Private Hospitals Vs Open Heart Surgery
Heart disease is considered as one of the major causes of death today worldwide. Statistics of heart patients vary from country to country and patient to patient. There are over 900,000 people who have suffered a stroke, and 'Stroke' is the largest cause of disability in England where 300,000 people live with moderate to severe disability as a result of a stroke.
In Sri Lanka the number of people admitted to hospitals for heart disease is about 219,000 a year. Some heart attacks are sudden and intense where no one even thinks about it as a heart attack! Some of the signs of the disease are the chest discomfort in the centre of the chest that lasts for a few minutes or that takes place intermittently; rise in blood pressure, squeezed feeling, fullness or pain in the chest area, discomfort or pain in one of the arms, back, neck, jaw or stomach or shortness of breath without any chest discomfort or even breaking out in cold sweat followed by nausea or light headiness are regarded as warning signs of a heart attack.
In writer's own personal experience none of the indications mentioned above were present except a normal stomach pain, which was put down to mild indigestion. A few months earlier even an endoscopy done in a local private hospital revealed only a slight touch of gastritis and a case of hiatus hernia (protrusion of the upper part of the stomach into the thorax through a tear or weakness in the diaphragm). Hiatus hernia often results in heartburn but may also cause chest pain or pain with eating.
On a Sunday evening the writer suffered this uncomfortable sharp pain in the stomach, which was treated with Asamodagam (an Ayurvedic preparation) that normally settles such stomach discomforts. But with the increase in pain intermittently, over the hours, it led to a 'full-blown cramp' inside the stomach, which made him rush to the nearest private hospital for a check up. An ECG revealed the writer had suffered a heart attack. Blood pressure was extremely high to red alert danger level but the medical staff could only administer drugs to bring the pressure down and hope for the best overnight.
On the following morning an ambulance rushed him to a prominent private hospital in Colombo on the recommendation of the cardiologist. The angiogram revealed four major blocks in the coronary artery, two of which were at 99 per cent. Balloon angioplasty (expansion of the coronary artery with the insertion of a balloon and using a stent) could not be performed as it posed a threat to life in case of a rupture of the artery. There was no other option except to depend on an efficient young London qualified thoracic surgeon and his team on a 'full risk' open heart Coronary Artery Bypass Graft Surgery (CABG).
Although the Cardiologist's advice was to get the operation done immediately, the surgery had to be postponed by six more days due to the anesthetist's non-availability. Hospital authorities allocated the author a private room in the intensive block at a cost. In the meanwhile hospital staff performed many tests as usual.
A common complaint against private hospitals in Sri Lanka is that patients are subjected to numerous investigations and tests by hospital authorities as the norm where medical authorities decide on their own accord to perform a variety of tests including that of HIV (without any explanation or reasons for such tests) which means that at the end of the day patients find that their hospital bills having skyrocketed to unprecedented levels.
Extra days lying on a hospital bed in a private room cost the writer an arm and a leg until the 'operating team' fixed a date' for the surgery. However, during many journeys to various departments he was struck by a prominent bank's advertisement offering attractive discounts on hospital bills for using their credit/debit cards. The range of discounts varied from room charges, pharmacy charges, X-rays, laboratory tests and special discounts to senior citizens etc.
The present trend at private hospitals with heart patients in Sri Lanka is that they have a newfound charging system akin to tourist hotel tariffs, such as 2, 3 or 4 stars! Here too, the package offered to different patients is directly proportional to the number of blocks the patient suffers from- i.e. for 2, 3 or 4 blocks. More blocks mean higher the charge would be for the operation. But it does not end there. When the final bill arrives it discloses additional charges ranging from medicine, visiting charges of various doctors and specialists, physiotherapist's visits, ECG technician's visits, drugs, linen charges, extra food or tea ordered to visitors, bed linen, and toilet paper, which cost the patient a fortune.
Those who are naïve to such undisclosed and concealed charges prior to surgery or come prepared only with sufficient funds to meet only the quoted 'package' amount simply become helpless and are thrown up against the wall at the end when they are faced with the final bill.
In unfortunate circumstances such as a patient's death during the operation or at the post operative ICU unit, and if the patient's family is unable to meet the final bill , certain hospitals have gone on record for not releasing even the corpse until hospital bills were fully settled. Apparently, since such inhuman practices and attitudes by money orientated hospital authorities have been exposed the state has intervened and made it clear that it is illegal to hold on to a dead body in a mortuary until the hospital bills are fully settled.
Three times a day the nurses kept walking into the writer's room to register TPR (Temperature and Pulse Rate), and to administer anticoagulant tablets to make blood thinner, drugs to lower the blood pressure, statins to regulate cholesterol level, pills to remove the excess fluid caused by congestive heart failure, as pre and post operative care. In this particular case, the author being allergic to aspirin posed a major problem. As a first priority desensitization had to be done prior to the surgery by gradually introducing aspirin in smaller doses and increasing its strength at every 15 minute interval until a full strength dose could be absorbed into the circulatory system without showing any allergic signs. This was regarded as clearing the first hurdle of the ' full risk' operation.
Day before the surgery an official from the accounts department of the private hospital visited the writer to advise that full payment covering the 'CABG' package was compulsory. It meant if he could not arrange it from his hospital bed in time, the operation would not have taken place!
Hospital referring to their past experiences insisted full settlement towards surgery beforehand. This attitude poses the ten million dollar question whether the hospital authorities were only hell bent in collecting money, rather than considering human life and patients' health care!
There are ample cases of dedicated surgeons performing operations without charging a cent from the poor, purely on humanitarian grounds, but it appears that certain hospital managements do not believe in what they term as 'charity.' Contrary to humanitarian deeds they rather employ representatives to various private clinics to canvass for heart operations offering 25 per cent commission on the hospital bill (author is personally aware of such an incident).
The surgery was scheduled at 3.30 p.m. The writer had heard many stories about people 'floating in the air,' and connecting with other worlds' during such life and death situations, but he experienced nothing of the sort while a major full risk heart surgery had taken place successfully.
After surgery the writer was transferred back to a private room to convalesce. During this short period nurses visited daily, dressed up lengthy lesions from ankle up to thigh area and the long incision on the upper thorax on a regular basis while a physiotherapist visited occasionally, made the writer blow into a lung expansion machine, took him on a gentle walk up and down the corridor for which extra charges had been included in the bills on an ascending order each day.
A few days later the writer contacted the relevant bank's Card Centre and obtained a detailed breakdown of discount levels agreed with the hospital on their promotion. On receipt of interim bills ("Rough Bill – Surgery") on a daily basis it enabled him to scrutinise charges and detect a variance where certain charges had been in a soaring order for the same service consecutively. He also noticed how the hospital authorities had completely ignored the discount facility agreed in the promotional agreement between the bank and them.
The 'Angiogram package' showed a breakdown (minus any discount for room charges), which carried an extra charge of Rs.78, 000, under a sub-heading called "Out of Package Charges”. The mystery surrounded further on the CABG charges where the hospital failed to give a detailed breakdown similar to that of the Angiogram package! What did thousands of rupees charged comprise? Did it include room charges, bed linen, administration charges (apart from the Surgeon's and the anesthetists' fees)? None of these were clearly explained or given a break down to account for the eight-day package. This is where the hospital earns a bad reputation referring to such actions as 'day light robbery.'
When the omission of discounts became crystal clear, the writer made a written enquiry with photocopies of all the bills to the hospital administration with a copy to the Executive of the bank who negotiated the bank/hospital package requesting an explanation and a breakdown as to how they could account for the discrepancies of escalating nature and of course what areas were covered by the CABG package.
The private hospital decided to remain silent for obvious reasons. They could not come up with any reasonable explanation for such flaws in their accounting system nor give a breakdown as to what consisted of the CABG package. The writer's determined efforts and exerting pressure continuously on the bank over a period of 2-3 months made the Bank Executive, who negotiated the deal with the hospital, to decide and calculate the discount levels according to their agreement with the hospital to honour their committed obligation. Yet, to this day the hospital has not been able to come up with a single response to the queries raised by the writer.
Innocent people visit hospitals when they fall ill or for a serious operation. In such circumstances should these voracious hospital sharks be allowed to play such outrageous games continuously forever? How many have become victims to such hospital embezzlers, while the timid community hesitates to throw challenges and put up with their losses and worries?
What needs highlighting in this article is the speed of realization of the situation initially by a team of doctors that it was a heart attack from a complaint of a stomach pain, and how quickly so many specialists gathered so speedily to sort out pre-operative problems in the local private institution and the surgeon, interventional cardiologist, physician, professor in allergy, all need to be mentioned with gratitude.
The senior surgeon diagnosed correctly because of inappropriate pain to the clinical signs in the abdomen- since ischemia pain is excruciating. He focussed his attention elsewhere due to blood pressure having rocketed to a hypertensive crisis levels. When the cardiogram was done - it was jackpot bull's eye. He found it as a heart attack with ST segment elevation in the electric tracing produced by the writer's heart. The following blood test Troponin too identified enzymes leaking out to the blood system from damaged cardiac cells.
This was a good surgeon's approach. Anyone would have given anti acid treatment Intra venous fluids, nil by mouth ordered on the phone and said 'I will see him in the morning round', and of course, the writer wouldn't have been living here today to write the story as no surgeon will come to see a patient until morning in a private or public sector. Or even a cardiologist!
In this particular case the writer not only got a sensible surgeon and a very clever cardiologist who saw him during the night. But as far as the Colombo private hospital charges are concerned the writer has his reservations.
Courtesy Ceylon Today 29 February 2016C
Tilak S. Fernando