VS Hospital budget doesn't reflect proper use of Ahmedabad tax payer contribution

By Rupa Chinai, Brijesh China, Jay Sheth, Dr. Nishith Shah*
This is with reference to the Budget of over Rs.173 crores (Rs.17331.96 lakhs as stated) for the financial year 2022-23 for Sarabhai General and Chinai Maternity Hospitals, Ahmedabad. We are constrained to point out, as we have done regularly in recent years, that this budget does not correctly portray the appropriate usage of Ahmedabad’s tax paying public. Neither does it support the health needs of poor citizens for whose benefit this institution was created. In fact this Budget is intended to ensure the death of the Sarabhai General and Chinai Maternity Hospitals (VSH).
This Rs.173 crore budget is designed to cater to a 500 beds hospital whereas with lesser amounts, our Board was running an 1155 bed hospital that was brimming with patients and was lauded for the 90 years of “glorious service” it provided to poor citizens. Hence we are compelled to ask where the funds are being funnelled back. Even a cursory study of this Budget does not inspire any confidence to a lay observer!

Denial of health care to poor patients:

Since 1930 VSH was the only public-charitable institution in Ahmedabad providing free or highly subsidised services to the bulk of poorest citizens irrespective of caste or creed. From 2012 onwards, the AMC’s illegal moves to usurp beds, staff and equipment from VSH and transfer the assets of this independently managed Trust to the for-profit Sardar Patel Hospital (SVP), has effectively denied emergency medical care to the poorest of citizens. We were told that Ayushman Bharat, the insurance scheme initiated by the PM for Below Poverty Line (BPL) patients, would take care of them in any public or private hospital where they sought entry.
At VSH, the figures for Ayushman Bharat show that between April 2019 to November 2021, barely 116 patients were treated over the course of 33 months. This averages to just four patients being treated per month under the PM’s prestigious health insurance scheme, that too while Covid raged in the city and citizens died beyond untold number because of the Administration’s inaccurate figures.
If we look at the Gujarat Chief Minister’s Ma Amrutam Yojana which should have been used to benefit poor patients during the height of the second wave of the Covid pandemic: Between April 2021 to November 21, over the course of eight months, only 351 patients were treated at VSH. This averages to just 40 patients per month, while the city saw patients dying on the streets while desperately seeking hospital admission! Or look at the figures on patient accident cases treated at VSH. Between April to November 2021, only eight accident cases were admitted over the course of eight months.
At the Chinai Maternity Hospital, obstetric delivery cases admitted to the ICU, according to the Budget figures, was 168 patients between April to October 2021. This averages to less than 25 patients per month when that Hospital has seen at least 25 cases being admitted on a daily basis in the past. During this same period of seven months, there were 948 registered deliveries, a figure that is absurdly low in a hospital whose past records shows far greater utilisation of services. Meanwhile Paediatrics Department treated 274 patients over the course of seven months during the same period of 2021 — an average of 40 per month.
The allocation for patient medicines — a mere Rs.2.3 crores out of a budget of Rs.173 crores is indicative again of the low priority given to patient care. While the Medical Superintendent in his response to our letter of 20th January says that the budget for patient medicine and equipment will be increased, there is no specific mention of any figures or details provided.
So the question we ask is, if services for patients are so drastically curtailed at VSH, for whose benefit are we using a Budget of Rs.173 crores? The Budget reveals that 80 per cent of funds, (79.09 per cent), is allocated to Establishment Expenditure for an institution that has no patients, permanent staff, services or beds that it can now speak of!
The Medical Superintendent in his response to our letter of 20th January, 2022, states that this 79.09 per cent allocation is earmarked for 1200 pensioners and 900 permanent employees of VSH. If such ‘ghost’ employees do actually exist at VSH, can we know the names of these 900 “permanent employees”, the specific department they work in at VSH and what is the amount of salary they are being paid? By this absurd figure we have more staff at VSH than we do patients!

Establishment Costs eat 80 per cent of the Budget:

The fact is that since 2013 the AMC has transferred the majority of VSH resident doctors and permanent staff to SVP and other institutions. It is now running the VSH on a shoe-string, contractual staff who lack training, motivation, commitment to patient care or sense of belonging to this institution. It is being held that contractual staff reduces costs. Hence one assumes that such staff do not get paid Provident Fund (PF) or Pension and there is no need to budget for the same in our books.
Yet, with no permanent staff to speak of, the current Budget shows a five fold increase in PF and Pension!! In the first six months of 2021 the Budget records over Rs.12 crores (Rs.12,10,57,230) and in the second six months of that year over Rs.27 crores (Rs.27,89,32,770). However total establishment expense in the budget for 2022-23 is estimated at Rs.137 crores, so how is this feasible? No explanation is provided in the draft budget on such a massive jump!
Other figures for 2021-2022 also provide for incredulous reading: The Budget says in the first six months of that period, Indoor Registration Fee was Rs.26,920. Then in the next six months its estimated figure shoots up to Rs.5,73,080. Such a huge rise? No explanation provided on how this figure is arrived at!
For the current year 2021-22 it states Indoor Fee in the first six months is Rs.5 lakhs (Rs.5,01,200), and shoots up to Rs.94 lakhs (Rs.94,98,800) in the next six months. How is a 20 times increase possible? No explanation yet again!
Against this income, establishment expenditure during this period of first six month is over Rs.28 lakhs (Rs.28,32,51,190), while in the second half it rises to over Rs.51 lakhs (Rs.51,67,48,810).
Unfortunately such a Budget with such non tallying figures make no sense. The strong suspicion arises then that the VSH Board is being used as a filter to wash away highly dubious money laundering transactions. This calls for an independent public enquiry which we will pursue if the above is not explained.
One possible instance of enquiry could be the Rs.8 crore Provident Fund scam that is an officially conceded fact. Has that money been adjusted from the VSH account and been paid to the PF Commissioner? The PF scam happened during the watch of then Superintendent Dr. S. Malhan who was clearly acting on the instructions of an unseen coterie and without the knowledge of the VS Board of Management. A police complaint was filed on this issue. The PF Commissioner tabled a report on this and imposed a heavy fine on the VS Board. Meanwhile the then AMC Commissioner, while bypassing the VSH (which he has no powers to do), gave voluntary retirement to Dr. Malhan with full pension and benefit rights.
We would like to know if the Rs.8 crore penalty of the PF Commissioner has been paid by VSH through such manipulation of its Budget? The office of the AMC Commissioner also needs to be held accountable and chastised for its repeated interference in the management of the independent VS Board of Management.
The administration evades this issue. We need a clear response to this question: Has a penalty amount been paid to the Provident Fund Commissioner from the VSH account, or not?
We the independent VSH Board members reiterate here that this Budget is full of misleading and questionable figures and we have nothing to do with it. Even at this late stage we urge the VS Board of Management to take responsibility for this deeply unhappy situation we find ourselves in. The way forward lies in restoring VSH to its 1155 beds; bringing back its entire team of resident doctors and other permanent staff and restoring multi-speciality services for poor patients.
—
*Independent Members, Board of Management, Sarabhai General and Chinai Maternity Hospitals, Ahmedabad