Practice Makes Profit

Those who like to deride them call these five-star hospitals. A more kindly classification would be super-speciality corporate hospitals. But ever since the allegations of medical negligence surfaced following the failure of Indraprastha Apollo Hospital, Delhi, to diagnose as acute myeloid leukemia the illness that claimed union power minister Rangarajan Kumaramangalam’s life, questions have been raised about the quality of medical care provided by these much-publicised, high-profile private hospitals.

True, corporate hospitals have several remarkable recoveries and breakthrough surgeries to their credit. Yet, here are some shocking cases from hospitals that crow about their efficiency:

What ails corporate hospitals? It is perhaps that they are run with profit in mind and with little accountability that leads to carelessness and negligence even in critical cases. It is well known that on the organisational chart of such institutions, the finance manager is placed next to the chief of medical staff and the hospital administrator.

In most such hospitals, financial planning hinges on profits. At Apollo, for one, the strategy revolves around the development of 20 profit centres. The departments making money are cardiology, cardiothoracic surgery and diagnostics. Says Bharath Jairaj of Chennai’s Citizen consumer and civic Action Group (cag): "Corporate hospitals have two commitments, one to the shareholder and another to the patient. Commitment to the profit bottomline often takes precedence over the needs of the patient."

According to Dr Ravi Duggal of cehat (Centre for Enquiry into Health and Allied Themes), a Mumbai-based ngo in public health, the government has allowed the private health sector to proliferate uncontrolled. Says he: "Neither the government nor the Medical Council have any control over medical practice, its ethics, its rationality and its profiteering." Stressing the need to organise private healthcare, Duggal says the private sector is responsible for nearly three-fourths of all healthcare in the country and yet is not regulated.

The conclusion he has drawn is that there are no fixed schedules of charges for various services being rendered and hospitals do not follow any minimum standards in the provision of services. He calls for drastic changes in the health policy and the reorganisation of the entire healthcare system with a fair public-private mix under strict regulation.

One other problem doctors point out is that by and large, corporate hospitals function on the strength of a battery of consultants who flit from clinic to clinic and have very little time to give the individual the attention these hospitals promise. Points out a senior doctor at Delhi’s Safdarjung Hospital: "These hospitals claim to be super-speciality centres and have some big names on the board. But the fact is that these doctors spend only a couple of minutes each day with their patients and then go off leaving the junior doctors to handle the actual care. Leaving behind mobile numbers is no substitute for actual presence."

Adds Dr Nalini Mullapudi of the Hyderabad-based Mullapudi Cardiac Centre, a private clinic: "Things go wrong if a hospital doesn’t have full-time qualified staff. The quality of medicare gets affected if the management, in a bid to make quick money, has reputed specialists in respective fields only as ‘consultants’ or ‘part-time’ visitors to provide their expertise and leave the rest of the treatment to juniors." She also admits that many corporate hospitals are operated on commercial lines as they raise funds from the financial institutions. "In our case, we have set up the hospital without borrowing money from the market. And we have no plans to claim 60 or 70 per cent occupancy like a five-star hotel, something that many corporate hospitals do."

But are corporate hospitals run solely on the profit motive? Says Thomas George, orthopaedic surgeon at Chennai’s Railway Hospital: "In most medical conditions, there’s more than one option. Corporate hospitals tend to choose the most profitable one rather than the most appropriate one." But corporate hospitals deny this. According to Dr Ramamurthy of the city’s Malar Hospital, patients are taken into confidence and any decision is based on "informed consent" of the patient.

Apollo Hospital strongly denies it had erred in the Kumaramangalam case. Its spokesperson also denies the hospital is run only on the profit motive or that it has ever wavered in its commitment to its patients, and asserts that very critical cases have been treated successfully at the hospital. That’s just what the others say. One consultant at a top Mumbai hospital even goes so far as to say that errors do happen and that one has to also look at the good work that the corporate hospitals have done.

But not everyone agrees with this defence of corporate hospitals. Says Dr N.H. Antia of the Mumbai-based Foundation for Research in Community: "People can make mistakes but one thing is clear: marble and granite cannot give you good results. These corporate hospitals are destroying the public health system. We must realise that in India most things can be done cheaper, at almost one-tenth of the cost at these hospitals. You should stop equating expense with quality. For example, a simple operation for hysterectomy will cost you Rs 75,000 in one of these private hospitals. And if two cysts in the breasts are to be removed, another surgeon will have to be roped in for Rs 35,000. What costs you a lakh or more should actually cost you only Rs 10,000! We are totally lopsided in our medical care."

A cag team led by Dr V.R. Muraleedharan of iit, Madras, did a study on treatment of maternity cases in all hospitals in the city. It found that out of a sample of 277 cases, 113 were caesarean and 164 were normal deliveries in private hospitals. Surprisingly, the sample from the government-run child welfare centres had no caesarean deliveries. "It can’t be just a coincidence. The price difference between a normal delivery and a caesarean delivery is around Rs 30,000. Corporate hospitals may justify their huge costs in the case of complex health issues like cardiac-related ailments. How do they justify this?" asks a member of cag.

But despite such studies and the reach of the public health system, there’s a growing tendency among the middle-class to rush to corporate hospitals. One reason, according to a government doctor, is the poor upkeep of state-run hospitals. "Cleanliness is associated with health and most people find public hospitals unclean," says a senior doctor at Delhi’s premier (government-run) medical facility, the All-India Institute of Medical Sciences (AIIMS). He also points out that very often, public hospitals become inaccessible to the average citizen. "You need to pull strings to get admitted to AIIMS or even get proper treatment. Whereas if you have money, you will be at least admitted to a corporate hospital. The quality of treatment you get there is another matter," he adds.

It is on the cleanliness and accessibility counts that government hospitals lag behind. And doctors who do the rounds of corporate hospitals themselves admit that there is no questioning the abilities and experience of doctors in corporate hospitals. Indeed, many of the consultants in these institutions have worked in government hospitals. But when it comes to ethics, many consultants are more corporate and business-like in their attitude.

For example, some doctors feel that getting a second opinion has been reduced to a farce in private hospitals. Says a cardiologist at the Christian Medical College Hospital, Vellore: "Second opinion has been unfortunately reduced to mutual back-scratching in corporate hospitals. ‘I okay your prescription and you okay my prescription’ seems to be the refrain. Though doctors accept the mistake of another doctor in private, they would never acknowledge it in public, thus causing more harm to the patient."

Also, doctors point out that corporate hospitals have a nice euphemism for forcing the patient to undergo innumerable tests. Says a senior doctor in AIIMS: "It’s called ‘extending the indications’. Unless a particular amount of revenue is generated, all these MRIS and CT Scan machines drain the hospital’s resource. These are instances where doctors become finance managers."

In the final analysis, not all private hospitals are guilty of callousness. Doctors in these hospitals are highly trained and skilled. These hospitals also have state-of-the-art equipment. But with next to no accountability, some of them have been guilty of extracting the maximum profit from patients. Says Dr Antia: "It is more dangerous to be rich in India and fall ill because the rich in this country are over-diagnosed, over-investigated, over-medicalised and over-surgicalised. And the middle-class who try to emulate the rich are consequently pauperised."

Perhaps it is time the Medical Council and the health ministry took a second look at the hospitals for the rich.