जिम्मेवारी सम्हालेको १०८ दिनपछि राजीनामा दिएका त्रिवि शिक्षण अस्पतालका कार्यकारी निर्देशक डा. भगवान कोइरालाले आफूले त्यस्तो निर्णय गर्नुको कारणबारे जानकारी दिन लामो विज्ञप्ति निकालेका छन्। ‘म चुप बसेर छेउ लाग्न चाहन्थेँ तर..’, विज्ञप्तिमा उनले लेखेका छन्, ‘हजारौँले यसलाई गम्भीर रुपमा लिए र मैले यस्तो निर्णय लिनुको कारणबारे जान्न चाहे।’ उनले त्यसमा आफू नियुक्त हुँदाको अवस्था, आफूले गरेका सकारात्मक कामहरुको वर्णन र आफूले सामना गर्नुपरेका बाधाअड्चनहरुबारे विस्तृत बयान गरेका छन्। के भनेका छन् त उनले ?
विज्ञप्तिका मूल बुँदाको भावानुवाद-
संकटको बेला मलाई नियुक्त गरिएको थियो। ६६ करोड बक्यौता भएको र धेरैको रकम भुक्तानी नभएको अवस्थामा मैले अनकनाउँदै यो जिम्मेवारी स्वीकार गरेको थिएँ। अस्पतालका कर्मचारीले समयमा तलब नपाएको महिनौँ भइसकेको थियो। कर्मचारीबाट रकम काटे पनि कर भुक्तान गरिएका थिएनन्, सञ्चय कोष र नागरिक लगानी कोषलाई पनि भुक्तान गरिएको थिएन।
मेरो कार्यकालमा टिचिङ अस्पतालमा भएका महत्त्वपूर्ण सकारात्मक परिवर्तनहरु-
- हाम्रो इमर्जेन्सीबाट बेड रहँदारहँदै पनि जानाजानी बाहिर रेफर गर्ने कार्य रोक्यौँ। यसले एथिकल प्राक्टिस बलियो बनायो र आय पनि बढायो।
- हामीले आर्थिक अनियमितता र अनुशासन उल्लङ्घन गर्नेलाई कानुनी कारबाही गर्यौँ।
- हामीले विद्युतीय हाजिर लागू गरायौँ र सबै कार्य क्षेत्रमा टाइमिङ अनुगमन गर्यौँ।
- अस्पतालको आय धेरै बढ्यो र समयमा तलब दिन सकियो।
- डिनको कार्यालयको सहायताले हामीले पुराना करको बक्यौता, नागरिक लगानी कोष आदि तिर्यौँ।
- सार्वजनिक सम्पर्कमा हुनुपर्ने सबै सेवाका क्षेत्रमा लन्च ब्रेकलाई हटायौँ।
- अन्डरटाइम काम गर्दा ओभरटाइमको पैसा लिने सिस्टम हटायौँ। यसले वर्षमा ७० लाख बचत गर्यो।
- कडा अनुगमन र सर्जिकल सामाग्रीको अभिलेख राख्नाले अपरेटिङ रुम र वार्डको खर्च झण्डै २० प्रतिशतले घट्यो।
- सेवाहरुको विस्तारमा सहजीकरण गर्यौँ।
- फार्मेसी २४ सै घण्टा खुल्ने बनायौँ।
- एउटा सानो ३ सय रुपियाँको केसबाहेक कसैले भ्रष्टाचारको एउटा कुरा पनि देखाउन सक्दैनन्। त्यो केसमा संलग्न व्यक्तिलाई बर्खास्त गर्ने सिफारिश गरिएको छ।
- तल्लो तहका कर्मचारीले मेहनत गरेर अस्पताल सफा बनाए, सुरक्षा चुस्त बनाए।
- व्यक्ति र प्राइभेट फर्महरुले १०० दिनमा एक करोड भन्दा बढीको मेडिकल र सर्जिकल उपकरण दान दिए।
उनले सामना गरेका बाधाअड्चन
• सबै विभाग प्रमुखहरुले सिस्टम पालना गरेनन्। विश्वविद्यालय प्राध्यापक एसोसिएसन र युनियनले कडा अनुगमनको विरोध गरे। डिन र अन्य निकायबारे हल्ला चलाए, दबाब दिए। केही ‘नेताहरु’ र ‘स्वच्छ’ प्रोफेसहरुले समेत अस्पतालबाट बिरामी बाहिर रेफर गर्ने पक्षमा बोल्नु निकै पीडादायी रह्यो। (उनले स्वच्छ र नेता प्रोफेसरका रुपमा डा. गोविन्द केसीलाई इङ्गित गरेको अनुमान छ। डा. केसीले टिचिङ सुधारका लागि आमरण अनसन बसेका थिए। उनी स्वच्छ छविका डाक्टर मानिन्छन्। तर डिपार्टमेन्टको प्रेसरले हो वा किन हो उनले बिरामी बाहिर रेफर गर्ने पक्षमा बोलेको बताइन्छ। डा. केसी जस्ता व्यक्तिले समेत असहयोग गरेपछि डा. कोइराला विरक्तिएको भनिन्छ।)
• उनले आफ्नो कार्यकाल सुरु हुँदासम्मको विशेष लेखापरीक्षण गर्न अनुरोध गरेका थिए, जुन हुन सकेन।
• बढी आर्थिक र प्रशासनिक अधिकार दिइनु पर्ने भनिएकोमा दिइएन।
• नियम अनुसार स्थायी कर्मचारीको तलबका लागि रकम टियुले दिएन।
• विगतको ऋण र दायित्व कसरी तिर्ने ? यो जिम्मेवारी सम्हाल्नुअघि मैले सरकार र सम्बन्धित निकायलाई यसबारे भन्दा सहयोग गर्ने वचन दिएका थिए तर त्यो पालना भएन।
• मैले दुई वटा पूर्णकालीन ट्याक्सिङ जब गरिरहेको छु। एउटा पूर्णकालीन प्रशासनिक काम र अर्को व्यस्त कार्डियाक सर्जिकल प्रोग्राम। यो पनि मैले यस्तो निर्णय गर्नुको मुख्य कारण हो। म टिचिङ अस्पताल परिसरमै रहेको मनमोहन कार्डियोथोराकिक भास्कुलर एन्ड ट्रान्सप्लान्ट सेन्टरको कार्डियोथोराकिक एन्ड भास्कुलर सर्जरी विभागमा काम जारी राख्छु।
उनको विज्ञप्तिको पूर्ण अंश-
After 108 days of taking charge of TU Teaching Hospital, I have decided to resign from the position of Executive Director. I wanted to remain silent and step aside, but I find that thousands of people have taken it seriously and want to know the reason behind my decision.
First of all, the Dean of Institute of Medicine and I were appointed at the time of crisis in the IOM and teaching Hospital. Similarly, I was also asked to help rescue Teaching Hospital by the Dean and TU Authorities. I ha d agreed hesitantly because the hospital had a total negative balance of about 66 crores and many suppliers and parties were not paid. The hospital staff had not received their salaries on time for several months. Moreover, the taxes were not paid although they were deducted from staff, nor were the “Sanchaya Kosh, Nagarik Lagani Kosh”. So, we were meant to take certain stern steps to rescue the Teaching Hospital from the brink of collapse. Let me share my feelings about my term at Teaching Hospital. There were many important Positive changes within Teaching Hospital, some of them being the following:
1. We actively stopped deliberate referrals of patient from our Emergency (and the Outpatient clinics) when the beds were available in the hospital. That helped strengthen the ethical practice and increase revenues.
2. We took legal action against those involved in financial irregularities and those violating discipline.
3. We enforced electronic attendance and observation of timing in all the work areas(the stage was already set by previous administration).
4. The revenue generated by the hostpital went up significantly and it became possible to pay salaries on time.
5. We , with the help of Deans office, cleared many of the previous dues including the taxes, “nagarik lagani kosh” etc, making our staff “legal”
6. We scrapped the “lunch break” in all the service areas with public contact.
7. We scrapped the system of paying overtime for an “undertime” work- paying extra for regular, even work less than regular hours- which saved us about 7 million rupees a year.
8. Expenditure in the operating rooms and in the wards went down by almost 20% despite the increase in workload, by tighter regulation and recording of surgical materials.
9. We facilitated the expansion of the services (The credit of construction of new buildings goes to the previous Directors): we shifted surgical and Skin OPD to a new block with much betterfacilities; we opened up a new ward for Department of Medicine; an additional operating room was opened; and additional trauma operating room is set to be launched; ENT services are being shifted to a previously constructed but underutilized Block (although most of the preparation was done by prior directors); Radiology and Endoscopy services were given more spaces to help provide more convenient services to people; Anew blood sample collection desk was opened, and additional cash collection counter is added to help reduce the crowd.
10. Pharmacy service is streamlined with 24 hour coverage. It already is generating revenue, and with addition of more drugs and disposables the revenue is guaranteed to go up.
11. We fixed almost all of the procedural problems in procurement. And nobody could point out a single episode of bribery except one small case of 300 rupees, in which case the person involved was recommended to be fired.
12. Lower level staff worked very hard to keep the hospital clean, keep the traffic in order, hospital security became much more empowered to make the hospital complex look like a hospital.
13. Individuals and private firms donated a significant quantity of medical and surgical equipment amounting to more than one crore in 100 days (the Ministry of Health needs a special mention for a crucial support by providing equipment when there was zero money to buy anything.)
I truly appreciate the hard work my administration staff did to get all this done. I appreciate the support of some senior professors, zeal of young faculty and technical staff that encouraged me to work harder. We would achieve nothing without the strong support from the Dean of IOM Dr. Prakash Sayami.
Now let me mention the obstacles I faced during this period.
• Not every Department Head complied with the system. The University Teacher’s Association and Unions kept showing resentments with tighter regulations. At times they spread unfounded rumors to defame the Dean and other authorities and kept exerting undue pressure. It became extremely painful when some of the “leaders” and “clean” professors started justifying patient referrals out of the Hospital.
• There were certain burning issues with financial liabilities of the past, which I could not comfortably sign cheques. I has requested for a special audit until my term commenced, which could not be done.
• The authority to make decision on financial and administrative matters had always been seized by the central office of TU, against the general Government rules and regulation. Dozens (or more) files of daily procurement have been lying for weeks in the central office to be approved. The intention for this to be so is unclear to me (clear in some cases), noting that the University gets closed for one or another reason for more than several months a year). By the way, our precondition to take charge of the Hospital (and deans office by the dean) was that more financial and administrative authorities would be given to IOM.
• The TU has not given the funds for the salaries of permanent staff as per the rules, citing that Government has not released money either. I can tell that it is impossible to generate money from the general public for salaries, recurring expenditure and equipment needed.
• The hospital has started making little more money, but just enough to pay for salaries and some recurring expenses. How can we generate extra money to pay for the huge debts/liabilities carried over from the past? This, I had put forth to the appropriate authorities and Government before taking up the job. They had promised to help but this help has not materialized. I feel it is unjust not to pay the parties off for their supplies and ask to keep supplying stuff to the hospital.
• Last but not the least, I have been doing two full time taxing jobs: run a busy cardiac surgical program and a full time administrative job. This also became a final tipping factor in my decision making process. I will continue to run the Department of Cardiothoracic and Vascular Surgery at the Manmohan Cardiothoracic Vascular and Transplant Center in the same Teaching Hospital Premises.
Finally, I would like to summarize by saying that this short period has been effective in many ways and disappointing in some ways. We have done what I think could be done by individual efforts; To take it to the further height, the system should also be conducive. We have proven that this institute can function well if honesty, wisdom and patience is exercised by all the concerned. Let me urge everyone to rise above party politics and help get a new leader to carry on with the agenda of clean deal.
I thank every on inside and outside the country who showed deep concern about our institute; I promise you all that I will still be in the public sector and be part of yours.