NWMH: Fading Into Oblivion?

Employees of Nowrosjee Wadia Maternity Hospital are protesting against deterioration of service and research, and the management's privatisation bid, which the management denies. Rita Dutta seeks out the real story

Employees seen protesting in front of NWMH

The Nowrosjee Wadia Maternity Hospital (NWMH), once deemed the Mecca of medical training and research, has now become a tale of disgruntled staff complaining of abysmal working conditions, employees deprived of payments for months, doctors leaving and closure of various key departments.

Wailing Protests

Located in Parel in Central Mumbai, the hospital is one of the early examples of a public private partnership (PPP) between the State Government, municipality and the Wadias of Bombay Dyeing. The esteemed institute, however, recently had discontented medical students, medicos, nurses and class III and IV employees of the hospital staging a 'dharna' in front of the hospital against a proposed privatisation and its consequences. "The management wants to pull down the present hospital and build a shopping mall and residential complex with a small hospital," bemoans Antony Swamy of Save Wadia Hospital Citizen's Committee (SWHCC). Employee unions like Lokshahi Hakk Sanghathana, Lal Bowta Kamgar General Union and RADA have formed SWHCC to campaign against privatisation of the hospital.

The campaign has been intensified since last year. "What triggered it was a report in a daily where Nusli Wadia had deposed, before the Bombay High Court-appointed committee of doctors, his intention to establish an ultra modern 75-100 bed speciality centre in the same premises where NWMH stands today," says Hutokshi Rustomfram, member of Lokshahi Hakk Sanghathana. "The hospital was built for mill workers of Parel and the management cannot sell the land to build malls. The area is still inhabited by lower middle-class people, who need subsidised treatment," says a former professor of nephrology at the hospital.

It All Began In 1999

The story of decline began in 1999, with a delay in payment of wages by the government, sometimes for even six months. This was only restored when a PIL was filed by the Lal Bowta Union of the hospital, demanding the government should pay arrears. During the course of legal proceedings, the court appointed a doctors' committee to examine problems plaguing the hospital. "The committee, which submitted its report in 2005, suggested that the hospital function as an autonomous institution, a move which was strongly opposed by the Union, as the first step towards privatisation," Rustofram says.

Closure Of Departments

Though no notice has been issued on privatisation, the management's motive is evident in closing down various departments, say doctors. The immuno-haematology department at the hospital, run by the Indian Council of Medical Research (ICMR), downed shutters in 2003, bringing pioneering research work to a grinding halt. "The department was doing research using molecular diagnosis and was also offering free neo-natal screening to patients referred by KEM Hospital. The hospital had the distinction of having India's first Rh positive unit to help Rh positive mothers, which of course stands closed today," says Dr Kanjaksha Ghosh, Director, Institute of Immuno-haematology, ICMR.

"Diagnostic tests, which were once offered free, were made available only at a price. Then the management started locking rooms of the department," Dr Ghosh adds. "Other services like the family welfare department, infertility clinic and a number of hospital wards have been closed. With speciality equipment in sonology department in disrepair, there has been a steep decline in the number of endoscopic surgeries," a professor informs.

Compelling Conditions

Over the years, the number of staff has been halved, complain doctors. "In the last few years, 25 prominent doctors had left the hospital. Such stringent conditions were imposed on doctors that they were forced to leave," says a professor of  gynaecology.

Even the working conditions of nurses are deplorable. "The nurse to patient ratio is 1:30, and thus we cannot give individual care to any patient," a nurse rues. Another one adds that the management conducts investigations for trivial reasons and refuses to grant leave when required.

Employees are also distraught about withdrawal of free medical benefits extended to them and their dependent family members. "Now, the employees have to shell out half the rate that is levied on other patients. In 2004, the management also lowered the retirement age from 58 to 55," an employee informs. This case in under trial and a stay has been granted.

Deterioration Of Service And Training

"The hospital, once known for its maternity care and training, is slowly slipping from its standards," says Prof Vijaylaxmi Ray, Director, National Plasma Fractionation Centre. The number of deliveries has plunged significantly. The Hospital Annual Report 2000-2003 reveals that in the year 1999-2000 there were 18,099 admissions and 12,126 deliveries. This has dipped to 7,000-odd deliveries now, sources reveal.

Another move resented by the employees is the introduction of user charges for services which were once offered free. Medicines, which were once given free, now come at a price. The once-free bed in the general ward is now charged at Rs 75 per day.

To the utter consternation of doctors, management wields the power in selecting teachers. "Right from its inception, the hospital has been an obstetrics and gynaecology teaching hospital under the GS Seth Medical College, attached to KEM Hospital. Now, the management sits to select teachers for obstetrics and gynaecology, without any expert on the subject on the panel," rues a professor.

Management Stance

Pankaj Phadnis, Officer On Special Duty, NWMH, however rubbishes the talks on privatisation as a canard. "NWMH is a charitable hospital and will remain so in the future. Wadia's statement has been misunderstood. When Wadia was asked by the High Court-appointed committee on ways the hospital can reduce dependency on government, he only said that number of beds for paying patients, which is 65 as of now, can be increased," he maintains.

Denying the allegation that the management selects teachers, he said, "The selection is done by municipality selected committee."

The Inside Story

According to highly-placed sources in the hospital, the reason for the seething discontent is funds deficit, employees not getting increment for the last four years and the fact that the hospital is not self-sustaining. "The deficit has resulted in the hospital identifying key departments which could be closed down and doctors not getting paid has made them leave," says the source.

The deficit, which is to the tune of Rs 6 crore, is to be borne equally by the government and BMC, as per the trust deed. While the BMC is paying the deficit, the government has faltered. Petitioner's counsel Sushil Mahadeshwar reveals, "The State had failed to pay a sum of Rs 3.2 crore from the year 2003."

But if the government is not paying, why is the ire directed towards the management? "That is because the employees belong to the hospital and not to the government or municipality," the source explains.

A recent verdict of the Bombay High Court came as a relief. It has directed the state and the Nowrosjee Wadia Trust to pay funds to the tune of Rs 1.8 crore and Rs 2.6 crore respectively to the NWMH to make up for the losses that it was incurring. The court also held that no deduction be made from the wages of the workers except the statutory cuts.

In Conclusion

With shrinking funds from the government, the hospital's situation once again raises doubts on the success of the PPP model in healthcare and underlines the need for making charitable hospitals a self-sustainable model. If the talks on privatisation are just a rumour as the management claims, then it is time that the management heard the grievances of its employees.

rita@expresshealthcaremgmt.com