Zero tolerance

The cancellation of Max Hospitals’ license after it wrongly declared twin new-borns dead, one who was later found to be alive, sends out the right message in terms of zero-tolerance to administrative or medical laxity at a hospital. For the affected family, it does not matter whether the doctor was wrong in diagnosis or the administrative system was lax. The bottomline is that a baby that was alive was passed off for dead — and someone needs to be held accountable.

The tragic incident comes even as the rumble against hospital facilities, especially private establishments, gets louder. Before the Max incident, Fortis Hospital was in the dock after a ₹16-lakh bill was handed to parents of a child who died of dengue.

Earlier this year, the National Pharmaceutical Pricing Authority cracked down on the high margins on cardiac stents, exposing in the process the role of the hospital in the chain of cascading costs that eventually is paid for by the patient.

While all of the above is true, it would be counter productive for policy-makers to tarnish everyone with the same brush. Instead, the recent tragic incidents at Max and Fortis Hospital should pave way for independent, faster medical audits.

It is not surprising that the general public seems to approve of the cancellation of an errant hospital’s license. A recent incident from Bangalore only revealed a common occurrence; in this case with gall bladder surgery. Its cost varied from ₹20,000 to close to ₹2 lakh, depending on the hospital the family went to.

Doctors complain of pressure from hospital administrators who “fix” the price of healthcare “packages” and “targets”. And while hospital administrators deny that, they complain that hospitals require much investment and have a long gestation time to break-even. The increased prices are for the technology and other services in the facility, they point out.

Both explanations are unlikely to wash with patient families paying from their pockets in the absence of a good public or private health insurance coverage. The mistrust between people and private healthcare systems is only growing, even as public hospitals collapse under the weight of multitudes lining up there across the country. In this dismal picture, the Government’s promise of increasing healthcare spending to 2.5 per cent of GDP by 2025 is way too little, too late (It should be at least 5 per cent!). Add to this, the woeful shortages in hospitals, hospital staff and other ills plaguing medical education.

Health is a State-controlled subject and the action by different State governments merely fuels a barrage of political finger-pointing. So in Uttar Pradesh’s Gorakhpur Hospital, a doctor and some administrators were sacked. Even that, doctors had said, was unfair, as the doctor’s job was to treat patients and not check whether the inventory of oxygen had depleted. The action was more severe in Delhi’s Max case, under a different political dispensation.

That said, cancelling a hospital license will not heal the situation. You need independent audits to ensure transparency in pricing and procedures, to check if hospitals treat a fraction of patients at lower prices if they had received land at subsidised costs, etc. Swift and tough penalties need to be taken on the entire chain of command involved with tragic medical incidents. And care should be taken to ensure that that no one is made a fall guy or girl to let the real culprits off the hook.

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