Experiences at Indraprastha Apollo Hospitals – I

Indraprastha Apollo Hospitals in New Delhi is our neighbour. Thus, one morning earlier this month, when my brother-in-law called urgently that my father was unwell, extremely lethargic, drowsy and a little disoriented, we decided to call an ambulance from Apollo and rushed him to the hospital.

In the Emergency room, we got prompt attention and we quickly determined that my father had low BP and his leucocytes counts were high indicating an infection. He was admitted in the hospital under Dr. Prasad Rao, who is a specialist in internal medicine. Dr. Rao turned out to be an articulate and soft-spoken man, who explained to me the plan of treatment (basically antibiotics) and said that he was hopeful of getting my father back home in the next 2-3 days. As expected my father made a swift recovery over the next couple of days and Dr. Rao discharged him from the hospital, the entire experience being on the whole quite satisfactory. Now this is what happened at the time of finalising the discharge.

As I went through the detailed itemised billing sheet, I noticed that we had been charged two nights of hospital stay, which was correct. However, under another head something called ‘Other Services’ we have been charged for a laryngoscopy, (which was actually done) and strangely another day’s bed charges. Since Laryngoscopy is a OPD procedure, I was baffled to see the additional bed charged buried under ‘Other Services’ and thought that it must have been a mistake. Enquiries with the billing clerk however revealed another story.

Indraprastha Apollo Hospitals I was informed now has a check-out time of 9 AM, which means that anybody being discharged after 9 AM in the morning has to pay the room rent for that day as well. Strangely everyone knows that in a hospital most discharges are planned after the admitting physicians take their morning rounds, which usually begin around 10 AM in the morning. Thus, it is just not possible for a patient to be discharged from the hospital before 9AM, and hence virtually everyone has to pay the additional charges. The Billing Manager, informed me that at least 130 out of the 150 discharges that happen everyday at the hospital, lead to irate patient attendants venting their anger on him. Clearly, this is a dodgy practice as the hospital knowing fully well that discharges can not be finalised before 9 AM, charges patients for an extra day.

In most hospitals the check-out time is 11-12 noon and the hospital management usually does not charge for a delay of an extra couple of hours as they clear the discharge formalities. The intent clearly is not to bill the patient and all efforts are made to finalize the discharges before the appointed hour. At Apollo, this is clearly not the case as the 9 AM check out rule is designed to bill the patient for an extra day, even when they know that their doctors will not be able to finalize the discharge summaries before 9 AM.

Complaint Redress Mechanism

When I asked the Billing Manager, about the process for lodging a complaint, I was told that I should speak with the GM for Resources Utilization, who refused to meet me saying that if I had a problem, I could write an email to him. When I insisted that I wish to lodge a formal complaint, I was directed to speak with Dr. Priyank, who turned out to be someone who worked in the office of the Managing Director of the hospital. Dr. Priyank too was far too busy to meet me and when I questioned him on this particular practice, he explained that this was all for the benefit of the patients, as it enhanced hospital efficiency!!!

As the word got around about my complaint, I received a message that Rajeev Bahl, GM Resource Utilization has now agreed to meet me. When I sought clarifications on this, he said that this was a new practice and that the hospital felt that this will encourage their doctors to finalize discharges faster. Basically, what he was saying was that since the hospital management is chary of asking its doctors to begin discharging their patients earlier, it would like the patients to put pressure on their doctors to do so. Strange to say the least.

Peculiarly, while the hospital authorities insisted that charging for the additional day was the right practice, they agreed to not charge the same to me now that I had protested. Thus, it seems if you protest and protest hard, the hospital moves quickly to placate you by waiving off the additional charges.

Indraprastha Apollo Hospital is a JCI accredited hospital and yet it seems that there is no formal complaints mechanism. In spite of my best efforts to lodge a formal, written complaint, there appeared no process for the same. Since no complaints gets lodged, the hospital would appear to be running faultless operations and the JCI accreditation can continue unabated.

Thus, in spite of having a reasonably satisfactory medical experience the hospital goofed up at the last leg. It spoilt my overall hospital experience and I came away wondering about the greed of the hospital (150 discharges per day at an average bed charges of Rs. 7500 makes a very tidy sum indeed), its ethics and its philosophy of ‘caring with a human touch’.

My experiences at the Indraprastha Apollo Hospitals

The other day I landed at the Indraprastha Apollo Hospitals, a stone’s throw away from my residence in New Delhi.  My wife needed a test and our doctor at Max Healthcare asked us to get it done at Apollo as the equipment at Max was out of order. The moment I walked in I felt as if I was on a railway platform.  The hospital was full of patients as everybody appeared to be in a mad rush. In the OPD area, the ladies at the reception were busy, chatting amongst themselves, while patients and their caregivers waited for their attention. They wore no uniforms and for some strange reason, they were also collecting cash from the patients (apparently for the doctor’s consulting charges) and handing out receipts scribbled on small chits, which did not even have the hospital’s name on it.

Strangely, I was than directed to a cash counter to pay for the tests.  

National Emergency Services-The Need of the Hour

The other day I was at the Delhi airport early in the morning waiting for the security check to get over, when I realised there was some commotion ahead in the queue. As I moved on, I saw a man flat on his back, and a lady, apparently an air hostess trying to revive him by administering the CPR. There were a bunch of people including some security men looking on. The lady was doing her best, but it was quite apparent that she would not succeed. She appeared to be going through the motions rather than making a desperate attempt to save a life.There was no one else to help her, while many watched idly. I did not see any medical personnel or the emergency medical paraphernalia, that one would expect  on such an occasion. The man had been without a pulse for almost 20 minutes, before CPR had commenced.

How can a busy airport (brand new to boot) be without adequate medical emergency back-up? Almost a year ago when I was working for Artemis, we had proposed to the authorities to allow us to set up an emergency service at the airport. Artemis is reasonably close to the airport, has an Advanced Cardiac Life Support (ACLS) equipped ambulance service and the hospital is fully geared to manage medical emergencies round the clock. Nothing came of our proposal and the last we heard was that Indraprastha Apollo Hospitals has been awarded the contract to manage the medical room at the airport. Apollo Hospital is all of 40 kms or more from the airport and with the traffic that one usually encounters on the way, there is no way that an ambulance can reach the hospital in less than an hour. That fateful day, there was no one for at least 30 minutes from Apollo or anywhere else, to help the unfortunate man.

India attracts scores of patients from across the world, most of them benefit from the world class healthcare services now available in the country yet we do not have an emergency service that can be remotely called world class. This is a serious concern.

The government must take the lead in establishing a centralised medical emergency service through a statutory body, let us say, Medical Emergency Services Authority of India. It can work out the details of how this service will operate, the nodal hospitals, the communication infrastructure and the logistics of transporting patients to these network hospitals. It should set clear guidelines on managing emergencies (who, what, where, how),  establish internationally benchmarked service levels and establish a monitoring authority to measure efficiency and service levels

The Medical Emergency Services Authority should be allowed to set up emergency handling outlets in high traffic areas like airports, on national highways and busy malls etc. The Authority would be required to invest in the communications and transport infrastructure including paramedical personnel, while the participating/network hospitals will be responsible for patient’s care once the patient reaches the hospital.

While all this and more is possible, the key question is whether we should have private participation in something like this. I believe we should not. This is a service that should be rendered by the government to its citizens in distress. It should be paid for by the taxpayers. The government can charge a small sum from the taxpayers annually to keep the service afloat. The real challenge for the government would be to maintain high standards in the face of crippling bureaucratic controls that underlie all government initiatives. Corruption, sloth and inefficiency so characteristic of all government organisations must not be allowed to eat at the vitals of this service.

Easier said than done. Maybe the government can find another Nandan Nilekani or an E Sridharan and give him a free hand to set this up. I would like to believe if there is a will and a burning desire to accomplish something as important as setting up the National Emergency Services a way can certainly be found. It is afterall the need of the hour.

Pic courtesy http://www.flickr.com

Hospitals and Luxury Hotels

Yesterday I came across a piece in The Hindustan Times, which talked about the ‘luxury’ that a hospital now offers. The piece had snaps of fancy chefs offering a choice of cuisine to patients, nurses ‘requesting’ young patients, mostly kids to have their medication and the pretty front office executive (with her ‘May I help you badge’ in place)making ‘guests’ welcome.

This made me remember my grandmother, who is all of 104 years old narrating to me her escapades in hospitals run by the British in colonial India. She had great admiration for the no nonsense English doctors, the stern nurses, who followed orders and paid little attention to patient grievances. She remembers these episodes with a mixture of nostalgia and respect for the efficiency that this system stood for. The food was always what the doctor ordered, the medicines were given like clockwork and chores like sponging were a must-the patient had little choice in the matter.