Cardiac patients in Andhra Pradesh are increasingly falling prey to the doctor-pharma collusion, resulting in indiscriminate stent implants and a good number of patients who are fit for bypass surgeries ending up with implants, doctors and experts said. Out of estimated 3,500 stent implants carried out every month in Andhra Pradesh, at least 30% are unnecessary, they said, three days after the arrest of Dr Sheshagiri Rao, head of cardiology at the Nizam’s Institute of Medical Sciences , for accepting bribe against favouring a particular stent manufacturer. Health department officials and cardiologists across the nation said indiscriminate use of stents was rampant in the country and the Medical Council of India (MCI) said it was soon coming up with new ethical guidelines for doctors. “If strict punishment is initiated against erring doctors, such acts can be controlled. Action should be taken on the pharma companies as well who are indulging in wrongful practices to push sales,” Dr Purshottam Lal, senior MCI board of governors member told TOI from New Delhi.
He said while the real motive should be to bring down healthcare costs, it is soaring due to commissions and as a result, patients are at the receiving end. The arrested NIMS cardiologist was found to be implanting 60% of the stents supplied to the hospital, sources said. “Doctors accepting commissions on stents is deplorable. There is no room for acceptance to such practices,” Dr Lal said. “The problem is that doctors have to pay through the nose to become cardiologists and once they come out of the training, they want to make money in quick time,” Dr Lal, who heads Metro hospitals in New Delhi said. Experts said with India becoming a global hub for the booming stent market, corruption and unethical practices had crept into the system in a big way. The multi-crore stent industry is witnessing an annual growth of 25% with a staggering 2 lakh stents worth Rs 600 crore being consumed annually in India as per conservative estimates, Industry experts said. Global survey forecasts show that coronary stents market is set to touch $1.4 billion mark by 2015 at a compound annual growth rate of 10.5%. While China accounts for nearly 30% of the global value, India claims around 25% of the market.
Experts like Dr RR Mantri, director , Cath Lab at the prestigious Sir Ganga Ram Hospital in New Delhi admitted some doctors might be taking commissions and also implanting stents unnecessarily but there is no auditing or regulating authority to monitor the issue. “India can work on the US model. FDA in the United States is an eminent body of doctors and administrators and a similar body can be constituted in India but the problem is in our country, if you appoint one body, there will be one more place of corruption,” says Dr Mantri. Some doctors while explaining the extent of corruption said, if a patient does not require a stent, he is being implanted with one, while a patient needing one implant is instead implanted with two. At least 20-25 varieties of stents are available in India, including imported ones and the cost ranges from bare metal variety costing Rs 15,000 to the advanced bio-absorbable stents costing Rs 3 lakh.
In 2010, the Central Bureau of Investigation (CBI) that probed the cardiac stent scam in the state found that a hospital was billing for a high quality stent, but actually implanting a low quality one during surgery. The CBI probe allegedly involved several corporate hospitals and staff of Central Government Health Scheme (CGHS) in Hyderabad. “We are yet to get the final report from the CBI. If we had got the report, we would have delisted the erring hospitals from our network hospitals,” said Dr P Parthasarathy , additional director, CGHS. Doctors say that Aarogyasri scheme in AP has considerably added to the total angioplasties being performed in the state.