SK is 32 years old. He is now destitute and depends on charity for food and shelter. Till two years ago, he was a construction worker and earned enough to live a lower middle-class life. One day he fell off a building during construction. He fractured his right femur and left hip. He was taken to a hospital run under the Employees State Insurance (ESI) Corporation scheme. He was there for a few days. After initial resuscitation, he received no further treatment. He was told that his fractures required surgery. However there was no indication when the surgery would be done. He was in severe pain and could not turn or sit. The slightest movement in bed displaced the fractured bones, which was terribly painful.

One day the doctor told him that the surgery could be done if he moved to a private hospital. The patient discussed the issue with his employer. The employer agreed to pay up to Rs 50,000. He was moved to a private hospital. His discharge from the ESI Hospital was shown as ‘at request’. The private hospital had an extremely small operation theatre unsuitable for orthopaedic surgery, which requires room to manoeuvre the X-ray machine and instruments.

A few days later, his left hip fracture was operated upon. He developed high fever after the operation. After a few days, he was operated again, on the right femur. When an incision was made on his right thigh, pus was found, so an external fixator was applied. After two weeks of the surgery, the employer had spent Rs 50,000 and SK had paid another Rs 20,000. He had no more money. He was discharged. He became a regular visitor to the ESI hospital because both the wounds were infected. Six months later, he lost his job.

Two years after the surgery, pus continued to ooze out from the left thigh. The right femur had not united and he walked with the help of a brace. He found it difficult to get a single meal a day. He weighed 37 kilos.

When I asked the surgeon involved in the surgery, he defended himself:

‘There are no facilities to operate such injuries in the ESI hospital. You know what will happen if I send the patient to another government hospital. He will have to wait months for surgery and there the infection rates are high. Also some other surgeon may move him to a private hospital. He had very little money. So I had to cut costs by admitting him in a small nursing home. I agree the implants are also not of very good quality, but you cannot get five star treatment at two star rates.’