Editor's note: Uttar Pradesh had been in the grips of a healthcare crisis long before Gorakhpur and Farrukhabad put the spotlight on the state's ailing public health system. The state's infant mortality rate is comparable to that of strife-torn African nations. There is one doctor for every 19,000 people; according to WHO, there should be one for every 1,000. This is the fourth of a four-part series that explores the state's policy-paralysis and places it against the larger backdrop of a systematic public health failure.
Farrukhabad: As government hospitals in Uttar Pradesh fail to cater to the state's massive population, private clinics have found a way to thrive: Pay the hospital staff to get patients. For a commission, security guards, ambulance drivers, chemists, nurses, compounders and even doctors working at the government hospital goad and coerce visiting patients to go to a private clinic instead.
This reporter witnessed these proceedings first-hand at Ram Manohar Lohia (RML) District Hospital in Farrukhabad. More than 150 private clinics have set up shop within a 300-metre radius of the hospital.
At around 2 am on 6 September, a 16-year-old girl was rushed into the hospital's emergency ward with burn injuries. The lone doctor on duty, Dr Akhilesh Agarwal, threw a perfunctory glance at her, did first-aid and asked the nurse to discharge her.
As her harried and confused father was trying to make sense of this treatment, the ambulance driver Shan Mohammad stepped in and recommended Farrukhabad City Hospital to him. He casually said they would get better treatment there. Unsure if he should accept an ambulance driver's suggestion, the father turned to the doctor.
Dr Agarwal put over the private hospital, saying how it has better doctors and is air-conditioned, and suggested that the girl be taken there as her condition was critical. Heeding his opinion, the jittery father requested the ambulance driver to take them to that hospital.
Shortly after the ambulance left, Dr Agarwal came out of the emergency ward and made a call. Within the earshot of this reporter, he hurriedly said on phone that he was sending a patient and that his share be given to the ambulance driver.
Unaware he was speaking with a journalist, a doctor working with a private hospital in the region spilled the beans on how this nexus works. Dr Vijay Singh of Kailash Hospital said whichever employee of a government hospital brings them a patient gets a spot fee of Rs 1,000-Rs 2,000. Besides, they also earn a 25-30 percent commission on the patient's final bill after he/she is discharged. And the payments are always made in cash.
The system he described is an elaborate one. The ambulance drivers get a call regarding a patient and while on the way to the government hospital, they try convincing the patient’s family to go to a private hospital instead. If the family insists on going to the government hospital, the doctors and other employees at the hospital do the private clinics' bidding.
Referral gone wrong
In July and August this year, 49 infants died at RML District Hospital, of which 19 died during or soon after the delivery. In media reports published soon after the deaths were reported, the hospital blamed most of the deaths on the babies' delayed arrival to the hospital despite being critical.
However, this reporter witnessed how RML District Hospital's staff persuaded an expectant mother to go to a private clinic for childbirth. Kusum Singh's family rushed her to the government hospital when she developed labour pain. However, the hospital's security guard Vikas Kanaujia talked them into going to privately-owned Shishu clinic instead.
Speaking with Firstpost, Kanaujia said he does this at the behest of the doctors, who give him a share of the commission they get from the private hospital. He said every staff member involved in sending a patient to a private clinic gets a share of the money. In the case of the pregnant woman, he said the hospital's sole paediatrician Dr Kailash Dulani was to get the commission.
A ward boy at Shishu Clinic confirmed to this reporter on the condition of anonymity that Kanaujia was paid Rs 1,200 for referring the woman. He said Kanaujia refers patients to them regularly.
Kusum gave birth to twins at Shishu Clinic, run by Dr Alka Jain, and was discharged. Three days later, the babies had to be rushed to the RML District Hospital as they developed breathing problems. The newborns' grandfather had faith in the government establishment, which is why he chose it over any private clinic for treatment.
At the hospital, this reporter saw first-hand Dr K Bose persuading the family to take the infants to Shishu Clinic. He told the family the clinic had better facilities, was cheaper and they should get the babies admitted there to save them. Unwilling, the family pleaded to have them admitted at the district hospital, but to no avail. The family then took the newborns to Shishu Clinic, where they were denied treatment.
The beleaguered family went back to RML District Hospital, which eventually admitted the babies after much begging and pleading. A day later, the twins died owing to multiple organ failure.
A source at Shishu Clinic told Firstpost neither hospital wanted to admit the babies as they didn't want their blood on their hands.
Denial and cognizance
Regardless of the statement of RML District Hospital's security guard and Shishu Clinic's wardboy, its owner Dr Jain vehemently denied that her clinic has ever paid any commission for such referrals. She said she is a doctor of repute and it's only natural if someone suggests her clinic to those who might be looking.
Dr BB Pushkar, the chief medical superintendent of RML District Hospital, told Firstpost the hospital management has heard about this nexus of government hospital and private clinics. He said the management was planning to investigate the matter to get to the bottom of the rumours. UP health minister Siddharth Nath Singh refused to comment on the issue.
(Saurabh Sharma is a Lucknow based freelance writer and a member of 101Reporters.com, a pan-India network of grassroots reporters. He tweets @saurabhsherry)
Updated Date: Oct 20, 2017 15:00 PM