Unpaid Bills

This August, sixty children died within forty-eight hours in a government-run hospital in Uttar Pradesh, the largest state in India. Hospital staff say the children died because of a lack of oxygen, while government officials claim the deaths were due to a range of understandable medical causes. Technicians at the hospital had informed the medical officer of dwindling supplies of oxygen a week earlier, and had filed a second notice the day before the crisis began. But nothing was done.

Opposition leaders lost no time in traveling to Gorakhpur to stand outside the hospital and make statements condemning the government’s callous ineptitude, while the government turned its wrath on the company supplying the oxygen, saying that “a probe would be initiated” to determine why it had failed in its duty to deliver a timely supply.

That probe won’t take long. The oxygen company had not been paid for months and a bill of 7 million rupees ($110,000) was pending. Notices were repeatedly ignored, and the company had warned the hospital in writing on August 1 that it could not continue without payment. When the acute shortage hit, the district magistrate, under whose authority the hospital functions, finally swung into action, procuring emergency supplies from somewhere at 1 a.m., but it was too little, too late. Of the sixty children who died, at least fourteen of them were infants in the neonatal intensive-care unit.

My organization for disabled children has worked in a government hospital in India for the past seven years. We’ve seen firsthand the inefficient, callous, and unfeeling care that the poor receive. (Only the poor use government hospitals.) But we’ve seen the same treatment meted out to hospital staff, who are given almost no support and are expected to perform heroic tasks in impossible conditions.

A typical pediatrician sees between eighty and a hundred children in an out-patient clinic every day. The doctor has no time to get information about allergies, drug interactions, or complex causes. With no secretarial staff, records are not maintained anyway. Each child is a new case without a history. Given the sheer number of patients, no doctor could be expected to remember anything about the last time a particular child had come.

Forty percent of doctors’ positions are unfilled; essential equipment is generally out of order; the pharmacy is usually out of the medicines the doctors prescribe, and nursing and ancillary staff are frequently on strike—not getting paid in over a year can have that effect. If a patient dies and his family is well connected with the local mafia, doctors may be beaten up. It is not uncommon for two patients to be in a single bed, and all the patients have the underlying problems of poverty and malnutrition complicating their illnesses.

Acknowledging the years of neglect of India’s hospitals is critical to understanding the colossal failure in Gorakhpur. This was not an isolated case of one district’s apathy. It was the natural result of a deliberate dismantling of India’s public-health system. In 1990, for example, a government order froze all fresh recruitments to public hospitals. When hospital staff retired or died, they were not replaced. Meanwhile, babies kept being born and the system couldn’t keep up. A public-health system that had once been respected and effective (albeit crowded and full of delays) sank into a mire of chaos and malpractice.

It is now generally considered wise to avoid government hospitals like the plague (the same is true of government schools). Only the poor, with no other options, resort to the free care these hospitals provide. Meanwhile, private hospitals, often unregulated, are springing up in every neighborhood and back alley. Those that are well run are havens for medical tourists from abroad and unaffordable for most Indians.

India’s health statistics continue to cause concern (in the district where this scandal occurred, the infant mortality rate is nearly 70 out of 1,000; India’s goal is 25) and as long as health is just another business opportunity, this is unlikely to change. The program we run in the Doon Hospital is also funded by the government, and our grant has been frequently delayed—once by two years. We keep things going because we believe passionately in the service we offer and because private donors step up to close the gap. Not so for small-business owners trying to make a living. You can’t blame the oxygen company for finally refusing to supply the government for free. And you can’t blame the poor for continuing to trust the public-health system. They have no choice.

But we can, and should, blame the government for its complete disregard for human life, especially when corrupt officials routinely squander public funds on their election campaigns and then go abroad for their own medical treatment. Not that different, I suppose, from U.S. lawmakers who vote to repeal Obamacare while enjoying fabulous taxpayer-funded health insurance themselves.