Pay per patient

Kathmandu’s private hospitals continue to bribe ambulance drivers to bring in sick-patients with an intention to extort them through their expensive treatment.

PRAMOD ACHARYA- Centre for Investigative Journalism

 

A year and half after CIJ’s investigative report (http://nepalitimes.com/article/from-nepali-press/Pay-on-delivery,1423) exposed hospitals who bribe ambulance drivers to bring in sick patients, nothing seems to have changed. Our follow up to the same story this year, now reveals that such practice has actually become more rampant in hospitals across Kathmandu.

“Of course you will get commission, that’s how it works. You bring patients, and take your cut,” Sandip from Blue Cross Hospital told this reporter posed as an ambulance driver.

Our investigation found that the hospitals are keen on taking in severely ill patients who are more likely to be hospitalised in Intensive Care Unit(ICU) for longer periods. Hospitals like Blue Cross prefer patients who are required to be kept under ventilator care, so that they can be charged more. We found, ambulance drivers bringing in patients in such critical conditions, from districts outside Kathmandu, negotiate higher rates.

Even doctors were found to be closely involved in such dealings, since they are consulted by the hospital staff about the condition of the patient and for how long the patient is likely to be hospitalized, before the commission rates with ambulance drivers are negotiated.

Although, this unethical business has been going on for many years, neither the regulatory bodies including Nepal Medical Council and Health Ministry, nor local authorities including police or district administration office who issue permit to ambulances have stepped in to take action.

Most of the ambulance drivers negotiate the deal over the phone while some hospitals, who are more cautious about such dealing prefer meeting the drivers in person. “Some hospitals have agents in place to strike the deals but in most cases hospital staff or the doctors themselves deal with us,” an ambulance driver told us on the condition of anonymity.

The ambulance drivers are either paid a negotiated lumpsum upon bringing the patient or given a certain percent commission from patients’ total hospital bill.

We learned City Centre Hospital in Kalanki pays a negotiated lump sum confirmed by the hospital’s marketing staff Shankar Lama. “Bring us the patient and we’ll pay you 15,000 rupees,” he instructed over phone. Similarly, Basanata Khadka of Vayodhya Hospital offered, “How about we pay you a certain percent from the patient’s hospital bill?”

Kathmandu’s renowned Norvic Hospital was also found involved in trading of patients. The hospital’s deputy General Manager Hanuman Golchha offered to pay the ambulance driver around 6000 rupees for delivering each patient.

“Hospital officials sweet talk us into bringing patients promising us high rates on the phone, but they usually don’t give us more than five thousand rupees,” says AlokThapa, an ambulance driver who has brought patients to several hospitals in Kathmandu after such negotiations. “Megha Hospital calls me up regularly,requesting me to bring in patients,” he adds.

According to Dr. Rajesh Kishore Shrestha, Treasurer at Association of Private Medical and Dental College of Nepal, concerned hospital management should be held accountable for such unethical practices.

However senior doctor and Chairperson of Nepal Medical Council, Dr. Dharmakant Baskota says that the council does not look into the management’s malpractices, but will seek clarification from doctors if they are found involved.

Audio conversation

Recorded conversations between the undercover journalist and management staff at various private hospitals in Kathmandu:

City Center Hospital, Kalanki

Shankar Lama: Hello! Are you bringing in any patients today?

Journalist: Yes, who’s speaking?

Shankar Lama: I am Shankar Lama, and I look after marketing department here.

Journalist: What are the rates sir?

Lama: How much do you want?

Journalist: I bring patients regularly, looks like this one will be hospitalised for long.

Lama: We will give you the going rate,10000 rupees.

Journalist: There aren’t many patients these days, can you pay more?

Lama: Okay, tell me how much? We’re like brothers, don’t hesitate, our rates won’t disappoint you.

Journalist: How much will you add more?

Lama: 12K

Journalist: How about 15K?

Lama: Done.

Janamaitri Hospital, Balaju

Fatteh B Chaudhary: Hello!

Journalist: Hello Chaudhary sir, the woman I just talked to said I will be paid only three thousand.

Chaudhary: Yes that’s what I told.

Journalist: Can you pay more? The patient will be hospitalised in the ICU, for long.

Chaudhary: Where is the patient from?

Journalist: Chitwan.

Chaudhary: Okay,bring the patient and we will renegotiate the rates.

Journalist: 3000 rupees is too less.

Chaudhary: Well, the patient may be hospitalised for long, but we will first have to see where the patient will be referred to after being admitted into ICU.

Journalist: The patient will remain there for long, and will not be referred elsewhere.

Chaudhary: Bring the patient here first and then we can talk.

Journalist: But 3000 just isn’t enough.

Chaudhary: We can add in another couple of thousand.

Journalist: Seven or eight thousand would work.

Chaudhary: Five.

Journalist: Let’s call it a deal at six. This patient will stay for a long period.

Chaudhary: We don’t give more than four,not even to those bringing patients from Nepalgunj. Bring the patient and meet me.

Journalist: I hope it isn’t less than six.Where should I meet you?

Chaudhary: At the accounts section, I am the accountant here.

Norvic Hospital, Thapathali

Journalist: Hello is this Hanuman Sir speaking?

Hanuman Golchha: Yes, who  are you?

Journalist: I am bringing a patient from Chitwan. I had called earlier and talked to someone there who told me to talk to you.

Golchha: What is it about?

Journalist: I want to negotiate the rate for the patient. This one is going to be in the ICU for long.

Golchha: Tell me the rate and I will inform the people here for the payment accordingly.

Journalist: How much will the hospital pay? Last time I was paid a lot less than what was promised.

Golchha: I haven’t paid anyone before. Why don’t you come here first and then we will talk.

Journalist: Ankit sir paid me a lot less last time.

Golchha: How much?

Journalist: I had asked for eight thousand, but he gave me only four thousand rupees.

Golchhha: Eight thousand won’t be possible.How about six thousand?

Journalist: Can’t you pay more?

Golchha: How about you bring the patient and we will negotiate.

Journalist: Should I meet you at the hospital?

Golchha: I will be informed as soon as the patient is admitted. I will instruct the counter to make you a payment then.

Journalist: Ok.

Blue Cross Hospital, Tripureswor

Sandip: Hello.

Journalist: I am bringing in a patient.

Sandip: From where?

Journalist: Chitwan.

Sandip: Ok. I am the person you need to talk to.

Journalist: Stomach related ailment, probably needs to be admitted into ICU for long.

Sandip: Bring the patient first. By the way, who are you?

Journalist: I am the driver. How much will I be paid?

Sandip: Don’t worry about the payment. You’ll be paid suitably. We can negotiate the rate.

Journalist: How much?

Sandip: If the patient is admitted into ICU,we won’t pay you less than others.

Journalist: I wasn’t paid as promised last time.

Sandip: Get in touch with me and the money won’t be a problem.

Journalist: First tell me how much?

Sandip: Will the patient need a ventilator?

Journalist: I don’t know about that.

Sandip: Bring the patient and we will decide, but it won’t be less than five.

Journalist: I hope I will be paid what is promised.

Sandip: Don’t worry.I will look into it.

Alka Hospital, Lalitpur

Journalist: Hello Kumar sir.

Kumar Thapa: Yes.

Journalist: I had called the reception desk earlier.I am bringing a patient from Chitwan.

Thapa: What is the case?

Journalist: Stomach related, I don’t know the details.They want to come to Alka, I am the driver.

Thapa: Okay then call me after you get here.

Journalist: And the other thing.

Thapa: Can’t talk about it over the phone.

Journalist: I understand, but last time I wasn’t paid as promised.

Thapa: I can’t make you promises on the phone. Bring the patient first and then call me.

Journalist: Hope you’ll pay properly this time.

Thapa: Sure.

Shivajyoti Hospital, Balkhu

 

KeshavTimalsina: Hello, who’s speaking?

Journalist: It’s me Dipak from Bharatpur. I am bringing in a patient who might need ventilator and wanted to ask how much you’d pay?

Keshav: We’ll see once you get here.

Journalist: It’s expensive bringing the patient during fuel crisis. So, tell me how much will you pay first.

Keshav: Can’t tell you on the phone.

Ganeshman Singh Hospital, Mahalakshmisthan

GovindaGhimire: Hello

Journalist: Hello sir! I have a patient here who needs to be admitted to ICU, will probably be hospitalised for long.

Ghimire: What’ s the case?

Journalist: Stomach related.

Ghimire: Where are you?

Journalist: I am at Bharatpur Hospital, will leave in few hours.

Ghimire: Sure.I will make the arrangements once you get here.

Journalist: How much?

Ghimire: What rate do you charge?

Journalist: Depends, anywhere between 10,000 to 15,000 rupees.

Ghimire: We will make the full payment only after the patient is discharged. For now you’ll be given 3000 rupees upon delivery.

Journalist: That’s too less. How about we call it a deal on 10,000 rupees.

Ghimire: That won’t be possible.

Journalist: Pay me five thousand for now and give me the remaining sum if the patient stays for long.

Ghimire: Bring the patient first. We will have to talk to the doctor before deciding anything.

Journalist: Hope it wont be less than five?

Ghimire: Don’t worry, just bring the patient.

Vayodhya Hospital, Balkhu

Journalist: Is this Basanta Khadka speaking?

BasantaKhadka: Yes.

Journalist: Sir, I had called earlier and was asked to call you about the payment.

Khadka: Is it your first time here?

Journalist: I have been there before but the payment wasn’t as promised. So, I just wanted to make sure before arriving.

Khadka: Bring the patient first and then we will decide about the payment.

Journalist: The patient will be admitted in the ICU and will probably be hospitalised for a long perid.

Khadka: How about we pay you according to the patient’s bill? It will be more beneficial to you. If the bill exceeds 100,000 rupees you will get at least 10,000. This is how we build relationship.Save my number and keep in touch.

Journalist: So how about 10,000 for now or maybe 10 to 20 per cent of the bill?

Khadka: That’ll be difficult, since we also need to pay the doctors.But you won’t be disappointed by our payment.

Journalist: Okay.

Khadka: Bring the patient and keep the patient’s name with you.

Journalist: Okay sir, I hope I to get the money when I return tomorrow.

Khadka: Sure.

Journalist: If the bill is around 2 lakh rupees, I hope you will give me 15-20 thousand rupees?

Khadka: Don’t worry, we will make arrangements accordingly. Minimum 10-12 thousand.

International Friendship Children’s Hospital

Journalist: Hello, is this Friendship Children’s Hospital?

Reception: Yes

Journalist: I am bringing a patient from Chitwan. Is the ICU available?

Reception: Which ICU?

Journalist: Need it for a 13 year old patient.

Reception: Is it a hospital’s referral? Does the patient need to be kept in a ventilator?

Journalist: Not sure, I am the driver.

Reception: Just a minute, I’ll transfer the call to the doctor.

(Call transferred, doctor on the line)

Journalist: Hello

Doctor: Yes, what’s the case?

Journalist: I don’t know exactly.I am the ambulance driver. The patient will be transferred soon,so I wanted to know whether or not the ICU is available.

Doctor: Where is the patient from and how old is the patient?

Acharya: From Chitwan, must be few years old.

Doctor: Yes the ICU is available.

Acharya: So, whom should I meet there for the payment?

Doctor: The cash counter will take care of it. Tell them you are the driver, they’ll understand.

Acharya: Okay

(Conversation with the person at the cash counter)

Cash counter: Hello.

Journalist: I am the driver, and I just talked to the doctor about bringing a patient from Chitwan.

Cash counter: Did you talk to the doctor?

Journalist: Yes, but I want to negotiate the payment first.

Cash counter: Our rate is 5000 for ICU case.

Acharya: Is that all? With the blockade, you know how difficult it is for us.

Cash counter: Yes, but that is our rate.

Acharya: Who should I meet there, your name?

Cash counter: I’ll be here at the counter.

Acharya: Okay

HAMS Hospital, Buddhanagar

 

Kumar Ghimire: Hello!

Journalist: Hello Kumar sir. I am the driver and I am bringing in a patient.

Ghimire: What’s the case?

Journalist: Stomach related, will probably be in the ICU for long. I want to know how much I’d be paid before bringing the patient over.

Ghimire: We will pay you based on how long the patient stays.

Journalist: It’d be better if we could decide on the rate now.

Ghimire: Six hundred rupees for local patients and one thousand rupees for those from outside Kathmandu.