18th January 1998

Private Hospitals:

• The treatment: who cares?
• Profits too are important
• Doctors' dilemma
• Never good

The treatment: who cares?

By Farah Mihlar

At 10.30 a.m. a patient is rushed ino one of Sri Lanka's leading private hospitals with symptoms of a heart attack. The doctor at the O.P.D leisurely reads the E.C.G and confirms the patient is coming in for a heart attack. He says it is imperative that she is warded in the intensive care unit and not anywhere else. It is a Sunday but there is no vacancy in the ICU. The doctor lethargically checks other hospitals, but all ICU's are reported to be under maximum occupancy. Ten minutes later a bed falls vacant at the ICU and the patient is addmitted . A deposit of Rs. 5000 is collected and the patient (who is coming in for a heart attack) is kept waiting for at least another 15 minutes before she is wheeled in to the ICU. Though the unit is air-conditioned, maintenance appears to be poor. The terrazzo white floor is discoloured, and there appear to be flies all over. Outside the unit there are cockroaches . All this is part of a package that costs an average of Rs 1800 per day.

Private hospitals have come a long way in Sri Lanka. In the past few years, they have managed to take away a substantial quantum of the work done by the government sector while offering far more than what small nursing homes were able to offer. The hospitals are almost always full and boast of a wide range of services.

The standards of service at these hospitals however have failed to keep up with the reputation and the hype. In the recent past the services offered by private hospitals have come under severe criticism, and unlike other private sector organizations ,when it is a hospital the consequences of poor service could be fatal. Nursing is a critical problem faced by the hospitals. Patients accuse nurses of being inexperienced. The numerous stories which highlight this fact, though often humorous, raise serious questions about the competency of nurses under whose care the patients recuperate. One patient relates an incident about a nurse who was doing a blood test at a leading private hospital. She took the sample, blew her nose with her fingers, and then with nasal discharge on her hands, applied a sticking plaster onto the patients finger. Most patients interviewed by The Sunday Times claimed that the nurses lacked training . One patient accused a nurse at the ICU of clipping the wires of a "Lead'' or a heart monitoring machine incorrectly.

Another who was rushed to hospital with acute stomach aches caused by a Renal Colic, recalls how a nurse attempted to inject him with three strong pain killers at the same time, inspite of the doctor recommending only one ,while the patient was allergic to another. "Fortunately, I was conscious enough to realize what she was doing . I would have definitely died if I didn't stop it in time" he says.

"Courteous , helpful and a smiling face" were the few compliments the nurses earned from patients; not enough though to compensate for the lethargy and inefficiency more often complained of.

Comment sheets filled in by patients also draw attention to the lack of dedication on the part of nurses who prefer to chat at the nurses station or gossip on the phone, rather than attend to patients. Based on patients' comments in November, nursing took second place in the reference for standard of service, according to statistics documented by Nawaloka Hospital Pvt Ltd.

In the previous month nursing standards came in last place. The margin of difference however was a mere 10-15%

Nursing is a problem even to the management of private hospitals. Most private hospitals train there own nurses. However once they receive a qualification, most nurses go in search of greener pastures. Attracting people to the profession also proves difficult because it is a 24 hour operation that requires immense dedication, commitment and hardwork.

Another problem is that private hospitals dont reap the benefits of nurses trained by the government.

The issue is not whether these hospitals provide a quality service but more importantly whether the service they provide is worth the money paid?

At the general hospital for example even though nurses are often criticized, their behavior may be justified to some extent because the patients do not pay for their service. At private hospitals however, the same inefficiency and lethargy cannot be tolerated because the patient pays an average of Rs.200 a day for nursing.

Profits too are important

What is the priority of a private hospital? Is it to make money or provide a service? Profits are important says Mr. Wimelasena. If we are not profitable we have to close down he says, but adds that "if we do not give a good service we do not get customers which means bad profits."

The sole aim of a private hospital is to be a successful business and in the process of making money they have to compromise some services, says one doctor. Unlike the general hospital which functions on government budgetary allocations and foreign grants the private sector must depend on profits. "We are dependent on our turnover, if our turnover goes down we have to close down," says Prof. Chandresena.

Obtaining the profit and loss accounts of private hospitals is difficult because these are not released to the public. Asiri hospital however which is a public quoted company has declared a profit for this year.

"A private hospital is a profit making venture,''says Economic Analyst Nouzab Fareed. However expensive it may be to maintain a hospital continuos operations ensures profits ,says Fareed. Most hospitals however are in heavy debt which has been incurred in purchasing modernized equipment . Some of these hospitals are expected to become public quoted companies this year. Stock brokers say that both Durdens and Nawaloka have indicated that they intend to be listed on the Colombo Stock Exchange.

The real problem lies in the local system which fails to provide a criteria to measure upto the standards of these hospitals. The Health Ministry is expected to present a bill this year which will set up a board to monitor the standard of hospitals . The move has been welcomed by those in the field who feel that the hospitals will make a greater effort t to provide a better service. A strong regulatory body will also ensure that patients enforce their legal rights on hospital management's in case of negligence. Despite the many complaints there has never been a case filed against the management of private hospitals.

Cost is not some thing incurred only by the patient , the hospitals too have heavy expenses. Patients demand a good service which they deserve considering that the average bill a patient pays a private hospital is Rs. 10 000. The cheapest average daily cost would be Rs. 500. Hospitals are also managed at a massive cost. Prof. Chandrasena explains that from the minute a patient walks in to a hospital and is checked by a security guard until he leaves the hospital there are hundreds of people serving him all of whom have to be paid.The equipment these hospitals boast of costs millions of rupees. Machines are bought for millions and the expenditure is recovered by small amounts like 5 or 10 rupees, he says.

Despite the criticism the facilities the private hospitals offer could never have been met by the government sector. They have the most modernized equipment. Asiri for instance boast of Sri Lanka's most advanced laboratory, while other hospitals offer the latest X ray and scanning machines which are available for use 24 hours a day. They also provide security , luxury rooms and some times a friendly and courteous service. The private sector has become an essential part of the health sector . ''If private hospitals are closed there will be a severe crisis''says a government doctor.

Inspite of the rising cost of medical treatment at these hospitals they are always packed with people. This could mean two things. Either people have no choice but to go to a private hospital or that these hospitals offer a worthwhile service. The latter explanation is accepted by more people.

Doctors' dilemma

It is most annoying when you visit a doctor in a private hospital and he prescribes medicine with a cursory glance at you . This is a constant complaint made by patients who say they are dissatisfied over the amount of time a doctor has to give a patient even though the bill is often high. Doctors fees dominate an average patients bill.

Despite the fact that resident doctors or ward doctors are always there for the patient and do bulk of the work, they are paid much less than the consultants are paid. It is noteworthy that most doctors who do private practice work at government hospitals as well, where they have to put in eight hours of work a day. What is unjustifiable is that they give private hospitals half the time they spend at government hospitals and yet earn almost 8 times more than they do working for the government sector.

Most patients say they have to pay exorbitant fees to some doctors who are only willing to give ten minutes of their day. A doctor's practice depends on their reputation says Director Nawaloka Hospitals Ltd Prof., Lal Chandrasena. He argues that large numbers that channel doctors is an indication that even in a short time period allocated to each patient, they offer quality service.

Never good

"I have never taken a meal after seeing a piece of hair in my food" writes one patient in a comment sheet.

Cleanliness and quality of food undoubtedly earn the most amount of criticism at private hospitals. Having insects in your room and cockroaches outside the ICU is deplorable for the reputation of such hospitals.

An average hospital room in a private hospital that costs almost Rs .900 a day is small, dark and badly maintained.

The hospital rooms appear to have hardly been cleaned, the floor is discoloured and the walls look like they have not been painted for months. One patient who was suffering from bleeding ulcers had to spend the whole morning on a chair because the hospital staff refused to change the linen which had been continuously used for days. Bed sheets in X ray and scanning rooms are not changed for the entire day, while patient after patient lies on them. In almost every comment sheet at Nawaloka and Asiri Hospital cleanliness earned the comments "fair'' or "poor" but almost never "good.'

The quality of food served at the hospital is also reported to be of poor standard . However the hospital authorities strictly refuse to take the blame . They explain that even though the patients are asked to adhere to a special diet by the doctors, they expect the food to be tasty . Most patients in return argue that leave alone being tasty, the food is hardly palatable and in most instances they complain that the wrong meal is brought to the patient. "Patients expect a hospital to be like a hotel which is not the case," says Managing Director of Asiri Hospital Mr. Wimelasena. One lady however complains that simple aspects such as serving tea and soup hot are neglected.

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