“For the first four days that she was in the intensive care unit tied to a ventilation machine, the doctors wouldn’t even let us meet her,” says Sanjay Goenka, a Calcutta businessman, recalling his mother’s death in a Calcutta branch of a prominent group of hospitals. “We desperately wanted to let her know that we were all there and pleaded with the nurses, but they rudely told us off. Not a single doctor bothered to talk to us about her condition, far less comfort us.” If the hospital staff’s callousness came as a shock, Goenka and his family wasn’t prepared for the ‘cruelty’ which came next. “On the fifth day, a doctor supposedly attending to my mother told us coldly that her throat would have to be cut open from the front and a tube inserted in order to intravenously feed her. We learnt later through our doctor friends that this was a test procedure that hospitals were conducting on patients who they knew were dying, using them as guinea pigs. My mother was old and frail and should have been left alone....”
For Goenka, who still seethes with impotent rage, it was like an endless nightmare. The emotional trauma was compounded manifold by what he calls the “mental and physical torture that she was being subjected to”. He says, “As if pipes forced through her lungs were not painful enough, they tied up her hands and feet so that she wouldn’t be able to move if she suddenly came to; they also made us sign a bond as though we had specifically requested for it.” And at regular intervals, Goenka remembers, there would be a doctor or nurse handing them a long list of medical treatments that we would have to pay for...immediately.
This disturbing experience of a Calcutta private hospital is less an exception than the norm and, as new tales of atrocities come to the surface every day, the issue has convulsed the city for the past one-and-a-half months. If the Goenkas were “scarred for life”, Calcutta’s privately-run clinics, nursing homes and hospitals are in the dock for a long litany of grievances, ranging from overbilling patients and entrapping them into a vicious cycle of tests and treatments to faulty diagnoses and even death by negligence.
The nadir, in this regard, was reached with a horrific fire at the swanky AMRI hospital in 2011, which saw 92 people, mostly patients, suffocate to death. The fire was caused by a short-circuit in the basement, where inflammable material had been illegally stored, and the fumes spread through the air conditioning ducts to the rooms in the upper floors where patients were in various states of immobility. An irate Mamata Banerjee, West Bengal chief minister, had ordered the immediate arrest of the hospital’s top management, including the owners. Accordingly, 12 erstwhile directors and four officers were charged with culpable homicide in 2016. They are out on bail, while the case is being heard in the trial court. The rest of the healthcare industry saw no reason to mend their ways and continued with their coercive ways.
Mamata showed that her government wouldn’t tolerate rampant abuse by the healthcare industry last month when, actuated by the emergence of a raft of cases of terrible wrongdoing, she took a path-breaking decision to draft and enact a law that would empower people against rogue private hospitals. The immediate trigger was the death of 16-year-old Saika Parvin, allegedly due to lack of proper medical attention at the Calcutta Medical Research Institute. It caused an incensed mob to go on the rampage—hospital staff was attacked, and property destroyed. When the violence threatened to spread to the rest of the city, as irate victims of hospitals mobilised themselves, it prompted the CM’s action.
On March 3, Mamata introduced The West Bengal Clinical Establishments (Registration, Regulation and Transparency) Bill, 2017, in the state Assembly, which aims to end the free run of the state’s private hospitals and their unbridled highhandedness. The 25-page ‘historic’ document aims to regulate costs of medicines and treatment and outright repeals hospitals’ ‘right’ to refuse patients. The punishments proposed are also tough. “No longer can hospitals turn away patients in critical need of medical attention,” declared Mamata. Indeed, the thrust of her current initiative, she said, is to remind private hospitals that medical treatment is about ‘seva’ (service). It’s anathema if it’s driven solely for profit. “It’s okay to make some profit,” she has said. “But private hospitals have exceeded all limits of fair practice to become centres of extortion.”
“Mamata Banerjee has proven again that she is a doer who does not simply stop at making campaign promises,” a Trinamool leader tells Outlook. “Healthcare is extremely important to her; that’s why she has kept the health portfolio to herself.” For sure, soon after becoming chief minister in May 2011, Mamata paid a surprise visit to a government hospital and reprimanded the superintendent for not meeting required standards. When he argued with her, she had him fired.
But there is a lesser known, personal fact lying at the bottom of what many have termed Mamata’s “extreme sensitiveness” about healthcare institutions. In her autobiography My Unforgettable Memories, she talks about the pain of losing her father, attributing his death to the neglect of the hospital where he had been admitted. While introducing the bill in the Assembly, Mamata expressed hope that the law would become a model for the rest of the country.
Mamata Banerjee in the assembly while tabling the healthcare bill
Soon after the law was passed, skeletons started tumbling out of medicine chests, as scores of top physicians came out with tales of how they were unconscionably coerced by hospitals to overcharge patients and act so as to drive medical bills northwards. “We are put under tremendous pressure from the management to get more patients admitted,” a doctor associated with a high-end Calcutta private clinic tells Outlook. “Every morning there is a stock-taking meeting and if you aren’t deemed to have done ‘enough’, you are made to feel inadequate, as if you’re underperforming. I would say that out of a hundred cases in which patients do get admitted, over 50 per cent could have been simply treated and let go.”
Another doctor admits that the battery of tests recommended by them is not only about helping in diagnosis. “If you want to survive in the profession in this country you have to play by the rules, which include giving business to the different hospitals and diagnostic centers,” she says matter-of-factly. According to waiting patients when Outlook visited her chambers, the neurologist is notorious for prescribing MRI scans for even the most innocuous symptoms. One patient says, “But I keep coming back to her because she is a very good doctor and her treatment works for me.... These tests are a huge financial burden, we had to sell our house, but I would have died if she hadn’t cured me.”
A medical representative working with every high-end private hospital in the city tells Outlook, “What you call ‘minting money out of the misery of the vulnerable’ is justified by hospitals with a simple philosophy: it’s a business...make the highest possible profit. There is no room for compassion or humanity.” He reveals that some hospitals refuse to allow patients to buy medicine from shops not associated with it, and charge them as much as 110 per cent more than the generic cost of the drug. “Even for drugs prescribed after a private visit to a doctor, she would pay over double the manufacturing cost. Doctors are trained to create fear psychosis in patients’ minds....”
Dola Chatterjee, a rare medical representative who agreed to come on record, said, “The only honest doctor I came across in my long career of 20 years was in Chandannagar. His advice to patients of respiratory trouble was, ‘Go home, take a vapour, sleep it off’. He has cured hundreds, but is not well off.”
Another example is Dr B. Bera, a doctor in Uttarpara, a town near Calcutta, who was forced to shut down his practice for treating patients at less than half the cost of private hospitals. “Locals thronged to him not because he was cheap, but because he is an excellent doctor,” said a former patient. “But since he refused to participate in the racket he was shunted out with the help of local thugs.”
The healthcare bill, which was passed after a brief Assembly debate, takes a strong view of the gamut of malpractices at private hospitals, including nursing and maternity homes. A salient feature is the provision for severe penalties, including monetary compensation (Rs 10 lakh for death, Rs 5 lakh for major injuries and Rs 3 lakh for minor ones), confiscation of license and property, even criminal proceedings under the Indian Penal Code for death or injuries caused out of neglect. The document also enforces strict cost-control, forbidding inflated or arbitrary billing and proposes that ‘fixed treatment packages’ with clearly mentioned charges, be made known to patients’ families. It stipulates that critical patients—specifically mentioning victims of rape, acid attacks and accidents—are to receive immediate medical attention. Refusal to admit is an offence. The release of dead bodies is made mandatory too, regardless of settlement of bills. The most prominent feature is the creation of a commission, headed by a retired judge, which will not just act as a watchdog, but is empowered to mediate and impose penalties.
Interestingly, other than a few points of dissent—that the bill does not take into account government hospitals, that too much power is vested with the commission, that doctors might be victimised and jailed, or attacked by rampaging mobs— voiced by a few, Mamata’s law has received overwhelming support.
Speaking to Outlook on her own “harrowing experience”, Sanghamitra Chowdhury, the BJP contestant from Raidighi during the 2016 Assembly elections, says, “If the bill is implemented correctly, it should be welcomed irrespective of political differences.” In January 2017, she was admitted with back pain to a well-known south Calcutta private hospital. “All they did was administer heavy doses of pain killers. While my pain was in the lower back, their diagnosis found only a compression in the upper spinal region—they couldn’t even diagnose it. They coaxed me to shift to a more expensive ward. When I told them I couldn’t pay for it, they assured me that it was complimentary. What rattled me was a bill of over Rs 70,000. Clearly, they had not just charged me for the luxury ward but also overbilled me for the medicine. I didn’t recall many visits by doctors, but the bill mentioned a host of specialists who attended to me. I demanded an explanation, telling them I was aware of exactly how many medicines I took, and they were forced to admit that they ‘made a mistake’ and lowered the bill by about Rs 10,000. However, they still made more money out of me than they ethically should have.”
Yet, hardly a day goes by without a complaint against private hospitals, each one more disconcerting than the other. On April 21, Mamata met the parents of four-month-old Kuheli Chakraborty, who allegedly died due to an overdose of anaesthesia at a top hospital. She promised the distraught parents justice.
Hobbled by a near-dysfunctional government healthcare infrastructure, private institutions are mostly a necessity for Bengal’s citizens, making them vulnerable to every manner of coercion and calculated quackery. For them, Mamata’s Bill comes as a panacea.
By Dola Mitra in Calcutta
