but when it comes to giving a little exemption to patients, they deny.    

Mukund Godbole, founder secretary, Ishwarpuram NGO

Our priority is to give treatment; we don’t run after money
It is wrong to say that hospitals in Pune are becoming commercial, insensitive or uncaring. A patient is always attended to and given immediate medical treatment in case of an emergency. The treatment starts even before the patient’s relatives arrive. However, at times when major surgery is needed, we have to take the consent of the patient’s family or relatives.

Then, it becomes necessary to explain to them what has to be done and the money required. But that does not in any way mean that the patient is refused treatment. Such a situation is  panicky for the relatives and thus they take offence if such things are mentioned to them. It is not that we are just interested in money. We ask them to pay only if it is possible. The medicines, injections and other things do cost a lot.

Also, there are many people who undergo treatment and refuse to pay once treatment is over. In such cases, hospitals suffer huge losses and every year lakhs of rupees are lost. But nobody looks at it from this point of view.

However, our top priority has always been to give treatment and make the patient stable. We are also humans after all. We do not run after money.

Dr Madan Hardikar, director, Hardikar Hospital

The billing process should be simplified for needy patients
I had a bad experience when my husband was recuperating in the hospital for nearly two months. If you are rich and have money, there is no problem. Hospitalisation for people from the middle class is a big ordeal. Even though there is an insurance cover, we are made to pay cash initially until the approval comes from the insurance company. In big hospitals, the daily mounting medical bills are enough to give you sleepless nights. The hospital administration has a cold attitude towards people’s financial conditions and don’t try to understand or give any leniency. 

The plight of the poor is beyond imagination. They have to resort to cheaper medical care centres, where the treatment is bad and the atmosphere is not patient friendly.

Billings over lakhs of rupees from hospitalisation has become common.  It burdens the middle-class people. Patients who have been treated in general wards or semi-general wards in big hospitals have to pay huge bills. The hospitalisation process must be simplified for patients and their relatives, especially the billing process should be made easy.

Anita Shinde, homemaker