Where the heart goes on


Can you really get a coronary bypass surgery for less than Rs 1 lakh? What does Dr P Venugopal mean by making such wild promises?  Nisha Susan finds out


Photos: Shailendra Pandey

LET’S LAY a bet. In the last month you’ve done all of the following: cursed hospitals, announced your distrust of doctors and thought wistfully of that old doctor you’d visit as a child – who accused you of not eating right. You mumbled your symptoms, sure of a scold, but came away assured he knew what he was doing. Lately you’ve thought of him because someone you know has been to a large hospital and met a series of faceless doctors. You’re considerably poorer and still don’t feel too well.

Dr P Venugopal, 68, is the concentrated version of your irascible family doctor. Certainly he has the same forbidding, faintly eccentric exterior. But with 50,000 cardiac surgeries behind him, he’s no rasam-recommending family doc. A pioneering surgeon, he performed India’s first heart transplant. During his tenure as director, Delhi’s All India Institute of Medical Sciences (AIIMS) leaped into stem-cell research and robotic surgeries, and had the astonishing ability to serve 30 lakh patients and perform 1 lakh critical surgeries per year. Today, after it took an act of Parliament to dislodge him, even temporarily, from AIIMS, Venugopal is about to wage guerrilla war in the badlands of corporate medicine.

His first sortie is a promise of cardiac surgery at half the current costs – without cutting back on care. At the Alchemist Institute of Medical Sciences, the hospital he now heads in Gurgaon, Haryana, you can have a coronary artery bypass surgery for Rs 85,000 (it normally costs upward of Rs 1.6 lakh in Delhi). At Alchemist, a single valve replacement costs Rs 1 lakh – elsewhere it ranges from Rs 1.5 lakh to 2.9 lakh. And no, he says, while being discharged you won’t find hidden costs nor will a charity underwrite the surgery. He argues that patients don’t have to haemorrhage money for a hospital to make profits.

Once explained, the plan has the simplicity of genius (Alchemist launches it in late March). Strategy one: where corporate hospitals’ outlay on land and plush buildings can compute to Rs 1 crore per bed. Alchemist has instead leased comfortable but nonflashy buildings. Two, it won’t mark up the costs of supplies (Hospitals can charge as much Rs 18 for a disposable glove that costs Rs 4, Rs 1 lakh for a Rs 50,000 valve). Three, instead of paying surgeons per surgery, encouraging them to be ambulancechasers, Alchemist will keep surgeons on salaries. What all this means is that you can get ‘private’ treatment for a little over government hospital rates.

Why has no one tried this before? A few small opthalmology hospitals actually have already successfully done so. It takes determination like Dr Venugopal’s to plan this in areas such as neonatal cardiac surgery. When his initiative takes off, it is bound to be embarrassing for the medical fraternity who have not made this leap of imagination, in hospital management and ethics. It is, in one sense, his happy hangover from AIIMS.

While enmeshed in queues and forms like any government hospital, AIIMS, remains one of the few places where cardiac surgery is affordable. It’s also a magnet for enormous power struggles, causing former Health Minister Anbumani Ramadoss to call it the ‘All India Institute of Political Sciences’. Once director, Venugopal was no longer just delivering succour to the frail-hearted. “I understood that if I wanted anything, any new equipment, get anything done, I had to exert power. I learnt to pull strings.” AIIMS was and is beset with accusations of caste discrimination as well as the simmering reservations debate. “It is all man-made,” dismisses Venugopal, preferring the see-no-evil view, only conceding that reservation laws must be followed. “I have met brilliant surgeons who came on quota.” In 2007, no string-pulling saved him when Ramadoss and he had bitter disagreements, resulting in his removal by an AIIMS Act amendment. The amendment lowered the director’s retirement age to 65 years, forcing Venugopal, then 66, to quit. He fought back and in 2008, the Supreme Court reinstated him.

‘Corporate hospitals do give doctors monthly targets for the number of stents and scans,’ confirms Dr Venugopal

This legacy is reflected even today in his posture. He might be Alchemist’s brand ambassador, smiling out of their advertisements. Nevertheless the good doctor meets the world with the grim defences of his arms folded at his chest and the terse, safe answer. Only at the mention of his wife — he married in his 50s — does a large, silly grin come over his small face. She is not from Andhra, she is not a doctor, he agrees happily. More grins escape as he describes his 13-year-old daughter who has already rejected medicine as a lifestyle. “She hates it. She wants to become a writer.”

EVER SINCE he left Rajahmundry — a big, influential Andhra Pradesh town — as a teenager, Panangipalli Venugopal’s home has been largely at AIIMS, (making his brief ouster particularly painful). At AIIMS his teachers were macheteing through the darkness around the heart. The impulse to serve the public had not yet become the mouthing of hokey nothings. As one of two sons from an affluent household with a freedom-fighter father, he could choose difficult work for pleasure and altruism.

During Venugopal’s career, the culture of medicine was to change enormously. The technology of cardiac surgery, developed in AIIMS to serve the poor man’s heart made its escape. Outside in a brave new world, it was not easily caged, not so easily bought. Those who once invested in gutka and ball-bearings now opened hospitals. Medical thrillers’ wildest plots of ruthless profiteering are now common practice. Venugopal confirms one terrifying rumour. “Corporate hospitals do give doctors monthly targets for the number of stent procedures and scans.

The other option is to go to charities such as the Sathya Sai Baba hospitals in Puttaparthi or Bengaluru (Venugopal helped set up both). Their records of giving free and excellent care is astonishing but for those in need of urgent care, the queues are a way of dying. It is in such a desperate context that Venugopal is making his promise.

Cardiac surgeons everywhere are accused of a god complex. And why not? After all, they do crack your ribs open and plunge about your heart. (They train like athletes because it is not enough to have clever fingers. Surgery means standing in one position for as long as four hours without a break.) It is difficult to prise out of Venugopal any of the tight-rope excitement except an acknowledgement that cardiac surgery is ‘charismatic’. Only once, when complaining bitterly about bureaucracy does he say, “They think all doctors are the same. They don’t understand cardiac surgeons are special.” Perhaps he has learnt to not share his obsession. Soon enough, he flees this inquisition and speeds down in his green scrubs to examine his new operation theatre.



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