CGHS, DELHI – AN ANIMAL KINGDOM (JUNGLE RAJ) plus.google.com/+DrMAPadmanabhaRaoPhD/posts


It is common that when a person or a senior citizen becomes seriously sick, a member of the family or neighbor rush to a nearby hospital to save the patient’s life. For sake of reimbursement of the medical expenses, none would leave the patient on his or her own fate and run for prior permission from Chief Medical Officer (CMO) of CGHS and to seek admission in the hospital he recommends. Will the patient survives until that? What would be the patient’s condition by that time? The CGHS doctors are least worried. As a Ex-faculty member at AIIMS during 1964 to 1983, I ask my doctor colleagues whether these are the medical ethics taught in their colleges?
For reimbursement, CGHS laid down a condition that prior permission is required from CMO for permission to admit a seriously sick CGHS beneficiary in a Hospital as emergency case. It is understandable that a seriously sick patient cannot go to CGHS Dispensary to obtain the CMO’s permission for admission in a Hospital as CGHS patient. 
If the patient is serious sick, say, due to pancreatitis after 20 omitings and loose motions cannot go to CGHS Dispensary for CMO’s permission to get admitted in a hospital as CGHS patient and to get reimbursement of medical expenses. 
1. Notably, CMO or some other doctor in CGHS will not go to the residence of CGHS beneficiary to examine whether the person is really sick needing hospitalization. WHY???
2. No ambulance with stretcher facilities for emergency cases or sick patients to show to CMO for his permission.                                         
1. Naturally, patient’s close family member and a CGHS beneficiary, if not available, a neighbor has to go to CMO in CGHS office and obtain permission leaving the sick patient at home to die without any medical care. 
2. My question is how CMO can give a permission to admit a serious patient in a Hospital without looking at the patient and assessing the seriousness? Is CMO competent enough to judge professionally without any medical aid at hand, whether the patient is really sick and needs hospitalization? CGHS dispensary lack simple facilities like Oxygen cylinder to meet emergencies. WHY??? No ward boys are available to mobilize sick patients. WHY No nurses are available to handle sick patients to give injections, if needed in emergency. WHY? If CMO is qualified in MD medicine, can he judge seriousness of a pancreatitis case? If seriously sick CGHS patients are brought to CGHS dispensary, they would die there itself due to lack of adequate facilities. In such circumstances, as a medical teacher, I consider what CMO issues is a bogus certificate of permission. 
3. If such a bogus certificate is not obtained, CGHS objects and will give a hell to CGHS beneficiary and rejects medical bill that happened with my wife 6 years ago, when she was admitted in Artemis Hospital at Gurgaon. 
Medical facilities and patient care is still an animal kingdom ‘Jungle Raj’ in the capital of India, Delhi. Therefore, issuance of this kind of bogus certificate should be stopped immediately from practice in CGHS.
Second e-mail    
SECOND e-mail SENT TO 3 OFFICIALS OF HEALTH MNISTRY AT SECRETARY LEVEL AT DELHI on June 4, 2015                                                         I went to CGHS Dispensary at Janak Puri after 4 years because for senior citizens it is difficult to fulfill so many formalities to show to a specialist and to get medicines.  When I went to Janak Puri  on June 1st to handover file for reimbursement of expenses met for total knee replacement surgery for left and right knees, someone in the office told me CGHS of Vikas Puri was shifted to Vikas Puri. When I asked him where it was shifted, no change of address is displayed anywhere. WHY? Yet, he helped in saying, it was shifted near Columbia School in Police quarters. The  CGHS of Vikas Puri is located one km inside police quarters, with no facility for public transport. Once a patient reaches, no vehicle will be available for return home. So I had to walk one km to get a vehicle on 1st June 2015.
                                                                                                                                                                                                                      SEE HOW CGHS AT VIKAS PURI WORKS?                                                                                                                                                      I saw a lady working in administration transferred from janakpuri. ***She kept two legs on the opposite chair and answered that CMO sits in room no 7. When I searched for room 7, it was not CMO’s office. Again I returned to office and again enquired, where is CMO’s office? She said room no 1. After some time, an official suggested me that the file had to be submitted in duplicate and should be bound with cotton tag. The office does not have a photocopy machine. WHY? Why top CGHS officials do not visit Vikas Puri dispensary and ask the patients their difficulties? Why they neglect their minimum duty as responsible doctors?
This is the style of office CGHS office works at Vikas Puri.  So I have to walk to nearby market 1 km away at 77 years age just to get photocopy of the file, and to get the file tagged with cotton thread. 
                                                                                                                                                                                                                      When I returned with the file and a duplicate copy, an official told me that the file may return 2 or 3 times for two reasons. 1. Prior permission was not taken from CMO for operation. 2 Knee replacement is not an emergency case. 3. So after return of file 2 or 3 times, the file will be directed to a Committee.  In my previous e-mail, I have explained why the CMO’s letter can be treated as a bogus letter from the view of medical parlance. 
                                                                                                                                                                                                                      WHY ORTHOPEDIC CASES ARE NOT EMERGENCY CASES?                                                                                                                                   It is wrong on the part of CGHS to decide that no orthopedic case is an emergency case. It should be decided on the merit of the case. My wife, Leela Rao was bedridden for 3 months and shaky while trying to stand. I was also unhealthy at 78 years due to diabetes. When my daughter took her to an orthopedic surgeon, he did not immediately advice knee replacement surgery after physical examination of knees.   He first asked to get X-ray photos of both knees and MRI for spine. Only after looking at the X-ray photo (Roentgenogram) he said “right knee is badly damaged than the left, and surgery cannot be postponed for long”. It is he who fixed operation at Saroj Hospital at Rohini in Delhi- 85 on Ist May 2015. 
                                                                                                                                                                                                                     CAN THIS BE DONE BY CMO AT VIKAS PURI?
1. No ambulance is available at CGHS dispensary at Vikas Puri. WHY? 2. No wheel chair is available. WHY? 3. No ward boy is available to help sick patients coming by private vehicles or by any means. WHY? How CGHS expects an emergency case will come and will be shown to CMO for getting prior permission to undergo surgery at CGHS empaneled Hospital. WHY? No Oxygen cylinder is available in the doctor’s room. Why? If the patient develops any complications, no emergency medicines or facilities available to meet medical emergencies and to save the serious sick patient. Currently, simply one table and a chair are given to doctors. 
2. More importantly, orthopedic surgeon has not decided operation by simple physical examination of my wife’s knees, but only after seeing  X-rays, and the extent of damage done to the bones. 
3. How a CMO can replace an orthopedic surgeon and provide a prior permission certificate? There are no X-ray facilities at CGHS to decide whether my wife or any other patient needs operation at all and when. I hope CMO at Vikas Puri, who was not available on June 1st is not an orthopedic surgeon to decide whether she needs operation or not. If he is not MS qualified orthopedic surgeon, how can he issue prior permission for an orthopedic case? If he issues a certificate just to blindly follow rules laid down by CGHS, against medical ethics, is it not a bogus or false certificate? 
4. The surgeon who saw and physically examined  my wife is a competent surgeon who conducted numerous operations so best judge in deciding whether the patient needs operation or not and how early. How CMO, without having MS Degree in orthopedics and experience can provide a prior permission. Am I correct? 

5. WHO DECIDES TIMING OF OPERATION? SURGEON OR CMO?                                                                                                                     CGHS has empanelled some hospitals at Delhi, in which Saroj Hospital in Rohini, Delhi 85 is already an empaneled hospital for orthopedics. 

CHANCE FOR IMPROVEMENT:  Top officials in CGHS should permit patients to directly show in empanelled hospital without any need for prior permission. 2. Let the attending doctor in the hospital decide what to do, rather than doing remote control by CGHS just to show red tapism.
Be humane. If this happens to your parents after your retirement, what would be their fate?
Delhi 6
1 comment.

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  1. New Delhi 110018
    September 3, 2015
    I have personally submitted file on June 1st 2015 to attending CGHS doctor (probably her name is Dr Bhatia) at Vikas Puri, for reimbursement of expenses met for knee replacement surgery of my wife Leela Rao, No 88426 at Saroj Hospital, at Rohini and she has kept in steel Almira in her consulting room, but no receipt was given and was in hurry to go to RK Puram.
    Though 3 months are over, no reimbursement was made for huge amount due. Can anyone help me in Ministry of Health in knowing the status of the file?
    M.A.Padmanabha Rao, PhD(AIIMS)
    CHGS card No 88425
    114 Charak sadan Vikas Puri, New Delhi 110018, Mobile: 9871257964 or 8800153690