The Andhra Pradesh government has pointed out that some private hospitals in the state are increasingly prescribing Computed Tomography or CT scans in a bid to fleece patients. Some hospitals are even denying admission and treatment to patients if they choose not to get a CT scan done.
Medical professionals working with the government in the COVID-19 fight noted that the CT scan is an efficient diagnostic tool to diagnose COVID-19 early, but its cost and limited availability has resulted in the test becoming an expensive option for patients.
Private hospitals started charging anywhere between Rs 5,000 and 10,000 for a CT scan since the onset of the pandemic. According to government officials, hospitals that were carrying out four to five CT scans per day, are now recording almost 100 CT scans per centre. They also alleged that most doctors in private hospitals get around 30% charge of a CT scan as commission.
According to Dr Prabhaker Reddy, the special officer for COVID-19 in Andhra Pradesh, a professor and head of the department of Cardiothoracic and Vascular Surgery at the Guntur Government Hospital, a chest X-ray is good enough to be used as a screening test for COVID-19. Besides, a chest X-ray costs only around Rs 200 and serves the purpose.
“A CT scan is a good diagnostic tool when used for particular cases. When it has to be used on a mass scale, then a chest X-ray is the best. The radiation exposure of one CT scan is equivalent to that of 100 chest X rays,” explained Dr Prabhaker, who is a professor and head of the department of Cardiothoracic and Vascular Surgery at Guntur Government Hospital.
“All viral flu cause pneumonia, fever and cough. By seeing a CT scan, a doctor cannot confirm if it is COVID-19. Because of the prevailing pandemic, we assume it is COVID-19. If people in Andhra Pradesh have any doubt about being infected with COVID-19, they should just head to a government hospital and get tested. This will save them from exploitation,” he added.
Explaining a possible scenario, Dr Prabhaker said, “A patient who is asymptomatic or has mild symptoms of fever or cough goes to a practitioner. Instead of sending patients to get an RT-PCR test done, the doctor might ask the patient to do a CT scan. After the CT Scan, if the patient’s report is found have mild shadows, he/she is suspected to have COVID-19 and is then sent for an RT-PCR swab test. If the swab test is positive, then the patient is referred to a government hospital. If the swab test is negative, they are referred to a government hospital, as 30% of the results may be false negatives in an RT-PCR test. In the end, the person is anyway being referred to a government hospital. In this process of repeated testing, patients are not only losing money but they are also panicking.”
According to the doctor, in Maharastra’s Vidarbha region, a chest X-ray is used as a screening test during contact tracing and also for patients with mild symptoms. In All India Institute Of Medical Sciences (AIIMS) New Delhi, when a person with likely symptoms of COVID-19 comes to the hospital, a chest X-ray is first taken. If it detects patches, an RT-PCR test is done and the patient is treated for COVID-19. A CT scan is only the last mode of investigation.
Dr PV Ramesh, Additional Chief Secretary to the Andhra Pradesh Chief Minister YS Jagan Mohan Reddy, said that it could be a money-making strategy. “Apart from CT scans, hospitals are also prescribing expensive antibiotics and antivirals. None of this is required. We should use the strategy being used at Christian Medical College (CMC), Vellore. The hospital uses oxygen in a prone position (to improve oxygenation), steroids and anticoagulants in tune with the pathophysiology of the disease,” he pointed out.
Dr Sanjeev Singh Yadav, the secretary of the Indian Medical Association (IMA) - Telangana unit, on the other hand, said that it is not right to put the onus on the doctors. There are multiple reasons for prescribing a CT scan, he said.
“If the patient has symptoms and there is a procedure pending, then a CT scan is mandatory. If there is no procedure and an RT-PCR can be done, that is sufficient. It is the fear psychosis among the doctors that a patient may be positive and can spread the disease that leads them to prescribe CT scans. Even when the patients are often panicking, a CT scan is done. Had the government done enough testing in the beginning to arrest the problem, then this issue would not have come up. If the doctors are being blamed, then the government should also be blamed,” said Dr Sanjeev.