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At HealthCare Global Enterprises, Sudhansu Mohanty was subjected to nuclear scan by a technician when a specialist’s supervision is mandatory. Instead of threatening to sue Aamir Khan, the IMA will do the nation a great service if it gets cracking on such cases
The comments to Moneylife's article on the Indian Medical Association (IMA) just shows how deep rooted the anger is there in the country with regard to the medical fraternity. While all of the comments brought out various aspects related to medical malpractices and corruption, one of the most shocking stories was related by Sudhansu Mohanty (as a comment to the above article).
Read on… to visualize and experience what Sudhansu perhaps went through on 24 May 2012 at HealthCare Global Enterprises (HCG), a Bangalore-headquartered specialist in cancer care. According to its own website, HCG "is the only dedicated cancer care network with quality care across 25 centres. …Each centre is provided with a business system, management expertise and capital resources to bring patient-focused, state-of-the art cancer care to new regions." As the website further notes, HCG's approach to cancer care is supposedly unique:
"We do extensive research and develop innovative treatment methods to provide the finest cancer care. This is supported by the most advanced technology to make cancer a manageable health condition and improve the quality of life of patients. It is our goal and commitment that one day India will be free from the agony of cancer. …For over five years HealthCare Global Enterprises (HCG) has been defining the future of cancer care in India by designing, building and managing cancer centres with a steadfast vision: To transform cancer care environment by bringing core clinical services to one central place. The intent of this single place is to help patients achieve longer, better lives-and to improve cancer care one centre at a time. …At HealthCare Global Enterprises (HCG), we view each centre as a model of excellence, a place where physicians can achieve professional fulfilment and breakthroughs in patient care. …Patients are the beneficiaries of these achievements-every accomplishment brings us one step closer to our ultimate goal of longer, better lives for cancer patients and their families." (To read more about HCG click here).
To be honest, if you ask me, anyone reading the above descriptions (on the HCG website) would be convinced to go to them for "Cancer Care".
Given that context, let us see what Sudhansu has posted on the Moneylife website the same is also available at his blog:
Mr Sudhansu states as follows...
"I seek to put in public domain my recent experience (just about 12 days ago, to be exact on 24 May 2012) in the HCG cancer hospital (also known as Bangalore Institute of Oncology) in Bangalore. I am a patient of carcinoid cancer. A month ago, I experienced pain in the anastomotic site. The CT scan done shortly after showed up cysts in the liver, apart from inflammation and ulceration in my colon. The most effective treatment for carcinoid is the complete, surgical removal of the tumour(s), which in my case had been performed. But microscopic cells could even show up after years and it's the tumour diasporic proclivity that prompted my doctors advises me a nuclear scan called Gallium-68 PET CT DOTANOC to zero in on the problem.
After the scan got over, I requested the nurse if I could speak with the doctor and get a preliminary idea of the scan before the detailed results came a day later. She said, "No doctors around. The technician did it."
I couldn't believe what I heard. "You mean to say that this nuclear scan was done without the supervision of a doctor, a consultant of nuclear medicine?" She looked at me, speechless. I walked over to the edge of the console room and asked the technician if he could do the scan without the specialist in nuclear medicine being around. In my money receipt the specialist's name was mentioned. I demanded an answer.
The technician panicked and spoke to the specialist seated in Tower 1. My scan was in Tower 4, about 200 meters away from where the doctors-consultant, nuclear medicine and the radiologists-sat.
Within minutes the technician materialized. "You can speak to Dr Kallur", he said, handing me the cordless phone.
"Doctor," I asked, "how is it that no doctor was around when my scan was done?"
His reply was pat. "I can't be present in all the 60-70 scans done everyday. You can take your money back!"
For all my ailments and my sundry visits to doctors across hospitals/cities wherever I've lived, I had never heard anything remotely resembling this. "That's okay but what happens to the radioactive isotope injected that's gone into my body? And is this the medical protocol your hospital follows?"
Silence. Later, I heard a voice say, "If you want to meet Dr Kallur, you can."
"But am I not speaking to him?"
"No, this is Pravin speaking." I asked him to come meet me.
He came half hour later-after two reminders. I demanded to meet the chairman. "The chairman is in a meeting," Pravin promptly conveyed.
"That he must be," I said, my voiced dipped in sarcasm, "but know that that ploy won't work. Please set up my meeting with him. Quickly."
He shuffled from one foot to another. Then moved away.
I sought him out again, as my wife and I sat in the patient's room in the high radiation hazard zone. It was getting to six in the evening.
Finally, Pravin after his string of meetings and phone calls materialized to take us. But no, it wasn't the chairman of HCG, Dr Ajaikumar. It was Elizabeth, the chief administrative officer. I told him I had nothing to do with her. After confabulation with Pravin, Elizabeth came over, now seated in the reception of Tower 2. I told her I wanted to see the chairman and there was no point repeating things time and time again. She hadn't been purveyed the full story. When she heard it, her face mirrored her shock.
I was fasting since morning. More than two hours after my scan got over, we're being escorted to the chairman. I was asked for my visiting card. "I'm a patient. You know my name, below it write PATIENT.
Dr Ajaikumar quickly apologized on Dr Kallur's behalf. "I've already told him," he said, "and I'm going to tell him again". I asked if his hospital followed the medical protocol prescribed for nuclear scans. He was politeness personified but his disembodied answers waffled with US examples. I knew they were faux excuses.
"How can a doctor ever mutter such words you can take back your money to a patient?"
"Stress", he tried to reason. "He's a busy doctor!"
"Who isn't? Certainly you don't do 60-70 DOTANOC scans everyday! Your hospital says about 3-4!"
Little later, he said Kallur is "compassionate" and "an icon!"
"Compassion" to a cancer patient I'd freshly experienced. So I told him to disabuse culting his icon. "My personal ethics prompted me to meet tell you before I hammer out the next course of action for the criminal neglect in medical care in your hospital. This isn't the Hippocratic Oath that you doctors are sworn to, this is Hypocrites' Oath! I speak here not for me but for the voiceless-the illiterate, uneducated masses-who know nothing what doctors, whom they trust blindly, do!" In my throat I added, "As you go pursuing Mammon relentlessly throwing all medical ethics out the window!"
The next morning I saw a half-page advertisement on the front page of a national daily enticing cancer patients to the hospital. In the evening I got my report. I found the radiologist's signature; three names (without signature) of consultants in nuclear medicine printed alongside, including Kallur's-conveying unmistakably that the nuclear scan was examined only by the radiologist, not the nuclear medicine specialist! So today, as I ready for another surgery, I must seek out another nuclear medicine specialist for an expert opinion-this after paying Rs17,000 and with the radio-isotope in my system. And how right you are Aamir!"
Very interestingly, I came across another item on the HCG's blog which is incidentally dated 25 May 2012-exactly a day after Sudhansu's experience of 24 May 2012 (as stated above). Read on…
First cancer centre in India to be accredited by NABH, NABL and CAP
25th May, 2012, Bangalore: HealthCare Global Enterprises, The Specialist in Cancer Care, Bangalore, is the first cancer centre in India, to have accreditation from National Accreditation Board for Hospitals & Healthcare Providers,(NABH) Government of India, College of American Pathologists ( CAP), State of Illinois, and National Accreditation Board for Testing and Calibration Laboratories (NABL), Government of India. The combined accreditation for quality from three distinguished accreditation bodies was possible because of HCG's focus on robust process for patient quality, efficient practice of diagnosis and improvements in medical outcome.
Dr. B S Ajaikumar, chairman, HCG, said, "We are proud of this achievement of a combined accreditation from three bodies which endorses our hat or clinicians and non clinicians' together have been working together ensuring highest quality standards in cancer care with a focus in delivering the best in medical outcome. I'm happy to note that our team was the first to get these three accreditations in India."
It seems unbelievable as well as ironical that an institution (like HCG) which has received accreditation from several bodies-including the National Accreditation Board for Hospitals & Healthcare Providers,(NABH) Government of India; College of American Pathologists (CAP), State of Illinois; and National Accreditation Board for Testing and Calibration Laboratories (NABL), Government of India - has allowed its process of treating its patients to degenerate to the levels suggested in Sudhansu's stated experience above. Specific questions that arise in this regard are:
a) Was it alright for a specialist doctor not to be present when the procedure-nuclear scan-was being actually done on the patient? This is especially a critical question given that the disease in question is (specialized) cancer and also given the fact that in the money receipt, the name of the specialist had been mentioned. Further, I have heard that to provide proper diagnosis, it is imperative for a specialist doctor to be part of the process of scanning - as much is learned from the process of scanning as the scanned output. That being the case, how does one explain away the doctor's absence when the patient (Sudhansu) was being scanned?
b) Can a doctor-because of being stressed, busy and/or excess workload (taking about 60/70 nuclear scans a day)-absent himself from a critical nuclear scan being taken? Is this appropriate as per the medical protocol prescribed for nuclear scans as well as critical care illnesses like cancer?
c) Was it fair and appropriate for the doctor to tell a patient-"You can take your money back"? Was not the doctor breaching the code of ethics and conduct by retorting to the patient in such a manner? And as Sudhansu argues, while money can be returned, what about the actual scan procedure experienced, the radioactive isotope injected into his body and the ramifications therein?
d) And, can a doctor who has behaved as described above be referred to as either "compassionate" or "an icon!"?
Moneylife sent an email to Dr Ajaikumar and other authorities at HCG, which was acknowledged by one official over phone. He said HCG will respond to Moneylife's mail after speaking with top management and the doctor concerned.
Here is what Dr Kallur has said in a reply to our mails...
Without any doubt, several issues need to be critically examined in the light of Sudhansu's narration above as also other comments that have come in response to the Moneylife article. And I hope that instead of taking pot-shots at Aamir Khan and threatening to sue him, the IMA will do itself and the nation a great service if it gets cracking on such cases (which seem to be in plenty) and takes appropriate action against those who break its (very own) code of ethics and medical protocol…
(Ramesh Arunachalam has over two decades of strong grass-roots and institutional experience in rural finance, MSME development, agriculture and rural livelihood systems, rural and urban development and urban poverty alleviation across Asia, Africa, North America and Europe. He has worked with national and state governments and multilateral agencies. His book-Indian Microfinance, The Way Forward-is the first authentic compendium on the history of microfinance in India and its possible future.)
The Planning Commission justified Rs35 lakh spend saying it as ‘routine maintenance and upgradation’. However, it has no answer on money spent for the non-feasible door access control system for toilets
After media reports surfaced on how the Right to Information (RTI) application revealed that over Rs35 lakh was spent on renovating two toilets, including the cost on installation of installation of Door Access Control System at Yojana Bhawan, the Planning Commission clarified that it is “routine maintenance and upgradation”, and said that it was found that access-control system was actually not feasible in practice. The RTI applicant has demanded explanation if this amounted to wastage of Rs5 lakh spent to install the system.
Subhash Agrawal, the RTI applicant, told Moneylife, “The clarification is an afterthought, seeing the media reaction on how money was blown up. While the RTI reply itself indicated that such system is not feasible, the Planning Commission’s reply backed it.”
In a statement the Planning Commission said, “These toilet blocks are meant for shared use and are all being renovated to the same standard. Because there have been instances of pilferages of newly constructed toilets, an access-control system was initially tried, but was not found feasible in practice. Yojana Bhawan is an important public building and must have the essential facilities. The costing and execution of works is not done by the Planning Commission, but by the CPWD (Central Public Works Department) which is the authorized government agency to do the same. The entire work is being done within the budgetary allocation and following the prescribed procedure.”
In a reply to a RTI application by Mr Agrawal, the Planning Commission revealed, “Cost of installation of Door Access Control System is Rs5,19,426 for two toilets. Cost of renovation of two toilets where door access control system is installed is Rs30,00,305.”
A communiqué from Planning Commission clarified that, “It is unfortunate that what is routine maintenance and upgradation is being projected as wasteful expenditure. The toilets being repaired or renovated are public toilet blocks, and not private toilets for senior officials or members. While the amount of Rs30 lakh being mentioned is correct, an impression is being created that this has been spent on two toilets. This is totally false, because these toilet blocks have multiple seats in addition to separate facility for the differently-abled. Each of these blocks can be simultaneously used by approximately ten people.”
However, information furnished under RTI revealed that CPWD has provided 60 smart cards for accessing these toilets to users including senior advisors, advisors, directors, personal secretaries, etc, making it clear that it was for private use.
The Planning Commission also said that more than 1,500 meetings are held every year and thousands of people use these public conveniences. A common complaint over the years was the poor quality of the toilets in the building—a complaint made not just by the ministers and foreign dignitaries who visit, but also by the staff and the journalists. “Does this mean that if I go to Yojana Bhawan, I have to find one of the 60 smart card users before accessing the toilet? Now they are saying the system is not feasible. But they have to answer whether the system is still in place or not in use and also what happened to those smart cards. Also, does this mean that Rs5 lakh is wasted?” asks Mr Agrawal.
Experts point out that it is still unclear who is responsible for the expenditure for the renovation on the toilets.
The renovation of the two toilets with “diplomatic embassy standards” and Japanese or German class fittings, should cost between Rs2 and Rs4 lakh in Delhi
The toilet controversies appears to be rocking the headlines in the print media and breaking news on television, and no less than the deputy chairman of the Planning Commission had to issue clarifications and press notes on the subject.
But one simple fact appears to have gone past unchallenged. Was the cost within rational levels, and if so, how much is our CPWD (Central Public Works Department), tasked with this job, spending on refurbishing toilets?
Based on quick television video grabs and media photos, I went on a walkabout in one of South Delhi's major “sanitary goods” market and the showroom of one of Indian’s most famous sanitary goods and bathroom boutiques. All are within two kilometres of where I live, and I have known some of the shopkeepers for about 30-40 years.
1) An estimate of renewing the bathrooms, including civil works, to what they refer as “diplomatic embassy standards”, was placed at between Rs2 and Rs4 lakh. This includes Japanese or German fittings, where required, or Indian equivalent. This is, as they say, for work done “with receipt”, which means they satisfy all mandatory and statutory requirements—except bribes. It is a considered opinion that the bribes involved through a chain of contractors and subcontractors would have been between 300% and 400% People smile at even higher numbers charged during the Commonwealth Games, and say, so what, nothing will happen.
2) A decent smart card reader configuration for 3-5 doors would cost between Rs30,000-Rs80,000, depending on configurations, and that would include 100 smart cards. And as we are all aware, a replacement smart card even for the Delhi Metro has a cash value of Rs50, while the actual cost when bought in bulk is in single digit Indian rupees.
Whether a building is 50 years old or almost new, rejuvenating a toilet which does not even have a shower cubicle from all appearances cannot cost so much money.
The bigger question to the Planning Commission, then, is this—would they like to use this as an opportunity to analyse how much a toilet should cost, whether it is for the exalted asses or ordinary human beings?
At Rs35 lakh, another friend who is senior enough in the hotel industry, could not help but say that it sounds like toilet humour —except that, it is we, the tax payers, who are paying for this joke.
(Veeresh Malik had a long career in the Merchant Navy, which he left in 1983. He has qualifications in ship-broking and chartering, loves to travel, and has been in print and electronic media for over two decades. After starting and selling a couple of companies, is now back to his first love-writing.)