The report is about what followed after a registered nurse, C T Tomlinson, sent a troubling letter to the chief ethics officer of the US multi-specialty hospital giant HCA, stating how a doctor at the Lawnwood Regional Medical Center at Fort Pierce in Florida had been performing heart procedures on patients who did not need them, putting their lives at risk. “It bothered me,” the nurse, C. T. Tomlinson, said in a telephone interview to NYT. “I’m a registered nurse. I care about my patients.”

Within two months, a HCA internal investigation found the nurse was right. And, not surprisingly, in alleged retaliation for his complaints, Tomlinson’s contract was not renewed. Investigations revealed that the nurse’s complaint was far from being the only evidence that ”unnecessary — even dangerous — procedures were taking place at some HCA hospitals, driving up costs and increasing profits.” There were cases in which doctors “made misleading statements in medical records that made it appear the procedures were necessary,” according to internal reports.

HCA, the largest for-profit hospital chain in the United States with 163 facilities, had uncovered evidence as far back as 2002, and as recently as late 2010, showing that some cardiologists at several of its hospitals in Florida were unable to justify many of the procedures they were performing. Questions about the necessity of medical procedures — especially in the realm of cardiology — are not uncommon. None of the internal documents reviewed calculate just how many such procedures there were or how many patients might have died or been injured as a result. But the documents suggest that the problems at HCA went beyond a rogue doctor or two, the report pointed out.

At Lawnwood, where an invasive diagnostic test, known as a cardiac catheterization, is performed, about half the procedures, or 1,200, were determined to have been done on patients without significant heart disease, according to a confidential 2010 review. HCA countered recently with a different analysis, saying the percentage of patients without disease was much lower and in keeping with national averages, the NYT report mentioned.

Back in India where ‘medical ethics’ exist only in paper, patients are often easy victims of dishonest doctors, greedy private hospitals and profit-hungry pharma companies. Practically abandoned by the government, its nameplate regulatory agencies and their highly corrupt officers and the so-called ethics committee of the self-regulatory Indian Medical Association (IMA), general patients have no way to know if they are going through right medical procedures and tests, often costing them a fortune. Unfortunately, there are no Tomlinson like angels in Indian medical profession — especially among those associated with private hospitals — who are prepared to risk their job to question unnecessary procedures and tests conducted on patients for profit.

Occurrences of patients dying in wrong treatment and drug side effects, often leading to violent protests before hospitals and medical centres, are common in India. Many of such cases are routinely reported in the local media across the country evoking no proper investigation or action by the government, whose primary concern seems to be only the VIP life. Doctors scaring middle-class or slightly well-to-do category patients, visiting private hospitals with complaints such as chest pain, asthmatic trouble, giddiness, severe muscle cramps, backache, stomach pain, high fever or prolonged low-fever, gastro-enteritis, urinary infection, kidney, gall bladder or pancreas malfunction or even general weakness, by linking them with the possibility deadly diseases such as cancer, tuberculosis, lung and kidney failures are to prolong the treatment just to extract maximum possible money from patients. The benefactors are invariably those rogue private hospitals and clinics, doctors and drug companies.

With only one per cent of the country’s annual GDP spent on healthcare during the 11th plan period (2006-07 to 2011-12), proper treatment in government hospitals is generally a day dream unless a patient is well connected with hospital doctors or top government officials. Government healthcare establishments are highly under-equipped and understaffed. In majority of the state-run hospitals, existing electro-medical and other sensitive equipment are often reported to be either ‘out-of-order’ or ‘not in operation’ in the absence of doctors or paramedics and technicians. Majority of these hospitals and health centres are badly short of specialist physicians and surgeons, junior doctors, qualified nurses and technicians. Lack of proper supervision make these state health establishments perfect breeding grounds for corruption of all sorts — from private practice by doctors and technicians to promotion of drugs on behalf of pharma companies.

India’s private medical practitioners, who prefer cash to other forms of payment from their patients or clients, are largely hand in gloves with drug manufactures as much as they are with corrupt income-tax department officials. Conversely, drug industry officials always manage to maintain ‘cozy’ relations with the department of drugs and chemicals in the union government to have their way in pricing their products. It is not surprising if the corrupt drug control administration of the central and state governments don’t even seem to be interested in the information about how multinational drug companies are fleecing the nations with overpriced, overprescribed products, aggressively marketed with the help of dishonest doctors across private or government hospitals, clinics and chambers.

Thanks to strict balance sheet disclosure norms for drug companies in the US, reports of bribing doctors in the third world countries by drug MNCs such as Pfizer, Wyeth, Johnson & Johnson and Teva come to light. Yet, the government of India shows no inclination to control and punish the malpractices by doctors and pharma companies. The drug industry seems to be exercising a vice like grip over the national government, especially since the economic reform era began in 1992. Corruption is extremely deep-rooted and widespread in India’s Rs 5,00,000 crore-plus healthcare sector, combining all segments of the business, affecting almost every citizen. Surprisingly, despite unpleasant common experience with hospitals, doctors and increasing drug prices, the society is yet to rise against this corruption that affects all. The issue, however grave it may appear, is yet to attract even the recent anti-corruption crusaders such as Anna Hazare and Arvind Kejriwal. There is never a call attention motion in parliament to discuss the subject that concerns every Indian life.

A recent settlement between multinational drug giant Pfizer and the US department of Justice for US$ 60 million or so provided a glaring example of how these drug firms buy up doctors in emerging markets, including India, to prescribe their pills. In China, Pfizer had reportedly set up a ‘club’ that provided “high-prescribing” doctors with all kinds of entertainment under the guise of attending conferences. In Kazakhstan Pfizer awarded an exclusive distribution deal to a local firm after it was told there was no other way to secure government approval for a Pfizer product.

Sadly, in the absence of a nationwide strong movement against rampant immoral acts in the healthcare sector, involving hospitals, doctors, drug manufacturers and dishonest government officials, and whistleblowers like Tomlinson, the country’s general public will continue to stay a slave of corruption and suffer. (IPA Service)