Monday, June 25, 2012

Letter to MD, ECHS and 3 Chiefs

Maj Gen (Retd) Satbir Singh, SM Vice Chairman Indian ESM Movement Mobile: 9312404269, 0124-4110570

To Date: 23 Jun 2012
Maj Gen J George MD ECHS Central Org ECHS Mod Lines Delhi Cantt-10
Dear Gen George,
1. ECHS was introduced with an aim to provide required suitable healthcare to the defence veterans in super specialty empanelled hospitals near to their place of residence and with smooth and comfortable procedures and also to reduce load on the military hospitals. However, in practice, due to multiplicity of authorities in operationalising the scheme, a lot of avoidable delays and cumbersome procedures have been introduced causing undue delays and harassment to the ECHS members.
2. We have been taking up the issues with AG and MD ECHS requesting them for streamlining the procedures to ensure minimum discomforts to the ECHS members in getting the required treatment. However, for the reasons best known to various authorities, these procedures have not been streamlined, which are causing a lot of inconvenience, discomforts, mental harassment, delays and too many rounds of ECHS-empanelled hospitals – approval authorities etc? Just to illustrate, the following example is given.
3. I developed some problem in my right eye. I went to ECHS Gurgaon and got reference to empanelled hospital which is Shroff Eye Centre (A renowned eye hospital). The eye specialist recommended some tests, for which I had to come back to ECHS Gurgaon the next day to get special referral for the tests, I then went back to Shroff hospital, the 3rd visit, where tests were carried out and ARMD was diagnosed in my right eye. The eye surgeon recommended that injection Avastin be given in my right eye for which I was to get back to ECHS Gurgaon to get Appendix ‘A’ signed. By then, four rounds had been made between ECHS Clinic & Shroff hospital and the treatment was yet to start. The OC ECHS Gurgaon who was new, was told by his staff that since the amount is more than Rs 5000/- the appendix ‘A’ is to be signed by SEMO Base Hospital Delhi Cantt. He sent the form to Base Hospital where the SEMO refused to sign since he wanted to see the patient. It is here; I got in touch with MD/Dy MD ECHS Delhi Cantt and asked them as to what was happening? Once a hospital has been empanelled after due checks on their capacities and abilities of being Super specialty hospital, the advice of the Eye surgeon for treatment must be honoured and the patient should not be made to run around just to do some administrative checks and audits. ECHS’s supervisory committees/teams should carry out these cheks and audit to ensure no malpractices are being carried out. The patient must not be made to run around. After a great amount of running around, the appendix A was signed and I was given the first dose of injection Avastin in my right eye. After a week I was required to be seen by the eyes Specialists. Again the same procedure was to be gone through (Another three rounds to get referrals). The eye specialist advised the second dose after four weeks and prescribed some medicines. These medicines were NA with ECHS and funds for local purchase were not available. I bought the medicines from the market. I had my 2nd injection thereafter, again four rounds I had to go through to get sanction for the 3rd and final dose of the injection which was required to save my right eye, even though partially. Sanction for the third appendix ‘A’ put me to extreme hardships. I had to get in touch with DGAFMS to seek his help. It took almost 15 days and finally Appendix ‘A’ was signed and my right eye received its 3rd dose of the injection on 21 June 2012.

4. I have narrated my own case to highlight that if this is what I had to go through, what about the jawan ESM? We had strongly suggested that single window super specialty medical care must be made available to ECHS members. The referral to the empanelled hospital should be for consultation, investigation treatment and follow up and there should be no need for the patient to run around to get administrative sanctions. Checks and audits may be introduced at the time of empanelling the hospital and subsequently by audit teams to ensure no malpractices are allowed to happen.

5. Some suggestions are made as under:-

(a) Emergency Cases: - ECHS members can be taken to any nearest hospital for emergency management. The Govt. while sanctioning License/ Registration to all hospitals should have a clause that defence personnel ECHS members are attended to in an emergency at the ECHS rates. The concerned hospital should inform the dependant ECHS Clinic/ECHS helpline about the patient. The designated team of doctors should visit the hospital within 24hrs to assess the condition of the patient.If the ECHS member who is admitted in an emergency, is in a state to be moved to an empanelled Hospital, the same may be carried out under ECHS arrangements. If he is not in a position to be moved out of the hospital, then he /she should continue to get treatment at the same hospital and the ECHS should make direct payment to the hospital at ECHS rates, The provision of the same should be incorporated in the terms and conditions of giving Licence to the hospital. If any extra charges are to be paid to the hospital, the same should be done by the ECHS and not the patient. The patient should not have to arrange and pay dues to the hospital. The case in point is of Brig Mahajan who was, in an emergency, taken to Madanta Gurgaon by his son & was kept in ICU for more than 15 days. His son had to raise private loans to pay bill of Rs 5,60,841.09 and only Rs 3,62,882/- have been reimbursed to him. He or his son is not in a position to bear the loan amount. The feelings expressed by Brig Mahajan in an attached mail will move any one; atleast, I had tears in my eye. As per terms and conditions of service, a soldier and his/her spouse are to be given free medical care for life. The ECHS scheme, in addition, provides for dependent parents and children.

(b) Normal Cases:- If it is not an emergency, the ECHS member should get referral to any empanelled hospital through any ECHS Polyclinic for consultation, investigation treatment and follow-up. ECHS doctors be kept informed by the ECHS member about his/her medical care once a month or as required. All bills be cleared by the ECHS and cheks and audits and any administrative sanction if required be carried out by the ECHS.
(c) MD ECHS should be the authority to operationalise the scheme. He can seek assistance of any military hospital nearby and other controlling authorities should be done away with.
(d) The budget provisions for the ECHS be made available in the beginning of the year. Additional projections may be made based on the requirement and sanctioned on Priority.
(e) The latest investigations and treatment techniques/facilities which have been introduced in the country within the last six months must absorbed by the ECHS empanelled hospitals. These should be updated every six months. There should be no need to get appendix A signed for any test/treatment already introduced and available in the empanelled hospital. It is intriguing as to why the injection Avastin which has been the treatment for more a decade in our country is not included in the ECHS Scheme.
(f) ECHS member should not have to spend money from his/her pocket to get any special consultation, investigation, treatment and follow up. ECHS should take care of the same.
(g) The facilities at RR, Base Hospital, Fd Hospital, or any other military medical establishment should be made available to the ECHS members who should have a choice to go to any one of these in addition to the empanelled hospitals
(h) AIIMS/Any other Govt hospital should also be available to ECHS member if they so choose to make use of it.
(j) Emoluments of polyclinic doctors and staff must be suitably enhanced to ensure that they all are functional for a minimum of six hours and remaining 2 hours for administration purposes.
(k) Hospital bills must be cleared within 15 days as assured by MD ECHS to instill confidence in the empanelled hospitals to stay on and more good super specialty hospital to offer their services.
(l) Out sourcing of Pharmacy should be operationlised at the earliest.
6. The above are a few of the suggestions. More can be added/subtracted as deemed fit by MD ECHS, AG and the MoD.
With Regards,
Jai Hind Yours Sincerely,
Maj Gen (Retd) Satbir Singh, SM Vice Chairman Indian ESM Movement Mobile: 9312404269, 0124-4110570 Email:
Copy to :-
Brig (Retd) Ravi Pandalai, SM - With a request to take-up the matter with concerned. Veterans Cell (C & W) Directorate department Adjutant General’s Branch Integrated HQ of MoD (Army) Room 153, Kashmir House DHQ PO, New Delhi -110011
Gen Bikram Singh, PVSM, UYSM, AVSM, SM, VSM, ADC - With request to take up the Chief of the Army Staff issues with the Govt for Integrated HQs of Armed Forces (Army) early redressal please. South Block, New Delhi-110011
Admiral Nirmal Kumar Verma, PVSM, AVSM, ADC -do- Chairman Chiefs of Staff Committee and Chief of the Naval Staff Integrated HQs of Armed Forces (Navy) South Block, New Delhi-110011 Air Chief Marshal Norman Anil Kumar Browne, PVSM, AVSM, VM Chief of the Air Staff Integrated HQs of Armed Forces (Air Force) -do- Vayu Bhawan, New Delhi-110011 Lt Gen JP Nehra Adjutant General Integrated Headquarters of the MoD (Army) -do- South Block New Delhi – 110 011