The Cost of Social Service – A Closer Look at the Tata Memorial Scam

Here are the stats: Rs. 80 crore is what Tata Memorial Hospital (TMH) spends on cancer-related drugs annually. They buy this medicine at a subsidized rate (upto 30% less than market price) and sell it at cost in their basement dispensary. Hundreds of people – from all over South Asia and spanning the cross section of society – wait in distress for their case numbers to be called out so that they can collect the drugs and rush back to the patient they are attending. They wait in stifling heat, with almost no accommodation to sit, and without any cellular signal for sometimes up to 3 hours for these drugs that might a) have a discount of only 2-5% or b) are not there at all. Yes, sometimes you have to wait a couple of hours before they call your case number and say that they don’t have it. You should see the desperation and defeat on some of the faces. Please note that these are the attendants of the cancer-afflicted patients we’re talking about. Imagine the state of the patients.

Anyway. Here is the question—

How is it possible that a hospital that spends Rs. 80 crores a year on meds a year, notch up a drug pilferage and sale scam to a tune of Rs. 100 crores involving only 6 people who work here?

The CBI says this has been on for ‘a few years’. For argument’s sake let’s make an assumption that this figure is 5 years. 5 years is a respectable amount of time to not get caught. So essentially, at an average, 20 crores has been filched every year.

That is:
•    25% of the amount that TMH spends on buying drugs
•    25% of drugs missing from the shelves of the dispensary
•    25% patients denied medicines or, another way to look at it, all patients denied 25% drugs at subsidized rates
•    No. of surgeries annually: About 9,000
•    No. of patients at TMH OPD daily: 1000

That’s hundreds of thousands patients suffering from cancer. Most of these patients are so poor, they can barely afford to get to the hospital in the first place. TMH promises free treatment (surgery and drugs included) to those who can’t afford it. TMH says that 70% of its patients are treated free, a claim that should be questioned further. People pour in from everywhere, notably the east. Of course, it is an insanely difficult process to actually qualify for free treatment, but what hope are these people living on anyway? Their families can’t afford to book a room in a hotel or even a seedy ‘lodge’ (there are several in the area catering to exactly this clientele) so they rent a 6×4 space on the pavement opposite the hospital for a ‘price’ paid to some enterprising Mumbaikar. They sleep, cook, live here while their loved ones – already suffering from a possibly fatal disease are trying to overcome a scary-looking general ward and OT redtapism that delays surgery.

Medicines from the dispensary – indented by the nurses – have turned up at the bedside of patients packaged as if new but empty inside. And these are medicines that are paid for by the patients in the private ward. What are the ‘free’ patients getting? No amount of logic or cajoling can convince the authorities to get replacement drugs for the damaged/missing goods. It is your bad luck, they say. You got to buy them again. And cross your fingers and hope they haven’t been sold to pharmacies on the outside. It’s sickening.

There are notices plastered all over the hospital walls asking people not to bribe staff. You wonder about that – what could the bribes be for? A bed? A quicker ticket to the OT? Just being accepted as a patient? Probably all of the above. And the notices prove the prevalence of the practice. But that’s another story. 100 crores? That’s just a whole new level.

Again – How is this possible?

If you have been to TMH at any point in the last year, you would know that there is always, always a posse of cops and police van posted in the driveway. There is no going in or out the main entrance without dodging the nakabandi barricades. Of course, given the sheer number of people (sick and attending) entering and exiting the building and the stress levels of the guards at the door, all you really need to do is wear a white coat and you’re all but invisible to all authority.

How is it that no one but 6 people – four pharmacists, an office-in-charge of the dispensary, and a clerk – are involved in cheating the hospital, patients, their families, the government, and the dignity of human beings? One would imagine it would take a lot, lot more. Could the Director of TMH, Dr R A Badve be blind?

What about the ones immediately under him? All blind? The cops who’re fanning themselves outside? The other people working in the dispensary (they’re a close-knit family, I assure you – laughing and joking in their AC section as people’s faces jam against the glass counters, staining them with sweat)? What about the doctors, the nurses, the politicians? It is important to note that TMH is not a private hospital but one under the aegis of the state government. What about the pharmacies that the drugs are sold to? Who are they in cahoots with? It’s hard to imagine almost Rs. 5.6 lacs (20 cr / 365) worth of drugs are hauled by 6 people in the dead of the night and distributed to various locations across the city on a daily basis. Where is the network?

And how did this information leak to the CBI after all these years? My theory is that one of the higher-ups didn’t get their ‘cut’ and in an act of retribution, decided to spill the beans.

The 6 people named had already been investigated in 2008, duly suspended, but reinstated within a few months! Topping this, the CBI has said on record: “Whenever these instances were being probed by the hospital’s own vigilance department, either the operations were stopped or the officials transferred,”

And we are to believe that only 6 lowly employees are the cause for this?

The modus operandi is even more stomach-churning. The drugs are charged to paying patients or attributed to dead ones. Patients, most who’ve lived in poverty and spent their last few months in pain fighting cancer, help fill TMH employees’ pockets and find no dignity even in death. Is this the price of hope?

Corruption in the health sector is not uncommon. Since independence, the system has allowed – perhaps even forced – doctors and associated staff of government hospitals to moonlight. And that’s being euphemistic. Public hospitals from the smallest towns to the prestigious TMH allow for patients to be cheated monetarily and denied basic healthcare. But it’s one thing to charge a consultation fee when you aren’t supposed to, and quite another to make a 100 crores off the dead and dying.

If you think that’s crossing the line, think about all those people who were duped and didn’t get the drugs on time. As we have seen, even paying patients are defrauded; how expendable are the ‘free’ ones? How many people died waiting for drugs or timely treatment? That’s the number that scares me. That’s the number that should wake people up.

This is not just another scam, this scam has cost lives. There is no line for the crooks.

PS – I’ve spent a major part of last two months attending to my ailing grandmother in TMH. I’ve stood in those endless queues at the dispensary and seen the plight of patients who’re hanging around for days waiting for an overdue surgery; she has received medicine bottles with nothing in them and has suffered a taxing time in this hospital that has no heart. And all for nothing: her surgery was a failure and they couldn’t fix her. The only thing giving her temporary comfort now, she says bluntly, is “being out of that goddamn hospital.”