“I ran with my dying wife from Nanavati to Cooper to KEM to JJ “


I ran with my dying wife from Nanavati to Cooper to KEM to JJ

A poor man’s damning testimony of our emergency services

Lata Mishra and Jyoti Shelar

Cover story Mumbai Mirror

This newspaper has run a series of stories on the hit and run accident that led to the death of the wife and unborn child of a construction labour in Juhu.

The circumstances that led to the accident; the police’s hunt for the mystery man who dropped Ram and a bleeding Reena Kutekar to the hospital but fled soon after; and finally, his surrender ten days later at the insistence of his family after they had read about it in Mumbai Mirror.

But there is a larger story that still remains to be told.

Ram Kutekar’s desperate hunt for a doctor and hospital that would save his wife’s life, and his frantic 16-hour journey from Nanavati to Cooper to KEM to JJ Hospital across Mumbai puts the spotlight on everything that is wrong with emergency medical services in the city. And why its poor can never bank on them.

• First, Nanavati Hospital refused Reena the operation she so urgently needed because her husband, a daily wage worker, couldn’t put together a deposit of Rs 25,000 (He was falling Rs 10,000 short, which he promised to raise as soon as he could).

• At Cooper Hospital, the next stop, there was no CT scan facility which meant Reena had to be taken to a private clinic close by leading to precious loss of time. The results showed Reena had suffered serious head injuries and needed urgent surgery.

• But Cooper had no neurosurgeons on call at the time, so Ram was asked to take his wife, battling for her life, to KEM Hospital in Parel.

• At KEM, there were no beds available in the ICU. Ram was told to head to JJ Hospital.

• By the time Reena was put on a ventilator at JJ, it was 11 pm. The neurosurgeon that operated on her told Mumbai Mirror she was in critical condition when she was brought in – “her brain was swollen, her blood pressure had dropped alarmingly”.

Reena – five months pregnant – died three days later. The baby inside her, doctors said, had died one day before her.

“It’s not just that young man who killed my wife,” says Ram Kutekar sitting in a cramped room in a Vile Parle chawl. “The doctors are equally responsible.”

In the Hipporcatic Oath which all doctors have to swear by before their passing out, there’s a line that reads so: “I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person’s family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.”

There is also a Supreme Court directive that says emergency patients must enjoy all the rights of a consumer even before they pay any money to hospital. Nanavati management, however, insists the hospital flouted no norms, as it was only at the second level of treatment that they asked for the deposit. “We admitted the patient, thoroughly examined her, and concluded she needed ICU care,” Dr Ashok Hatolkar, Medical Superintendent at the hospital, said. “Our policy clearly states that a deposit of Rs 25,000 has to be paid upfront for an ICU admission.”

The distinction between the first and second line of treatment is specious. Reena Kutekar was examined merely physically. There were no tests run to gauge the extent of her concussion. Tests she needed urgently and which, as later events proved, could have saved her time.

“I remember waiting nervously at the reception as Reena was taken for a preliminary examination. Then the doctors told me she would have to be shifted to the ICU. This was at around 8.30 am… the nurse came around and asked for a deposit of Rs 25,000.”

Ram had around Rs 200 on him, and Siddharth Pandya – the man who had been behind the wheel, and who had dropped them to the hospital – was his only hope. He spent 20 minutes looking for him… in the car park, in the washrooms. By this time, Ram was joined by his brother Sachin, and sister-in-law, who he had asked to rush to the hospital with as much cash as they could manage. “We were still falling short by over Rs 10,000,” he says, “I pleaded with the doctors to not stop the treatment, while I arranged for the money.”

Instead, Nanavati provided Ram with an ambulance – for which he paid Rs 600 – to take them to Cooper Hospital. “By the time we got there at noon, my wife’s condition was deteriorating, I was told that she was bleeding internally, and that the injuries to the head could prove fatal.”

Following the CT scan at a private clinic, which cost Rs 3000, Reena was put on a ventilator and Ram was asked to wait. At around 4 pm, the Cooper authorities said no neurosurgeon was available, and suggested Ram take his wife to KEM Hospital in Parel. “All this time, I kept telling myself that the doctors knew best; that my wife was in safe hands and that she would be alright. I followed their instructions, ran from Nanavati to Cooper to KEM. I told the doctors that they were like gods, and that they had the power to save my wife and our unborn child. They kept saying, ‘don’t worry, just take her to so-and-so hospital’,” he says.

By the time the couple reached KEM, more than eight hours had passed since the accident, and here they encountered the most common problem poor patients face in Mumbai: No beds. “I was told there was a long waiting list, that the ICU was packed beyond capacity. The authorities asked me to try my luck at JJ Hospital,” he says. Yes, the words emergency medical services and luck are closely linked in this city, and unfortunately, the Kutekars had none.

While Reena was operated upon at JJ, she passed away three days later. When Mumbai Mirror spoke to neurosurgeon Velu Varnan, he said she had been brought there in “extremely critical condition”.

Nanavati Hospital authorities say they “sympathised” with the victim’s family, but add that they were “helpless” under the circumstances. Medical Superintendent (Nanavati Hospital) Dr Ashok Hatolkar said, “We never flouted any directive. From our end, we did everything we could to help the victim. We only asked for the deposit at stage two, which is ICU treatment and surgery. It is unfair to blame the hospital for the death. We treat poor patients who ahve requisite documents but can’t treat everybody as we don’t get funds from the government.”

Ram, who earns around Rs 4,000 a month working as a daily labourer, says Reena supplemented the family’s income by working as maid. “Just a few days before the accident, I had told her to stop working as she was more than five months pregnant. In a matter of hours, my family was gone.”

On paper there are several schemes to enable the poor patients to take treatment at the private hospitals. The newest of them all is the Rajiv Gandhi Jeevan Dayi Yojna that promises free treatment for over 972 ailments. The problem is, none of the private hospitals want any part of it. These hospitals feel that the price list offered by the government is extremely low and they want a better price to be a part of the scheme. Medical superintendent of south Mumbai’s Jaslok Hospital, SK Mohanty, says, “We had agreed to be a part of the scheme assuming that the rates would be fair if not at par with our charges. But the rates are so low that we would have to bear huge losses if we agreed to be a part of this scheme.”

For instance, the state has set the cost for a bypass surgery at Rs 1.30 lakhs while packages at most hospitals are above Rs 1.65 lakhs. For an angioplasty, the state has set the cost to Rs 50,000 while the actual packages range from Rs 1 lakh and above depending on the make of the stent.

“We need a viable policy or else we won’t be able to run our hospitals with the new scheme. Also, the government should not force us to be a part of this scheme and it should be left to us to sign the agreement or not,” says president of Association of Hospital (AOH), Dr Pramod Lele.

The hospitals say that they already need to keep 10% of their beds reserved under the Bombay Public Trust Act (1950) for the poor. In addition to this, they have to set aside 2% of their revenue as an Indigent Patients Fund (IPF) for subsidising treatment for poor patients. If they are asked to be a part of this new scheme as well, they will not be left with any profits.

The IPF is yet another scheme aimed at benefiting those below poverty line which has hit a roadblock, again due to the negative response from these hospitals.

In this case, private hospitals claim that they were not properly explained the details of the scheme. “We were under the impression that the state will pay us some minimum amount under the scheme for the two per cent indigent patients that we already treat as per the charity commissioner’s rule. However it turned out that we were expected to treat yet more poor patients,” says a senior doctor attached to a private hospital on condition of anonymity. “We will suffer losses running into crores of rupees if we start doing charity this way,” he adds.

The government on the other hand had already collected a database of over 2 crore people across the state who will be benefited under the scheme. While earlier, the state had made it optional for the private hospitals to join the scheme, recently they announced a compulsory reservation of beds under the scheme. Early this month, health minister Suresh Shetty requested the chief minister to consider withdrawing the compulsion.

Last year, more than 14,000 people were benefited under the scheme and the state spent over Rs 110 crores. However, the scheme covered only four diseases and several hospitals complained about delay in payments.

(With inputs from Santosh Andhale)

Privatisation of radiological services opposed


Ananya Banerjee : Mumbai, Mon Mar 19 2012,

The decision of the state government to privatise radiology services in 14 government medical colleges and all district hospitals in the state has not gone down well with the healthcare professionals, trade unions and NGOs.

At a state-level convention held on Saturday, members of these organisations have unanimously opposed the move expressing their fear of further privatisation of the public health sector.

“Following the Seven-Hills debacle, the state government should have known better than to involve the private sector into the public domain. What the government is calling a Public Private Partnership (PPP) is actually a back door entry for private organisations. There is no need for PPP if the existing public health system can be strengthened,” said activist Kamyani Bali Mahabal.

While announcing the move to privatise the radiology services a few months ago, additional chief secretary Jayant Kumar Banthia had said that government hospitals had been unable to run efficiently due to the lack of competent staff. Paucity of funds was also stated as one of the reasons for the privatisation.

“There are hospitals in the public sector like Bhabha Hospital in Mumbai and the All India Institute of Medical Sciences (AIIMS) in Delhi which are functioning smoothly. Once the staff is sufficiently trained, better treatment can be provided. As far as funds go, if the state government puts forth a planned proposal to the Centre seeking funds for the health care, then there will be no need to resort to privatisation,” said Dr Anant Phadke, member of the Jan Aarogya Abhiyan.

A petition having the signatures of 171 people from across Maharashtra has been sent to Vijay Kumar Gavit, Maharashtra health and education minister, seeking a withdrawal of the proposal.

However, there are those working within the public sector who feel that privatisation will help in boosting the quality of treatment in public hospitals.

“ Most of the public hospitals are understaffed. Technicians have to be trained separately to operate MRI and CT scan machines. If trained personnel are deployed to operate the machines, it will lead to better utilisation of manpower,” said a senior doctor from JJ Hospital.

“Machines worth crores have been sold off as scrap as no one knows how to use them. If trained people provide services, the quality of treatment will improve,” another doctor from JJ Hospital said.

Immediate Release- Stop Privatization of Health Services in Maharashtra


State Convention’s Critique of the Privatization Proposal

Do not privatize Lab. Investigations, MRI, CT scan Facilities

in Medical College Hospitals and Radiology Services in other hospitals!

This Privatization will be disastrous for the people and Public Health Services and Medical Education in Maharashtra

—————————————————————————————————————————

March 17 Mumbai

During a state level convention, at Mumbai Marathi Patrakar Sangh on 17th March 2012, wide spectrum of social organisations, health-activists, healthcare professionals across Maharashtra expressed their disapproval and anger, against the proposed privatization of certain key services in Public Hospitals in Maharashtra which is being pushed in the name of Public – Private partnership. The Convention resolved to launch a movement against the privatization of MRI, CT scan services and certain laboratory services in government run medical colleges as well as district hospitals across Maharashtra..

Jan Arogya Abhiyan (a network of civil society organisations working in the health sector in the Maharashtra since 2000) along with various mass organisations, trade unions, other civil society organizations, health sector professionals and academicians had organised this broad based state level convention to discuss the issue and to chalk out strategies and action plans.

Dr. Abhijit More a co-convenor of the Jan Arogya Abhiyan, brought attention of the convention towards Maharashtra State Government’s proposals to privatize key services in medical college hospitals and district hospitals. He said, “Two senior cabinet ministers – Minister for Medical Education and Research, Dr. Vijaykumar Gavit has floated proposal to privatize radiology services (like CT scan, MRI etc) and laboratory services in 14 Government Medical College hospitals while Minister for Public Health and Family Welfare, Shri Suresh Shetty has floated proposal to privatize radiology services in all District Hospitals, across Maharashtra. “

Speaking at the convention Dr. Abhay Shukla pointed towards larger design for privatization of the healthcare system in the state. He said, “Maharashtra State Government is planning to hand over huge sums of public money to insurance companies and large private hospitals through a flawed Private-Public Partnership (PPP) in the form of Rajiv Gandhi Jeevandayee Arogya Yojana (RGJAY). This scheme involves large scale public finances being given to corporate hospitals without adequate standardization or regulation of their services, and no protection of patients rights. At the same time, the government is planning to privatise its most revenue generating units in public hospitals like radiology services and laboratory services. The Public health system, which is already neglected by the state government, will collapse in this kind of negative policy environment, leaving people completely to the mercy of profit-seeking private hospitals. These changes will adversely affect not only poor people but also the middle class, for whom private healthcare is becoming increasingly unaffordable these days.”

Pramod Nigudkar from Jan Swasthya Abhiyan-Mumbai said that privatization of health services is becoming norm even for Mumbai Municipal Corporation run hospitals. This has increased burden of fees on patients. Marginalized communities are badly affected by such moves.

Dr. Anant Phadke, co-convenor of Jan Aarogya Abhiyaan, criticized the proposed privatization of key health services. He said, “The so called Public Private Partnership has no real economic, social, managerial justification. All justifications given by health officials do not stand on merit. There is no truth in health officials’ claim that there is paucity of funds to develop modern medical facilities, forcing government to privatisation proposal. The report of of the Steering Committee on Health for the 12th FYP has clearly recommended cashless universal health care for all and not only for the poor people. Towards this end the Planning Commission is set to double the public health expenditure in India from the current 1.2% of GDP to 2.5 % of GDP during the 12th Five Year Plan. This would mean an additional budgetary availability of Central Govt. funds of more than Rs. 80,000 crores annually! This amount would be more than 10 times the additional budgetary allocation for the NRHM during the 11th Five Year Plan! Hon’ble President Pratibha Patil’s speech before Parliament on 12th March 2012 also gives ample clues in this direction. Maharashtra Government should take advantage of this situation by coming with innovative ways, schemes to strengthen public health system rather than resorting to privatisation. Apart from that, Maharashtra govt. should also increase it’s own contribution to health care from the current miserly health care expenditure 0.5% of the State Domestic Product to atleast 1.5%.”

Mr. Tukaram Sathe, President of Shasakeey Padvidhar Ksh Kiran Tantradnya Sanghatana pointed out that- “Radiology technicians were hardly taken into confidence before such proposals by Maharashtra State government. Whatever problems that may exist in the management of MRI and CT scan facilities in the medical college hospitals, must be solved by seeking active cooperation of the doctors and other staff in these centres. Privatization is no answer to these problems. The experience of the so called PPP in case of MRI and CT scan facilities in the GT hospital in Mumbai shows that only a small proportion of patients get service at government rates. Moreover, under some pretext or other, even such ‘free, subsidized ’patients are made to spend beyond the official rate. The rest have to pay at commercial rates. This will clearly increase burden on lower middle and middle class patients. Also, as a result of privatisation- Radiology, Microbiology, Pathology, Biochemistry departments in the government medical college hospitals would remain ‘Public’ only on paper; it would also damage the training of new generation of doctors.”

Mr. Sanjay Salunke of the Laboratory Technicians’ Union-Mumbai, “Public hospital labs are able to conduct many sophisticated tests. Skilled doctors and technicians are also available. There is a need for their better utilization. There should be more transparency while purchasing laboratory equipments and reagents. Concerned doctors and lab technicians should be taken into confidence while making such purchases to avoid wastage of public money. Instead of privatisation, government should focus on better management and modernization of public hospital laboratories.”

“In the 21st century health care should be regarded as human right and in most developed countries as well as in many developing countries like Sri Lanka, Thailand, Brazil, Malaysia and Venezuela the goal of Health Care for All has been achieved. In this process, the Public Health Services have played the role of leadership, of trend setting and as a back-borne for the National Health Care System. India cannot be an exception,” said Girija Gupte.

“On one hand our Prime Minister has expressed concern regarding our health system and has promised to substantially increase financial allocations to improve healthcare delivery to citizens, and Planning Commission of India is proposing to double its public health budget. The High Level Expert Group formed by the Planning Commission is recommending a system of Universal Health care for every citizen with strong emphasis on strengthening our public health system and abolition of user fees in all public hospitals. On the other hand, our learned Ministers from Maharashtra Government are considering seriously regressive steps which would weaken public hospitals, and are likely to deny health rights to large number of citizens,” said Sonya Gill from Akhil Bharatiya Janawadi Mahila Sanghatana(AIDWA).

In the light of facts and analysis presented by various speakers in the convention regarding proposed privatization key public health services, this Convention unanimously denounced the proposed privatization of above mentioned public health services and

RESOLVED TO-

1. Build a state-wide campaign to oppose proposed privatization of key health services in government run medical college hospitals and all district hospitals across Maharashtra.

2. Raise these critical issues with Chief Minister, Public Health and Family Welfare Minister, Medical Education and Research Minister, any other Minister from the state of Maharashtra, Members of Legislative Assembly, Members of Parliament, senior health officials and convince them to withdraw this proposal.

3. Reach out to wide spectrum of stakeholders like current and past medical college students, medical professors, nurses, technicians and other public health staff to get their support to stop privatization of public health services in Maharashtra.

4. Raise awareness amongst general public, academicians, Panchayat Raj representatives, other social organisations, networks and media about grave outcomes of privatization of public health services and need to reverse the process.

5. Work out proposals to improve public health services without privatization by using various innovative ways and increased utilization of resources; and put forward these proposals as constructive alternative measures during dialogue with health officials and concerned Ministers.

issued by—-
Jan Aarogya Abhiyan, JAA- Maharashtra, Jan Swasthya Abhiyan- Mumbai, (apanalaya build, ccdt, icor, , RFTI, sneha, vacha, yuva,) Laboratory Technicians’ Union-Mumbai, Shasakeey Padvidhar Ksh Kiran Tantradnya Sanghatana, Jagrut Kamgar Manch, Akhil Bharatiya Janawadi Mahila Sanghatana (AIDWA), Maharashtra Sarva Shramik Mahasangh, Ghar Bhanao Ghar Bachao Andolan, Justice and Peace Commission, Nirmaan-Mumbai, Institute for Community Organisation Research, Movement for Peace and Justice, Jan Shoshit Andolan, Indian School of Social Sciences , Nurses Federation Maharashtra, Nurses and Para medical staff Union , Asha- Workers Association, Vacha, Majlis, Media Action Group,Women Research and Action Group (WRAG) ,Special Cell for Women

Maharashtra State Level Convention on

‘No’ to privatization of Public Hospitals

‘Yes’ to Strengthening, Improving Public Hospitals

17th March 2012, at Mumbai Marathi Patrakar Sangh

—————————————————————————————————–

RESOLUTION

—————————————————————————————————–

In the light of facts and analysis presented by various speakers in the convention regarding proposed privatization of certain radiological services in 14 government run medical college hospitals and district hospitals in Maharashtra, as well as laboratory services in government medical college hospitals; this Convention has come to the unanimous conclusion that from the point of view of the people, this proposal of so called ‘Public Private Partnership ‘ has no real economic, social, managerial justification. The justifications put forth by the votaries of this so called ‘Public Private Partnership ‘are misleading. Firstly, since the Planning Commission has announced a quantum jump for health care during the 12th FYP, there would not be now paucity of funds for buying the necessary equipments for the Public Hospitals. Secondly, thanks to tele-radiology, experts in Public Hospitals in bigger cities can prepare reports of x-ray films taken in other places. Thirdly, Health Dept. in Maharashtra canmaintain functionality of modern hospital machinery and equipments and retain expert-doctors in Public Hospitals by learning from the successful examples like Command Hospitals, Bhabha Hospital etc. This ‘Public Private Partnership ‘ on the contrary, would have grave consequences like weakening of public health system, denial of access to healthcare to the poor and middle class people.These departments in the government medical college hospitals would remain ‘Public’ only on paper; greatly damaging the training of new generation of doctors. This Convention unanimously denounces thisproposed so called ‘Public Private Partnership’ and

RESOLVES TO-

1. Build a state-wide campaign to oppose proposed privatization of MRI and CT scan facilities and laboratory services in Government run medical colleges, and of radiological services in district hospitals across Maharashtra.

2. Raise these critical issues with Chief Minister, Public Health and Family Welfare Minister, Medical Education and Research Minister, Members of Legislative Assembly, Members of Parliament, senior health officials and convince them to withdraw this proposal.

3. Reach out to wide spectrum of stakeholders like current and past medical college students, medical professors, nurses, technicians and other public health staff to get their support to stop privatization of public health services in Maharashtra.

4. Raise awareness amongst general public, academicians, Panchayat Raj representatives, other social organisations, networks and media about grave outcomes of privatization of public health services and need to reverse the process.

5. Work out proposals to improve public health services without privatization by using various innovative methods and increased utilization of resources; and put forward these proposals as constructive alternative measures during dialogue with health officials and concerned Ministers.

Jan Aarogya Abhiyan, JAA- Maharashtra, Jan Swasthya Abhiyan- Mumbai, (apanalaya build, ccdt, icor, , RFTI, sneha, vacha, yuva,) Laboratory Technicians’ Union-Mumbai, Shasakeey Padvidhar Ksh Kiran Tantradnya Sanghatana, Jagrut Kamgar Manch, Akhil Bharatiya Janawadi Mahila Sanghatana (AIDWA), Maharashtra Sarva Shramik Mahasangh, Ghar Bhanao Ghar Bachao Andolan, Justice and Peace Commission, Nirmaan-Mumbai, Institute for Community Organisation Research, Movement for Peace and Justice, Jan Shoshit Andolan, Indian School of Social Sciences , Nurses Federation Maharashtra, Nurses and Para medical staff Union , Asha- Workers Association, Vacha, Majlis, Media Action Group,Women Research and Action Group (WRAG) ,Special Cell for Women

State Convention’s Critique of the Privatization Proposal

Do not privatize Lab. Investigations, MRI, CT scan Facilities

in Medical College Hospitals and Radiology Services in other hospitals!

This Privatization will be disastrous for the people and Public Health Services and Medical Education in Maharashtra

In the name of Public Private Partnership, in all the 14 Govt. Medical Colleges hospitals in Maharashtra the Maharashtra Govt has, decided to

1) Privatize MRI and CT scan facilities

2) Hand over part of it’s pathology laboratories to private companies

3) Privatize radiological services in Rural Hospitals and District Hospitals.

Thus these private companies who will use the premises of these Medical Colleges hospitals, and other govt. hospitals to give services at govt. rates to certain categories of the people like those below a certain level of annual income of say Rs. 1 lakh and the rest would be charged commercial rates There is no real economic, technical, managerial rationale for this decision and it will be disastrous for the Public Health Services and Medical Education in Maharashtra.

The justification given by the concerned authorities for this step is misleading-

Justification no. 1 – Paucity of funds with the Health Dept to develop modern facilities

Reality – The report of of the Steering Committee on Health for the 12th FYP has clearly recommended cashless universal health care for all and not only for the poor people. Towards this end the Planning Commission is set to double the public health expenditure in India from the current 1.2% of GDP to 2.5 % of GDP during the 12th Five Year Plan. This would mean an additional budgetary availability of Central Govt. funds of more than Rs. 80,000 crores annually. This amount would be more than 10 times the additional budgetary allocation for the NRHM during the 11th Five Year Plan! There would be thus no financial constraints in providing free health care services including MRI and CT scan services and modern pathological investigations in the government college hospitals. The Maharashtra govt. will have to prepare a proper plan and submit it to the Central Govt. to obtain these funds. Secondly, the Maharashtra govt. should also increase it’s own contribution to health care from the current miserly health care expenditure 0.5% of the State Domestic Product to atleast 1.5%.

Justification no. 2: This is not privatization but Public Private Partnership (PPP) which will make available benefits of the latest technology to the poor people

Reality – The experience of the so called PPP in case of MRI and CT scan facilities in the GT hospital in Mumbai shows that only a small proportion of patients get service at government rates. The rest have to pay commercial rates. Moreover, under some pretext or other, even such ‘free, subsidized ’patients are made to spend beyond the official rate. Secondly the people from lower middle class, middle class background currently pay much less at the govt. hospitals compared to the commercial rates. But now they will have to pay at the commercial rate. In a city like Mumbai majority of the families who barely manage to make two ends meet have a yearly income more than Rs. 100,000 and they will have to pay at commercial rates. As mentioned above, the govt. would have enough money for health care during the 12th FYP to make available all essential health care free of charge for all patients visiting Public Health Facilities. Instead of withdrawing user fees at the point of service, as per the recommendations of the High Level Expert Group (HLEG), appointed by the Planning Commission, the Maharastra govt. is going in the opposite direction.

It has been the general experience that after privatization of Public Health Services/ facilities, the private parties violate many of the terms of agreement; there being hardly any adequate mechanism to effectively monitor and ensure the observance of free/subsidized care to the poor, ordinary citizens.

Justification no. 3: Inability to get, retain expert doctors, radiologists in govt. sector.

Reality – This is not exactly true. Hospitals in the govt. sector like the Command Hospitals, the BHABHA hospital in Mumbai, AIIMS in Delhi have been able to retain expert doctors by offering good salaries and good working environment. Why can’t other govt. hospitals learn from them? If there is no corruption, baburaj, many expert doctors would like to work in govt. hospitals, turning away fromlucrative (but unethical) options in the private sector. The political and health bureaucracy has to set personal example of commitment to clean, competent work in Public Hospitals.

In case of CT scan and MRI, expert radiologists stationed in bigger cities can, with the help of extensive use of tele-radiology, do the reporting of the x-ray films taken at places like Nanded, Ambejogai. Anyway no private company will be able to depute full time qualified radiologist in all medical college hospitals, especially in places like Ambejogai, Nanded. They will also use tele-radiology. Thus unavailability of expert radiologists to report MRI and CT scan in these fourteen medical college hospitals cannot be the reason for privatization of these facilities.

Medical college hospitals are meant to train new generation of doctors. This can not be done without hands on practical training of using CT and MRI machines and modern machines/ equipments in laboratories. Private companies would not allow trainee doctors to use their machines. These departments in the government medical college hospitals would remain ‘Public’ only on paper; greatly damaging the training of new generation of doctors.

In case of atleast District Hospitals, radiologists can be hired on a part time basis as qualified radiologists are available in all district places in India. Secondly expert radiologists stationed in some of the district towns can, with the help of use of tele-radiology, do the reporting of the x-ray films taken at smaller district hospitals.

Justification no. 4: Frequent breakdown of machinery, irregular supplies of spare parts, chemicals

Reality – It is not as if good maintenance is not possible in Public Sector. In high tech areas if institutions like ISRO, Atomic Power Plants, Meteorology dept, Radio and television can function effectively, if such examples are there in the health care field also, why can’t Maharashtra govt. achieve this? Her again, there is a question of providing leadership to take on whatever challenges that exist in the functioning of the Public Hospitals.

Whatever problems that may exist in the management of MRI and CT scan facilities in the medical college hospitals, must be solved by seeking active cooperation of the doctors and other staff in these centres. Privatization is no answer to these problems. Public Health Services currently account for a small proportion of health care in India and it is not possible to achieve the goal of health care for all as envisaged by the HLEG report mentioned above if there is further whittling down of Public Health Services.

Need for a proper public debate

This step of the Health Dept in the direction of privatization is contrary to the recommendations in the report of the High Level Expert Group (HLEG) appointed by the Planning Commission(with initiative from the Prime Minister’s office) with the mandate to suggest a ‘blue print’ for achieving by 2020, the goal of Universal Access to Health Care (UAHC). The HLEG has recommended abolition of all user fees in all public health services.[*] In the 21st century health care should be regarded as human right and in most developed countries as well as in many developing countries like Sri Lanka,Thailand, Brazil, Malaysia and Venezuela the goal of Health Care for All has been achieved. In this process, the Public Health Services have played the role of leadership, of trend setting and as a back-borne for the National Health Care System. India cannot be an exception.

In any case, such a major decisions should not be carried out without a proper public debate as this decision would adversely affect millions of patients and medical education in Maharashtra.

[*] The Executive Summary of this report is available at http://www.phfi.org/images/what_we_do/HLEG-UHC_Exec_Summary_Dec_2011_1.pdf.

 

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