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

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.”