HOW IT WORKS

CORRUPTION TRAP: even the country’s best hospital is not immune to the lure of money

Those in the know say that, over the years, the system has become much meatier for the doctors and the centres. What started out as a verbal understanding between various parties has today become much more structured, even computerised. There are two ways a resident doctor can ensure a fat packet from his chosen centre. He can either send in the patient right after the check-up from the opd, or can arrange for the admitted patient to be whisked away from the ward. Either way, he knows there wouldn’t be any protest from the patient, for the doctor dangles the lollipop of a heavy discount.

Sitting in his opd room, the doctor recommends his chosen centre to a patient. The next step is to convey the details of the test to the pro – the name of the patient, the test required and, most importantly, the cost to be charged. The representative then calls up the centre and conveys the same. By the time the patient comes over, the individual in charge of the billing counter of the centre already knows what is to be done.

But this option is laden with risks; there is always the possibility of other patients overhearing the doctor’s advice. So, many of them prefer the other way, to get the patient taken away from the ward. The process followed, though, is almost the same.

The pro is given the details and strict instructions not to make any noise, lest a ward boy or a nurse gets a whiff of it. This reporter, too, was asked by Dr Rakesh Mishra to whisk away patients from the Safdarjung Hospital’s ent department. On the bed was lying Afzal Ahmed, 21; his neck was swollen to the size of a football.

Unemployed, Afzal had been living with his cousin in Noida, a suburb of Delhi. While this reporter was roping him in, his cousin was out looking for a centre, which they could afford. What they could afford wasn’t much though, considering the cousin worked as a carpenter, out of work for a fortnight, looking after Afzal.

After convincing Afzal, this reporter did what all representatives are supposed to do – call an ambulance from the centre, stealthily ship the patient out, and go out looking for another prey. At the centre, the name of the doctor is recorded on computers as soon as the money is paid.

At the end of the month, each doctor’s salary is calculated on the computers. If the total is high, then the chief representative (usually one of the partners in the centre) pays a visit to the practitioner; otherwise, it is up to the lower-rung representatives to ‘make the payment’. Along with the currency notes, the centres usually attach a sort of a ‘covering note’, which gives details (names, tests recommended, dates on which patients were sent), for the doctor to crosscheck with his own list. For, often, doctors try to add names to the list and centres try to make subtractions. After a few rounds of heated exchange, a ceasefire is called.

One evening in March, this reporter received a call from Dr Kataria, a senior orthopaedic surgeon in Ram Manohar Lohia Hospital, who had called to remind about his delayed payments. Apparently, the doctor always carried on his person a list of all pending cash from all centres. When this reporter met him, he instantaneously gave out the list of names and dates of referral on another centre’s reminder: “Geeta (14/3)” and “SN Gupta (18/3)”. Just before the end of the meeting, he confessed with an amiable smile, “Normally, when some other doctors are there na, we don’t talk about this.”