By Sayantan Chakravarty

The list is long and illustrious. In March 1991, P.V. Narasimha Rao, a mere MP then, flies to the prestigious Texas Heart Institute, USA, for treatment of myocardial infarction. Three years later, Sitaram Kesri, welfare minister, travels to the UK as well as the US for treatment of "acute respiratory problem". In May 1995, Ajit Panja, minister of state for coal, goes abroad for the treatment of acute pancreatitis. The Bahujan Samaj Party (BSP) supremo Kanshi Ram's heart problem is treated abroad twice -- in 1995 and 1996.

So what's wrong in sending our VIPs abroad? A lot, if you look closer. In most cases, the ailments were of a nature that could have been successfully treated in the country. And the government's profligacy in the matter would have remained under wraps but for a retired Rajasthan state government clerk, H.C. Gupta, moving the Delhi High Court in February this year.

Sixty-four-year-old Gupta needed dialysis in December last year but was turned away by all government hospitals he approached in Delhi, even the prestigious All India Institute of Medical Sciences (AIIMS). He ended up in a private hospital, paying through his nose -- Rs 4,000 a day. Gupta then approached the Delhi High Court which converted his petition into a public-interest litigation (PIL) and directed the Union government to file details on the people who were allowed treatment abroad and the expenses run up on this account. The reply, filed last month, tells only a part of the story: how much was incurred on the hospital bills and how many attendants and doctors accompanied those treated. By November 19, the court will also have to be given details of the expenditure incurred on airfare, hotel bills and daily allowances. Once these are added, say sources, the amount could cross Rs 15 crore.

In each of the cases, the government ended up spending lakhs of rupees for costly treatment that is available in India. In Rao's case, doctors at AIIMS say myocardial infarction is an ailment that the hospital routinely handles. Kesri's medical bill (about Rs 5 lakh) could buy a modest flat in Delhi. To repair Panja's pancreas, the government had to cough up Rs 48 lakh.

The list goes on. The VIP patients who have flown abroad at the taxpayers' expense include former prime ministers, ministers, former governors, MPs, bureaucrats and even junior customs officials. All influential enough to bend the rules to wangle trips overseas. According to an affidavit filed before the Delhi High Court in September by the Union Health Ministry, between April 1991 and March 1997, over 80 VIPs went abroad for treatment, accompanied by 65 attendants and nine doctors, mostly to the US and the UK. Over Rs 8 crore was spent on medical bills alone by the Centre.

The mind-boggling amounts have made the Government sit up and begin a damage-control exercise. Following the pil, it has set up a committee to review the antiquated guidelines for treatment abroad, laid down in 1986. Headed by Dr S.P. Agarwal, director-general, health services, the committee met for the first time on September 30. While all Agarwal will say is, "The fresh proposal is with the Government," other members -- the director and the chiefs of cardiology, neurosurgery and urology departments at the aiims, and the medical superintendent of the capital's Ram Manohar Lohia hospital -- say that the new list of diseases that warrant foreign trips is considerably shorter. Cardio-vascular surgery, kidney transplant, joint replacements, lithotripsy, laser treatments, neurosurgery and most cancer treatments do not figure in it. Now, all the cases will be studied carefully and only "highly complicated" ones will be recommended for treatment abroad, they say.

The review of the guidelines, couldn't have come sooner. For, since 1991, rules had been flouted with abandon. Politicians were allowed to travel abroad with an array of attendants and doctors, despite Indian specialists saying that treatment was available in hospitals within the country -- and at a fraction of the cost. According to sources, in most cases a standing committee, which decides on the matter, was pressured into recommending treatment abroad for the VVIPs.

Take the case of Kesri, who travelled with three attendants and two doctors in tow. The standing committee recommended treatment abroad for him because "the referral at aiims did not yield satisfactory results". Top aiims experts are surprised at this. They insist that when Kesri came for treatment to the institute, his condition was stable.

Before that, in 1992, former petroleum minister B. Shankaranand bypassed the aiims and went abroad for treatment. He was initially admitted to the aiims cardiac-care unit, but sources say he wanted the doctors to certify that treatment abroad was necessary. When they refused, he went to prime minister Rao and got a recommendation for treatment of diabetes, hypertension and ischemic heart disease.

Some of cases recommended by the standing committee have bordered on the ridiculous. Former Union law minister A.K. Sen was sent to the UK in June 1991 for a triple leg fracture because he had been there for the same treatment before and had developed complications.

Sheila Kaul, a former Congress minister and governor, was another high-profile politician to get a questionable recommendation. In June 1996, the standing committee cleared her for rectifying an eye problem without bothering to find out why Kaul did not get her eyes checked at reputed ophthalmic institutes in Delhi.

Most doctors agree that all this extravagance could, and should, have been avoided. Since the guidelines were first framed, Indian hospitals have acquired facilities for treating most of the ailments for which VVIPs routinely seek permission to travel abroad. "There is absolutely no area where we are lacking, when it comes to heartcare. We have the technology, the expertise, the results. Our mortality rate is less than 1 per cent. So is the infection rate," says Dr Naresh Trehan of the Escorts Heart Institute (EHI), one of the foremost cardiac-care centres in the country. Several VIPs have successfully undergone bypass graft there. "Even Sam Pitroda (technology czar), who stays in Chicago, visits us for heartcare," says Trehan. Adds Dr Prathap Reddy, chairman of the Apollo group of hospitals: "It saddens me because the skills of our doctors equal the best in the world."

But with the court demanding more facts and a new set of guidelines in the pipeline, treatment abroad for VVIPs may not be so easy. Says Adish Chandra Aggarwal, the Centre's senior counsel: "The Government is determined not to hide anything and place all the facts before the court." Noble intentions indeed, but it remains to be seen if they will be translated into reality.

© Living Media India Ltd