Systemic ills

The rot runs deep in West Bengal’s private health care system.

At the general ward of the cardiovascular institute of R.G. Kar Hospital in Kolkata, a 2011 picture. More than 70 per cent of the patients in West Bengal prefer government-run health establishments.

ON the morning of March 15, Sunil Patra, a small businessman from West Bengal’s South 24 Paraganas district, met with a road accident in which his leg got severed. His family members rushed him to a well-known private hospital in Kolkata, where he was allegedly denied treatment unless his family deposited Rs.50,000. Not being able to come up with that sort of money at short notice, his family took Patra to the State-run SSKM Hospital, where he was admitted after much delay and paperwork at 10 p.m. It was too late, and his severed limb could not be rejoined. The private hospital denied knowledge of such a patient. For close to 11 hours, Patra suffered as his family and friends moved from pillar to post to get treatment.

The incident took place just 12 days after the Trinamool Congress government passed the West Bengal Clinical Establishments (Registration, Regulation and Transparency) Bill, 2017, to keep in check inhuman and unethical practices of private medical establishments in the State. Earlier, Chief Minister Mamata Banerjee had chastised representatives of private hospitals and nursing homes and urged them to take a more humane approach in dealing with patients. On March 16, Governor Keshari Nath Tripathi gave his formal nod to the Bill.

The very fact that such a piece of legislation had to be enacted is an indication of the state of health care in West Bengal. The legislation was prompted by an increasing number of complaints of harassment and malpractices in private health care facilities.

“A patient’s family members are often too scared to challenge the extortion that takes place inside private hospitals in the name of treatment. Their situation is most vulnerable while the patient remains in hospital as their foremost concern is to save the life of the patient. When they cannot pay any more, they are forced to shift the patient to a cheaper hospital, but often the hospital where the patient is admitted will not release him or her until the bills are fully cleared. Nor will it continue with the treatment, and the patient’s situation worsens,” said Uttan Bandopadhyay, patient rights activist. According to Uttan, in most cases of harassment of patients in private hospitals happens in the form of inflated bills.

‘Eye-opener’

The tragic story of Sanjoy Roy, which caused widespread outrage in the State, is a case in point. Roy, who met with an accident on February 16, was admitted to Apollo Gleneagles, Kolkata, where in just six days the hospital ran up a bill of Rs.7.23 lakh. Unable to pay it, the family wanted to move Roy out of the establishment, but the hospital allegedly refused to release him until his family members submitted their fixed deposit receipts and other financial papers.

Roy died within a few hours of being finally allowed to shift to SSKM. Preliminary investigation by the State Health Department revealed that the hospital bills were highly inflated.

Although such incidents are commonplace in Kolkata, this one served as an “eye-opener” to the West Bengal government. The Chief Minister made it clear that the government would not hesitate to act against erring private hospitals. “We have been quietly carrying out inspections of private hospitals in the State. Of the 2,088 private hospitals and nursing homes registered in the State, inspections have been carried out in 942 of them; 70 have been showcaused and licences of 33 have been cancelled,” she said.

A senior doctor told Frontline on condition of anonymity that the “rot in the system has gone too deep”. According to him, doctors in large private hospitals that are run in a corporate style are helpless. “There is nothing written down, but doctors are constantly under pressure to generate more business than to actually address the problems of the patients. Like salesmen, the doctors too are given targets of making money for the institution. I know many young doctors who were initially traumatised by this situation, but eventually they succumbed to the pressure and now they have no qualms about doing what they do,” said the doctor.

Priya Chakraborty (name changed), the mother of an eight-year-old girl, recounted her traumatic experience at a top private hospital in Kolkata where she took her daughter with a stomach ailment. “The doctor there tried to convince me that my daughter had acute appendicitis and wanted me to admit her immediately. Fortunately, I insisted on having a second opinion, where I was assured it was nothing more than a minor stomach bug,” she told Frontline .

State of public health

Dependence on government-run health establishments in West Bengal, particularly in Kolkata, is highest among the States in the eastern region of the country, with more than 70 per cent of the patients preferring government institutions. However, the bed capacity in these hospitals has not been increased for long. Although there has been substantial capacity enhancement in the past six years, it is hardly enough to make any perceptible difference. In 2010, the total number of beds in a government hospital stood at 55,942, which increased to 62,665 in 2015—a growth of 11 per cent; in the same period the growth in private health care establishments was around 26 per cent (from 34,281 beds to 43,564). The State government has claimed that in the past two years many more beds have been added in government hospitals.

A comparison between the number of beds in the critical care unit (CCU) of a public hospital and those in a private hospital is telling. The usual benchmark for the number of beds in the CCU in a hospital is at least 15 per cent of the total beds there. In Kolkata, government establishments have fewer CCU beds than private establishments. For example, the sanctioned hospital bed strength at SSKM is 1,775, and it has 72 CCU beds, whereas Apollo has 510 beds, but 116 CCU beds. NRS Medical College has a total of 1,890 beds, and only 40 CCU beds; while R.N. Tagore Hospital, which has a total of 550 beds, has 171 CCU beds. There are around 48 government hospitals in Kolkata today, and near about 370 private medical establishments.

“In most cases, the poor and the general masses go to private hospitals not out of choice, but out of compulsion,” said Uttan.

Provision for the poor In West Bengal, as early as 2003, the Clinical Establishment Rule based on the West Bengal Clinical Establishment Act of 1950 had laid down that 10 per cent of the inpatients and 20 per cent of the outpatients of private hospitals that received concessions from the State government would have to be treated free of cost. This rule, which was incorporated in the new Act, states that “any clinical establishment which has received land or other facility from the Government during initiation and in course of continuance of their projects shall be responsible to provide completely free treatment to 20 per cent of Outdoor Patient Department patients and 10 percent of Indoor Patient Department patients”.

As for those private medical establishments that have not availed themselves of any benefits from the State, the Act states that they may “endeavour to provide completely free treatment to 20 per cent of Outdoor Patient Department patients and 10 per cent of Indoor Patient Department patients as part of their Corporate Social Responsibility”.

Shantanu Sen, State secretary of the Indian Medical Association (IMA), told Frontline , “There are several private medical establishments in the State which have taken concessions from the State government, but none of them fulfil their part of the agreement.” In fact, according to a source in the Health Department, for a long time the files of the agreements between the State government and the private hospitals had been missing.