India's Tendulkar Syndrome

The news that cricket star and MP Sachin Tendulkar lobbied with Defence minister Manohar Parrikar to settle a dispute between his friend’s retreat in Landour and a defence institute over an ‘illegal’ construction is symptomatic of Indian psyche that believes that rules are flexible and can be tweaked if only the powers-that-be are spoken to by someone high and mighty. This syndrome typifies our national collective unconscious which believes rules are for the aam aadmi – for whom the arm’s length system is inviolate – not so for the well-placed, the well-connected and the networked.

It is a different matter that the Raksha Mantri Manohar Parrikar declined to intervene, which is indeed commendable, given the way things get done – as exception – by dubbing it as a one-off (and not to be quoted as a precedent!) with some vague reason thrown in as justification and for future record. But what’s disturbing is: why do icons like Sachin Tendulkar, a Bharat Ratna awardee, stick their necks out to invite opprobrium from their countless fans? Is it worth it when it’s ex facie wrong?

Around the time when we joined the civil service in late-1970s, the oft-heard remark was Show me the Man and I’ll show you the rule! In no time, this changed to Show me the Man and I’ll rewrite the rule! Such was – still is – the fungibility of rules! Far from being ashamed with the nature of nepotism, apologists of this model bemoan that today’s India resembles the Gilded Age of US – alluding to the second half of 19th century when, although the economy grew at the fastest, it paradoxically was the high noon of scandal and corruption with rich industrialists like Rockefeller, Carnegie, Mellon, and Vanderbilt dubbed ‘robber barons’ – an inevitability in a nation’s life, which with passage of time and maturing of democracy would be a thing of the past.

Little do we realize that history does not repeat itself in entirety but mostly in profile; and another nation needn’t go through the same processes since the inexorable forces of history throw up not only a dialectic of change based on lessons learnt but also simultaneous dialectic of change brought forth by technological changes, which in times now has leaped phenomenally. Playing catch-up is a lot faster in today’s world, and given the willingness, lessons learnt can be cloned literally in a nano-second – so connected the world is thanks to the world-wide-web! This, coupled with the fact that citizens have wised up with relentless real-time information hitherto denied them much as the increasingly strident media have, issues of nepotism, favouritism and crony-capitalism occupy public domain as never before. As citizens take up cudgels on perceived wrongs and with the rule of law resonating more and more, what we see today is a new dialectic: conventional, nepotistic norms of biradiri inclined to selective circumvention of rule versus uniform application of rule of law for all citizens.

While the old order refuses to accept the change, the new social order emboldened with hope of a better tomorrow via openness and technology refuses to go the beaten path. What we witness today is a battle of these two. The old order/mindset won’t give in easily, the new order having glimpsed the benefits they realize is rightfully theirs, won’t give up either. What’s inevitable is a battle of attrition – a seething, lacerating battle – where wrongs join hands and indulge in Orwellian shibboleth to paint the right as wrong and the wrong right and where the pot calls the snowflakes black! Yet, in today’s democracies, neither can the spoils system (read nepotism) nor the robber barons (read corruption) make a comeback without citizens raising their voice of disapproval. No right thinking government can risk such misadventure.

Yet in the interstices of this dialectic are efforts made with some getting reported. Thankfully, we’ve none of the compulsions of the American Gilded Age or the long shadows of Tammanyism that were born when the world was decidedly opaque. What though stays is human pathological greed and possessive acquisitiveness. The lack of transparency in body politic and administration in implementation of rules and regulations is a cause of concern. How else is one to explain the proclivity of an icon to make a request to bend the rule? In today’s time when with burgeoning urbanization the pressure on land is staggeringly high (remember Sukhna & Adarsh land scams!) and with the Ministry of Defence with 17.54 lakh acres under its charge the largest land bank, the need for an inviolate land policy and execution cannot be overstated.

Not just that. From time to time there have been alleged irregularities in gross mismanagement of defence land and government buildings built on them, such as Services’ messes in sundry cantonments, which far from being located in the periphery of cities they once were, are upscale today in rapidly growing urban megalopolises. To compound the issue, far from leveraging Government dues from commercial exploitation of defence lands/buildings, even legitimate government receipts are siphoned off to non-governmental funds. The haemorrhaging of such revenues is humongous and doubtless the nation cannot afford this, when it can be used for developmental activities such as Smart Cantonments, an appurtenant of Swachh Bharat, and sustainable development of Smart Green Cities. It is intriguing that such illegalities on specious grounds have persisted. How else is one to countenance diversion of rightful government receipts as license fee to Non-Public/Regimental Funds that clearly belongs to Caesar? The loss can easily tot up to hundreds of crore of rupees annually.

This, despite, the fact that the issue of irregular diversion of Government revenue to non-public funds had come under scathing criticism from Parliamentary Committees; as per media report, in 2013-14 the Public Accounts Committee had severely criticized and directed the Ministry to formulate a policy for realization of Government dues from commercial utilization of defence lands. 

The motivations are reprehensible. Such depravity must stop and the Tendulkar syndrome granted burial through robust policies and cast-iron execution, even strong declamation by the government that such impulses shall not be tolerated. Time it is to remember the words of Thomas Fuller, the 17th century English historian – Be you ever so high, still the Law is above you!

***

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One Last Time – Perhaps, and Perhaps Not!

(Disclosure: This, of course, wasn’t meant to be uploaded here but on the CGDA website and written accordingly; even there is a reference first up to my last message as CGDA on September 30, 2015. Last week, I had spoken with Shri S.K. Kohli, then Additional CGDA [now CGDA-in-charge from June 1, 2016], when he had visited my office in South Block and mailed it to his personal email ID on May 31, 2016. When it wasn’t uploaded till the evening of June 1, 2016, I spoke to Shri Kohli with a request to kindly upload immediately and sent him yet another email attaching the Message. Nothing happened though. I waited and waited – for another full day and a bit, anxiously awaiting the CGDA to upload. Sadly, that wasn’t to be. Having exhausted all options and not to lose any more time, coupled with the fact that I didn’t wish to leave my extended family of DAD staff and officers without one final Message conveying the contours of my thoughts after being a part of this family all my working years, the same is published here, though not without ample regret and with a stab of pain that one wouldn’t like to carry as a parting shot. I would have appreciated if I were told that the content was too disturbing to carry as a legacy and hence it wasn’t possible for the CGDA organization to upload the Message of the FA(DS) on his retirement, who incidentally also once served as the CGDA not too long ago, and had initiated the practice of communicating with the entire DAD family from time to time through his messages From the CGDA’s Desk (still available in the CGDA website). Hence this clarification, to grant the message the much needed “clarity, nostalgia and placement” – no kinship sought with the Defence Accounts Placement Board (DAPB)’s proceedings and office notes I had put out in public domain for sake of transparency and openness, which everyone is familiar with. Alas! Amen!) 

The last message I wrote was From the CGDA’s Desk, exactly eight months ago when I bid adieu to you all from the Department and joined the Ministry of Defence. Now the time has come for me to bid a final adieu on my superannuation from government service. It’s been a long journey – from Patna to Siliguri to Meerut to New Delhi to Balasore to New Delhi to Pune to New Delhi to Bangalore and finally New Delhi – almost a marathon one trotted and at times cantered along. But all the while it was one change after another that followed in interminable succession, while as years rolled by, the change became the constant. And it was this constancy of change that has stayed with me, and it is this I’m going to take it to my superannuated years.

It is difficult to convince people how happy I am – to retire! In fact, I’ve been getting happier by the day as the day of my transfer to the pension establishment has gotten closer. Now that I’ve reached the finish line I am thrilled to distraction. It will grant me time to relax and indulge my passion that I always strove for but never got in ample measure. I never harboured any ambition of a post-retirement sinecure or even a temporary employ in Committees/Commissions which most retired bureaucrats often aspire for. In point of fact, I have always abhorred any thoughts of post-retirement sinecures because I believe such favours often compromise civil servants’ role as honest advisers in the government (especially in the last years of service when they hold senior responsible positions) and have, over the past several years, placed my thoughts in the public domain in my columns in national newspapers and in my books. Even I have teased and tantalized the favour-seekers tempting them if a more permanent solution couldn’t be found in retiring retirement!

Transparency was – still is, shall always remain – too dear to divorce myself from, even in retirement. In my thinking, all scams and scandals trace their origin to opacity and secrecy. Opacity, born out of secrecy, breeds manipulations. Much hullabaloo is made of in the name of secrecy to shroud things, quite strange in today’s time, when the world thanks to technology pretty well knows what the other person is up to. Transparency is the answer to ridding wrong decisions and illegitimate moves – of corruption, nepotism and manipulation. Sunlight is the best disinfectant available freely and in plenitude. It must be invoked and leveraged. The mere openness of processes scuppers any invidious moves to perpetrate wrongs. Instead, it creates a level playing field. In India today, sadly, the distribution of opportunity has typically become an insider trade. It’s a win-win for networkers! This needs to be busted.

In my own humble way, it has always been my constant endeavour to impugn this system so rife with nepotism, and where I saw opacity ruling like a potentate. Transparency and an arm’s length system I tried to put in place all my life, fully convinced that it was the only way to take the processes of change and progress forward. Of all that I did during my short tenure as CGDA, transparency was at the top of the heap. Putting the processes in the public domain came naturally to me. I saw transparency working its own magic, empowering people all around and granting voice to the voiceless. Fairness and objectivity became the jingle. I tried to set them in stone. I came to realize how powerful a weapon transparency is. It exceeded even my wildest imagination. I carried the same baton when I moved over to the Ministry of Defence. I did whatever was possible on my part, working up a furious pace and in the roller coaster ride if the processes upset the high and the mighty I was as unfazed as ever. So be it, I told myself. And I let it be. As a card-carrying transparency (st) – a cyst that’s stayed with me all my living years – I didn’t care less when the networkers screamed and ranted before scurrying for cover. I enjoyed their disquiet, their discomfiture.

As Father Time moves on, the old order changes, the new takes over, and we must make way gracefully. But the constants of transparency, objectivity and fairness shall always remain, and only because they are a part of human verities. They have always been a part of me and shall always stay that way as lodestar, buzzing about my head and finding utterance at every available opportunity. I shall carry this with me as I begin my second innings and pursue what I always wished to but never was granted in full measure. The reason I say this, as I formally bid you adieu and officially take your leave – you the members of my extended family – is because your battle cry of fairness, honesty and transparency which I realized during our journey together shall keep me going and agog. I will resurface now in a new avatar, in my home turf, in an arena, I’ve always loved so much – my BlogSpot, Babupaedia [babupaedia.blogspot.in] – which dimmed just yet shall light up soon and hover about time and space as one (dis)interested ombudsman keeping a watchful eye over citizen’s sense of right and wrong, battling dishonesty and constantly endeavouring that the righteous have, eventually, the last laugh.

Adieu, then one last official time – perhaps, and perhaps not!

Date: May 31, 2016                                                       Sudhansu Mohanty 

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We live not in a Democracy but in a Nepocracy!

One of the most defining narratives of present-day India is nepotism. Otherwise a simple term – a polite hark back to help out poor dear nephew(s) – that sounds and feels so innocuous, it is hard to believe how this cancer has metastasized and colonized every cell of Indian society. We see it everywhere in India today, even in places which proclaim to be the high priests of the rule of law, so much so that what we see is not democracy but nepocracy (or nepotcracy, if that’s easy on your tongue!) – the rule by nepotism.

Blame it on feudalism or the biradiri culture that pervades popular thinking and our collective unconscious, the damage nepotism – by its seeming legitimacy, by edging out and derecognizing merit – has wrought on a supposedly arm’s length system that bureaucracy pretends to be, is incalculable. It is heartening that the PM has accorded accountability and transparency the pride of place in governance. While the will is admirable, the biggest challenge lies in execution. So firmly entrenched nepotism is and so smug and comfortable most networked practitioners in high social/official perches are with this cuddly abstraction that it will take the most cosmic – even unconscionable and asinine – optimist to believe that this nepo-cart can indeed be upended. Nepotism, to be honest, is a part of the gene-DNA combo of our national character, and followed with such zeal and fervour that it is difficult to see the difference between this brand of fundamentalism and the one called religious – this the holy grail of Nepotistic Fundamentalism!

Nepotism is spawned when the arm’s length system supposedly in place via rules, codes and manuals is given a royal heave-ho and the questionable relationship system takes over, gains traction and trumps the former. While financial dishonesty in our popular template has been accorded legitimate censure and frowned upon as reprehensible, the insidious damages wrought by intellectual dishonesty is often glossed over and not granted its rightful due. We have experienced over the years, particularly in the last decade, how the Teflon-coat of unimpeachable financial honesty shrouded the wanton and relentless intellectual dishonesty, which is unfolding even today.

So inside, beneath, and wrapped around this innocuous nepotism there is the unmistakable touch of intellectual dishonesty. This kind of dishonesty makes a man with zero morality a potentate in an opaque atmosphere where the relationship system is firmly entrenched, duly aided by discretion, and abetted by the surety of no punitive action forthcoming. In cold calculus it can be represented thus: Nepotistic Relationship System (NRS) = Intellectual Dishonesty (ID) + Discretion (D) – No Punitive Action (NPA) – No Instant Transparency (NIT). Or simple put: NRS = ID + D – NPA – NIT.

See the formulaic elements. While instant transparency and quick punitive action, as also discretion, can be taken care of externally either by instituting a system in place as in the case of the first two or by removing or limiting the third, not so the other element –intellectual dishonesty – because it is one which can only be appropriated from within and not taught or imposed from without. In a way, intellectual dishonesty will put pay and decimate all trappings of instant transparency and quick punitive action – and foil foisting an Arm’s Length System (ALS), the ideal to approximate.

Man congenitally is an obsessively possessive epicurean – so aptly captured in the prime minister’s Independence Day speech, mera kya, mujhe kya – the reason why he is more kleptocratic even in a much touted democratic construct; his every behaviour either mimics or at best shrouds through unmistakable posturing such gross instincts. In ideal conditions, his behaviour is impeccable; but when no one is looking around, he does what his primitive instinct prompts him to – to steal and pillage, appropriate unto himself things not Caesar’s, and weave his way around to perpetuate every wrong for himself and his biradiri. It embraces the entire society, every profession and vocation – government, private, corporate – feeding and cross-nepotizing each other and one another as it flits across these divides. Though I would rather not speak to any particular case, it is only the obtuse who can miss out how this cross-fertilization of nepotism shows itself up in today’s world: public officials’ children punching much above their academic weight in bagging blue-chip jobs in the corporate world, postings in high perches and post-retirement sinecures given away as quid pro quo – past, present, and future – are but a few illustrations to emphasize the efficacy of nepotism. Given this scenario, the need is to checkmate this nepotistic man so that the relationship system – spawned in a value-free environ stemming from no scruples and morals – he is congenitally keen to give full rein to, is stymied.

How, then, is one to approximate this? And how likely such a system can be ushered in in an environment where public servants delude telling the world that they are public servants when they are nothing better than serious private servants forever pursuing personal interests, though, to be fair, once in a while – more as an accident than any else – they do something worthy that possibly can qualify as public work? This is when – and why – an arm’s length system that admits of no tinkering needs to be clamped. Inverse the Relationship System (RS) by snuffing out the self-regarding acts and you possibly can think of an Arms’ Length System (ALS) that translates to the following calculus: Arms’ Length System (ALS) = Quick Punitive Action (QPA) + Instant Transparency (IT) – Intellectual Dishonesty (ID) – Discretion (D). More simply put: ALS = QPA + IT – ID – D.

Introducing instant transparency though seemingly easy, isn’t exactly so. While in popular parlance, sunlight is said to be the best disinfectant, it is well to realize that most people are fiercely scared of sunlight. But it is possible, though people will demur at the completeness of wholesale and real-time transparency. Punitive action that is quick and time-bound too doesn’t appear very likely in a democracy where long-winded legal processes and procedures, coupled with legalese mouthed by motormouth lawyers, duly propped up with labyrinthine rules and procedures, can help drag and protect the corrupt for decades on end. It is any one’s guess if we are in a position to work through this maze and bonsai cast-iron punitive measures out of it. Similarly, given the feudal mentality of most networked public officials and the long years of practice they are used to, the issue of discretion that needs to be exercised in a bipartisan manner seems a far cry.

A resurgent media, a vigilant judiciary, and a growing bulge of an enlightened middle class aided by instant transparency seem the likely straws. Much unlike Cassandra, I hope the cold calculus holds and works – and upends our nepotistic modus vivendi!

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On their own trip!

It is nobody’s case that foreign visits are not essential in a globalised economy. Negotiations and consultations are an intrinsic part of bilateral, multilateral and international ecosystems. But sundry inconsequential visits are a problem. The ministry of finance and the cabinet secretariat have put limits on the number and duration of visits. Since visits abroad entail spending precious foreign exchange, secretaries have been directed to be strict in sanctioning them and to use our permanent missions abroad to represent the country instead. Sadly, these directions are rarely heeded.

The urge to go on foreign trips is endemic. Proposals for deputation abroad are immaculately crafted and processed with such speed that it could easily give a lie to the putative snail-pace of the Indian bureaucracy. It admits  no restraint, no shame, no twinge of conscience —  indeed, the tenacity is admirable. The urge to go abroad is rather natural, flowing from an immutable human impulse —  obsessive hedonistic individualism.

Let’s accept reality. The standards of financial propriety enjoined on public servants —  to exercise the same vigilance with public money as a person of ordinary prudence would with his own —  are rarely met. It is disturbing when proponents of a junket suggest that the extant orders be rewritten so that no questions are asked about their trips. I have even known an officer to travel abroad 60-odd times in three years, against the prescribed 12 (four per annum), spending about two-thirds of his time, excluding travel time, abroad.

There are wheels within wheels in foreign junkets. For instance, when economising measures were taken for domestic travel (officers who were earlier eligible for executive class travel now had to travel economy), the measures for international travel were only symbolic. Those eligible to travel first class (secretaries and above) were downgraded to business class, while those eligible to travel business (joint and additional secretaries) and economy class remained unaffected. The one good economising measure was that the tickets had to be bought at the lowest fare in the class. This brought an end to the free companion ticket facility. I myself insisted on the lowest fare rule and was staggered by the stout resistance and fusillade of bad logic trotted out against it.

The impulse to travel using government money when sponsorship from international agencies is available has assumed alarming proportions. All because officials are allowed to travel business class. It matters little that such acts mean the wanton depletion of taxpayer money. So, officials should live by the following rules: Thou shalt not covet foreign visits except those that are most necessary, unavoidable, inescapable, thou shalt not manufacture foreign jaunts through specious logic or spend all thy office hours coveting such excursions; instead, thou shall devote all thy time and energy to the job at hand, which thou as public servant art solemnly sworn to perform and art being paid handsomely, with all attendant perks, to do.

Doing this is rather easy. All it needs is undoing the blatant wrong perpetrated by the Sixth Pay Commission. While for domestic travel, the daily allowance was done away with by the commission and replaced by the reimbursement of food bills, the same logic wasn’t invoked for foreign visits, which continue with the per diem allowance. Consequently, foreign jaunts are an easy way to earn non-taxable dollars. Rectifying this egregious error, say, through a travel card (with limits), shall demonetise and cap the urge to seek out foreign safaris. It’s likely that restless minds will be stilled (due to the lack of possibilities) and their extra time made available to their work in office. It shall verily amount to putting the internal moral compass (ever so artificially, though) in the right place.

Given the prime minister’s emphasis on minimum government and maximum governance, and his firm commitment to transparency, one would suggest that there is also a dire need to rid the system of nepotism, and establish an arm’s-length and merit-based system instead. It needs to be remembered that networkers are not-workers. Because at the end of a long, arduous, networked day, they are far too mentally fatigued and physically drained to perform their assigned tasks.

Though a tad off-centre, I would like to sign off with a bit of mirth to lift the spirit of unrelieved pessimism by recalling Eugene McCarthy’s wry words: “The only thing that saves us from the bureaucracy is inefficiency. An efficient bureaucracy is the greatest threat to liberty.” How ironic and predictable. And yet another cause, however small, for gratitude.

(Reproduced from The Indian Express, 20.06.2014) 

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The Cunning of Healthcare

In my last post I had mentioned about my experience with a doctor named Dr K. G Kallur, Consultant Nuclear Medicine at HCG Bangalore Institute of Oncology during a nuclear scan. I had lodged an FIR against him with the police who, in turn, had referred the case to the Karnataka Medical Council (KMC) for investigation.

I had in my written submission brought to the notice of the Hon’ble Council (KMC) that according to Atomic Energy Regulatory Board (AERB) Safety Code, it is mandatory for a specialist doctor/nuclear physician to supervise scans such as mine and had annexed a copy of the relevant code.

The Code inter alia spells out that the nuclear physician shall:

(a) have the responsibility of dosage administration and maintenance of records providing name of the patient, nature of procedure, radiopharmaceutical prescribed, quantity prescribed, name of the nuclear medicine physician with signature and date, and name of the person administering the radiopharmaceutical with signature and date;

(b) prevent any possibility of misadministration and promptly report to the licensee and the competent authority in the event of any misadministration, adverse reaction or death of a patient administered with radioactivity;

(c) consider factors such as proper choice of radiopharmaceuticals, monitoring of procedure and immobilisation of the patient in order to minimise absorbed dose to the patient;

(d) inform patient on safety measures to be observed to avoid radiation exposure to the family members and others;

(e) instruct nursing and ancillary staff on radiation safety and precautions in nursing/management of therapy patients;

(f) obtain an informed consent from the relatives of the patient, prior to administration of therapeutic dose;

I had stated that all the above mandatory prescriptions of AERB were flagrantly disregarded by the specialist doctor, Dr Kallur, Consultant Nuclear Medicine, since neither he (who as per the money receipt was mentioned as the doctor to oversee the scan) nor any nuclear physician supervised the said scan. In fact, the doctor had not seen, leave alone examined and discussed any issue with me, the patient.

I had further brought to the notice of the Council that the HCG Bangalore Institute of Oncology Speciality Centre claims to have accreditation from National Accreditation Board for Hospitals & Healthcare Providers (NABH) Government of India. According to chapter 2 (CPP) Control of Imaging Processes and Procedures of National Accreditation Board for Hospitals & Healthcare Providers (NABH) [Page 41]:

“The imaging protocol shall address general population as well as provide for specific modifications in patient with special needs, e.g. children, pregnant, females etc. The quality of images shall be verified by the technician as well as by the supervising radiologist/nuclear physician in terms of its technical nature and the diagnostic content relevant to the patient’s condition.”

The above stipulation enjoined as a “Shall” requirement in the NABH’s Standard for Medical Imaging Services (MIS) was violated with impunity by Dr Kallur.

I had brought out that my apprehension that the nuclear scan was done without the specialist’s supervision was further vindicated upon receiving the report. While the radiologist’s signature was affixed to the report, names of three consultants in nuclear medicine were printed alongside, including Dr Kallur’s, though no signature of any of the three consultants had been affixed. This clearly shows that the nuclear scan was examined only by the radiologist, not the nuclear medicine specialist, Dr K. G. Kallur.

I had concluded that from the foregoing it was evident that Dr K. G. Kallur, Consultant Nuclear Medicine has breached every conceivable norms and standards prescribed by AERB Safety Code 2011, NABH, Society for Nuclear Medicine India, Code of Medical Ethics prescribed by the Medical Council of India. Also that the behavior of Dr K. G. Kallur, Consultant Nuclear Medicine, HCG has caused tremendous mental agony and harassment to me and the damage caused is incalculable. Such behavior – inexcusable from any denizen of a civilized society in normal times – is entirely unacceptable coming as it does from a service provider (specialist doctor) to whom the patient had gone seeking specialized service on payment of requisite fees.

In light of what has been mentioned above, I had prayed to the Hon'ble Council that it may be pleased to investigate the matter and find out the following:

i.            Can a Nuclear Scan be done without the supervision of a specialist doctor in the concerned medical speciality and if this is as per the universal medical protocol that HCG Bangalore Institute of Oncology Speciality Centre espouses and is required to follow? Does this not amount to criminal neglect in patient care?

ii.           How could the hospital, a service provider, flout its own stated commitment of a nuclear scan under Dr K. G Kallur and not perform the task for which they have charged an amount of Rs 17,000? Is there no accountability?

iii.            Can a doctor – because of being stressed, busy and/or excess workload (taking about 60/70 nuclear scans a day) – absent himself from a critical nuclear scan being taken? Is this as per the medical protocol prescribed for nuclear scans as well as critical care illnesses like cancer?

iv.             Was it fair and appropriate for the doctor to tell a patient – “You can take your money back”? Was not the doctor breaching the code of ethics and conduct by retorting to the patient in such a manner? It is well to remember that (as I had told the doctor) while money can be returned, what about the actual scan procedure experienced, the radioactive isotope injected into his body and the ramifications therein? Isn’t Dr K. G. Kallur’s insensitive words and behavior reprehensible/abominable and completely bereft of the moral and ethical fibre expected of a doctor in his dealing with the patient? Is this as per the MCI’s Code of Medical Ethics relating to the PROFESSIONAL CONDUCT, ETIQUETTE AND ETHICS for registered medical practitioners?

v.            Can a nuclear scan be done and findings prepared by a doctor who is not a specialist in that discipline when the specialist is available and whose name is mentioned in the money receipt? Does this not amount to cheating and fraud? I’d stated that since the issue is of wider public interest, as it affects the lives of vulnerable section of people (patients) who often are voiceless – the illiterate, uneducated masses knowing nothing what doctors they trust blindly do – and with wider ramifications, appropriate punitive measures as deemed fit in the form of cancellation of his license be passed against the errant doctor, Dr K. G. Kallur, in the interest of justice and in the cause of upholding the Hippocratic Oath that all doctors are sworn to.

Among other things, Dr K. G. Kallur in his written submission has given a new twist to his not signing the report. To wit from para 8 of his written submission: “I submit that Mr Mohanty’s PETCT report was dictated by me and left early on the day of this episode i.e. on 24^th May, 2012. However, next day the driver of Mr Mohanty came to collect the report and he was in urgency to collect the report and repeatedly pressurized Mrs Chandrakala (PETCT – Coordinator) to hand over the report and that he has to leave urgently. Since I was not in station on 25^th May, 2012, the report was not signed by me. Mrs Chandrakala had clearly informed the driver that I was not in station and that the report has been signed by Dr Shiva Kumar Swamy. S (Consultant Radiologist). Since the driver was in urgency, he informed that he would collect this report. Though there is list of names of doctors in the report, it is not mandatory that all should sign. PETCT report is a multidisciplinary approach. Radiologist is also involved. He is also a responsible person reporting. It is customary in most of the centers that at least one of the members signs the report if not all. In view of the unpleasant scene created by Mr Mohanty the previous day and based on the driver’s request, Mrs Chandrakala handed over the report. I submit that as per the hospital protocol, original report will be issued after getting the receiver’s signature in the outward register. In this case, since the original report was not issued, signature was not obtained from the receiver. The original report signed by all is still with us and the same has not been collected by Mr Mohanty or his authorized representative.”

The Karnataka Medical Council has passed the following ORDER on 19.07.2012:

‘Karnataka Medical Council is of the unanimous Opinion that the Respondent Dr K. G. Kallur has followed the Standard protocol while performing the PET Scan. The Complainant has failed to establish “Negligence” on the part of the Respondent. With the result the Case is dismissed.’

I desist from giving my impressions here. I am merely putting the facts in public domain for readers to judge for themselves. I need only remind readers to compare Dr Kallur’s version conveyed in his letter dated 8.6.12 published in Moneylife article titled Callousness and high-handedness of Bengaluru cancer hospital HCG with the one he has given now and quoted above [about my driver collecting the report (and even the CD of the scan – that he forgets to mention] in his written submission to the KMC. On 8.6.12 he had said thus: “He (i.e. me) has abused front office people and taken the report away from the front office of people even before I signed off the report. Now he is alleging that that I have not seen his scan images and not reported and this amounts to medical negligence.” Heavens! In my reply dated 10.06.2012 posted in the Moneylife site, I had said: “You (Dr Kallur) don’t have to give me an answer, nor to any one else, let you dialogue with your conscience. How your petulance, which prompted you to refuse signing the report because I had complained against you, has coiled you today in so many knots? To tell one lie, you’ve to manufacture few more numbers; the lies get squared and cubed, and on and on it goes gathering momentum and flight – an infinite loop that you’ll find hard to keep pace with. It’s already happened, and the more you try defending yourself through lies, more lies, and still more lies, you’re likely to get ensnared more and more, inextricably, and get caught in your very own self-created web of lies.” How gloriously Dr Kallur has lived up to the expectations I had reposed in him! This is, what I call, the cunning of healthcare in India today.

This has become rather long and I apologize! But truth must prevail. I know it’s a long haul. Well, I’m happily ready to travel the distance – seeking out every available constitutional mean in quest of justice.

Satyamev Jayate!

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Healthcare Today: Is this what Hippocratic Oath Enjoined!

The news of post-graduate seats in radiology going at an astronomical price in medical colleges in India was news not long ago. Lesser disciplines (with lesser revenue-raising potential) charge less; the pecking order of rates charged, offered and administered seemingly in sync with present-day market demand or the perceived future (foreseeable, not distant) demand as it likely would pan out, with genomics and proteomics and other latest frontier discoveries duly factored in.

Today, US – the high-priest of capitalism – is in veritable quandary, wrung out, and ruing its healthcare model that threatens to blow up societal equilibrium. Activists and policymakers are in a funk in finding solution to high medical costs. A piece titled Cost Conundrum published in The New Yorker in 2009, which caught the attention of Obama and his Administration, observes: “In the war over the culture of medicine—the war over whether our country’s anchor model will be Mayo or McAllen—the Mayo model is losing. In the sharpest economic downturn that our health system has faced in half a century, many people in medicine don’t see why they should do the hard work of organizing themselves in ways that reduce waste and improve quality if it means sacrificing revenue.”

The McAllen model refers to one of the most expensive health-care markets in the country. The primary cause of this billowing cost is the across-the-board overuse of medicine and doctor-care when less would do; yet more is preferred because it helps revenue-swell. In contrast, the Mayo model that believes in accountable-care followed in the famous Mayo Clinic is one where the “needs of the patient come first – not the convenience of the doctors, not their revenues.”

Change tack to India and see how in our honeymoon capitalism we have monkeyed what US today is struggling to rid. Throw in our endemic and much-vaunted DNA to cheat and con, and see what a deadly cocktail we concoct. This piece seeks to put in public domain my recent experience in a cancer hospital in Bangalore. I am a patient of carcinoid cancer and underwent two surgeries to remove the offending tumour in the colon, a large part of which was excised. Ever since then I have been under the close observations of my doctors.

About a month ago, I experienced pain in the anastomotic site. The CT scan done shortly after showed up cysts in the liver, apart from inflammation and ulceration in my colon. The most effective treatment for carcinoid is the complete, surgical removal of the tumour(s), which in my case had been performed four years ago. But microscopic cells could even show up after years and it’s the tumour diasporic proclivity that prompted my doctors advise me a nuclear scan called Gallium-68 PET CT DOTANOC to zero in on the problem.

            For the uninitiated, this PET CT is a nuclear scan and radioactive isotope is injected before the procedure. After the scan got over, I requested the nurse if I could speak with the doctor and get a preliminary idea of the scan before the detailed results came out a day later. She said, “No doctor’s around. The technician did it.”

I puzzled, finding it hard to believe what I’d heard. “You mean to say that this nuclear scan was done without the supervision of a doctor, a consultant nuclear medicine?” She looked at me, speechless. I walked over to the edge of the console room and asked the technician if he could do the scan without the supervision of the specialist nuclear medicine. In my money receipt the specialist’s name was mentioned. I was livid. I demanded an answer.

The technician panicked and spoke with the specialist seated in Tower 1. My scan was done in Tower 4, about 200 meters away from where the doctors – consultant, nuclear medicine and the radiologists – sat.

Within minutes the technician materialized. “You can speak to Dr Kallur” and handed me over the cordless phone.

“Doctor,” I asked, my voice quizzical, “how is it that no doctor was around when my scan was done?”

His reply was pat. “I can’t be present in all the 60-70 scans done everyday. You can take your money back!”

For all my ailments and my sundry visits to doctors across hospitals/cities wherever I’ve lived, I had never heard anything remotely resembling this. “That’s okay but what happens to the radioactive isotope injected that’s gone into my body? And is this the medical protocol your hospital follows?”

He had no answer to my riposte. After a deafening silence that refused to die down, I heard a disembodied voice say, “If you want to meet Dr Kallur, you can.”

“But am I not speaking to him?”

“No, this is Pravin speaking.”

I asked him to come meet me.

He came half hour later – after two reminders. I demanded to meet the Chairman. “The Chairman’s in a meeting,” Pravin promptly conveyed.

“That he must be,” I said, my voiced dipped in sarcasm, “but know that that ploy won’t work. Please set up my meeting with him. Quickly.”

He shuffled from one foot to another. Then moved away.

I sought him out again, as my wife and I sat in the patient’s room in the high radiation hazard zone. It was getting to six in the evening.

Finally, Pravin after his string of meetings and phone-calls materialized to take us. But no, it wasn’t the Chairman of HCG, Dr Ajaikumar. It was Elizabeth, the Chief Administrative Officer. I told him I had nothing to do with her. After confabulation with Pravin, Elizabeth came over to us, now seated in the reception of Tower 2. She was nice. But I told her I wanted to see the Chairman and there was no point repeating things time and time again. She hadn’t been purveyed the full story. When she heard me her face mirrored her shock. I told her Dr Kallur wasn’t rude, his behaviour was downright obnoxious.

I was fasting since morning. More than two hours after my scan got over, we’re being escorted to the Chairman. I was asked for my visiting card. “I’m a patient. You know my name, below it write PATIENT”, I replied.

Dr Ajaikumar quickly apologized on Dr Kallur’s behalf. “I’ve already told him,” he said, “and I’m going to tell him again”. I asked if his hospital followed the medical protocol prescribed for nuclear scans. He was politeness personified but his answers were neither here nor here waffling with US examples. I knew they were faux excuses.

“How can a doctor ever mutter such words you can take back your money to a patient?” “Stress”, he tried to reason. “He’s a busy doctor!”

“Who isn’t? Certainly you don’t do 60-70 DOTANOC scans everyday! Your hospital says about 3-4!”

Little later, he said Kallur is “compassionate” and “an icon!”

“Compassion” to a cancer patient I’d freshly experienced. So I told him to disabuse culting his icon. “In my 56 summers spent on Mother Earth I’ve met many busy icons but they’re invariably polite and professional,” I said. “My personal ethics prompted me to meet tell you before I hammer out the next course of action for the criminal neglect in medical care in your hospital. This isn’t Hippocratic Oath that you doctors are sworn to, this is Hypocrites’ Oath! I speak here not for me but for the voiceless – the illiterate, uneducated masses – who know nothing what doctors, whom they trust blindly, do!” In my throat I added, “As you go seeking Mammon relentlessly throwing all medical ethics out the window!”

The morning next I saw a half-page advertisement in the front page of a national daily enticing cancer patients to this hospital. I gulped at the patent conning, my experience fresh in mind. In the evening when I got my report, my apprehension was further vindicated. I found the radiologist’s signature; three names (without signature) of consultants in nuclear medicine printed alongside, including Kallur’s – conveying the nuclear scan was seen only by the radiologist, not the nuclear medicine specialist who was to oversee the scan. Now I need to see another specialist in nuclear medicine to give me expert advice on my nuclear scan – to make my doctors wiser before they plan my imminent surgery. This after paying Rs 17,000 and with the radio-isotope in my system!  

Remember, my experience isn’t a one-off, an outlier. Exceptions apart, it is symbolic of the general malaise that afflicts, if it already hasn’t, hospital practice across the nation – to maximize revenue.

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Bangalore - Then and How

Two things happened almost around the same time. A friend had forwarded a clutch of old pictures of Bangalore and the morning next the newspapers carried the news of Bengaluru airport being renamed after its founder, Kempegowda.

The images of Bangalore were indeed refreshing as all things old are – the buildings, landmarks, roads, people, their attire – everything, and for me it brought back unmistakable nostalgia. It reminded me of my first visit to Bangalore in June 1980. We’re probationers on Bharat Darshan. We stayed in Hotel Kamadhenu what then seemed one dead end of the MG Road. My memory is fogged but the road appeared (but it couldn’t be as I realized later, since Ulsoor lake lay beyond) a cul-de-sac – leafy trees trimming either side of it. We paid twenty rupees for the double-bedded room and I remember having (only) sumptuous masala dosa (3 in number each repast; some gastronomic desecration!) for breakfast, lunch and dinner all the seven days we stayed in Bangalore. It was utterly delicious. I’d never had anything like that before, so quickly concluded with youthful exuberance that it was the best available in the WORLD! A friend with passionate sub-nationalism tried disabusing my mind saying Woodlands in his native Madras dished out better dosas than Kamadhenu. But Woodlands’ no patch!

I can’t remember how much it cost, maybe 1 rupee, it couldn’t be more, because Rs 10 (Room-rent) + 9 (9 Dosas) made it 19 and one rupee must’ve been on coffee (filter or instant I can’t recall). Our DA was Rs 20 and I’d resolved to live off my daily allowance the five months we Bharat Darshaned and splurge my humongous salary of Rs 1103 on books. The Cellar was the bookshop on MG Road I gorged on: the entire lot of Camus, Kafka, Sartre, Lawrence, Conrad, Orwell and others. The exchange rate of Pound Sterling was Rs 17/18 but bookshops charged Rs 20, and the books (mostly) were between 20-60 pence.

A small-town bumpkin who had never spent a day in any metropolis (Bombay was already a megalopolis) before joining civil service and extremely wobbly in my soul, I can’t forget the stars that struck me times without number looking at the plentiful books in these big cities and feasting on them. The books are still with me, proudly carrying my signature with dates. Reading them was of no great earthly consequence – then, even now; passion and show-off and gewgaws were all that mattered! Chinnaswamy Stadium was a must-visit where I exulted seeing Gundappa Viswanath and Syed Kirmani in flesh and blood (they looked so surreal!), paying off the taxi-wallah, close to where I stood, across the barricade. Later, years after, I told Kirmani first up about this when we met. TV, for us in Cuttack, was still in distant future! 

Bangalore was the city of PSUs. So we’re taken to BEL, BEML, NAL on educational tours. A double-decker Brindavan Express chugged us out of Bangalore (near Majestic which seemed neither majestic nor populated) and took us to Madras. We’re absolutely thrilled and kept darting up and down the two floors – one lower than the normal, the other none too high (kind of mezzanine) – and it reminded yokels like me of my first bus ride in Delhi’s double-decker a few months earlier.

Bangalore was quiet and sleepy. And, for someone brought up in hot and muggy Cuttack unbelievably cold in the ides of June. This despite being in deep south. It felt unreal; my sense of geography, bad in normal times, could find no answers. And internet and googling were still a millennium away! I wallowed pitilessly in my own ignorance. 

When on posting I came to Bangalore in 2006, it seemed an altogether different city. Though I’d come off and on the past decades, the traffic and tumult of the city had passed me by during the short time I spent here. The new century/millennium with its accompanying ITspeak had taken a toll on the quietude of this pensioners’ paradise. The incessant traffic majestically riding high on a soaring sensex had democratized the road. The nightly din was no different from the day’s. The paradise had been lost – to incipient tawdry modernity. Today, only memory remains, as images speak to my eyes and mind.

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