Harassment and Hell in Healthcare

From the Crucibles of     JPS Customer Value Academy

Just Plain & Simple 
….. Helping Create Customer Value
I realize that this piece is quite long, but really do want to share it with you …..

I am sharing these events despite my father asking me not to. He is a very fair and balanced person, who has always lived his 81 years as a karmayogi. Something in him tells him not to talk about the issues that I intend to bring out here with you. Is it softening due to age ? Is it fear of something ? Is it realization of the futility of the effort and circumstances and hence resigning to the fact that no difference or improvement can or will ever be made ?

 

Case I : He had to undergo an emergency procedure. After suffering the entire night, he told me about his problem only in the morning, so that I did not get disturbed. Immediate response, when you realize that your parent is suffering like this, is to rush to the first ‘good’ healthcare centre that comes to mind, irrespective of costs that maybe involved. Though my parents are covered under Central Government Health Scheme (CGHS), this centre was not ‘entertaining’ CGHS patients for whatever reasons (I was told due to low and delayed reimbursements). But one doesn’t wait to start checking these things in an emergency situation. Some sensible bureaucrat realized this and made a provision under CGHS rules, to allow CGHS cover in emergency cases, even if the hospital is not CGHS empanelled !! My father was aware of this rule. Even in his state of extreme pain and discomfort he remembered it and requested the treating surgeon to make an emergency certificate. The doctor readily agreed and provided the same. The procedure also went off well by The Grace of God !!

The ‘chase’ started subsequently ….. After recovering somewhat, though he had to go through another ‘follow up’ surgery three months later, he submitted the ‘medical claim under emergency treatment’ to the local CGHS dispensary, despite my advising him about the ‘futility’ of it all. This is what happened on subsequent weekly/fortnightly follow up visits :

Follow up visit 1 : The claim has been rejected by the dispensary. My father explains that this was an emergency and that they should consider the case favourably. They ask him to come after a few days.

Follow up visit 2 : The claim rejected again. He was advised to give a ‘written’ explanation/clarification if he wished to, which he did.

Follow up visit ‘n’ : Claim rejected. He could go to their ‘regional’ office some 15 km. away to check and pursue his case.

Follow up visit 1 to ‘regional’ office : They have fixed days for senior citizens !! WOW !! What understanding !! ….. But what that meant was that he had to visit again on one of ‘those’ days.

Follow up visit 2 to ‘regional’ office : The office bearers haven’t come as it is some ‘off day’.

Follow up visit ‘n’ to ‘regional’ office : They have fixed days to handle ‘appeal’ cases. That meant that he had to visit again on one of ‘those’ days.

Follow up visit ‘n+1’ to regional office : Final verdict. Claim rejected. It does not qualify under ‘emergency’ classification.

The issue I want to bring up here may not be necessarily about the ‘validity’ of the case or the ‘judgement’ of a ‘babu’ or ‘junior doctor’, but the process, apathy and lack of clarity and harassment that follows …..

So much for follow ups by a retired elderly person !! So much for a person who dedicated his entire life ‘Serving The Government of India’.

Jai Ho !!

 

Case II : While all the above was still going on, somewhere after a certain ‘nth’ visit for the previous ‘emergency medical claim’, three months had passed and it was time for the second follow up surgery. This was not an ‘emergency’ situation and was ‘planned’ to be done after three months. My father insisted on going to a CGHS empanelled hospital this time, considering the high and unsettled previous medical bill that was still bothering him. I did rounds of some CGHS empaneled hospitals, checking ‘hygiene’, processes, doctor panel etc. etc. and shortlisted Dr.AB at AB Hospital in West Delhi. Nice to talk to, polite doctor, who very patiently listened to and answered all queries !!

Another thing that you need, if you have to go to a CGHS empanelled hospital, is a clearance by a government hospital specialist. We duly went, through contacts/acquaintances though and with a genuine case, to get the specialist’s recommendation and clearance and obtained the same.

Appointment was fixed with Dr.AB at AB Hospital again, though under ‘private OPD’ to have a speedy access to the doctor. Excellent patient handling, diagnosis etc.etc. My father, armed with all the right and needed papers, then mentioned that he would want the procedure to be done under CGHS ….. to see a changed expression on Dr.AB’s face. “We have a quota under CGHS; we don’t know when you will get a bed, we have a restriction on the cost/quality of the ‘implant’ we can put under CGHS …..”. Very meekly, we asked “What if we pay the difference ?” “NO, we DO NOT have that system here”, was Dr.AB’s firm reply. Familiar with the ‘CGHS’ led experience earlier and realizing that there seemed to be a clear discouragement, I said we will go as he said. Seemed like the second surgery would also have to be fully paid for.

A date was fixed for the surgery and we reached the hospital a day earlier to get my dad admitted. The admission staff saw the ‘CGHS’ approval kept in the file of papers and asked why we wanted to ‘pay’ advance, since the entire procedure could be done ‘cashless’ with the CGHS approval that we had. I narrated Dr.AB’s points and the admission staff said that 1)they have beds under CGHS quota, 2)there were no ‘different types/costs/quality of implants’ for this procedure that they were aware of and 3)that in case there was a difference in charges over and above CGHS rates, we could always pay the difference. “Are you sure all that is true ? That all that can be done ? Dr.AB had told us otherwise”, I asked again and again and got a positive confirmation on all the questions. So they kept the government hospital’s approval and said they will proceed under CGHS. We got my dad admitted that evening.

But I still wanted to speak to Dr.AB and inform him of the change, considering that he was to operate the next morning. I tried his phone several times, but he did not pick up. Maybe busy with patients. I told the attending doctor of my dilemma and questions. He seemed quite surprised at the mention of ‘differences in cost/quality of implants’. “You can speak to Dr.AB”, he said. Same response from the nurses as well. But I wanted to be open and tell Dr.AB about the change in situation, before he operated without being told proactively by me about the same.

That evening we could not contact Dr.AB. In the morning, my dad was being taken to the Operation Theatre. I requested to speak to Dr.AB again, to be told that he was tied up in the OT. My dad was taken to the pre-operating room. When an assistant surgeon called me over for signing the consent form, I told him about my dilemma again. Same surprised look and he said “there are no different types of implants”. I told him to still go in and inform Dr.AB about the change in admission procedure from what he would have been aware of till then. He said he will and went in. I went back to the patient’s room where my mother was also to be waiting while the surgery took place.

Within five minutes, my mobile  rang. Dr.AB was on line from the OT. Very curtly and rudely his voice said “Mr.Singh, you shifted to CGHS. I am NOT going to touch your father till you go down and make changes to ‘private’ category. He can keep waiting on the bed outside the OT. You go downstairs to the billing section, make the revised changes/payment and confirm to me. Only then will I take him into the OT”. These were his exact words.

I stepped outside the room so that my old mother got no idea about the tone and content of the conversation. “But Sir, the billing clerk told us that this process is OK and accepted by the hospital”, I said in a shaky voice with sweaty hands holding the phone. The voice at the other end thundered again through the phone from the OT, repeating what he said. I visualized my old dad on a bed outside the OT and said in a shivering voice “Sir, please carry on. I will rush down and change all payment modalities”. “Go down. Make all the payments and confirm back to me. I am NOT going to touch him till then” Dr.AB repeated. “Yes Sir” and I rushed down two floors to the billing section.

As I write these lines, I can feel my throat drying up and my pulse racing all over again …..

The ordeal continued …..

Billing Clerk (BC) : Why do you want to convert to a full paying private when you have an approval for a totally cashless procedure ?

JPS : Because we want a better quality implant and that is not covered under CGHS

BC : Who told you that ?

JPS : Dr.AB

BC : There is no such thing that I am aware of, but in any case, even if there is a difference, you can pay that at the time of discharge.

JPS : No, but I am told that this is not allowed.

BC : Who told you ?

JPS : Dr.AB

BC : Sir now that you have registered under CGHS, we cannot convert the same. In any case, I don’t understand why you want to do so when you have an approval.

JPS : How does it matter ? It is my personal decision. Please convert to the fully paying private option.

BC : But Sir, we cannot.

….. All this while I know that my old dad is outside the operation theatre upstairs.

JPS : Can I speak to someone senior please. My dad is outside the OT and Dr.AB is refusing to operate on him. Can you understand the situation ?

The conversation carries on for some more time and the billing clerk finally speaks to someone on the phone for what seemed like an eternity and reiterates the point that she cannot change the registration.

JPS : Whom did you speak to ?

BC : The Medical Superintendent (MS).

JPS : Can I speak to her ?

She tries the phone and I am told that the MS has gone to another department. I rush there, to be told that she has gone back to her room. I rush back to her room and she is not there ….. and I keep waiting. After a while I the MS arrives and I explain the situation once again. The same exchange, as with the billing clerk, continues.

I finally start getting aggressive and say that I am now getting very suspicious about the way things were going on and even if I was not to do anything till now, I would clearly want to know all the details as to why it was becoming such a big issue.

MS : Sir, the CEO has refused

JPS : What ? Why does the CEO have to come into picture here ?

This is something I definitely have to know now, I say to myself.

MS : Sir, such a situation had arisen once in the past also. A patient had converted from CGHS to private paying and after discharge, had complained to CGHS and filed a case as well. You have a permission for CGHS and we cannot shift now. You may also end up lodging a complaint after discharge and hence we cannot take a chance.

JPS : But your own doctor is saying that he will not operate unless I shift. What is this going on ? Do you know how much time has elapsed since they took my dad out of the room ? He is waiting outside the OT.

MS : Sir, I will speak to Dr.AB and tell him to operate.

JPS : But he will use an inferior implant in that case. We don’t want that.

The MS picks up the phone and calls up Dr.AB in the OT. They have a long argument lasting almost 20 minutes (wasn’t he supposed to be operating there ?) I keep waiting, watching the expressions changing on the MS’s face.

Finally the MS puts the phone down and says “OK Sir, we will change the package to private. You will not get the ‘approval’ document back though. Please give a written declaration that you will not claim the amount separately and that you are doing it out of your own choice and that you absolve the hospital of any responsibility ….. “

I agreed and signed all the documents. The MS tells me that the operation has started. “How will I know that the implant being used now is a superior one ?” I ask.

MS : We have changed the package for you Sir

JPS : But how will Dr.AB know ?

So she picks up the phone and speaks to Dr.AB in the OT (how many calls does he attend to in the OT ?).

MS : Sir, I have communicated to him

I thanked her and returned to the room where my mother was waiting. “What happened ?”

I dropped myself onto the sofa and said, “Nothing …..”

One week later, I was diagnosed with a problem, which I was told, could have got triggered due to extremely high stress ….. I had to be in hospital for five days and then stranded at home recuperating for three weeks ….. fortunately under the care of a very good and friendly senior surgeon who not only counseled and treated really well, but also went out of his way to help with all the procedures, admission, insurance claim etc. etc. ….. Hope in Healthcare !! 

 

Satisfy one’s desires, certainly, but which ones ?

And to what extent ?

To determine precisely what I want and how.

Children ? Money ? Glory ? How ? ….. Swami Prajnanpad

 

J.P.Singh,

Justplainandsimple Consulting Pvt. Ltd.

Website : www.justplainandsimple.com

Twitter : @jpsingh55

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