Robbing Peter to pay Paul seems to be an art perfected by the Brihanmumbai Municipal Corporation (BMC) - on the one hand, it is hiring private consultant doctors at an exorbitant cost of Rs 2,00,000 each per month; while, on the other, it is unable to pay the salaries of its own doctors and medical staff employed at the 16 civic peripheral hospitals for the last six months.
The BMC had invited 186 private doctors with six to eight years of experience to teach Diplomate of National Board (DNB) courses to post-graduate medical students at six of its peripheral hospitals, of whom about 20 senior doctors were appointed as medical consultants. Junior and senior consultants are paid Rs 1.50 lakh and Rs 2 lakh per month, respectively.
The policy was supposed to reduce the load on the four tertiary BMC-run hospitals – King Edward Memorial, Dr R N Cooper, B Y L Nair and Sion Hospitals -- so that the students of the three-year specialisation course — could provide treatment at its peripheral hospitals. The BMC had hired specialists for fields such as medicine, surgery, gynaecology, paediatrics, orthopaedics, anaesthesia, radiology and ENT, among others.
The move was expected to reduce the number of critical patients referred from a peripheral hospital to a tertiary care centre for treatment and thereby help patients receive life-saving treatment in time. More than 40 per cent of patients from the BMC’s peripheral hospitals are referred to major civic-run hospitals such as KEM, Cooper, Nair and Sion, for want of specialists at its peripheral hospitals.
The super-speciality doctors hired by the BMC, to teach DNB to post-graduate medical students at the six peripheral hospitals — Rajawadi Hospital, Bhabha Hospital in Kurla and Bandra, V N Desai Hospital, Bharat Ratna Dr Babasaheb Ambedkar Hospital (Shatabdi Hospital) in Kandivli and the Pandit Madan Mohan Malviya Hospital in Govandi — are available for a few hours and usually never available during emergencies after 3pm and weekends. “Most super-speciality doctors have thriving private practices which they prioritise, neglecting their duty to BMC hospitals. It defeats the entire purpose of hiring them to reduce the load of the main hospitals, and these peripheral hospitals end up referring patients to Nair, KEM, Cooper and Sion Hospital,” rues an irked resident doctor at the BMC-run Rajawadi Hospital in Ghatkopar.
A case in point is that of a consultant anaesthetist, Dr Reena Debu, at Rajawadi Hospital, who has not attended a single case since her appointment as a super-speciality consultant last April but continues to draw her monthly pay of Rs 2,00,000 at the cost of the anaesthetist on the BMC payroll. Rajawadi Hospital is forced to call an external anaesthetist on the list of those approved by a BMC panel and pay them separately for each case. In many cases, patients are referred to other hospitals citing the lack of an anaesthetist even for routine surgeries. “It is a double whammy for funds-starved BMC hospitals, which must pay outside doctors and also pay consultants exorbitant fees while our own staff salaries are pending. It defeats the purpose of reducing the load at the tertiary hospitals,” explains a senior staffer at Rajawadi Hospital.
At the BMC-run V N Desai Hospital in Vakola, it is a repeat of the same story. ENT surgeon Dr Amrapali Kenny was appointed as consultant last year but most times, she is not available and doctors have to refer critical and emergency cases to another BMC-run hospital -- Cooper – in Vile Parle. Ironically, one of the criteria for hiring the doctors was their proximity to the respective hospitals so that in emergencies, they could be called on duty immediately.
Interestingly, the DNB course is not recognised in any of the BMC hospitals and yet, consultants are handsomely remunerated to teach a non-approved course to PG students.
Another glaring anomaly that has come to light is the appointment of senior specialist doctors appointed at the four tertiary hospitals on an ad hoc basis, at a cost of Rs 75,000 each per month, who quit these positions to join as consultants elsewhere at thrice this amount and without any restriction on their private practice.
A senior orthopaedist, Dr Virendra Agrawal, appointed at Somaiya Medical College on an ad hoc basis, quit and joined the BMC Shatabdi Hospital in Govandi as a senior consultant with higher pay and the freedom to continue private practice.
“Super-specialist consultant doctors at peripheral hospitals not only do clinical work but also academics and research, adding to the manpower of the BMC hospitals for positive outcome in medical care. Payscales for contractual doctors are decided by the hiring committee, based on the formers’ experience and academic qualifications, which adds value to the peripheral hospitals in terms of academic faculty for post-graduate students,” said Dr Virendra Agrawal.
“Our main intention is to strengthen the peripheral hospitals, which are the first line of treatment facilities. This will help us lessen the workload in major hospitals and also help in saving more lives,” Additional Municipal Commissioner (Health) Suresh Kakani had claimed in April 2021, when hiring these super-specialist consultants.
The BMC plans to gradually increase the number of seats for students and expand the teaching faculty to produce more specialists every year, to help bridge the gap between patients and specialist doctors in peripheral hospitals.
The first proposal for super-speciality consultants was approved in the BMC’s annual budget for 2020. The consultant doctors would be responsible for providing students with lessons in theory and practice and would also be involved in treating patients, the rules framed by the hiring committee explicitly state.