Referral reference

A patient getting referred out of the State for treatment might benefit from the expertise of super-speciality hospitals and specialist doctors, but the process can be long and the paperwork tedious and complicated. Here are some detailed tips on how to negotiate your way around if you, God forbid, end up as a member of a ‘patient party’ attending to a referred patient…

Sikkim is arguably among the most generous of states when it comes to providing financial assistance to its citizens seeking advanced healthcare remedies outside the State. It has several healthcare related programmes and schemes being implemented through the Health Care, Human Services and Family Welfare Department. Among these, here I would like to share my experience with regard to two schemes- the Sikkim State Illness Assistance Fund [SSIAF] and the Mukhya Mantri Jeevan Raksha Kosh Scheme [MMJRKS]. Both schemes provide cashless access to advanced healthcare to patients referred outside the State.
SSIAF is meant for patients from BPL families referred outside State and who are in need of necessary assistance to receive medical treatment for certain life-threatening diseases, treatment for which is normally very expensive, in super specialty hospitals. In Sikkim, the patient is provided up to Rs. 1.50 lakh in the form of cashless treatment facility i.e. payment made directly to the hospital by the State Government. Financial assistance beyond Rs. 1.50 lakh is to be provided by the Central Government.
MMJRKS, on the other hand, is meant for APL patients referred outside the State for treatment. In this scheme, the State Government provides cashless assistance starting from Rs. 20,000 up to Rs. 2 lakhs depending on the case history of the patient.

How to avail these facilities?
When your patient is diagnosed with a life threatening disease and doctors advice you to take your patient outside the state for further treatment, you have to go through the following procedures:
i.    Collect all the papers like hospital card, all test reports, attested copies of patient’s Sikkim Subject Certificate or CoI.
ii.    Rush to Department of Economics, Statistics, Monitoring and Evaluation [DESME] office situated at Old West Point School, Gangtok. File an application enquiring whether the patient name’s is included in the BPL list. If the name appears, the patient will be provided with BPL Certificate and if not, the competent authority will authenticate patient as APL on the application itself.
iii.    With all these, you go to STNM Hospital’s referral section situated above the hospital. You will be provided with a public form. After filling this, you need signatures of five doctors, who are the members of State Medical Board. In case of emergency, signatures of three will also do.
iv.    After getting signatures done, the form has to be signed by Medical Superintendent of STNM Hosptial. With this, you have to again go to referral section. Here you will be provided with Referral Certificate of the State Medical Board.
v.    This Referral Certificate has to be deposited with the Health Department. After consulting with the guardian of BPL patient, the office will issue a letter to a hospital empanelled with the State Government to extend cashless treatment.
vi.    For APL patients, the officials will go through the medical history of the patient maintained by the doctors at STNM Hospital. The amount of financial assistance will depend upon the seriousness of the case. Accident victims with serious head injuries and similar cases usually receive the maximum assistance. After this a letter will be issued to concerned hospital detailing the maximum amount towards treatment that the Government will bear.
At the Hosptial
Here, I would like share my experience at the All India Institute of Medical Sciences [AIIMS] in New Delhi. Around 90% of the BPL patients are referred there. Before going to the hospital, you have make arrangements for meals and lodging. For patients referred to AIIMS, I will suggest the Governemnt of Sikkim’s Denzong Kunga Khangsang, popularly known as DKK Bhawan situated at V-15, Green Park Extension, New Delhi. The accommodation charges here are very reasonably and you can also rent utensils and pillow covers. If you are lucky, you will get separate room to be shared with another patient party, otherwise, you will get accommodation in the dormitory with no bed charge for BPL patients. There are four-five gas stoves available in the kitchen to be shared with the rest of “patient parties” on turn basis. A minimum amount per week is to be paid for pipeline LPG consumption.
Though AIIMS is a walking distance from DKK Bhawan, it will be better to take your patient by hiring an auto rickshaw which cost Rs. 30-50 up to the Hospital’s Rajkumari OPD Clinic Gate. The proceedings at AIIMS are similar to STNM Hospital. A Card has to be made in the OPD. Doctors’ chambers are on the 1st floor. Stay in queue and wait for your number to be called. Take your patient to the doctor, show all the relevant papers from STNM hospital. You must be prepared because 99% patients have to go through re-tests of procedures already done at STNM Hospital.
The above sequence might read simple and uncomplicated, but in reality, the job is really tough. Unlike STNM Hospital, more than 50,000 patients from all over country and also from neighbouring countries line up at AIIMS every day! You are constantly in a race with them because everyone is in a hurry and everyone has an emergency. Sometimes the queue at the OPD stretches more than a kilometer long! The line can be seen snaking from the ground floor to the level 5th stairway. If you are not one of the early birds, before your number is announced, the OPD will have already closed down [promptly at 4p.m.].
Suggestion: For the first couple of weeks, you must have another team member in the “patient party” assisting you. Wake up early, by around 3 a.m., leave the patient at DKK Bhawan with your “team member”, reach the OPD and get in line to make a card [yes, people stay up all night in queue to get a card made]. This will give you 40% chance of getting an appointment with the doctor before lunch-break. Otherwise, enquire with your seniors at DKK Bhawan about some good Samaritans in the Hospital who have been assisting patients from Sikkim at AIIMS for many years now. Ask for Kesu or Budhan, meet anyone of them and introduce yourself and your patient, offer them koseli from Sikkim. This will not only save your valuable time, but also help you find testing centres spread across the more the extremely big AIIMS campus. Don’t worry, all tests are done under one roof and charges are reasonable.
It will take more than 15 days to receive all the test reports. After that you have to meet the first doctor – the one who had examined your patient on Day One. Show all the reports. Remember, doctors at AIIMS have OPD duty only once a week. Remember the day when your patient was checked and return to the OPD on that day. It is advisable to get the concerned doctor’s mobile phone number because none of the other doctors will examine your patient in case of an emergency.
After verifying the reports, the concerned doctor will refer your patient to a specialist. He or she will suggest what treatment your patient has to undergo. There comes the importance of referral letter from Health Department. The doctor will give you an estimate detailing the total expense for treatment. This has to be faxed to the Health Department in Gangtok. As soon as the State Government deposits the invoiced amount into the Hospital’s account, the treatment begins.
Some more suggestions:
i.    Only in the rare cases will a patient be admitted in the hospital at AIIMS. Otherwise, for the entire treatment, you have to take your patient from DKK Bhawan. The gap between treatment day varies from a week to even a month. The days between treatment will be boring.
ii.    For some reason, except Vodafone, none of the other mobile networks find a signal in the DKK Bhawan dormitory. Don’t forget to keep going outside to check for missed calls.
iii.    The Sikkimese are known to be bad at bargaining and it is accepted that they invariably drive up market prices with their gullibility. This is on evidence at the Mandir Galli market near DKK Bhawan where prices are comparatively higher than the market a short walk away. Go to that market instead – the exercise will help you and the prices will be more reasonably.
iv.    Those staying in the dormitory during summers need to be careful. The dormitory below the road level and if it rains a lot, water enters the dormitory. It is thus advisable to keep all the valuables in the lockers available at the Bhawan.
v.    You can play cricket in the nearby park, take your patient to Deer Park also within walking distance.
vi.    For local sightseeing, I suggest Sharmaji’s auto rickshaw. Sharmaji is in his fifties, has an always smiling face and a tip-top auto rickshaw with “Patience Duty” emblazoned on the back. He is always available in front of the DDK Bhawan gate. A Nepal national who has been residing in Delhi for the past more than 30 years, he is a well-known face at DKK Bhawan. He will be a best local guide for you and your patient during your stay in Delhi.
vii.    Stay away from gambler friends. Stay there long enough and you will hear of stories of patient parties which lost their treatment money in the name of ‘timepass’. You will be well advised to keep your priorities in order.
viii.    Finally, make ample arrangements back at home because I met some of patients and their attendants who had been staying at DKK Bhawan for more than four years in the course of treatment.