Vikas Sagar, 35, went to Apollo Hospital with a reference letter from Directorate of Health Service (DHS), but was refused free treatment for his four-year-old daughter under Economical Weaker Section (EWS) scheme, as she cannot hear and speak.
His daughter needs a cochlear implant to remove the tag of dumb and deaf. Vikas works as a field boy in a private garment export company. With a measly salary of four thousand rupees per month, he is hardly able to provide two square meals to the family of six people, let alone cochlear implant. “I went to Mr Ashok Kumar Rana, nodal officer for Apollo Hospital, he referred me to Dr Ameet Kishori, an ENT specialist and senior surgeon, Apollo Hospital, who asked me to submit Rs 6 lakh for surgical and hospitalisation charges,” says Vikas. The document of the hospital demanding the above amount is available with Uday India.
Here it is worth mentioning that Delhi High Court directed private hospitals to reserve beds for free treatment to poor patients. So as per the High Court order, any patient belonging to EWS category is entitled to get free treatment. Vikas has run from pillar to post to narrate his pitiable plight to hospital authority concerned, yet he is deprived of his due right. “I do not earn much, so from where I will get such a huge amount for the treatment of my daughter. I told the hospital authority that I belong to EWS category, still they refused to treat my daughter for free of cost. Since the HC has delivered a verdict to this effect, why are we not getting our right?” asks Vikas.
This is only one of many such cases. Defying the HC order, majority of private hospitals in the National Capital Territory of Delhi are still not providing the weaker sections their due. Therefore, a monitoring committee has been appointed by the High Court to oversee the implementation of the HC rule. Dr JN Mohanty is the chairman of the monitoring committee. This committee claims to inspect these hospitals regularly and often finds out that the beds reserved for EWS remain vacant. However, sources revealed that this committee inspects hospitals in three to four months.
Another case is of Farman. He was brought to Ram Manohar Lohia Hospital (RML) after he suffered a stroke on November 15, last year. As per the emergency case, the hospital admitted him and made him undergo the required tests and found that there is a blockage in one of the arteries in his heart. He needed to be operated upon as soon as possible. Hospital authority told Farzana, Farman’s spouse, to submit sixty thousand rupees till 20th November, 2009, if she wanted her husband to be operated upon. The hospital discharged her husband on November 21 just because she was unable to submit the demanded money. Although, she had already told the hospital administration that she did not have any source of income. Even then the hospital demanded money. “When I asked for EWS right, then the authority concerned asked me to show my BPL certificate and prove that I am poor. And later they told me to take my husband out of the hospital,” said Farzana. Whether they are private hospitals or government hospitals, they are not following the High Court order seriously.
The latest quarterly report submitted by Dr Mohanty to the Delhi government shows that there are only 25 such hospitals out of 39 hospitals that are providing free treatment to EWS category. They are Dr BL Kapoor Memorial Hospital, Mata Chanan Devi Hospital, Rockland Hospital, Sir Ganga Ram Hospital, Batra Hospital, Delhi ENT Hospital and Research Centre, National Chest Institute, to name a few. The rest of the fourteen hospitals have failed to comply with the HC order. According to Dr Mohanthy, “These hospital, however, do not refuse to admit EWC patients and provide them with the appropriate facilities in emergency but during the routine checkup they charge money from the patients and as well as for the tests that the patient undergoes like X-rays, ultrasound, etc, and also demand money for operation,” says Dr Mohanthy.
“Any hospital going against the HC order will be charged with Contempt of Court and a criminal case will be filed against the hospital,” told Ashok Aggarwal, Advocate, Delhi High Court and the first person to file a petition in court in 2002. “When I got to know that any such order has been passed but there is no implementation and also the government has forgotten to pass an order. In such a scenario, what one can expect of the common man. Also one of the major reasons for non-compliance by the hospitals is lack of awareness as the government and hospitals haven’t done much to inform people about their right. So being an advocate I filed a petition in the HC so that the weaker section can get their right. For, the real democracy is when you enjoy all your rights”. But even after the HC verdict, several private hospitals are still developing cold feet and hiding behind every legal loophole that they can find,” claims Advocate Aggarwal.
Rajiv Gandhi Cancer Institute and Research Center, Mool Chand Khairati Ram Trust and Hospital and St. Stephen’s Hospital Society are allegedly three such hospitals which are not following the order in letter and spirit. They refuse to treat any patient free of cost, or to reserve beds for EWC, saying they are not covered under the said obligation, citing a High Court order.
In 2007, the Delhi HC had ordered 39 such hospitals, built on government land paying nominal lease rentals for prime land, to reserve10 per cent of their beds in indoor and 25 per cent in the outdoor for poor patients holding below poverty line certificate and treat them free of cost. Apollo Hospital and Batra Hospital are such hospitals which are given land at a rate of just one rupee per sq metre. And anybody holding a BPL card with rupees four thousand as monthly family income will get free treatment. But now the government has dissolved the BPL card system and thus it has further increased problems for patients belonging to weaker section.
At first glance he appears like any other government official in his late fifties. But a closer look reveals a stark truth that can make one instantly empathise with the man. Confronted with heavy odds the man has chosen to take up cudgels against a huge multi-national tobacco company. Deepak Kumar, Commissioner of Customs Mumbai, was operated upon for cancer surgery of his larynx at the Tata Memorial Hospital in November 2008. After 40 years of regularly smoking, he had developed throat cancer. While he was lucky to survive the operation, but his voice box had to be removed. Kumar’s once powerful voice, that he was so proud of is gone.
Today Kumar can just barely utter a few words and that too with the help of prosthetic voice box a machine and after covering the hole in his throat with his palms. The white gauze cloth covering his neck is not a cravat but a cover-up for the gaping hole left behind after the two complicated surgeries and several rounds of radiation therapies that he has undergone in the last few months. And with his voice was gone forever his dream of becoming an attorney after he retired from the Customs.
People who have known Kumar say he is not his old self any longer- neither physically nor mentally. The once jovial, happy go lucky man has turned into a recluse. Serious and thoughtful today he is neither confident about his present even less so about his future. Once the life of a party, today he shuns any social get-together. But the officer is always ready to be part of any gathering where he can talk about his strong case against tobacco consumption. This he says is part of a promise he made to himself when he was being wheeled into the operation theatre for surgery the first time. “If I survived I would be the strongest voice in the anti-tobacco lobby, I told myself” said Kumar. He kept the promise he made to himself in that anti spectic surroundings.
After a month the surgery on December 2, 2009, Deepak became the first serving government official in India to register a case in the Consumer Disputes Redressal Commission in Mumbai. He has demanded compensation of Rs One Crore from ITC Ltd, Kolkatta. His contention is that the warning on cigarette packets is grossly underplayed. In fact according to him smokers of his generation were not even warned at all. It was only in the mid eighties that the warning of
‘cigarettes being injurious to health.” was printed on the packs.
“More than anything, I regret smoking that first cigarette. Ultimately, it ruined my life. How many more lives must be ruined by tobacco in this country?” he asks, adding that education and awareness for the people is the most important step, especially in India which has more tobacco users than almost any country in the world.
Whether he wins or loses he says is not important. The important thing is to make his point strongly against use of tobacco. Members of anti-tobacco lobby waited anxiously for 14th January, 2010 for a judgment in the case but the same was put off till February.
“It is not money, it is not personal vendetta, and I await this judgment because it is in larger interest of tobacco consumers. The consumer must know he is inhaling and chewing poison,” Mr Kumar told media persons at a national level media interaction organised in Mumbai by Healis, Sekhsaria Institute for public Health. He wants the tobacco companies to be made accountable, pressurise government bodies to curb tobacco products in India and make public aware of the ill effects of tobacco and draw attention to the hardships faced by users of tobacco.
Kumar who addresses the gathering through a power point presentation as he has difficulty in speaking describes his journey from a 16 year old boy, thrilled and excited at smoking his first cigarette. In the next 40 years the number increased to 40 sticks a day.
According to Dr Prakash Gupta, director Healis, which has its mission to advance public health in India and other developing countries, “Not only is it healthy to shun tobacco it is also economical.” The doctor illustrates his point by taking the case of Mr Kumar. By smoking 40 cigarettes a day even by rough calculations Mr Kumar was spending Rs 6000 per month. In 40 years he had consumed poison worth Rs 24 lakhs. Add to it the cost of medicine on diseases associated with tobacco consumption and in case of severe medical expenses like surgeries and you realise how much money has been smoked away.
Dr Pankaj Chaturvedi, associate professor TATA Cancer hospital, Mumbai could not agree more. A cancer surgeon, Dr Chaturvedi has seen the pain and trauma of cancer patients. It surprises him that smokers almost invite this life-threatening disease upon themselves.
“Treat smokers as patients and look at them with sympathy,” said Dr Chaturvedi speaking on challenges of spreading awareness and establishing the concept of smoking cessation. He was highly critical of how many a time the laws are diluted and the tobacco companies which has a lot of money and also acts as a pressure group succeeds in always getting the upper hand. He expressed happiness that people like Mr. Kumar despite all the personal traumas have the commitment to fight against such a strong lobby. They are ready to let their personal tragedy serve as an example to deter.
Maybe there is no bigger punishment then repentance and Kumar is repentance personified. “I ask myself this question so many times a day. Why did I smoke my first stick of poison? I regret it, am sorry for all the trauma I caused my family and friends. I know it is too late for me now but I strive to ensure it is not too late for others. Take a cue, stop inhaling death” says Kumar. Kumar is doing his bit for the anti-tobacco campaign.He is putting all his force against this powerful lobby that sells addiction packaged in dream packs.
By Kulsum Mustafa from Mumbai
On the other hand, private hospitals maintain that they offer free treatment to more poor patients than that has been mandated and that they treat poor patients from all over the country and who don’t have BPL cards also.
Dr Ramany, chief group of operation at Sir Ganga Ram Hospital, said that they have some other criteria for considering EWS patients. “We have more than 20 per cent beds reserved for the poor, which means we have 68 beds reserved for EWC category and at present 52 beds are packed with patients of different categories. We only accept those patients who have BPL certificate. However there are a few hospitals that admit patients just by believing patients’ words about their economic condition. But this this should not be acceptable, because you never know, which person really falls under poverty line. By following this practice, these hospitals are depriving the poor people of their right. Hence, there should be some uniformity in the implementation of the HC order.”
On this, Dr Mohanty, commented: “We concur with the fact that every hospital should have its own policies; we are not against it. But according to the HC instructions hospitals should admit those people whose monthly family income is below four thousand, whether they carry a BPL card or not. So there should not be any confusion.”
“Out of the total numbers of patient coming to the hospital, only 10 per cent genuinely belong to EWS. Others get themselves treated by the reference of the influential persons to avoid paid-treatment. I do not understand why people do such things. Rights of weaker section are usurped by this mal-practice,” says Vinay Aggarwal, member of Indian Medical Association. When we sought Dr Mohanthy’s reaction on this, he refused to comment.
All government hospitals in the city have been directed by the Chief Medical Officer (CMO) and medical officers-on-duty to refer patients to private hospitals if they lack the required facilities or face space constraints. Weather the patients belonging to weaker section are refereed by the government hospitals to the private hospitals, they fear to go there, thinking that they would not be able to bear the burden of expenditure incurred on treatment. It happens because most of these patients are unaware of the order.
“Government should make some uniform policies and a regulatory authority so that strict check could be initiated. And no stone should be left unturned in this regard,” suggests Dr SCL Gupta, Member, Indian Medical Association and an MLA.
Sources reveal that there are hospitals that play a discrimination game. These hospitals have separate OPD counters for lower, EWS and general categories. They have OPD for general category provided with roof and seats. On the other hand, OPD counter for EWS outside the hospital building are without even sitting arrangements. And the most shocking part is that even some of the members of the inspecting team are not aware of this discrimination.
“It is nowhere written in the order passed by the High Court that the OPD counter for EWS and general categories should be separately made,” says Advocate Aggarwal who is one of the member of the inspecting team.
Advocate Aggarwal, however, pointed out: “In the recent meeting with Sheila Dikshit, Chief Minister of Delhi, we presented a proposal for establishing a special monitoring cell under the Directorate of Health Service. So that every hospital can be regulated through a single window.”
Meanwhile, the Delhi government, it is learnt, will soon set up a mechanism to ensure that private hospitals built on subsidised government land provide free treatment to economically weaker sections of the society in the city.
By Vaishali Tanwar