Nagpur: The nation is collectively shocked to read the sad news of a little 7 year old girl in Gurugram (Gurgaon) dying of dengue and then the hospital concerned handing over a ‘bill’ of Rs. 16 – Rs.18 lakhs. (Depending on which newspaper/ channel you are reading about it.)
To lose their dear child and then to have to face this ‘mercenary’ and ‘money minded’ hospital who wants to still charge you a fortune for the treatment does seem cold hearted and brutal – to any non medical lay man at least.
But what do Nagpur Docs have to say about this case?
May be predictably so, they all spoke up for Fortis Hospital, even the one Doctor who I know is against Corporate culture of many big hospitals.
The Physician administrator of Nagpur’s newest and most modern hospital opines that unless one knows the exact medical condition of the patient and what line of treatment was being followed it is impossible to opine on the amount of the bill.
But he did say that no big hospital suddenly springs a big bill on patient’s relatives. The prognosis of the patient , specially if he or she is in the Intensive care unit , is discussed with her closest relatives everyday. Most hospitals even insist on regular, periodic payment of bills, sometime even on a daily basis.
But how much should treatment of Dengue cost? What would be an approximate bill in his hospital?
The Doctor refused to speculate on even that saying it would all decide on the condition of the patient and what line of treatment needed to be followed.
The other Doctor I spoke to, who is M.D. of Care, a hospital chain that believes in Ethical and transparent patient care. He is Dr. Varun Bhargava, one of the best known and respected Doctors of the city.
When we recounted to him that Health Minister J.P. Nanda had intervened in the matter and promised to probe any wrong doing by Fortis, Dr. Bhargava welcomed the move and said the Minister MUST do probe. It would be good both for the hospital and the patient’s family. It would clarify the family’s doubts an clear the hospital’s name too.
“Critical care is often very expensive, especially if machines like Ecmo have been used” he clarified.
The treatment for Dengue
Dr. Bhargava clarified that 80 to 90% of Dengue patients don’t even need hospitalization. Younger children and people who have never had the infection before tend to have milder cases than older children and adults.
It is the few patients whose condition deteriorates who require to be hospitalized.
As per a medical website (Web MD): serious problems can develop. These include dengue hemorrhagic fever, a rare complication characterized by high fever, damage to lymph and blood vessels, bleeding from the nose and gums, enlargement of the liver, and failure of the circulatory system. The symptoms may progress to massive bleeding, shock, and death. This is called dengue shock syndrome (DSS).
If the patient is in severe distress and lungs are badly affected an ecmo machine works to by pass the lungs and heart thereby giving some rest to the lungs and helping them recover faster, explains Varun Bhargava.
Such life saving machines are expensive and appropriate medical protocol has to be followed.
“I do not know the details of the case, and neither am I an Intensivist, (Docs trained in intensive care) but as M.D. of a large hospital I can say that critical care CAN cost up to Rs. one lakh per day. Besides costs are bound to be more in big metros like Delhi and Mumbai compared to smaller cities like Nagpur.” Said Dr. Bhargava.
NT finally spoke with Dr. Ashwini Tayade, who is one of Nagpur’s few Infectious Diseases Specialist. Besides she has extensive experience in managing dengue fever, complicated typhoid fever, leptospirosis, falciparum malaria, scrub typhus with multiple organ failure in intensive care setups.
She also refused to comment on the specific case of Adya Singh, the girl in question who succumbed to Dengue, but she did clarify that when a patient does start manifesting DSS, treatment has to be multi pronged.
“Such patients of Dengue have blood involvement, fluid accumulation, capillary leak and their severely depleted physical condition can make them host to secondary infections too. So though antibiotics are not prescribed for normal Dengue when additional infections have occurred they will play role.”
When a patient is in a hospital for some time hospital acquired infections cannot be ruled out either.
What about the accusation that patient was brain damaged yet she continued being treated?
Dr. Tayade explains that there is a strict procedure for declaring a patient “brain dead”.
A panel of Neurologists has to evaluate all reports and then decide whether the patient is indeed brain dead and her/ his organs can be offered for transplant.
A hospital cannot decide unilaterally that patient is brain dead and then advise relatives that life support has to be stopped.
Dr. Tayade did say however that it is unusual for a hospital to not co operate if the relatives want to transfer their patient to another hospital if they cannot afford treatment.
Even if the patient is in critical condition, Doctors and nurses can be sent along with the ambulance for shifting. (Two years ago, a patient who was in coma and had sustained brain injuries was successfully shifted by air ambulance from Nagpur to a hospital in New York, USA.)
Adya’s case does point to many lacunae though in our health care that our Health Minister MUST probe
If Adya’s sad case does point to anything it is that health care, specially when patient is critical, is generally unaffordable for most Indians.
Public health system – free or affordable Government hospitals do not exist, or have poor facilities and shortage of Doctors. Smaller private hospitals too lack facilities for treating severe cases. They do not want patients dying in their hospital – it affects the hospital’s ‘record’ so they try to get a dying patient off their premises ASAP.
Our Health insurance schemes are also mostly out of reach of middle class Indians – they only seem to work for white collar people in big Corporates or MNCs.
With no insurance cover for patients hospitals are forced to charge and collect payment on a daily basis. The distrust against hospitals goes up when Doctors do not have enough time or patience to communicate compassionately with relatives and answer questions. This culture just does not exist, except in very few cases.
Finally let’s understand the unique nature of ‘hospital business’
Whatever they may sugar coat their definition with, private hospitals are Business entities that must make money to survive.
But there is a basic difference between hospitals and other business’.
When you do any other business transaction, the more you pay, the better product you get and more satisfaction is guaranteed.
Hospitals are one business place though where no matter how much you spend the result can be a complete loss. Not just any loss, but loss of life.
In fact, the less your chances of survival, the more you can be expected to shell out as treatment gets more aggressive and more and more sophisticated equipments and costly high generation medicines are prescribed. Most of them imported.
If the government cannot offer Health Care to its citizens it should at least work upon making medicines cheaper and reduce taxes on import of equipment. Why is ‘Make in India’ not implemented for such life saving machinery rather than Defense equipment. What is more important for people’s well being?
Till such points are not pondered upon, cases like Adya’s will continue where everyone comes out looking like a loser.
Your heart goes out to the mother who bemoaned ” we did not even have time to cry at our child’s death. We had to think about paying bills, arranging ambulance and getting a death certificate.”
There are no two ways about it – the entire system failed Adya and her parents that fateful day.