LAHORE - Not only the private but also public sector cardiac centres are flouting the Supreme Court orders of not charging excess of Rs100,000 for Angioplasty involving one stent.

Public sector centres like Punjab Institute of Cardiology (PIC) is charging at least Rs113,000 from a private patient for Angioplasty involving one stent and that too of first generation budget medical device. If one patient ask for third general FDA approved stent, the charges increase to Rs160,000. The charges increase with the addition of number of stents required for normalizing blood flow of a patient.

Private cardiac centres are charging at least Rs200,000 for Angioplasty involving single stent. Addition of every stent after that first one at least cost Rs90,000 to hapless patient going to the private centre for better treatment from a senior consultant.

In a human rights case, the Apex Court bench headed by Chief Justice Mian Saqib Nisar directed fixing charges for Angioplasty involving one first generation stent at Rs100,000 on March 20, 20018. The court also directed fixing prices of life saving medical devices (LSMD) in the light of recommendations of panel of experts from Pakistan Cardiac Society. 

In pursuance to the Apex Court verdict, Drug Regulatory Authority of Pakistan (DRAP) fixed prices of different categories of LSMD through a notification issued on June 6, 2018.

DRAP fixed prices of US and Japan FDA approved third generation stent at Rs90,000, second generation at Rs60,000 and that of first generation budget stents at Rs45,000. Price of bare metal stent was fixed at Rs20,000. Similarly, prices of special and ordinary balloons were fixed at Rs15,000 and Rs10,000 respectively.  As per the cardiologists, panel of experts from PCS and not the Apex Court was responsible for the prevailing scenario mainly caused due to fixing of unrealistic charges for Angioplasty.  “These are the rates given by panel of experts comprising senior and seasoned cardiologists. Now they are not ready to accept the mistake saying it will be disgraceful for them to suggest the Apex Court to review rates”, said a cardiologist working at Mayo Hospital who wanted not be named due to the reason that his teachers were in the panel of experts. 

Referring to the working of leading private hospitals, he said that most of these centres were only taking selective cases to avoid possible anger of the Apex Court as Angioplasty within prescribed limit was not possible.

“It is possible if bare metal stent is used in Angioplasty while hiding the quality of device from the patients. This is unethical but the practice is going on”, he said.

Consultant cardiologist at PIC Dr Aamir Hussain Bandesha seconded the viewpoint of his colleague at Mayo Hospital, saying leading private hospitals stopped offering Angioplasty soon after the apex court verdict.

“Now they (private centres) are taking patients. But they have decreased the number of patients. Only selective patients are offered Angioplasty facility. The reason is avoiding possible action if caught charging extra amount”, he said. 

Referring to the possible solution, he said that slight increase in the maximum limit could enable public sector institutes like PIC to offer Angioplasty to private patients within prescribed limit. He said that there was no issue of any hindrance in Angioplasty of the poor patients as it was free of cost.  In the wake of ever increasing burden of cardio vascular diseases, he suggested improving facilities not only in Lahore but across the province.

In major cities like Lahore, cardiac centres at teaching hospitals should be made functional. Proper cardiac centres should be established at DHQ/THQ hospitals for easing burden on tertiary care hospitals and providing treatment to heart patients in the close vicinity of their homes, said Dr Bandesha.