Dr Ramakant Panda narrates his inspirational story of ascent to the league of the world’s top heart surgeons

Dr Ramakant Panda’s name comes up very high on any list of the world’s top heart surgeons who perform high-risk surgeries. Coming from a village in Orissa, Dr Panda was a topper at the All India Institute of Medical Sciences, New Delhi, but dejected by favouritism, he decided to go abroad. Good for him and for India because Dr Panda went on to do his Fellowship at the Cleveland Clinic, US, where he was trained by the pioneer of bypass surgery, Dr Floyd D Loop. Dr Panda has done over 10,000 bypass surgeries, making him one of the most prolific surgeons in the world. More importantly, he has performed more than 1,500 high-risk surgeries which have offered new life to many patients who were considered ‘inoperable’. He is the first in India to have introduced beating heart surgery, as well as ‘off-pump’ bypass surgery. His failure rate is just 0.5% against a world average of 2%. But being the top heart surgeon is not what makes him stand apart. It is his integrity, passion and humanism. One unique honour he has received was the prestigious Rashtriya Samman from the Income Tax department, for being one of the highest taxpayers between 1994-95 and 1998-99. Unlike many top doctors, Dr Panda refuses to be paid in cash. The same integrity and zeal has gone into setting up of the Asian Heart Institute in Mumbai, probably India’s best heart hospital. Here is his inspirational story
 

ML: Could you tell us about your education and family background?

RP: I was born in Orissa in a place called Jaspur. My parents were landowners. I spent my early childhood with my grandfather who was a freedom fighter. He was the headmaster of a school and a strict disciplinarian. For several years, my elder brother, a cousin, and I lived with my grandfather. I was with him till he died; I was then in the fifth standard. After that, I returned to live with my parents. My grandfather’s discipline had a tremendous impact on me. He loved us; at the same time, he was very strict. He used to insist that we wash our dishes after meals and wash our own clothes.

ML: Where did you study?

RP: Initially, at my grandfather’s school. After his death, I came back to my village and had to walk around 7-8 kilometres each way to school and back. My three brothers, my sister and I, all went to the same school. All of us used to stand first in our class. After high school, I went to BJD College.

ML: Did you know by then that you wanted to be a doctor?

RP: I had some interest, since one of my uncles is an ENT surgeon. Then, one of my cousins got married to a doctor; that had some impact on me. I clearly remember one incident that made me aspire to become a heart surgeon. In 1969, LIFE magazine had done a cover feature on Dr Denton A. Cooley (president and surgeon-in-chief, who founded the Texas Heart Institute), one of the all-time great heart surgeons, who had done the first heart transplant in the US. My uncle had brought a copy of the magazine, which had a big picture of Dr Cooley. That is when I had the dream of becoming a heart surgeon.

I studied for two years at BJD College and then went to SCV Medical College; I was the university topper in both places. It is at Cuttack Medical College that I began thinking of becoming a heart surgeon. The actual drive to become a heart surgeon came in the third year when clinical postings began; my first clinical posting was in the cardiology department. I was fascinated with heart surgery. I was always among the top five in the class at the medical college. For a year after that, I did my post-graduation from Burhampur Medical College, which is near Cuttack. I then appeared for the all-India entrance test to get into the AIIMS at New Delhi (All India Institute of Medical Sciences). I did my post-graduation in surgery and heart-surgery there between1980 and 1985. That is where the real grinding took place. I was always a hard-working student, but the actual drive to excel and do better in life happened at AIIMS. Those were among the toughest five years of my life, but they were also the formative years, which made me work hard. I often work about 18 hours a day. Actually, I used to work 18 hours a day on an average; now I have cut down to 14-16 hours a day. It was a really tough time for me.

ML: Tough because of the hard work, or even otherwise?

RP: Yes, even otherwise. I would rather not talk about it, except to say that there was a lot of bias. But that made me resolve that I wanted to do something and show people what I can do. So indirectly, it helped me.

ML: Is that when you decided to go to Cleveland?

RP: That was when I decided to go out of the country to get more training. In those days, in India, there were only four or five hospitals in the whole country doing heart surgery and they operated as a close-knit group. So if your boss was not happy with you, you were gone, because everybody knew one another. So there wasn’t much opportunity. I knew then that I had to go to some good place outside India and come back. So I gave those two qualifying exams for the US: it was called USMLE (United States Medical Licensing Examination) those days. It was getting tougher and tougher for doctors to go to the US, but I passed both the exams and began to search for institutes which offered the specialisation I was looking for. One of the consultants at AIIMS helped me get an appointment with Dr Dudley Johnson. Those days, Cleveland Clinic was the best in cardiac care. Luckily, a friend of mine went and spoke to the chief of cardiology about me and they took me in. So I went to Cleveland in 1986. Initially, I was under a culture shock. But that is where my whole life changed. In six months, I became the pet of my boss, so much so that even now we have a father-son relationship. His name was Dr Floyd D. Loop (chairman and CEO of Cleveland Clinic from 1989 to 2004). If you ask me, he was one of the founding fathers of bypass surgery. Within six to 12 months, I was fairly close to him and that is where I learnt all my surgical and technical skills.

ML: Cleveland Clinic is among the best in the world, isn’t it?

RP: Today, it is the best. For the last 15 years, it is rated as the best in the world. It is a very tough place; it requires you to be extremely hard working but with zero bias. If you are good and you are hard working, it is immediately recognised. That made a big difference to me. Within a year, I was doing the maximum number of surgeries as a resident – they never give so many surgeries to a resident doctor – to the extent that when I left, my boss wrote that I was the best resident doctor they ever trained in that place. I almost wanted to settle down there; at the same time, I also wanted to come back to India.

ML: When was that?

RP: This was in 1992. The reason I wanted to settle there was that I was also involved in a heart transplant programme. We used to go at night to harvest hearts from the small village and town hospitals. That is when my concept of a hospital underwent a complete change. Those days, AIIMS was the best hospital in India, but I saw that there was simply no comparison in the infrastructure and facilities that even small-town hospitals and community hospitals in the US had – they were far better than ours. So I thought I could come back and build that type of a hospital here. At that time, I had a staff position at Cleveland Clinic as a consultant which was one of the most sought after positions those days. But one day, while I was operating with Dr Loop, I told him that I wanted to go back to India. He said, “What?” He was stunned and wasn’t happy with my decision at all. I said, “Yes, I want to go back and start a small heart hospital and I want you to help me.” Those days, Cleveland Clinic was expanding very rapidly under him. He said, “Why don’t you go to one of these hospitals and develop a cardiac surgery programme?” But I told him that I wanted to go back and, after six years, I returned.

At that time, I wanted to do transplant surgery programmes. There is a place called Hairfields in London. There was a surgeon called Dr. Magdi Yacoub… he is also absolutely one of the all-time great cardiac surgeons. I spent around nine months to a year with him to learn about heart transplants. I came back in 1993.

ML: When you decided to return to India, did you know which city you would come back to?

RP: I just wanted to set up a heart hospital; that was my dream – my aim was to do it in Delhi. I knew people there. In those days, there was only Escorts Hospital and AIIMS; Batra Hospital had started but it wasn’t doing well and Modi Hospital was supposed to come up. Once I decided to return, I started coming to India on short trips from 1990 onwards. The first time I came here, I thought ‘no way I want to come back’. Then I introspected and decided that I did want to return, so I’d better start acclimatising myself. I came to India eight times in the next two years.

ML: Were you married by then?

RP: Yes, I got married in 1986 and both my children were born in the US. At Cleveland Clinic, our work routine was 40 hours of work; go home to sleep for eight hours and come back work again for 40 hours – this went on for three years. You earned money, but you got up at 4.30am; by 5am / 5.15am, you left for the hospital; at 5.30am, your morning round starts; 5.30am to 7.00am, you take your ICU round. The previous night’s team hands over charge to you. By 7.00 O’clock, if you are assigned to the operation theatre, the whole day you are in there; otherwise you have 60 patients to see – even at one minute per patient, it takes an hour. There was absolutely no time to eat; you often got time to eat only at 2pm.

ML: Why was it such a punishing schedule?

RP: You got used to it. Part of the reason is they wanted to keep the number of trainees to the minimum and give you that kind of intensive training. For instance, whatever I learnt in three years at AIIMS, I learnt in six months at Cleveland. So you go through a punishing schedule but you basically do a 10-year training in two to three years. When you leave Cleveland, you are one of the best. I think this was the best period of my life. My hard work was recognised and I was the most popular doctor there. Even now, people remember me and if I need anything, they will always help me without hesitation.

The work culture at London was very different. I came back from there in nine months because it was just like the Indian government hospitals. Nobody came before 9am; I was the only guy there at 6.30-7.00am. Nobody was discharged quickly from the ICU and there were long waiting lists. I tried to push the standards and get them to handle more cases, but it only made me a lot of enemies. So I thought: this is not the right place for me, I must get out.

When I returned, my first stop obviously was Delhi, but no opening was available there. Bangalore was the next option because my sister was there. Honestly, Mumbai was not on my radar; but that was the best thing that happened to me. So I went all over the place – I went to Apollo (Hospital) and that is another story; it is one of those experiences that taught me not to trust certain types.

ML: What happened at Apollo Hospital?

RP: I had signed an agreement to join Apollo Hospital at Hyderabad. I did some cases at Apollo, Chennai, and I went back to resign my job at Cleveland and wind up. A week before I was to leave, I received a phone call saying ‘we want to delay your appointment’. So I called up Apollo chairman’s daughter – Mrs Sangita Reddy – and she said, ‘we think you will be better at the Apollo Hospital coming up at New Delhi.’ I said, “I am ready to go to India, I have sold off everything and I have bought a ticket; and, at the last minute, you are saying wait for two years, how do I trust you?”  I decided it was not the right place for me.

Some time later, I was passing through Mumbai on my way back to the US. That’s when one of my patients, Dr PV Mehta, a gynaecologist at Jaslok Hospital and his wife also a eminent doctor – took me out for dinner. When they heard about my plans, they said, ‘why don’t you consider Mumbai?’ They insisted that I meet them at Jaslok the next day, although I was flying out. They were showing me around, and I met Dr AV Mehta. When he came to know that I was from Cleveland and was looking for an opening in India, he said: ‘you are joining us here’. He took me to the chairman, Mr Mathuradas, and that is how the whole thing started rolling.

ML: At that stage, when you were looking to be attached to a hospital, why did you not consider Escorts with Dr Naresh Trehan?

RP: At that time, I had a dream but no money. So I had to join some hospital whether it was at Bangalore, Delhi or Mumbai.  Yes, I know Naresh, but I also knew I would not be able to grow there. So in 1993 I started practising at Jaslok and, after a few months, at Breach Candy Hospital. My experience at Cleveland helped, because the technology and expertise was 10 years ahead of other places. I started doing the most risky cases. My first five or six cases were those of patients that nobody wanted to touch. All of them survived and that created an impression; there has been no looking back since. One case I remember was that of a senior IAS officer – he is still alive. He had a major cardiac arrest and his heart stopped beating for 20 minutes. He needed an angioplasty and most of the other surgeons refused. At that time, I had just come back from the US and had no case. So when the family asked me, I said I will take the case provided you don’t sue me. He was saved and I remember I was by their side for almost two months. A few cases like that established my reputation.

I was still looking for a place, since my dream was this hospital. My NRI friend and I started looking for a plot, even though I had no money, no car and no place to stay. I have probably looked at every single piece of land in Mumbai -- from Cuffe Parade to Panvel -- you name it and I have seen it. If I found a good location, the title was not clear; and I was getting frustrated. I used to talk to my boss at Cleveland and he said, ‘why are you rotting there, why don’t you come back?’ I told him, ‘I will try for a few more years and if I still don’t get what I want, I will come back (to the US)’. Meanwhile, my career had zoomed professionally.

I almost finalised a place near INORBIT Mall. But one of my very close friends, Mr M.R. Chandurkar, chairman of IPCA Laboratories, said: ‘nothing doing, we will find you a better place’. Then we got to know about a plot of land at the Bandra-Kurla Complex under the Mumbai Metropolitan Regional Development Authority (MMRDA), which was soon advertised.

ML: This was during the first round of auctions and not very expensive?

RP: It was not very expensive and nobody wanted to come here, since it was not a residential area. My friends said I was mad, but I said, I am not looking at the present; I am looking 10 years ahead. Believe it or not, I didn’t have even Rs30 lakh, out of the Rs60 lakh that we had to pay as a deposit. So we begged and borrowed from friends and put up the money.  

ML: You also gave a lot of thought to the capital structure and hospital design, didn’t you?

RP: Yes, that model and thought process came from the Cleveland Clinic. My entire infrastructure and management technique came from the Cleveland Hospital. I also got involved in helping others to get some experience in hospital design and architecture. I read a lot; my cupboard is full of books on hospital architecture, design, layout of the ICCU (intensive cardiac care unit) and the OT (operation theatre). In fact, I now know more about OT and ICCU design than anybody else in the country. The owner of Lilavati Hospital is a good friend of mine, so I helped design their entire first floor. I was also involved with designing seven or eight other hospitals around the country, including Medicity in Hyderabad. I basically incorporated whatever I saw in Cleveland over here. For instance, the doctors’ consulting room, the operation theatre and the ICCU have to be as close to one another as possible because, in an emergency, you need to attend to a patient within seconds. In India, you will find that the doctor’s office is on one floor, the OT is on another floor and the ICCU is on some other floor; you lose patients before the doctor can reach them. In my hospital, the OT and CathLab are only 15 feet away. I can transfer a patient from one to the other in 10 seconds and it can make the difference between life and death. I learnt a lot from other people’s problems.

ML: What kind of problems?

RP: For instance, about raising finances. We decided to have at least 80% of the money in place before starting the construction. I delayed the project by six months to get the finances and spent a lot of time with the architects and consultants, designing and planning everything on paper. My brief to them was: you can break a wall 10 times on paper. But, once you build, I am not going to allow any breakage.

ML: How did you organise the funding?

RP: A lot of my family members and friends chipped in; they are all equity holders. And yes, I raised money from relatives of my patients and colleagues. I also looked for a bank loan, which was very tough to come by then. Healthcare was considered a useless industry those days and the Industrial Development Bank of India (IDBI) had lost Rs1,800 crore. I went to IDBI; luckily I had happened to operate on one Mr MS Verma who was then the chairman of the State Bank of India. We became close friends and I requested him to help me – he also happens to be our chairman now. So Mr Verma spoke to the IDBI chairman Mr GP Gupta. I clearly remember that five of us had gone to meet them and one of the directors said “you guys don’t know sand from cement; how are going to complete this hospital project in 18 months?” He said it would take five years to complete. Mr Verma pushed the case with Mr Gupta and they agreed to give me the loan. While the negotiation was going on, I happened to operate on the then Bank of India chairman, KV Krishnamurthy. He had already undergone two bypass surgeries and everybody had said he was inoperable. I agreed to do the surgery. It took 16 to 18 hours and he came out of it successfully and is doing well. He said, ‘doctor, what can I do for you’? I told him about my dream and that no bank was willing to lend money to a hospital and that I had no collateral. He single-handedly took up my case and convinced the board to give me money. He also roped in Mr Leeladhar (then chairman of Union Bank of India). I decided not to borrow from IDBI but to go to BOI instead; I had a good rapport with them and they would be a little merciful, if we had repayment problems. That is how we started construction. I had a very strict schedule with all my contractors – they were eligible for a bonus if the work was done before time and had to pay a penalty for every day of delay. I had a target of 18 months to complete the project. It was a really crazy schedule; I was working for almost 22 hours a day, seven days a week, and I was sleeping for only two hours a day.

ML: The work on the hospital started in 2003?

RP: No, the work started in May 2001. I had a target of completing the work in 18 months and was driving everybody nuts. Luckily, my brother-in-law was the president of ABB (in charge of Far East) in Singapore. He had come back to start his own manufacturing firm for exports. But 9/11 (New York bombing) happened and everything was in a state of flux for a while. So I said, ‘why don’t you come over and help me?’ That was a great help; he also worked 14 to 16 hours a day. I would have finished the project in 14 months except that the air-conditioning experts goofed up and forced us to re-do a lot of work. We finally finished in 19 months and started paying the banks one and a half years in advance.

ML: How big was the project?

RP: When MMRDA allotted the land, they gave all the available plots to others and the remaining one was given to the hospital. It had a zigzag shape and we could not have constructed a hospital. The police had an equally bad plot of land adjacent to ours. So I went to the Mumbai police commissioner M.N. Singh and said, ‘your land is just as bad; can we merge it and divide it so that we have better plots?’ He agreed. Mr Ajit Warty was the MMRDA commissioner then; he was extremely helpful and agreed to let us merge the plots and re-do the boundaries. I initially met Mr Warty to apply for the land. He laughed at my wanting a plot, but when I then told him about my dream, he said, “Doctor, go home and rest. When the plot is advertised, make sure you are the highest bidder”. We did that and got the land.

ML: Didn’t MMRDA have reservation for a hospital in their plans?

RP: Yes, but nobody wanted to come here, so there were only 10 or 12 bidders. My plan was to construct on a smaller scale because I did not have that kind of money; and then do the second phase after 10 years. That was not possible, so we decided to complete the entire civil work; we also reduced the project cost from Rs112 crore to Rs95 crore. We put our own money into the construction first and also did a lot of tax management. We took the bank loan only at the end so as to reduce our interest burden; and also so that they would have no reservations about lending us money.

ML: Who was advising you on financial matters?

RP: Nobody. Our inauguration was also novel; we called three religious heads – the Kanchi Shankaracharya, the Archbishop and a Muslim leader. My boss from Cleveland, Dr Loop, flew down from the US and inaugurated the Asian Heart Hospital.

I must tell you another interesting episode. When we were planning the construction, our interior designers and architects kept comparing what I was doing with Jaslok and Lilavati. Finally, I got really mad and said I am trying to build a modern hospital. I then took a team of them to the US and showed them what the hospitals there look like. We went to Detroit, Chicago and Cleveland Clinic and I sought permission to let them take over 5,000 pictures. I also had a minimum brief – there was to be no black, brown or grey colour in this Hospital.

There is another interesting story on design. HOSMAC was our local hospital architect. During design phase, I talked to my boss Dr Loop. He got in one of the best from Cornell, NBBJ – the largest firm of hospital architects in the US. Cleveland Clinic had done more than $5 billion worth of business with them. Their chief architect told me ‘your boss has asked me to help you; I have no choice’. Over the next five days, they whetted my plans and gave a lot of suggestions.  

As I said, I have gone into the minutest details of the hospital. On the quality side, I put in strict protocols and gathered a core team of people who were hard-working and totally dedicated. I have a surgical team that is very good. My anaesthetist is the best in town; my intensivist, Dr D’silva, is probably the best in the country -- and their hallmark is that, like me, they work 14 to 16 hours a day.

ML: How do you manage to keep people enthused and retain them?

RP: Yes, it is tough, especially in Mumbai. The Indian mindset is not used to working in world-class conditions and that’s the reason why the turnover rate (attrition) is pretty high here. But my core group, which is the basic structure on which my hospital depends, is there. Within six months of commencement, we were doing the toughest procedures. But the turnover rate is high. Once people get the Asian Heart brand name, they are paid twice or thrice the salary, since there is a tremendous shortage of trained people. But my core group has not changed. They are loyal to me.

ML: Tell us a little about your work in surgery. We learn that you have the safest hands in operations with the highest success rate.

RP: Yes, my surgical failure rate, on an average, in the last seven or eight years is 0.5%, while the US average is 2% to 3%. I still spend around 10-12 hours out of my 16-18-hour working day on my clinical practice. That is close to my heart. I still do the highest number of most difficult cases around the country and I don’t want to give that up. I have done over 10,000 operations till date; even tomorrow, I have six to eight heart operations. It is only on weekends that I catch up with research and other work.

ML: What are the major differences between the US and India as far as the work is concerned?

RP: The major difference here is that patients have tremendous respect for you; in the US, it is like I have paid you money, you have to do your job. The patients’ expectation level in India is very low and their appreciation is what can make you go on for 16 hours. The problem is the work culture. Bringing people to their highest standards and getting them to keep at it day in and day out is very tough. They are not used to it. Half the staff is from the slums; so training them to be very clean and courteous for half the day and then sending them back to a totally different reality is difficult. So we have constant training and supervision.

ML: Collectively, how much stake do the doctors hold in Asian Heart Hospital?

RP: All the senior doctors have a stake; collectively, we hold around 70%. I made sure that doctors hold more than 50% because, if it is a question of choosing between quality and cost, we will choose quality; a pure businessman is not going to like that. If a doctor comes tomorrow and wants certain equipment because it is important, I would immediately say yes; while if it is a management decision, they will ask for a business plan and repayment ability, etc. We don’t compromise on quality issues. That’s why ours is the only hospital in the country that has both ISO certification and JCI (Joint Commission International) certification – no other hospital has both. I have insisted on certification right from the beginning. You have standard processes for everything in industry; but a hospital, which is one industry where you are dealing with human lives, has no standardisation. I am among the first in India to push for standardisation in the whole industry. JCIR is for standardisation of the care processes; it is a tough US-based accreditation. ISO mostly looks after the back-of-the-house processes. Then we went for an NIAHO (National Institute for the Accreditation of Healthcare Organizations) accreditation, another accreditation which is basically a combination of both ISO and JCI standards.

ML: In terms of medical techniques, how do you keep up with developments?

RP: In terms of medical equipment and technology, the competition among the good hospitals is such that everybody gets it immediately. Even techniques -- what you learn today, everybody knows tomorrow morning. The difference between a good hospital and an average hospital lies in how it uses the technology to provide better services and that is where we score better than any other hospital. No other hospital in the country can match our workspace, our ICCU care, our inspections or appraisals. That is where, I think, very strong systems and processes and a core group of doctors to deliver results on the surgical side and the intensive care side have made a difference.

ML: What next, any expansion plans?

RP: Yes, we had planned the second phase in 10 years but we are now doing it in five. We are going to add another 150 beds; after that, we have other expansion plans. We have already identified four places for expansion in the next two years -- one of them will definitely be my home town Bhubaneshwar, where we have already got the land from the Orissa government. I will start construction by December 2007. My long-term dream is to start a medical college in the next 10 years; again with quality as the focus.

ML: There is a lot of talk of medical tourism; do you see that developing in a big way?

RP: Right now, we are catering to people from the Middle East and the NRI population from around the world. Getting people from the USA is a little tough mainly because of the distance. Travel for 18 hours is tough and perception about India is also an issue but it is changing rapidly. If we can target the 30% of the population that is not insured in the US, if we can tap those, it may work.

ML: What about the NHS backlog in the UK? Can’t we get those patients?

RP: I was part of the Prime Minister’s delegation that went to the UK last October. We were told it is a sensitive issue: don’t even raise it in this forum. The problem is the European Union law that says that no patient can travel more than four hours for treatment. So India gets excluded. We still get a few patients. Last year, we got 10 patients, of whom six were Indians. These aren’t big numbers. In the US, the insurers are offering substantially lower health insurance premium and other financial incentives for those willing to be treated outside -- in countries like India, Thailand or Singapore. They pay the airfare and cash allowance. What people forget is that Malaysia, Singapore and Thailand are far ahead of us in terms of infrastructure. There is a hospital in Thailand, called Bumrungrad Hospital, which treated 65,000 Americans last year. A single hospital gets more patients from overseas than all of India; and the infrastructure, hospitality and customer service is really unbelievable. It will take some time for India to catch up with them. I take some credit that, with Asian Heart Institute, I am somewhat closer to them.

ML: Do you have plans to go public and get listed?

RP: Yes, somewhere down the line; but right now, we want to expand and finish paying off our Rs65 crore loan.

ML: How much will it cost to set up a new hospital today?

RP: It depends. I will not spend so much on interiors. The basic thumb rule for hospital beds is Rs30 to Rs40 lakh per bed. If you are doing a 100-bed hospital, it should ideally be Rs30 crore or a maximum Rs40 crore; beyond that, breakeven becomes tough. But I never looked at economics while building Asian Heart – this is my dream project, which I have built from my heart. Otherwise, do you think I would have had an office like this? Lots of people tell me there is wastage in terms of space. But I say two things: I did it from my heart and I did not look at economics. Besides, I have seen every hospital in Mumbai. Once you are successful and have the money, you want to provide ambience and services, but you have construction restraints and cannot do anything about it. So, I wanted flexibility right from the start.

ML: How much was your cost per bed here?

RP: Very high, around Rs80 lakh. Normally, this would not have been viable; the reason it worked is that my partners and I already had a successful practice in Mumbai and could transfer that here immediately. We have 80% occupancy.

ML: Can you tell us about your Bhubaneshwar project?

RP: My father came here three years ago. He said I will give you some advice. I asked what? He said, “Are you going to take all the money when you go up (die)? You are not from here (Mumbai); why don’t you do something for Bhubaneshwar?” I said okay, I will do something, and I approached the chief minister (Naveen Patnaik). He was very helpful; he is going out of the way to help me. I have got half of the land now, the other half was under litigation, but I will get it by December.

ML: You have an unusual honour among doctors for being among the highest taxpayers…

RP: : It is a funny thing; I always took my fees in cheque, even in 1996 when it was not usual. So my first CA asked me, ‘Doctor, what is your cash income?’ I told him this is all the income I have; there is no cash income. He told me that nobody would believe it and that I should better start taking cash because the income-tax officials won’t believe it either and will claim that you earn thrice as much. I said, ‘okay let them come and check my house, if they want to rip up my sofa to look for cash, I don’t mind.’ That’s when I had come back to India; and, from day one, I have been taking only cheque payments and the tax authorities gave me the highest taxpayer award in 1996.

ML: Tell us about your plans for a medical college?

RP:  I would love to do it in Mumbai – the city has given me so much. I never imagined that I will land up in Mumbai. In retrospect, I don’t think I could have achieved what I have, had I not been in Mumbai. What I like about this place is that it doesn’t matter where you come from; it is what you do that counts.

ML: When you are expanding, how will you ensure the highest standards?

RP: I am creating a core team that will fly down for critically ill patients. But that is never more than 10%. Over 80% of the work is routine and that can be handled by local doctors. I have given up attending to the day-to-day administration. I am no longer the CEO. I just have a weekly management meeting. I have also created a quality team that continuously monitors quality in all sections and gives me a report. We have a management council where we have taken six managers who, between them, take all key decisions. So everything is decentralised and I plan to follow this model everywhere. The future of healthcare is not in nice interiors or in new concepts in hospital design but in higher standards of patient care. Those are the areas, I think, I have contributed to.