Of the approximately 12,000 stents implanted last year, patients had to procure about 7,200 stents from outside while the rest were supplied from the hospital stocks.Till August last year, many patients were being persuaded by cardiologists in the hospital to buy DES at a cost of Rs 68,000 or Rs 42,000. By the last week of August, after complaints of overcharging and media enquiries regarding stents, doctors stopped recommending the Rs 68,000 stent.
Instead, now patients are being told that the stent costing Rs 42,000 is better in quality than the one that costs Rs 23,625.
Hospital director Sanjay Tyagi, who used to head the cardiology department, told TOI that the current head of cardiology V K Trehan was more familiar with the running of the department. Dr Trehan said the hospital did only about 500-600 angioplasties per month but claimed he was unable to give the exact figure of how many stents are used.
The manager of the Syndicate Bank branch inside the campus, where the hospital has an account, said the bank got about 20 slips daily for payment for cardiac stents."Every day, two or three of these slips would be for more than one stent. But these are for stents sold for Rs 23,625. Here, every payment is duly recorded with the name and details of the patient," said the manager.
Interestingly, hospital staff familiar with the cardiology department said that every day about 30 stents worth Rs 42,000 are implanted. "Patients are asked to make the payment at a chemist's shop outside Gate no.3 of the hospital. The agents of the stent companies who sit there collect the money.That money does not come into the official account of the hospital," said a staff member." So how are about 50 stents implanted in a day? According to the hospital staff, the doctors in cardiology work late into the night and cath labs stay open way beyond the regular hours.
In July 2014, the GB Pant hospital purchase branch issued an order stating that ceiling rate for DES was Rs 23,625 and asking all vendors of cardiac stents to submit their compliance to supply at this rate failing which they would not be allowed to keep their stents in the hospital imprest store. The earlier ceiling, effective since early 2013, was Rs 25,000 per DES.
If patients get the DES stocked by the hospital store, the payment is made directly to the hospital's account through the bank. However, many patients needing angioplasty are told by the doctors that the cheaper stents available in the hospital are of inferior quality and are being persuaded to buy Rs 42,000-stent from suppliers outside.
Most stents bought from outside are learnt to be the Xience brand of Abbott. Interestingly , Abbott sells three different sub-brands of DES under the Xience umbrella.While the price for the three varies, the company itself claim that they are identical products (see accompanying story). It is supplying one of these to the Maharashtra government for Rs 23,625.
"If the doctors prescribed the stent stocked in the hospital, they would not get any cut.They are helping the companies circumvent the system and loot the patient by persuading them to buy expensive stents from outside claiming that the patients demanded the more expensive brand," said a senior doctor familiar with the working of the system in the hospital.
With about 7,200 of the stents implanted annually being bought from dealers outside for Rs 42,000 each, it amounts to more than Rs 30 crore worth of stents. If we consider the price of hospital-provided DES, the amount overcharged on each stent would be Rs 18,375 (42,000-23,625) or over Rs 13 crore being looted from patients each year.
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