How a Private Hospital in Delhi May Be Keeping Families Below the Poverty Line From Availing Free Healthcare

People move through the corridor of a patient ward at the Indraprastha Apollo Hospitals facility, operated by Apollo Hospitals. The government of India leased over 15 acres of land to Apollo at Jasola village near Delhi-Mathura road at the rate of a rupee one per month for 30 years. This was done under the condition that the hospital would have to provide a third of its indoor patients and forty percent of its outdoor patients with free access to medical facilities. Prashanth Vishwanathan/ Bloomberg/ Getty Images
14 September, 2015

On 12 September 2015, theDelhi government issued show-cause noticesto five private hospitals—Moolchand Khairati Ram Hospital in Lajpat Nagar, Aakash Hospital in Malviya Nagar, Max Hospital in Saket, Saket City Hospital and Irene Hospital in Kalkaji—for their alleged refusal to admit a seven-year-old boy who was reportedly suffering from dengue on 8 September. Following his death, the child’s parents committed suicide by jumping off a four-storey building in Lado Sarai, Delhi. Thenotice issued to these hospitalssought to know,“why an order of cancellation of registration of your nursing home/hospital should not be issued for refusing emergency medical care to the deceased child.”Less than a month ago, on 28 August, the directorate of health serviceshad issued an advisoryto all government and private hospitals, asking them “to ensure dengue patients requiring admission are not denied the same due to lack of beds.”

Private hospitalsare often given incentivesby the government in the form of inexpensive land leases on concessional rates under the stipulated conditions that these hospitals would provide a certain percentage of their beds for free to poor or indigent patients. However, as the case that prompted these show-cause notices has illustrated, these conditions are not always met. Ishan Marvel, a web reporter at The Caravan, investigates the story of one such patient at another private hospital, the Indraprastha Apollo Hospitals facility in Sarita Vihar.

Ten-year-old Fuzail Ahmad, first started showing signs of ill health in July 2015. “He would quietly keep repeating certain words, such as khaana, khaana, khaana—food, food, food—and his voice kept receding,” Mohammad Zakir, Ahmad’s father told me when I met him at the Indraprastha Apollo hospital on 10 September. “Then, his right hand and left foot began to get rigid. We showed him to some local doctors and we even tried an ojha (healer), but his condition became worse,” he continued. “Finally, he was diagnosed with brain tumour at Ram Manohar Lohia hospital [in Connaught Place, Delhi] last week,” Zakir said, before adding, “But we were told that he wouldn’t get good treatment there, so we came to Apollo.” On 8 September, Ahmad’s family brought him to the Indraprastha Apollo Hospitals in Sarita Vihar to get him treated under the free healthcare program offered by the hospital to families that are below the poverty line (BPL).  Instead, the family was shuttled back and forth between doctors for hours without any conclusive signs of treatment for Ahmad. Despite his condition, Ahmad was not given a bed for nearly ten hours after he reached the hospital.

“We reached [sic] around 10 am,” Ahmad’s cousin Shahzad Ali recounted, “and we were made to run around from one place to another. We discussed our case with so many doctors and hospital staff, but to no avail. All this while, Ahmad was on a stretcher in the lobby.” At around 1 pm, Ahmad’s family met Pervez Mohammed, a local businessman who first brought this case to public attention. Mohammed told me that he regularly helps poor patients get treatment at private hospitals. By around 2.30 pm, Mohammed started making calls to local journalists and politicians that he knew. According to Mohammed, at around 4 pm, a neurologist inspected Ahmad and said that his condition was very critical. The neurologist referred Ahmad to a neurosurgeon, who ordered that he be admitted to the Intensive Care Unit (ICU) immediately.

A member of Ahmad’s family told me that the hospital claimed that the ICU had no free beds. After the Out Patient Department closed at 6 pm, Ahmad was left to wait on a stretcher in the lobby. An official hospital record file was created and Ahmad’s family was told that they would be given a bed by 7.30 pm. However, no bed was allocated by then. Meanwhile, Mohammed had called Amanatullah Khan, the member of the legislative assembly from Okhla who belongs to the Aam Aadmi Party (AAP). A little before 8pm, Khan reached the hospital with Rakesh Sharma, the sub-inspector at the Sarita Vihar police station. “I think it was only because of them that Ahmad was finally given a bed around 8 [pm],” Ali told me.

Around twenty years ago, in 1986, the Delhi Government had called for proposals to build a super-speciality “no profit, no loss” hospital in the then-incomplete Player’s Building near Indraprastha stadium, that was lying vacant with its medical department. This hospital would have to provide a third of its indoor patients and forty percent of its outdoor patients with free access to medical facilities. Dr Pratap C Reddy, the chairman of Apollo hospitals, submitted a proposal to the government wherein he stated that the hospital would treat nearly 10,000 in-patients and over 30,000 out-patients every year. The proposal further stated that the hospital would provide 10 percent of its facilities free of cost; 10 percent of the facilities at a nominal cost wherein the patients would pay only for medicines and disposables; and 10 percent of the facilities at subsidised rates. This proposal was selected, and Apollo entered into a joint-venture agreement with the government, under which the government agreed to provide about 26 percent of the equity shared capital of the proposed company. The Player’s Building was eventually rendered unavailable and the Delhi government, according to a new agreement, leased over 15 acres of land to Apollo at Jasola village near Delhi-Mathura road at the rate of a rupee per month for 30 years. The hospital was partially commissioned in 1996 and under the new terms, the government’s contribution amounted to nearly Rs 39 crore. Yet, according to Mohammed,  “they won’t keep their part of the bargain to treat poor people.”

When I met him and Khan at his office on 9 September, Mohammed said that cases such as Ahmad’s are unfortunately far too common. “I was already at Apollo with another patient when Ahmad’s family approached me. I pressurised the staff and made calls to some journalists such as Ashutosh Kumar Singh [who runs the Swasthbharat Abhiyan—the Healthy India Campaign],” he told me. “See, for Apollo it’s a regular thing—there are so many similar cases—but yesterday was too much.”

Ashutosh Kumar Singh told me over the phone that on 8 September, he had called Angad Bhalla, the assistant manager for communications and public affairs at Apollo. Bhalla had then facilitated the appointment with Dr VB Gupta, the neurologist who first performed a check-up on Ahmad. Singh also called Satyendra Kumar Jain, the health minister of Delhi. “I talked to his personal secretary and he told me that he’ll convey the information to the minister,” he told me. Mohammed and Khan both confirmed to me that they received calls regarding Ahmad’s case from the health minister’s office that evening.

“As per MCI (medical council of India) rules,” Khan told me, “Hospitals need to maintain minimum standards as expected of a general ward, but Apollo has created separate sections for BPL patients with cramped beds and minimal supervision.”

Of the 710 beds at the hospital, 33 per cent—234 beds—are supposed to be reserved for BPL patients. Khan added that the hospital has 165 Intensive Care Unit (ICU) beds, of which 54 are supposed to be reserved for BPL patients—but that “they never give more than 20 to 30.” Mohammad continued, “Of all the beds meant for BPL patients, they have removed around 200 to make the “Platinum Lounge“ for VIP patients.”

Khan then called Dr RK Basaia, the nodal officer of Apollo. In 2009, the Delhi government created the post of a nodal officer, following an order by the Delhi High Court to ensure that Apollo complied with the land lease agreement. Basaia informed Khan that as of 8 September, the number of BPL patients in the general ward was 61, and 26 in the ICU.

Both Khan and Mohammed informed me that this was not all. In 2009, the Delhi high court had imposed a fine of Rs 2 lakh on Apollo hospital for not offering free treatment to the poor in compliance with the land lease agreement. The court order also laid down the guidelines for free patients, which are now prominently displayed next to the reception. In 2014, the Supreme Court issued an interim order asking the hospital to stop charging BPL patients for treatment. However, Mohammed claims that none of these directives were ever followed and that “it’s still going on.” “They charge around 20 percent [of the cost] for tests and 100 per cent [of the cost] for medicines,” he said. According to the financial reports on their website, Apollo recorded a profit of Rs 3249 lakh for the last financial year.

I asked Ali if Ahmad’s family had incurred any cost on the treatment. “They [Apollo] asked us for Rs 10,000 as security,” he said. “Then, Rs 10,000 more for a couple of tests. Since then we have been buying expensive medicines and other equipment, which comes to around five or six thousand more.” Showing me the receipts, Zakir added, “They have already done one MRI [magnetic resonance imaging test], now they want to do another, along with a biopsy report.”

A senior official at the hospital refuted Mohammed and Zakir’s claims, saying that Ahmad’s case was not an emergency and that he was “stable, not critical.” “He was shown to three specialists. There was some delay because the neuro-specialist was in the operation theatre. The boy needed surgery. Something like that needs to be planned,” the official continued, before adding, “We have a lot of patients and limited beds, but Ahmad got one on the same day, didn’t he?” The senior official also refuted the claims of expenditure made by the family, saying that in Apollo, treatment for BPL patients is “completely free.”

On 10 September, when I went to Indraprastha Apollo hospital, I accompanied Zakir and Ali to the sixth floor of the hospital to the ward where Ahmad was admitted. The ward contained four other beds, and an attached bathroom and toilet. Ahmad lay on a bed toward the centre of the room. His body and face seemed to be contorted, but when I approached him, he smiled. A middle-aged man was sleeping on the adjacent bed, separated by curtains. His relative told me that the family had come from Bareilly in Uttar Pradesh, and like Ahmad, they had to wait for 5 or 6 hours before getting a bed. They did not, however, fall under the BPL category.

On the same day, I visited Sarita Vihar police station, right across the road from Indraprastha Apollo hospital, to meet sub-inspector Sharma. Mohammed had mentioned to me that on 8 September, he, along with Ahmad’s family, had spoken to the police and that there would be a First Investigation Report (FIR) against Apollo. When I asked Sharma about the FIR, he said there would be none since there are no criminal charges. “What sections do we put in the FIR?” he asked me. “There was a complaint, but it’s an internal matter for the hospital, and they’ll take care of it. On our part, we sent a letter to their concerned administrative officer and well, the child has a bed now. Yes, if something wrong turns up [sic], then maybe we’ll file an official complaint.” Sharma claimed to not know the name of the administrative officer to whom the letter was addressed. He then gave me the phone number of sub-inspector called Nagendra, saying that he would be able to help me with further details. However, when I called him, the sub-inspector said he had never heard of the matter.

At the hospital, I visited Bhalla in his office. I asked him if he could give me any data on the number of BPL patients the hospital had treated over the past few years. Bhalla told me to mail my queries to his official email address, assuring me that he would respond the same day. The next day, I called Bhalla around 1 pm. He told me that the queries had been forwarded to the “concerned departments” and that I would get a reply as soon as possible.

I asked Mohammed if he had any information on the number of BPL patients at Apollo. He informed me he had filed an application under the Right to Information (RTI) act to find out the exact number and was expecting a response soon. Singh said that “according to sources at the hospital, only 1500 BPL patients had been registered since 1996.” He too intends to file an RTI application for the exact numbers and guidelines soon.

On 12 September, Bhalla called to inform me that Ahmad had been operated upon and that he was doing well. “You can call his family and confirm,” he confidently said. I thanked him and asked him about the data regarding the BPL patients that I had requested for. His answer hadn’t changed, “We are still trying to find them.”