Red-tapism shuts heart surgery dept of Nair Hospital
With Rajiv Gandhi Jeevandayee Yojana rejecting claims, hospital has no money for surgical supplies.
It has been a month since 26-year-old Anju Kannojiya, a heart patient who needs a valve replaced and bypass surgery as well, was admitted to the BMC-run BYL Nair Hospital for surgery under the Rajiv Gandhi Jeevandayee Arogya Yojana (RGJAY).
During this period, the Goregaon resident's surgery has been postponed twice, with vendors of medical supplies refusing to extend further credit to the hospital till it clears bills worth over Rs 4 crore.
Anju's husband Sanjay, who irons clothes for a living, is at his wit's end. "Her surgery has been cancelled twice. It's so difficult for me to come all the way here everyday, leaving three small children at home. Anju's condition is very bad; she is having a severe breathing problem, I can't even take her to a private hospital for treatment as I can't afford the Rs 1.5 lakh that it will cost me. Why does this scheme exist if they can't provide treatment to the poor under it?" said Sanjay.
The funds bottleneck for surgeries done under RGJAY - the state's medical scheme that covers over 50 lakh families earning below Rs 1 lakh a year -- has seen nearly a 100 vital surgeries at BMC-run hospitals being postponed or cancelled since the beginning of March.
On April 12, Nair Hospital announced that its cardio-vascular and thoracic surgery (CVTS) department will remain closed till further notice - the first instance where a civic hospital has shut a vital department citing lack of supply by vendors.
A senior doctor from Nair Hospital said, "It's not only CVTS. other departments too have gradually stopped doing surgeries under RGJAY. Almost Rs 4 crore in vendors' bills are yet to be cleared."
A senior surgeon with the CVTS department added, "We have no choice but to ask the families to take their patient to another hospital as all patients here require emergency surgeries. Their relatives are angry with us, but we can't perform any surgery without surgical implants. We have written several times regarding this to the hospital authorities, but the problems didn't get resolved. Finally, we have closed the department since April 12."
Five vendors stopped supplying material. One of the vendors Mirror spoke to said he hasn't been paid since December 2012 (the scheme was launched in July 2012). "My claims amounting to Rs 2 crore are yet to be cleared. Each time, the authorities assure us that it will be cleared, but nothing happens," he said.
Dr Ramesh Bharmal, dean of the hospital, said, "We are trying hard to convince vendors to continue with the supply so that patients don't suffer, but they are not ready to co-operate. The problem is, around Rs 4.5 crore in claims got rejected by RGJAY, leading to the vendors remaining unpaid. We have informed higher authorities regarding the same and asked for funds. We hope it comes through soon." Now, even the Cardiology department is in danger of a similar shutdown, with some surgeries already cancelled. "We have no choice but to shut the department. Vendors who supply stents and other implants have written to us saying they will stop supplying us from next week."
Piyush Singh, CEO of RGJAY, talking to Mirror, "After last month's issues, we held a meeting with the insurance company, and we cleared nearly 12,450 claims worth Rs 27 crore before March 31. Soon, we will clear the pending amount as well, which is around Rs 30 crore. The problem is with only civic hospitals in Mumbai. We also told State public health secretary Meeta Lochan during this meeting that those claims which did not meet our criteria will not be entertained. In order to get the claims reimbursed by the insurance company under this scheme, hospitals must submit all relevant documents."