WAITING LIST OF HEART OPERATIONS FOR CHILDREN

Key Words – Superspeciality Departments in Public Hospitals,

Financial viability, self-expanding Public Hospitals, Cardiology at K.E.M. hospital.

          Cardio-vascular Dept. of K.E.M. hospital has a long list of patients waiting for their surgical treatment. 288 children with congenital defect in their heart are waiting for months and years and some 22 have died without treatment. Another 400 adults are also on the waiting list, majority of them presumably for Coronary By-pass operation; most of them could wait.  The news was flashed by Mumbai Mirror.

          Perturbed by  the news, the Municipal authorities are running helter-skelter to get these children operated at the earliest and Dr. Shetty from Bangalore and cardiac surgeons from major private hospitals in Mumbai are offering to operate on them within a month, to finish the waiting list. But very little attention is being given to find the root-cause for such delays and to find a permanent solution. A few years later, Mumbai Mirror can again flash the news of a new waiting list  of children.  The show will go on-- or can we stop the show?

          If the need in so great why can we not expand the services?  The fault lies in the system.

a)    It is the nasty “accounts department” which needs to be  convinced, before any costly machine is purchased.  Otherwise there is no plausible reason why a 15 year old heart-lung machine could not be replaced for 4 more years.  The catastrophy has arisen after 19 years when the old horse died. The deans are answerable, so are the secretaries, but There Is No Answerbility for the account Department.  Half the hospital problems will be solved, if the Accounts Dept.  was held answerable for undue delays in purchase of Vital Equipments.  

b) Every patient pays around Rs. 60,000/- for the operation. Why ? it is Totally for the Consumables used during the operation.  Lot of costly tubes (intra-vascular catheters) are inserted in various blood vessels as also to drain urine/fluid collection in the chest, as also for monitoring.  The total cost of these materials is the only thing charged to the patient and that amounts to Rs.60,000/-.  Everything else is totally free.  That explains why the charges in private go to 3 Lakhs.  The surgeon charges 1 Lakh, the hospital charges 1.1/2 lakhs for hospital services.  No doubt, they make some profit but that profit/excess money allows the hospital to expand the Services.  Wherever there is more demand for the services that section expands.  That is What Does Not Happen in K.E.M. or any Municipal / Government Hospital.

The Continuous Clamour For Everything Free Must Be Reviewed.  It causes stagnation.  If these patients were to pay just 10% of the hospital expenses, that would add just Rs.15000/- more.  The patients will be paying Rs. 75000/- instead of Rs.60,000/-  as of now.  With just 2 operations a day and 300 working days in a year, each operation theater will collect 30,000 x 300 = Rs.90 lakhs. Within 5 years, the hospital can expand to have one  more operation theater and another 20 beds. Why is it not happening?  Again because of the “nasly accounts department” On behalf of BMC, the accounts department Claims the money in general pool and the concerned department may not get a paisa out of it.  If only the dept. was allowed to claim of least 80% of the amount collected by it for its expansion and /or maintenance, a system of  self- expansion will be established and rising expectations of the  people will be met by the dept. expanding as per the needs of the people.

What is worse is that senior specialists in teaching hospitals are now allowed to do private practice.  So, their interest in the department has dwindled even more.  It is better to go out and earn thousands more than to struggle with the beurocracy and the accounts department for improving the facilities in the dept.

          A permanent solution is staring at us for solving at us for solving such problems that who is listening?