Doctors at the department of orthopaedics of the Postgraduate Institute of Medical Education and Research (PGIMER) are referring patients to private suppliers for buying implants and medicines used in orthopedic surgeries, pointing towards a doctor-distributor nexus.
It is the patients who are at the receiving end as they have to pay more. The practice, under the law, is unethical and doctors can lose their job, if caught. Due to this nexus, the Affordable Medicines and Reliable Implants for Treatment (Amrit) outlet is not able to sell quality orthopaedic implants at reasonable prices.
“We had to return the stock as it did not sell. The surgical implants we were selling would have cost a patient Rs 40,000 less than the distributors’ rate,” said an AMRIT outlet employee.
Recently, this reporter acted as an attendant of a patient undergoing treatment at the department and called the three distributors for buying implants for a total knee replacement, giving reference of some senior orthopaedics surgeons.
“Two total knee replacement surgeries will cost you around Rs 2.2 lakh. Besides, accessories and drugs will cost Rs 40,000,” said a representative of an ortho implant distributor.
Asked if the implant is effective, he said, “The doctor is efficient and he has been using this implant only for nearly three years.” When this reporter called up another distributor by giving a doctor’s reference, its representative said, “We have two types of implants. One costs Rs 98,000 and another Rs 1.8 lakh. You also will have to pay Rs 50,000 on medicines and other items.”
Asked about the efficacy of the implant, he said “Woh to doctor sahib batayenge, hum toh smaaan bechte hain.” (Only the doctor can tell you that. We just sell our goods).
Yet another distributor, when contacted, said, “This doctor conducts surgeries twice a week. He uses implants of our company only as they are good. You can visit the ward and meet his patients also. Two knee implants will cost around Rs 2.4 lakh, including accessories.”
Shardha Hemta, a patient on bed number 66 in the female ward of the Nehru building, said, “I underwent the total knee replacement surgery 15 days ago. This doctor referred us to a Sector 16-based distributor for buying implants. It cost us around Rs 2.4 lakh besides drugs.”
Dr Gurinder Singh Grewal, former president, Punjab Medical Council (PMC), said, “This is a clear-cut case of nexus. The doctors apparently do this for financial gains. There is no reason a doctor should be telling a patient to buy an implant from a particular company. If they do not have the facility in the hospital, they can ask the patients to buy it from anywhere.”
As how the prices vary, Dr Grewal said, “I have a copy of the quotation of a top ortho implant manufacturer which is selling an implant at Rs 60,000-70,000 to a Punjab-based hospital which is charging the patients over Rs 1 lakh for the same.”
Asked if doctors in the orthopaedics department directly send patients to distributors, an ortho surgeon said, “Yes, it is true. While some doctors are trained in using implants of one company, some use the others’.”
“I don’t know whether the AMRIT outlet has implants or not. They should have implants of all companies. How does it matter if the companies are providing implants directly to doctors instead of selling these to the AMRIT outlet?” he asked.
Another doctor from the department, when contacted, hung up the phone citing voice disturbance. He later switched off the phone.
“The AMRIT outlet never had ortho implants. When PGI purchases implants from other distributors, they ask for a quotation from the AMRIT outlet also. They inform us that they do not have the implants,” said Dr Mandeep Dhillon, head of the orthopaedics department. Asked if doctors are referring patients to distributors, he said, “If AMRIT keep universally used implants, why would not patients buy implants from them?”