It was the year of an epidemic. In 2011, dengue hit the province of Punjab. There was a panic in the hospitals. Thousands of patients thronged the Emergency Departments of the hospitals in fear. Even doctors were not trained enough to handle such huge influx of patients.
The government figures state some 300 people lost lives, and 140,000 were hospitalized, 90 percent of them in Lahore due to dengue.
Almost everybody even with a regular fever rushed to the diagnostic laboratories to get the Complete Blood Count (CBC) done – a lab test that counts the platelets in the blood to confirm whether or not a patient has contracted dengue.
And this is when Punjab government “discovered” a pitfall: diagnostic labs charged patients at their discretion as there was no regulatory authority to check their practices.
The labs charged as much as Rs 900, almost 10 times more than the actual price, for a simple CBC test.
The government came into action and under the Punjab Prevention and Control of Dengue (Temporary) Regulations, 2011 made it mandatory for all the diagnostic labs not to charge above Rs 90 for a CBC test.
The epidemic exposed how these diagnostic labs in Punjab are looting patients under the very nose of the government authorities in the absence of any regulatory laws. As soon as the epidemic was over, laboratories were back to their usual practices.
Currently, the charges for a CBC test at private diagnostic labs, done free at all public hospitals, range between Rs 200 to Rs 700. The labs charge for standard tests like Liver Function Tests (LFT), complete urine test and sugar tests on their discretion.
A same test of LFT costs Rs 850 at Sahara Laboratory, Rs 1200 at Chughtai Lab, Rs 1400 at Shaukat Khanam Lab.
“These labs are only looting people. There is no check on them and in the absence of any strict laws to regulate their practices, these labs are thriving. There are thousands of labs only in the city of Lahore. They charge patient as much as they want and sometimes they force the patient to get those tests done which are not even required. This is done just to mint money from the patients,” said Dr. Salman Kazmi, General Secretary of Young Doctors Association and a Medical Officer at Mayo Hospital.
Diagnostic Labs mint money by fake clearance certificates
“There are certain labs which have signed contracts with different firms that send laborers/workers to Middle East, Saudi Arabia and other Gulf countries. This is now an open secret that many of these labs don’t give a fitness certificate to healthy patients without taking a bribe or doing same tests for multiple times. Many such people come to Mayo Hospital after they are diagnosed with Hepatitis B or C at some private labs, and once their tests are done here, they are pronounced completely fine. The problem is that the firms don’t accept the medical certificates by labs other than the ones which are on their panel. This makes things really complicated for people who sometimes not only pay huge sums of money to get clean reports but also go through a mental trauma of suffering a disease despite being healthy,” Dr. Kazmi said.
He said the health department and Punjab Healthcare Commission need to play an effective role to end such practices. “I got a job to work in Dubai for a construction company. I was told to get my tests done by a private laboratory in Shadman. When the reports came, I was told I had hepatitis. I got really disturbed as I hadn’t faced any problems or health issues. I spoke to the lab guy and told him of my problem that I had to go to Dubai. He said he would charge me Rs 50,000 to get me clean reports. I negotiated and in the end, I gave him Rs 30,000, and he got me cleared. Later, when I got my tests from another laboratory, I had no virus in my blood. I realized that I had filled a form which said that I needed reports to go abroad and may be that was the point when the lab guys tried to cheat on me and minted money from me,” said Fayyaz Hussain, a citizen.
“These laboratories not only charge higher than the actual prices of the tests they use malpractices to mint money,” he added.
Mian Suleman, another victim of the diagnostic labs, said he and his family had to suffer extreme trauma due to a mistake by the labs. He, however, isn’t sure was it an honest mistake or a deliberate tactic. “I was suffering from fever for some days. The doctor advised getting some tests done. When the reports came, they suggested I had cancer. The doctor, my family physician, was astonished and furious. He asked me to get tests done from another lab. And when the reports came, they didn’t indicate any problem. I protested with the first lab. However, they just excused and said it may have happened due to some mistake,” he maintained.
Pakistan Medical Association (PMA), Vice President Dr. Rana Sohail, believes the majority of the diagnostic labs are running a dangerous business and don’t have enough qualified staffers.
“At a diagnostic lab, you should have at least a qualified pathologist and hematologist. But sadly, most of these labs just use the name of the doctors on their boards who actually don’t work there. Their names are used, and unqualified people run the affairs at these labs. If you strictly start scrutinizing these labs, you will find out that many of these labs use the names of the same doctors on their panel. This is how they cheat patients,” Dr. Sohail said.
Speaking about the malpractices of the diagnostic labs to make money he said, “I am aware of the patients who paid a huge amount of the money to these laboratories through the third party to get clean reports. They deliberately issue unfit reports to people and later declare the same person fit after minting the money. The companies which send labor to countries in the Middle East cut a deal with these labs. They make a deal with their clients to issue them clearance reports from these labs and keep their share of the money as well”.
“The lack of any uniformity in the prices of the test is another issue. The government should ensure that the quality is maintained at these labs, and they do not charge patients as per their discretion,” he added.
Health Department Spokesman Ikhlaq Ali Khan said the government made these labs bound under special regulations during dengue epidemic of 2011 not to charge above Rs 90 for a CBC test. He said uniformed pricing was done at that time because that was an emergency situation. He, however, stated that currently department didn’t do anything to control the pricing and quality at these labs.
“One reason they give for different pricing is that some labs claim their quality of tests is much better than others so they charge more,” he added.
“Punjab Healthcare Commission has the mandate to check the malpractices of the labs,” Khan said.
Punjab Healthcare Commission Spokesman Javed Pasha said that the commission was working on ensuring the quality at the diagnostic labs.
“This is true that many of these laboratories don’t meet the prescribed standards and have unqualified people. The commission had launched a campaign against them. So far the commission has sealed 35,000 such clinics, labs and operation theaters where unqualified people were running the affairs, and quality was not maintained. Many of the diagnostic labs involved in malpractices have been sealed,” he added.
Pasha said that the commission has also fined Rs 150 million to those health practitioners who do not follow the Standard Operating Procedures (SOPs) to run clinics, labs or operation theaters.
“Things cannot be changed overnight, however, we are working on ensuring the quality health care service delivery at all public and private healthcare establishments in Punjab. PHC has also composed a draft of Minimum Service Delivery Standards for all the government and private health facilities,” he said.
To a question about issuing fake reports to the patients on purpose Pasha said, “We have established a Complaint Center at PHC office in Shaheen Complex. If anybody, a doctor or a patient has any complaint about any health care providing the facility, he/she can file an application with us. The commission investigates the matter, and we have our court which even awards punishment to those involved in malpractices. All those who had paid for getting clean reports thought they were healthy should write to us. We will investigate their complaints and if anybody is found guilty will be punished in accordance with the law,” he added.
PHC Chief Operating Officer Dr. Mohammad Ajmal Khan said initiative of developing and implementing Minimum Service Delivery Standards for healthcare establishments had been taken first time in Pakistan. He said PHC was also providing training to the health providers to implement these standards and monitoring its application. “This will also keep a check on quacks and non-qualified health care providers. This is one of the primary objectives of the commission,” he added.