A Bengaluru prescription for regulating healthcare

In October 2015, a young software techie died of cardiac arrest in a leading Bengaluru hospital. His family believes the hospital made an extra ₹3 lakh by keeping him on a ventilator, a good three days after he had died. Though the hospital vehemently denies this, it angered people on the non-transparent ways of hospitals. The unease with hospital practices reached the boiling point this month as private doctors protested the Karnataka government’s proposal to amend the Karnataka Private Medical Establishments (KPME) Act that sought to crack down on negligence, harassment of patients, the practice of inflated, non-transparent bills and so on.

Just this week, the Amendment Bill was passed by the Assembly but without the clause on imprisoning doctors on charges of negligence. It did, however, include a penalty and cancellation of registration in cases of non-compliance with the Patients’ Charter and Private Medical Establishment’s Charter.

The developments in Karnataka hold out a direction for other States, especially since this week saw another tragic incident from a Gurugram hospital, where parents were handed a ₹16-lakh bill after their child died of dengue. While there is much that’s ailing in the hospital system, doctors say the government’s prescription was too stringent. Bengaluru saw doctors protesting the Amendment Bill that proposed pricing cap on healthcare costs, setting up of a grievance redress committee and accreditation of hospitals. The protest saw support from renowned doctors, with video messages from Devi Shetty of Narayana Hrudayalaya going viral on WhatsApp and garnering support from 50,000 doctors.

But as doctors threatened an indefinite strike, social media was on fire. Opinions were divided, as some backed the amendments, others criticised the “corrupt” Karnataka government and still others felt the doctors were using patients as pawns to fight the government.

“It is a progressive legislation that seeks to protect the basic values and ethics in the profession,” says Akhila Vasan from Karnataka Janaarogya Chaluvali, an organisation representing people’s rights for healthcare. There is considerable angst against the system and it has to do with negligence, malpractices by doctors and the rising healthcare costs.

A National Sample Survey Organisation report estimates admission in a private hospital is three times the cost at a government facility. In obstetrics or neonatal cases, it is seven times more, and childbirth costs 8.5 times more.

Doctors defend themselves saying they too have sales targets. “Hospital chains or the ones backed by funds treat it like business and not necessarily follow the Hippocrates oath,” says an independent private doctor.

BS Ajaikumar, HCG Chairman and CEO, counters. “A sweeping generalisation should not be made. Instead, enforcement mechanisms and transparency such as publishing rates related to treatments should be enforced,” he says. All of us should have a responsibility to the public, and should be ethical and transparent in our dealing with them, states Ranjan Pai, Chairman, Manipal Group.

The grouse is also about government hospitals not coming under the KPME ambit, though they are accountable to the State administration. Vasan argues private hospitals don’t come under the Karnataka Civil Service Rules, Vigilance Cell, Lokayukta, Arogya Raksha Samitis and others. “If they want government hospitals to be treated at par, are they willing to come under this,” asks Vasan. Health advocates also point to government concessions on land to hospitals that need to be monitored. Ajaikumar explains, “Cost of people, realty, supply of clinicians go up 15 per cent every year. ” “Every medical equipment needs to be imported, the government spends less than 1 per cent of GDP on healthcare but says we are over-charging”, adds Vishal Bali, Chairman, Medwell Ventures. He suggests a more “participatory approach”, taking on board both patient and doctor concerns.

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