LAHORE Punjab Institute of Cardiology is a tertiary care teaching hospital, which was renowned for providing state-of-the-art investigation and treatment facilities to cardiac patients coming not only from Punjab and other provinces, but also from across the border. This public institution was established in order to provide free medical facilities to the deprived as well as entitled patients, which was the main theme behind its inception, and for which purpose the Punjab Government used to fund it heavily. Sadly, this institution has seen a steady decline in standards of care over the last few months with priority being given to private and paying patients at the cost of the poor. An example is the glaring disparity in the waiting list of angiography patients: while private patients will have this carried out on the same day or even within a few hours of admission, the poor patient on the other hand is given a waiting time of 8 months on average or even longer for a simple procedure, which may be detrimental to the health of the person. Similarly, the Coronary Care Unit beds (CCU beds) are reserved mainly for private patients whilst depriving poor patients of better care. Many times poor patients treatments are postponed and their procedures delayed as too many private patients have been admitted on that particular day and most available slots have been taken up by the privileged class. During the course of treatment, many patients need angioplasty and stent procedures. For the last three months stents are ominously not available for the poor patients, whereas the same item is readily available for private patients. Many patients are questioning as to whether this is a public hospital or a private centre. Sources reveal that this problem has arisen due to mismanagement of funds rather than shortage, and haphazard priorities set by the hospital authorities. Heart pacemakers are battery-like devices which are crucial for taking care of patients with heart rhythm problems; these devices are life-long implants and it has been learnt that different criteria are being used on a mercenary basis for private and poor patients. Where the private patient will have the best device implanted, a poor patient is provided with substandard pacemakers, cheaper by a few dollars only. Are we not supposed to look after the ailing humanity with equality and provide them with the best possible care, irrespective of their financial status? Sadly, this is not being observed in this public hospital. It may be mentioned that purchases are carried out by the Chief of Department and the Medical Superintendent who work in close coordination and comfort with each other regarding financial matters. Many patients need an echocardiogram, which is an ultrasound-based simple examination of the heart. Whereas poor patients are being given appointments for April 2012, private patients can walk in and get it carried out instantly, solely at the cost of the underprivileged class. As a result of chaotic and misdirected policies prevalent at PIC nowadays poor patients are suffering constantly and have nobody who will listen to their woes sympathetically. This teaching and training institute was once well-known for conducting workshops and inviting learned foreign faculty for the transfer of latest technology as well as update of novel developments, this activity has come to a grinding halt which has led to educational deprivation in the junior trainee doctors. The hospital share of a few consultants is running into hundreds of thousands of rupees and the head of institution is making millions as share-money every month. The distribution of share amongst hospital staff is heavily based on nepotism, with favourite nurses and paramedical staff being rewarded with discrimination towards other menial stall, by the Chief Incharge share committee. Similarly, duties are assigned to hospital staff on the formula of favouritism; some suspended employees with criminal inquiries against them have been re-instituted on better positions and the inquiries have been abruptly ended or dropped. The cardiac surgery department is in shambles, with high infection rates and heavy cost of antibiotics, which has led many organizations to reconsider referral to this hospital for elective surgery, and some are on the verge of cancelling their contract with this institution altogether. Modern modalities of surgery are lacking and no progress is being made in important fields like cardiac transplant and valve implantation via mini-surgery. In fact, the idea of Heart Transplant program was initiated by this institute but unfortunately the Armed Forces Institute of Cardiology has taken up the challenge and is now the pioneer in this field with a complete and comprehensive transplant set-up. Many of the above problems have arisen as a result of poor policies formulated by the hospital authorities, and subsequently endorsed by the controversial board of management; many members of the board openly practised nepotism, using the Head of institution and the Medical Superintendent for their own agenda, without looking at the needs of their public institution, and in fact, they have been favouring private-patient oriented policies rather than taking care of the poor and destitute population. It is high time for the Punjab Govt. to investigate matters of this hospital and set priorities favouring poor and deprived patients, whilst at the same time, instituting a neutral board of management. The declining standard of care of this once-prestigious institution is a sad and depressing story, which needs early correction with positive changes at several levels and positions. Only drastic measures will now be effective in saving this public institution and restoring it to its former glory.