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Patients pay doctors to use surgical equipment at Igbobi

For non healthcare worker who wish to express opinion on nursing and hospital issues.
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Kunle Emmanuel
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Patients pay doctors to use surgical equipment at Igbobi

Unread post by Kunle Emmanuel » Sun Jul 20, 2014 9:04 am



Adeyoyin Olatayo’s coming to Lagos again in January 2014 after many years of visiting the city was neither for funfair nor tourism. Since 1967 when she clocked 15, she had been suffering from a severe pain in her right hip, causing her great pain anytime she used the leg to walk. Up till today, she said she could not explain what could have caused the pain.

Since then, she had held many prayer vigils and taken uncountable doses of drugs to suppress the pain. But it wouldn’t go. Instead, it got worse by the day until eventually about two years ago, the two legs finally failed to carry her anywhere again; and so she started using crutches.

But she still hoped she would walk with her legs someday. With this hope constantly burning in her, she learnt that she could be treated at the National Orthopaedic Hospital in Igbobi, Lagos, one of the three national orthopaedic hospitals in the country. And for the first time in over 40 years of living with the hip pain, she heaved a sigh of relief – that her ‘miracle’ might truly be in sight.

After many medical tests at the hospital, it was discovered that her femur (the thigh bone located in the leg) had degenerated and worn out, thereby making her right leg to become weak and heavy. But she was still happy that at least, there was a solution in sight.

The solution would be a total hip replacement in the leg – a surgery that could only be performed at a specialist hospital.

However, that feeling of happiness was almost marred when, five months after she had gone to the hospital for registration and medical tests, she was not called up for the surgery – the primary reason being that the hospital wards were filled up, and so some patients had to leave before others could be admitted.

Eventually she was operated on in May 2014, after some months of waiting. Nonetheless, the total cost of the surgery almost made her to give up – but for the financial support she received from her family and friends, she finally had the surgery, and made it.

But one thing would not stop to baffle her, before and even after the surgery had taken place. When she thought the payment of N787,200 stated by the hospital as the cost of the surgery would cover almost every medical expense, she was nonplussed when she was asked to pay N35,000 by one of the two doctors who handled her case for the rent of an equipment called the surgical drilling machine, one of the tools that would be used to operate on her in the theatre.

An orthopaedist, Adewale Oyediran, said the surgical drill is a medical instrument that looks exactly like a drill, fitted with a rotating cutting tool, and used in making holes in the bones.

Oyediran said the tool is used in performing many orthopaedic surgeries, and is found in orthopaedic hospitals only.

He also explained that it is used only on patients whose bone had been worn out or degenerated from its joint and needs to be fitted back into it.

“It is a tool you don’t find in any other hospital. It is special and is used only in orthopaedic surgeries. It is a bit expensive, with one costing about N1m or more, depending on the type, he said.”

Even at that, Olatayo said she had never heard of cases where patients were asked to pay to any doctor to rent any equipment that would be used in the course of their treatment in any hospital – except probably in private hospitals.

To confirm her thoughts that something was wrong somewhere, she was not issued any receipt for the payment made to the doctor in charge of the operation. Meanwhile, for every other service rendered to her by the hospital, receipts were issued.

She said, “It was strange to me when the doctor told me I would pay to rent one drill machine prior to the commencement of the operation to be carried out on my leg. I had never heard of this anywhere before that patients rent equipment to be used on them. The hospital should have been the provider, I guess.”

To tell her this, she said the doctor had called her and her daughter aside where no other hospital official could have heard their conversation.

“But it was never stated in the cost statement issued to me when I paid for the surgery, and I do not see it as normal that the equipment would have to be paid for separately after paying a huge amount of money for the operation already,” she added.

Olatayo also added that the doctor told her that she had a choice of either buying the equipment brand new or renting it. Either way, the most important thing is she needed it for a successful surgery on her hip.

If she were to buy the surgical drill, the cost, according to the said doctor, was over N1m. But since it would be unwise to spend such an amount of money on one equipment that would be used only once, she said the doctor advised her to rent it – at a cost of N35,000 though.

Doctors exploiting, extorting patients

A source, who pleaded anonymity, and who has knowledge of operations in the hospital, told our correspondent that at least three patients are operated on daily in the theatre. On the day Olatayo was operated on, they were six.

“Not all of them would need the drilling machine, though. Maybe about 10 of them would need it in a week. It depends on the severity of their cases,” the source said.

If this mathematics is therefore accurate, surgeons at the National Orthopaedic Hospital in Lagos could be making as much as N1.4m monthly off patients who need the surgical drilling machine to perform surgery on them.

Another source in the hospital, who also pleaded anonymity, said it was a pure case of doctors exploiting and extorting patients – because they know that the patients do not have any other choice, the reason being that the hospital is the only known public orthopaedic hospital in the South-West.

The source said, “Remember, we have just three national orthopaedic hospitals in the country. Hence, it would be unfortunate for any patient to think he/she could go somewhere else if they cannot afford to pay for the medical services here.”

To corroborate the claims of extortion and exploitation by the doctors from the patients, the source revealed that the hospital currently has the equipment.

He said, “I work in this hospital and I am aware of every particular equipment we have. But presently, Igbobi has the surgical drilling machine. We have the machine and I am sure of it. Though it is possible we have only a few, I am sure we have it.”

The source added that if any doctor was asking a patient to pay to rent any equipment, it was nothing less than extortion – taking advantage of the patient’s situation to make money.

It added, “For Christ’s sake, no receipt was even issued. That tells you it is totally wrong. So, if any doctor is asking patients to rent it, it means they (the doctors, not the hospital) are extorting those patients.

“Normally, they should refer patients to the assessment department because every surgery has a cost. That we don’t have the equipment is a lie; or maybe the one they have is obsolete.

“But even if the one they have in the department is obsolete, the proper thing is to inform the hospital management to provide a new one, not asking patients to pay for rent. It is unheard of.”

Olatayo was not the only patient who paid doctors to rent the equipment; some other patients, lying on their beds on the day our correspondent visited the Mobolaji House Accidents Ward lamented the outrageous bills by the hospital.

One of them, a woman in her 60s, who wouldn’t want her name in print for fear of humiliation by the hospital officials if she needs to go back for check-up, said the cost almost discouraged her, if not for the fact that she had paid almost a million naira as the initial cost of surgery.

She said, “After paying about N800,000, I thought it would cover all the expenses. But it did not. The bills never stopped coming.

“I paid another N44,500 for some petty instruments that were used in the theatre room for the operation on my knee, aside paying for drugs and feeding.

“A part of this money I even had to borrow, all because I want to walk again. The bills here are too outrageous, despite that it is a national hospital.”

Saturday PUNCH findings showed that if these patients were to go for a private medical attention, it would surely cost them their arms and legs. Knowing this fact, the patients had no option than to pay for any service they were asked to pay for.

“I could have been discouraged from coming for this surgery if I knew it was this expensive,” another woman said.

She said she just retired from the civil service and had used her gratuity to foot the bill.

A nurse, who works in one of the female wards, said that if the patients knew they would pay for other services aside the main cost of surgery right from the beginning, they probably would have been discouraged.

“So to make them come, they didn’t have to be told everything. After all, it is for their benefit,” she said.

This scenario is not, however, peculiar to the National Orthopaedic Hospital in Lagos. Such was the case when Mrs. Chioma Dike, a widow, who resides in Owerri, had her leg broken when she had an auto accident in 2012.

Promptly, she was taken to the National Orthopaedic Hospital in Enugu where she had a surgery conducted on her left leg.

Her son, Mr. Chibuzor Dike, who spoke with our correspondent on the telephone said the cost of the surgery had affected his business negatively.

“I spent almost everything I had on me, being the first born and the only person working. My siblings are still in school,” he lamented.

“They asked us to pay for the use of some medical equipment because they were not available in the hospital. Since I am not a medical personnel, I was not interested in knowing the names of the equipment. All I cared for was that my mum should be treated.”

He said her 65-year-old mother is now walking a bit – but the doctors said she would improve soon.

Patients provide for their own comfort in the hospital

A visit by our correspondent to a patient at the Mobolaji House Accidents Ward 2 of the National Orthopaedic Hospital, Lagos also revealed that despite the outrageous bills patients pay to the hospital, they (the patients) still have to take other things that could guarantee their comfort to the hospital.

For example, standing on the table close to their beds, each patient in the female ward had her fan – a rechargeable one for that matter.

Curious to know why each patient had a rechargeable fans by her side, our correspondent asked one of them whether it was the hospital management that bought the fan for them, and she retorted how that could be.

She said, “How could that be? We bought these fans ourselves when we were admitted here. The heat here could be worse sometimes, and the ceiling fans are not working well to cater for everybody; so the nurses advised us to buy rechargeable fans.”

Our correspondent observed that even when there was electricity, the patients still used their rechargeable fans to fight heat, suggesting that the ceiling fans were not working well.

When the lights went off, apart from using the rechargeable fan, some patients still used hand fans to blow themselves. Findings by our correspondent revealed that the rechargeable fans cost N5,000 each and are supplied by an electronics dealer who probably has a close relationship with some of the hospital officials.

Apart from the rechargeable fan, the patient who our correspondent visited said she had to buy two pillows for her comfort because the only one provided for her in the ward had gone so flat that it could not make her rest her head well.

Why patients pay to rent equipment

When our correspondent approached the Chief Medical Director of the National Orthopaedic Hospital, Lagos, Dr. Olurotimi Odunubi, he said it was wrong for doctors to rent out surgical equipment.

However, he said it was true that since June 1, 2014, patients who needed the drill in the course of their surgery pay a certain fee into the hospital’s account, and not to an individual.

He explained that the hospital had to do that because of the high cost of maintaining the drill, among other issues.

But he said patients were required to pay such amount into the hospital’s account, and not to any doctor or any other hospital official.

“Doctors are not supposed to collect fees from patients at all. It is wrong,” he said. “However, people who are doing total hip replacement now pay N40,000 for the drill because to sustain the usage of the drill, we found out that it would be difficult we are not charging for it specially.”

He added that the payment for the drill varies depending on the severity of the patient’s condition, “but these fees are paid into the hospital’s account.”

Odunubi said, “If the drill is not working, what the doctors should do is to report to me, because I know that sometime in May, most of the drills were not working when I also went to the theatre to perform a surgery.

“That same day, I asked for a company to bring it. For a patient who had paid for a total hip replacement, they should have let me know and we could have made a request from a vendor, except the vendor does not have, which sometimes happens.”

Odunubi also explained that the major challenge hospitals face in Nigeria is maintenance of equipment.

He said, “If we can solve this problem, things will be good. Sometimes we buy some equipment and six months later, they go bad because nobody knows how to maintain them and the vendor does not provide any technician to do that.

“If you look at the inventory of our drills now, we have about 28, but at a time, not more than three were working. Others are under repair, but the people who should repair them are not able to do so.

“The people that supply them do not have technicians to repair them, so we keep buying them every time.”

“That is why the hospital decided that if the technology and personnel to maintain them are not available, and instead of disappointing patients, let them pay a certain fee and then we keep buying.

“We spend quite a lot of money buying drills. A good one from Europe costs about N6.8m, not the Chinese one. A Chinese one costs about N800,000, but they will get bad easily, and could disappoint in the course of using it.

“And even the ones we buy for N6.8m don’t last because we don’t have a good maintenance unit. There was a time we even bought one for that amount and six months later, it got spoilt. Our supplier sent it back to Germany and it was there for about 18 months.

“It was when we made a lot of noise that they replaced it, and even at that, the new one also got spoilt three months later. There is another one whose battery is not working. We want to buy the battery, but it is not available. Another one has cable problem, and we have not been able to get the cable for almost two years.

“So these are the problems we are facing. And if you look at the matter, how much are patients paying that we keep spending N6.8m every three months to buy drill?”

When he was asked what the hospital could do to prevent the wastage of resources, he said, “What can the hospital do? We sent people to Germany and India for training, but the technology is always changing. The person we sent to India came back better, but still couldn’t understand everything.

“What I have told suppliers of this drill is to join hands and establish a school of Biomedical engineering so that they will not just sell us equipment, but should be able to also maintain them for us. That is the major problem, not only here, but also in every other hospital in Nigeria.

“Some of the equipment that are not working, we go to hospitals in Italy and Germany and see them working and they will tell you they have been using them for over 20 years.”

He pleaded with the Federal Government and the suppliers to come to the aid of hospitals in Nigeria as this would solve a lot of problems they are facing.

He added, “If the Federal Government and the suppliers could take the initiative, things will be better for us because these suppliers just import and dump them on us, and pray that the guaranty period would lapse – which is usually a maximum of one year. Once this happens, we are on our own. They hands off everything about maintenance and repairs for us.

“These are the issues we are facing. We borrow the drill from companies that rent it out like Morrison, Johnson & Johnson, etc. We even pay more money than what the patients are paying to borrow this equipment. For instance, the mentioned companies rent it out at an average price of N70,000, but we charge patients about N40,000.

“Overall, patients pay to rent the drill, but they are to pay into the hospital’s account, not to an individual.”

On the issue of patients providing for their comfort such as the case of patients buying rechargeable fans, Odunubi said it was not the pleasure of the hospital not being able to adequately provide for the patients.

“The ward where you went to even needs not just renovation; it needs to be pulled down and rebuilt. But we do not have the fund to do all these,” he said.

The National President of the Nigerian Medical Association, Dr. Kayode Obembe, could not be reached for comments on the issues at stake. His phone lines were unreachable.

However, the Lagos State chairman of the Nigerian Medical Association, Dr. Francis Faduyile, also condemned the practice of patients paying to doctors to rent equipment, describing it as improper.

He said, “It is not proper for patients to pay doctors to rent any equipment to be used for their treatment. The normal thing that a doctor should do if he finds out that an equipment needed to carry out any form of treatment for a patient is unavailable, is to tell the patient to go and seek treatment where such equipment may be available.

“But at times, it is not as if our hospitals do not have equipment. It is just that the equipment might need to be serviced, or something is just not working properly; and the bureaucracy in such institution may make it very difficult for them to get it done.

“Many times, the equipment are outright obsolete. So these are the situations we are facing and I think the moral thing about the whole issue is that the doctors should tell the patients that they do not have the equipment and refer them somewhere else.

“Doctors should be able to restrict themselves to the equipment that are available in the hospital. For a doctor to tell patients to bring money and serve as middlemen in this issue is wrong.

“We have discouraged our members from discussing negotiation for the rent or purchase of any equipment with patients. It is good for them to stay on the clinical aspect of treatments alone so that doubts about their reputation will not arise.”

Nonetheless, Faduyile added that it was the fault of the Federal Government that things had become that bad in government hospitals.

He said, “It is not only Igbobi that this problem is peculiar to. There are many other teaching and federal hospitals in this country that do not have up-to-date equipment.

“I know some orthopaedic surgeons that have some highly specialised surgical equipment, and many times the institutions they are working for do not have them.

“We plead with the government to put up-to-date equipment in the hospitals because unless this is done, the issue will recur.

“That is why we have been fighting for these things. It is just that the government we have is irresponsive. If it does not invest heavily in the health sector in terms of equipment and personnel, nothing will work; and if nothing works, we will all be the victims.”

http://www.punchng.com/feature/amazing- ... -hospital/


Nigerian Nurses lighting up the world one candle at a time.

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Kunle Emmanuel
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Re: Patients pay doctors to use surgical equipment at Igbobi

Unread post by Kunle Emmanuel » Sun Jul 20, 2014 9:21 am

Please I have been there in MBA 1 for a surgery as a result of a car accident had on my hip which I spent almost 6
months. I knew what I passed through. Doctor Olurotimi Odunubi just said that to cover up what is happening there. Why are they not giving receipt to patients when this money is paid to them? They even go more than that when they see that patient is desperate to pay whatever amount just to save life.

This N787,200.00 is the bill they also gave me for total hip replacement and since last year I have not been able to raise to that amount and I know too well there will be another payment after N787,200.00.Hospital account, after that the consultant came and explain other expenses when patient has settled down in the hall or ward waiting for the hour to come for the surgery.

Infact, after mine, which was not done very well when I visited another hospital with my X ray to check, also confirmed in Igbobi hospital by another doctor that it was done well. I was having severe pains day by day.
The amount is almost the same to do the same total hip replacement in India. Just that patient will spend more on flight and hotel bill. I shared my X ray with them through e mail and in 24 hours they responded stating what is to be done, duration of 15 days I will stay in hospital in India and all these consulting was free and after then, they keep following up on me because I told them I want to raise money for the surgery. They called me every two weeks until I traveled to India and the surgery was done successful. I walk now, do my job here in Lagos.

Finally, yes Government have to help us by checking all these in public hospitals to stop all extortion Poor masses are spending a lot in our Government hospitals, some have died because they cannot afford to pay the bills. Maintenance is the key which Our Government should have monitoring team but all our explanation, complaint dies here on air. If one is treated fine at the hospital and patient feel better before leaving the hospital or even after that the Patient will definitely show an appreciation to the doctors no matter how small and not when the person is down it becomes an opportunity for doctors to extort.

Godwin Afolabi
Nigerian Nurses lighting up the world one candle at a time.

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