Citizens' Issues
Doctors’ poison pill burns our pockets

It’s all well to talk about Bofors and 2G corruption. But what about the cuts taken by doctors who refer patients for tests and scans?  

In these heady days of Anna's triumphs, it is difficult to write about anything but corruption in India, and the subject is so vast, encompassing as it does every aspect of human activity, that the mind cannot think of other subjects on which to write.

Anna Hazare's campaign and the Jan Lokpal Bill have concentrated on corruption among government servants-the term extending from the prime minister to the lowest clerk in a tehsildar's office. This covers a wide swathe of economic and social activity of the people.

Corruption erodes the moral and ethical fibre of the bribe-taker and the bribe-giver. But this is not the worst effect of bribes, graft, kickbacks. The worst effect is that corruption is a cost of production. This is well-known, but few realise that it is the first axiom in the geometry of graft.

Bofors paid a bribe of Rs64 crore to some of the highest people in the land. We know who they were, but officially they were unknown and unnamed. Do you think Bofors wrote off the payment as charity? No way. The equivalent of Rs64 crore was added to the cost of the Bofors guns delivered to India. And who footed the bill? The people of India through the defence budget of the Government of India.

And let us take the tonnes of crores of graft paid in the 2G scam? Who will really reimburse the cost to the mobile phone companies? Who else but the users of the ultra-smart mobile phone services that the licensee companies will put on the market. It will be you and me; the man in the street may escape.

Let me take an example which affects all of us, including the man in the street, and the dog at the lamp-post:  the kickbacks taken by doctors who refer patients to scan centres and diagnostic labs. Yes, we put the haloes on the doctors' heads, but they are not shining white, they are black and baleful.

It all seems so simple and innocent, doesn't it? The general physician, or the specialist, examines your wife. He prescribes a scan and recommends a particular scan centre. He even has the centre's requisition pad with him and writes down your name and the investigations required.

You go to the scan centre and wince inwardly at the huge cost. But you think it is good for the beloved wife and you pay up; you notice it's all in cash. You take the scan to the doctor and the process continues.

You do not know that you have been cheated by as much 15% or 20% of the price of the scan. The doctor has an arrangement with the scan centre: up to 20% (depending on the number of referrals) of the value of the scan goes to the doctor as kickback. The amount of kickback is added to the cost of the scan, so your bill is bloated by that much more. Everyone's happy, including the patient who does not know. Ignorance is bliss, as the proverb goes?

I have written this on the basis of first-hand experience and a story that I wrote for my newspaper, about 15 years ago, detailing the entire process.

At the end of each month, the doctor sends to the scan centre, a list of patients that he has referred, the real cost of the scans and the total cut due to him. The amount is delivered in cash the next day. If it is not, the tap is turned off and the doctor starts referring patients to another scan centre. This keeps the scan centre owner in line.

I had written the story on the basis of written records, including the doctors' letters, the scan owners' record of payments, the cost of the scan before the kickback, the price charged to the patient and a few other bits and pieces of evidence.

Not surprisingly, nothing happened. One of the aphorisms I worked out is: today's newspaper wraps tomorrow's peanuts.

But I didn't give up. I sent the whole lot of evidence to the income-tax officer in whose ward the doctor fell. Again, nothing. And I thought of the saying: there are two types of people whom one does not antagonise, doctors and income-tax officers. Here the income-tax officer did not want to antagonise the doctor, who happened to be a neurosurgeon.

And nothing has changed.

(R Vijayaraghavan has been a professional journalist for more than four decades, specialising in finance, business and politics. He conceived and helped to launch Business Line, the financial daily of The Hindu group. He can be contacted at rvij10@yahoo.com.)

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COMMENTS

HM

5 years ago

Around 10 years back...i was a part of the team that was chosen to create a software for a diagnostic center in Mumbai (very well known).

The company wanted features for discounting & commissions. From the commission table i know that, based on hospital the doctor is given from X% - Y% as commission. If the referrals cross 5 in a week another few %age points are added & so on for month & quarter. All in all this kickbacks would go to as high as 60%-65% for some expensive tests based on the quarterly & volume model.

This sector is much more darker than even politics.

REPLY

nagesh kini

In Reply to HM 5 years ago

My late mother was admitted to three well known hospitals of Central Mumbai. During her stay we did come to know the extent of malpractices perpetrated.
At their appointment itself each consultant surgeon or physician is fixed a quota for 'business to be generated' that only includes his own fees but also referrals to others, all diagnostics, medicines and what not. Hopefully not the eats taken by the relations at the cafeteria! The contracts are not renewed if there is a shortfall.
The Indian Medical Council, call it the Watchdog or Regulator, is a toothless tiger that cannot bite because its President, a surgeon, is in jail facing serious corruption charges. Obviously the dictum of physician heal thyself is not considered applicable to a surgeon in him!

RNandakumar

In Reply to nagesh kini 5 years ago

In old age brittle bone is a problem for many. If an unfortunate one breaks his hip bone then he becomes a money spinner for the hospital.
Atleast two nurses are employed for 24 hrs care to avoid bed-soars , a condition that developes due to the patient lying in the same posture for a long time. His heart condition would be monitored through a mobile ECG machine. Then comes the kidney monitoring. One has to pray that stomach does not get upset due to the antibiotics administered. All these monitoring does not come free. Every time the specialist visits his visiting fees is added in the bill. In many instances these specialists comes to the door-step of the patients room accosts the patient and go away. Still the bill be added. GOOD HEALTH
NOWADAYS IS A MAJOR WEALTH.

RNandakumar

5 years ago

You have seen only the tip of the iceburg. Nowadays Medical Representatives do not discuss the product. They discuss sponsorships to important dramas or pictures to the doctor and his family. Many carry cheques for the amount purported to have been given by the doctors by way of prescribtions. Many doctors are wholesale distributors of pharmaceutical companies run locally manifacturing many me-too products. The doctor prescribes these products along with original products( to have good theraputic effect) to the shops nearby. Retailers stock the product to complete the cycle. 50-100% margins are norms in this business. In Western countries doctors are coruppted by sponsoring them to international conferences taking care of their expenses for the trip. In India physicians samples in many places become the bargaing chip. The ignorance and fear of diseases is exploited by doctors to levels which would make even our politicians blush with shame.

REPLY

nagesh kini

In Reply to RNandakumar 5 years ago

My late father was a Med. Rep. of a well known British pharma major now Indianised.
Today's Reps. are nowhere near the ones of those. I saw them carry laptops and display materials. Not surprised that they carry cheques too.
I know for certain the corruption levels in the US. I've seen it for myself!
The medical profession is encashing on the suffering of the patients. Ethics given a go-bye!

RNandakumar

5 years ago

You have seen only the tip of the iceburg. Nowadays Medical Representatives do not discuss the product. They discuss sponsorships to important dramas or pictures to the doctor and his family. Many carry cheques for the amount purported to have been given by the doctors by way of prescribtions. Many doctors are wholesale distributors of pharmaceutical companies run locally manifacturing many me-too products. The doctor prescribes these products along with original products( to have good theraputic effect) to the shops nearby. Retailers stock the product to complete the cycle. 50-100% margins are norms in this business. In Western countries doctors are coruppted by sponsoring them to international conferences taking care of their expenses for the trip. In India physicians samples in many places become the bargaing chip. The ignorance and fear of diseases is exploited by doctors to levels which would make even our politicians blush with shame.

Adi Daruwalla

5 years ago

On becoming a DOCTOR you are administered an OATH, anyone knows that OATH and what the Docs are doing is they have defiled that OATH. Not only defiled that OATH but made it gutteral. The only otah they know is Money Money Money, stent apply ke replace knee only money. When patients undergo an angio, the specialist will say I used three stents, but one did not baloon open but you have to pay for that one also!!!!!! ????

REPLY

Nipun

In Reply to Adi Daruwalla 5 years ago

There are a quite a no. of doctors who may practice like this but not all.
And secondly even this ill is propagated by the government....do you have any idea how much money does it cost on an average for a person to become a doctor...more than 12 years and around 70-80 lakh rupees...now where do you think the person will claim back this money he has put..
The doctor only suggests the centre..it is entirely the patient's decision if he wishes to go there or not...The patient is not compelled and he has to know this..

Adi Daruwalla

In Reply to Nipun 5 years ago

You have the passion to become a doctor, dont use unscrupulous means to get the money back work hard for it. Dont tell me in 50 years of a Doctors life he cant recover his investment. Doctors education with professional specialisation is not more than 8 years, its not 12 years for sure

RNandakumar

In Reply to Adi Daruwalla 5 years ago

Good reply. A specialist in India is so busy nowadays whether they give serious thought about quality of their work. India having become a Medical Tourist Centre all reputed hospitals find it difficult to manage their time. A concentious physician or surgeon easily earns not only for him but also for the next generations of his/her. Just like the value of our rupee doctors adhering to ethical values are found to be diminishing. But fortunately for India there are still a lot of gems among them.

Vikas Gupta

5 years ago

There is a recent case of Medical Corruption reported in Today's Dainik Bhaskar of Medical College, Rohtak. There was a serious patient admitted in the ICU yesterday in Medical College, Rohtak because of Heart Attack. The attendant of the patient was asked to bring an Injection of Rs 28,000/-. He brought the injection but Doctors on duty refused to use the injection as it was not bought from either of the 2 Chemists recomended by the Doctors on duty. The attendant got that injection from some other nearby chemist for Rs 5,000/- less than those 2 Chemists. The doctors only used the injection after the intervention of Director, Medical College, Rohtak. This is a clear cut case of corruption of Rs. 5,000/- per injection. The doctors are so much corrupt they don't think even for a moment about the life of the patient but only for their bribe. Shame for such an act.

SAMAR

5 years ago

None practically does anything for any one in Mumbai, without an embedded agenda.Even the security staff at the society, fixing a housemaid for you, takes a cut.In the process, unscrupulous elements spoil the culture.Technology should help us to connect the patient to Doctor/specialists, duly accredited,medical test centers & Jana Ausadhalayas, for generic alternatives.
Current practice in the domain is well known, & does not need publicity.What we need is Helplines with retired Consultants to guide us..

Mesa

5 years ago

My silent prayer, O my God, never make me sick, nor let me attend a police station or a court. Amen

REPLY

Adi Daruwalla

In Reply to Mesa 5 years ago

Very true, three people to be weary off in todays Kalyuga, Police Doctor and Lawyer, but one must be positive and not generalize. I live with the basic concept that people are good, look for the good in them, but then again in todays Kalyug thats difficult and then I am really naive.

Samar

In Reply to Mesa 5 years ago

How true.Doctors study at huge cost.They treat their profession as business not a service to humanity.Chain of supply is a truth in trading.They have to have ROI.THUS ARGUED A Doctor's wife.

nagesh kini

In Reply to Mesa 5 years ago

I think it is said - keep away from a khaki, white and black coat - police station, hospital and court. All places full of bribes and cuts unlimited!

Adi Daruwalla

In Reply to nagesh kini 5 years ago

It cuts the common man very deep.......

Nagesh KiniFCA

5 years ago

We only talk of the corruption of the babus. The 'cut' practice among doctors is far worse than the MNC pharma cos. overcharging for the drugs that necessitated regulating the MRPs by the PPCO. All this is utimately paid for by the patients, not all of them rich.
Coming from a family of doctors, I've been observing this closely. My uncle who was a senior GP had a favourite anecdote - a person upturning a bottle of medicines in a gutter, when asked, he replied, I was sick,so I went to a doctor, he wanted 'further investigations for blood, scan etc. another 'expert second opinion' that cost a bomb, went back to the doctor who collected his fees - he has to live, next he gave me a prescription that is for this bottle, I went to the chemist and paid him, he has to live too. Now that I'm throwing it away - I have to live too! I've a kid running out of a Radiologist's clinic with money, when asked, he says he is rushing to pay his Uncle, the Radiologist's younger brother who is a GP down the lane his 'hafta' the Marathi slag for bribe/cut
The so-called oath the medical students take has become a Hypocritical oath rather than Hippocratic Oath. That learned man must be turning in his grave!

mukesh

5 years ago

THIS CANCER IN MEDICAL FIELD HAS TO BE CURBED BEFORE IT BECOMES AIDS - UNCURABLE - ESPECIALLY AS LASRGE NO. OF PEOPLE ARE BEING DRAINED OF THIS DR.-LAB NEXUS WHICH IS DRAINING THE PEOPLE OF INDIA OF THOUSANDS OF CRORES EACH YEAR ON TOP OF THEIR MEDICAL ILLNESSES & SUFFERING.

Vikas Gupta

5 years ago

I totally agree with Mr. Raghvan. But he had shown a trailer & the Whole picture is too big to be written. I would like to add some more points:-
1). The medicines which Dr. prescribes in a Nursing Home is mostly not available in other parts of the City/State/Country. So the patient has to purchase it from the Pharmacy of the nursing home. The medicines given are of Lowest Standards & of Highest MRP to give maximum gain to the Doctors.
About Govt. run Medical Colleges & Hospitals, Dr.s are not prescibing the medicines available in the Dispensary to be given free of cost by the Govt but they prescribe similar salts with Particular Brand Names to be bought outside the Hospitals with Highest MRP while Brands of Reputed Companies of same salts are available at a much lower price. After calculating the monthly sales of the Prescribed Brands, Their proportion reaches them in Cash.
2) The doctors have formed a Nexus together so that they refer their patients to other Superspecilists to earn their Referral Commission in spite of the fact whether there is genuine need for that or not. That's true for both Private as wellas Govt. Doctors.
3) Doctors in Govt.run Hospitals instruct their patients to go out for various Diagnostic Tests privately even when these tests are available in the Hospitals only for free only because of their Commission.
There a lot of other ways by which Doctors are cutting the pockets of Public. In fact, Each & everthing of a Dr.from Underwear to Foreign Trips, Luxuary Cars is sponsored by the Companies associated with his Practice.It can be future agenda of Corruption for some Anna Hazare.

VIKAS

5 years ago

I want to put two updates in the story -

1. Cut for the doctor is infact much more. Heard from a govt. doctor who is also into private practice in a small town in MP that for every CT scan costing Rs. 1500 to patient, doctor gets 800 (yes 800 out of 1500).

2. Process is much better fine tuned. Doctor does not keep any record himself. Everyday or week - depending
on the 'business volume' and mutual understanding, diagnostic center sends cash to doctor along with count of patients.

This is really pathetic. I think problem is that each section of society - irrespective of class, profession, education etc., is suffering from the curse of corruption - someone is more corrupt someone is less. I recall one wall painting put up in my hometown longback by Gayathri pariwar - 'Apna apna karo sudhar, tabhi mitega bhrastachaar'.

IL&FS subsidiary trims fund raising plans by $1 bn

IL&FS Financial Services plans to raise $4 billion, of which, $1.5 billion has already been mobilised in the past six months

Non-banking financial company IL&FS Financial Services (IFIN) today said it plans to pare down its fund-raising by around $1 billion to $4 billion because of the problems in the infrastructure projects.

Earlier, the company was planning to mop up $5 billion from the markets through debt by the end of this fiscal to fund its infrastructure projects.
"Frankly, infrastructure projects are not doing well for the last 8-10 months. Therefore, we decided to reduce the amount," IFIN managing director and chief executive Ramesh C Bawa told PTI.

Now the company plans to raise $4 billion, of which, $1.5 billion has already been mobilised in the past six months. The rest will be raised by the end of fiscal, he added.

The Mumbai-based NBFC, a wholly-owned subsidiary of Infrastructure Leasing & Financial Services (IL&FS), plans to use the funds to finance projects in the power, road, coal and port sectors. The company is currently engaged in over 10 power and road projects.

"We will raise this money from both domestic as well as overseas markets. Around one-third amount will come from overseas and the rest from local markets," Bawa said. IFIN has also set up its international presence through its wholly-owned subsidiaries, IL&FS Global Financial Services in Singapore, London and Dubai.

When asked about the reason for funds raising from overseas markets, Bawa said frequent interest rate hike had made fund-raising too costly from the domestic markets. The RBI has hiked policy rates 11 times since March 2010, to curb inflation.

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Ashok Leyland sales slips 3.5% in August

Ashok Leyland reported a 3.50% decline in its total commercial vehicle sales to 7,218 units in August 2011

Hinduja Group flagship company Ashok Leyland reported a 3.50% decline in its total commercial vehicle sales to 7,218 units in August this year compared that in the same month of the previous year. The company had sold 7,480 units in the same month of 2010, Ashok Leyland said in a statement.

Domestic sales stood at 6,168 units in August against 6,705 units in the same month of the previous year, down 8.01%, it added. Exports, however, increased by 35.48% to 1,050 units last month from 775 units in the year-ago period.

The company also reported a 7.82% fall in total domestic sales of medium and heavy commercial vehicles to 6,132 units in August from 6,652 units in the same month of the previous year.

On Tuesday, Ashok Leyland ended 0.39% down at Rs25.80 on the Bombay Stock Exchange, while the benchmark Sensex gained 0.89% at 16,862.81.

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