DMCH doctors refer most patients to pvt diagnostic centres

Elderly Mofizul Islam, a patient at Dhaka Medical College Hospital (DMCH), was worried how he would bear the expenses of four pathological tests at a private diagnostic centre as advised by the doctor at the medicine ward of DMCH.
The doctor came up with a solution, saying, "No problem, I am introducing you to a representative of ….. Diagnostic Centre. You will get a 40 percent discount from there."
Referring patients to private diagnostic services by in-house physicians in exchange for "commission" or "gift" from the private services are rampant at public hospitals including DMCH, the country's largest public hospital, and the adjacent Dhaka Medical College (DMC), said sources.
Although both the DMCH and DMC have laboratory facilities where 90 percent of the pathological tests and other investigations can be conducted round the clock, the physicians send about half of their patients to private diagnostic centres for the tests, the sources added.
This sort of unethical practice at seven medicine wards of DMCH alone causes a loss of nearly Tk 1 lakh each day to the hospital, according to them.
Mofiz, the 75-year-old muajjin at Masjidul Aksa in Ohab Colony area of Bashabo, was admitted to the DMCH on July 11 with complaints of pain in the abdomen.
After the DMCH doctor told him to get the tests done from a private diagnostic centre, the confused patient asked the doctor, "Can't you do it here? 'Cause I thought there's arrangements for that in here."
The DMCH lab is closed on Fridays, the doctor replied to him. Besides, "It's way past 2:00pm and you can't get it done here now. But don't worry, I'm arranging a discount for you," he insisted and introduced Mofiz to a representative of a diagnostic centre.
The representative said the discounted charge for the four tests -- urine, blood CBC, blood Vrea Creatinine and serum electrolytes -- would be Tk 1,000 instead of the regular Tk 1,660.
Mofiz's son Osman Gani refused to accept the doctor's explanation about the DMCH lab hours and started arguing with the doctor as Osman had earlier found out that the lab is open 24 hours everyday.
A DMCH laboratory health technologist, who overheard the altercation while he was passing by, challenged the doctor. "Sir, you can't do this. All four tests can be done here," he insisted.
"Is that right? I didn't know that," said the doctor expressing his ignorance.
"There's a notice posted in your chamber in this regard as well as in all other doctors' chambers. The 24-hour service had begun over two months back," the technologist argued.
Mofiz was later diagnosed with kidney problems after he had all the tests done at the DMCH lab for only Tk 420.
The patients, health technologists and doctors interviewed by The Daily Star correspondents alleged that most doctors and staff members of the DMCH receive bribe from private diagnostic centres for referrals.
Despite launching of the 24-hour laboratory services at both the DMCH and the DMC, an increased number of their patients are getting their diagnostic tests done at private laboratories, the sources said.
On an average, diagnostic tests of around 100 patients were conducted at the DMCH lab everyday a year ago when the lab was open for eight hours everyday.
After the lab started to offer 24-hour service, the average number of patients availing the service each day now stands at 150 -- not a significant increase considering the huge number of patients getting their diagnostic tests done from outside, said a health technologist.
According to sources, many of the dishonest doctors at the DMCH receive Tk 20,000 to Tk 1 lakh in cash as advance payment from the diagnostic centres in exchange for referrals. Besides cash incentive, they also receive all sorts of perks including air conditioners for personal use, added the sources.
The Daily Star came across a categorised list of "commissions" prepared by a small size diagnostic centre in May 2005. The list mentions the cash incentives a hospital doctor or staff member would get for each referral to their laboratory.
According to the list, the commission for each pathology test is 50 percent of the regular charge, for Enzyme-linked ImmunoSorbent Assay is 40 percent and for X-ray, Histopathology and Ultra sonogram the commission is 20 percent.
Furthermore, there is Tk 1,350 in commission for referral of each MRI test, Tk 1200 for CT scan, Tk 90 ECG test, Tk 225 for Echogram, Tk 200 for EEG and Tk 400 for ETT test.
A few doctors at the DMCH however said many patients are being driven out to private labs since the authorities have imposed fees for conducting tests at the DMCH lab that used to be free for all about two months ago.
A technologist rejected this notion saying, "Tests at the DMCH lab are still lot cheaper and reliable than the private centres."
Following are the fees set by the government to conduct tests at the DMCH and DMC labs: CBC Tk 55, blood sugar Tk 25, Serum Creatinine Tk 250, blood urea Tk 30, lipid profile Tk 180, USG 1-part Tk 100, USG whole abdomen Tk 220 and liver function Tk 170.
The fees charged by private laboratories for the same tests are: CBC Tk 250-Tk 350, blood sugar Tk 100-Tk 150, Serum Creatinine Tk 250, blood urea Tk 200, lipid profile Tk 800-Tk 1,000, USG 1-part Tk 500-Tk 800, USG whole abdomen Tk 800-Tk 1,600 and liver function Tk 550, according to the sources.
Dr Kazi Shafiqul Halim, clinical pathologist at the DMCH, said, "Tests are very reliable here because qualified doctors and technologists carry out those."
DMCH Director Brig Gen Abdus Shahid Khan told The Daily Star, "Since we cannot do all the tests here, we can't prevent the representatives of private diagnostic centres from entering the hospital. Such action will cause sufferings to the patients."
However, all the persons in charge of the wards have been instructed to get the signature of the doctor concerned while referring a patient to a private lab for a test that cannot be conducted at the DMC or the DMCH, he added.