Cost of survival

Why blood banks will continue overcharging patients despite government capping the price

Maharashtra officials have hauled up a Mumbai blood bank for overcharging patients. But the problem runs deep.

Maharashtra’s Food and Drug Administration initiated action against a south Mumbai hospital for allegedly overcharging patients for blood and its components including platelets. Last week, the hospital was issued a notice by the drug authority for selling single donor blood platelets to a patient for Rs 12,000 when the price for the same is fixed at Rs 11,000 by the National Blood Transfusion Council.

To curb the menace of overcharging, the council in 2014 had issued guidelines fixing the price of blood and its components. It prescribed processing costs based on whether the processing blood bank was privately run or run by the government. More than 2,700 blood banks operate in India which includes government, charitable and private blood banks.

Despite capping the price, blood banks continue to overcharge, said officials monitoring blood banks. Take the case of Wockhardt Hospital’s blood storage unit, which FDA officials allege was charging patients for tests they never ran. “They sold five units of platelets to patients without running a test called NAT," said Madhuri Pawar of the FDA. NAT is an advanced sensitive nucleic acid test that detects the presence of recent HIV infections in the blood. "However they charged the patient for NAT testing,” Pawar added.

Despite repeated attempts, the hospital was not available to comment on the issue.

Last year the Maharashtra FDA surveyed 310 blood banks and found that 74 were overcharging patients. However, the blood banks were let off the hook after a meeting with the State Blood Transfusion Council where they agreed to not overcharge patients.

According to Dr RS Gupta, director of the national council, around 36 blood banks in the country have been penalised for overcharging patients since February 2014, which is when the notification was passed. “The rates are fixed and all blood banks should follow it,” said Gupta.

Helpless officials

Senior FDA officials said that the Drugs and Cosmetics Act does not empower them to take punitive action against blood banks for overcharging.

“There is big loophole,” said AK Malhotra who works with the Drug Licencing and Controlling Authority in Uttar Pradesh, a state with 275 operational blood banks. “The problem is even if we find a blood bank overcharging patients the law does not allow us to suspend or cancel their licence.”

The FDA in each state is the licence issuing authority for blood banks. However, they said that there is no mention anywhere of price control as a prerequisite for a licence. “Even if they overcharge, technically they are not violating the conditions on which they were issued the licence,” explained Malhotra.

The Maharashtra FDA worked around these technicalities and asked the State Blood Transfusion Council to initiate action against the erring blood banks. In fact, this council issues a no-objection certificate to a blood bank on the basis of which it applies they apply for a licence. “We have asked the local corporation as well as the Council to initiate action against the banks,” said Pawar. “If the Council revokes their no-objection certificate, we can cancel their licence.”

This, however, is easier said than done.

In the past, blood banks that were found to be overcharging patients in Maharashtra, were left scot-free after the Council issued a warning.

Malhotra feels that the number of complaints the council gets does not reflect the extent of overcharging. “We have only got two complaints regarding overcharging,” said Malhotra. He suspects that lack of awareness about the government’s notification is responsible for the small number of complaints.

Echoing the sentiment Dr Bharat Singh, director of the Delhi Blood Transfusion Council, said that it is widely known that blood banks, especially those run by corporate hospitals, overcharge patients. “The problem is that we don’t have a provision under the current Act to take action against these banks,” said Singh. “We need a legislation fixing the price for blood. The Council has already informed the ministry about the issue.”

Singh said that patients rarely complain because they are comfortable paying for the services of an expensive hospital.

Control replacement donations instead

People working with non-profits working on blood donation said that the biggest challenge for patients is not price. “The problem with blood banks is that they expect relatives of patients to arrange for blood,” said Vinay Shetty from Think Foundation, a non-profit that helps organise blood donation camps among other activities.

Shetty receives several calls from harried relatives looking for a blood donor. “The bank can always take the blood unit or component from another blood bank but they insist that the relative brings in a donor who donates blood at their facility,” said Shetty. “Sometimes the patient’s surgery is also done but the bank insists on a replacement.”

The National Blood Transfusion Council disallows replacement blood donation. Blood banks are expected to conduct regular donation drives and collect blood voluntarily. “By forcing the relative to get a replacement, the banks are indulging in some form of coercion,” said Shetty.

Experts said that the council has made blood costly for the poor by fixing its price. “The government banks are following the price set by NBTC which is out of reach for many poor patients. They should look at subsidising the cost of blood for poor,” said Shetty.

To control this menace of replacement donors, the council has allowed blood banks to have a bulk transfer of blood and its components between them. By transferring blood between banks, the relatives of patient seeking blood will be spared from running around.

Even with blood banks rampantly flouring the guidelines, blood transfusion councils are reluctan tto take very stringent action. As Gupta explained, “If we close blood banks, the community living around it gets affected, which we don’t want.”

Support our journalism by subscribing to Scroll+ here. We welcome your comments at letters@scroll.in.
Sponsored Content BY 

Swara Bhasker: Sharp objects has to be on the radar of every woman who is tired of being “nice”

The actress weighs in on what she loves about the show.

This article has been written by award-winning actor Swara Bhasker.

All women growing up in India, South Asia, or anywhere in the world frankly; will remember in some form or the other that gentle girlhood admonishing, “Nice girls don’t do that.” I kept recalling that gently reasoned reproach as I watched Sharp Objects (you can catch it on Hotstar Premium). Adapted from the author of Gone Girl, Gillian Flynn’s debut novel Sharp Objects has been directed by Jean-Marc Vallée, who has my heart since he gave us Big Little Lies. It stars the multiple-Oscar nominee Amy Adams, who delivers a searing performance as Camille Preaker; and Patricia Clarkson, who is magnetic as the dominating and dark Adora Crellin. As an actress myself, it felt great to watch a show driven by its female performers.

The series is woven around a troubled, alcohol-dependent, self-harming, female journalist Camille (single and in her thirties incidentally) who returns to the small town of her birth and childhood, Wind Gap, Missouri, to report on two similarly gruesome murders of teenage girls. While the series is a murder mystery, it equally delves into the psychology, not just of the principal characters, but also of the town, and thus a culture as a whole.

There is a lot that impresses in Sharp Objects — the manner in which the storytelling gently unwraps a plot that is dark, disturbing and shocking, the stellar and crafty control that Jean-Marc Vallée exercises on his narrative, the cinematography that is fluid and still manages to suggest that something sinister lurks within Wind Gap, the editing which keeps this narrative languid yet sharp and consistently evokes a haunting sensation.

Sharp Objects is also liberating (apart from its positive performance on Bechdel parameters) as content — for female actors and for audiences in giving us female centric and female driven shows that do not bear the burden of providing either role-models or even uplifting messages. 

Instead, it presents a world where women are dangerous and dysfunctional but very real — a world where women are neither pure victims, nor pure aggressors. A world where they occupy the grey areas, complex and contradictory as agents in a power play, in which they control some reigns too.

But to me personally, and perhaps to many young women viewers across the world, what makes Sharp Objects particularly impactful, perhaps almost poignant, is the manner in which it unravels the whole idea, the culture, the entire psychology of that childhood admonishment “Nice girls don’t do that.” Sharp Objects explores the sinister and dark possibilities of what the corollary of that thinking could be.

“Nice girls don’t do that.”

“Who does?”

“Bad girls.”

“So I’m a bad girl.”

“You shouldn’t be a bad girl.”

“Why not?”

“Bad girls get in trouble.”

“What trouble? What happens to bad girls?”

“Bad things.”

“What bad things?”

“Very bad things.”

“How bad?”

“Terrible!!!”

“Like what?”

“Like….”

A point the show makes early on is that both the victims of the introductory brutal murders were not your typically nice girly-girls. Camille, the traumatised protagonist carrying a burden from her past was herself not a nice girl. Amma, her deceptive half-sister manipulates the nice girl act to defy her controlling mother. But perhaps the most incisive critique on the whole ‘Be a nice girl’ culture, in fact the whole ‘nice’ culture — nice folks, nice manners, nice homes, nice towns — comes in the form of Adora’s character and the manner in which beneath the whole veneer of nice, a whole town is complicit in damning secrets and not-so-nice acts. At one point early on in the show, Adora tells her firstborn Camille, with whom she has a strained relationship (to put it mildly), “I just want things to be nice with us but maybe I don’t know how..” Interestingly it is this very notion of ‘nice’ that becomes the most oppressive and deceptive experience of young Camille, and later Amma’s growing years.

This ‘Culture of Nice’ is in fact the pervasive ‘Culture of Silence’ that women all over the world, particularly in India, are all too familiar with. 

It takes different forms, but always towards the same goal — to silence the not-so-nice details of what the experiences; sometimes intimate experiences of women might be. This Culture of Silence is propagated from the child’s earliest experience of being parented by society in general. Amongst the values that girls receive in our early years — apart from those of being obedient, dutiful, respectful, homely — we also receive the twin headed Chimera in the form of shame and guilt.

“Have some shame!”

“Oh for shame!”

“Shameless!”

“Shameful!”

“Ashamed.”

“Do not bring shame upon…”

Different phrases in different languages, but always with the same implication. Shameful things happen to girls who are not nice and that brings ‘shame’ on the family or everyone associated with the girl. And nice folks do not talk about these things. Nice folks go on as if nothing has happened.

It is this culture of silence that women across the world today, are calling out in many different ways. Whether it is the #MeToo movement or a show like Sharp Objects; or on a lighter and happier note, even a film like Veere Di Wedding punctures this culture of silence, quite simply by refusing to be silenced and saying the not-nice things, or depicting the so called ‘unspeakable’ things that could happen to girls. By talking about the unspeakable, you rob it of the power to shame you; you disallow the ‘Culture of Nice’ to erase your experience. You stand up for yourself and you build your own identity.

And this to me is the most liberating aspect of being an actor, and even just a girl at a time when shows like Sharp Objects and Big Little Lies (another great show on Hotstar Premium), and films like Veere Di Wedding and Anaarkali Of Aarah are being made.

The next time I hear someone say, “Nice girls don’t do that!”, I know what I’m going to say — I don’t give a shit about nice. I’m just a girl! And that’s okay!

Swara is a an award winning actor of the Hindi film industry. Her last few films, including Veere Di Wedding, Anaarkali of Aaraah and Nil Battey Sannata have earned her both critical and commercial success. Swara is an occasional writer of articles and opinion pieces. The occasions are frequent :).

Watch the trailer of Sharp Objects here:

Play

This article was published by the Scroll marketing team with Swara Bhasker on behalf of Hotstar Premium and not by the Scroll editorial team.