Dr. NARESH TREHAN - HEART SURGERY IN INDIA

aresh Trehan, Cardiac surgeon
‘Somebody runs away with Rs 600 crore, there’s obviously no question of morality here’
Naresh Trehan is much more than merely the executive director of the recently-sold Escorts Heart Institute in Delhi. As the NRI doctor who came home and brought back modern heart surgery with him, he is almost the pin-up boy of India’s medicare revolution. The Indian Express Editor-in-Chief Shekhar Gupta talks to him on NDTV 24x7’s Walk the Talk programme

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Posted online: Tuesday, October 11, 2005 at 0000 hours IST

Naresh Trehan • Naresh, tell me a little of what it was like when Escorts began. Because when you came in, in the mid-1980s, you couldn’t import a chappal into this country.

There were many, many people who contributed to the creation of this institution, from the idea to its actual completion in 1988. Mr H.P. Nanda — who unfortunately is not with us any more — Indira Gandhiji, Rajiv Gandhi, the bureaucracy: everybody helped. It was a great homecoming for me.

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People said: ‘You can’t do it, nothing moves in India.’ Even Rajiv Gandhi remarked at the inauguration: ‘The first prize goes to you for creating the institute in this environment.’ But it’s been a good run since then.

• Tell me some of your early experiences — dealing with the bureaucracy, your first patients who’d never heard of something like this in India.

Well, at the very beginning, when we got the land, somebody put a stay on it saying it had been donated to the Church by Bahadur Shah Zafar when his daughter converted to Christianity.

The lieutenant governor, Mr Jagmohan, who was a very practical man, stepped in and said: ‘This is nonsense; the government wants to create an institution of this sort so that people don’t have go abroad for heart treatment.’ We used to spend $40 million a year sending heart patients outside.

But that was in the mid-1980s. Today, we have overseas patients from America, the UK, Europe, Australia, Indonesia, Russia ... you name it. And they’re here for surgery. It’s a great reversal and it happened because somebody could grab the vision that was in my head and keep it going, like I said, through successive governments.

We’re now the largest heart institute in the world. We do over 4,000 surgeries and, not only that, we have one of the best outcomes: 0.8 per cent mortality and 0.3 per cent infection rate, which is better than anybody else in the world.

• How would this compare to other famous institutions — Cleveland, for example?

Cleveland would be around one to two per cent. The gold standard for great institutions is one to two per cent mortality and a less than one per cent infection rate. But the most significant thing is that it’s all been done by Indian doctors, Indian staff and Indian nurses. This is what the pride of it is for me.

People used to say: ‘Who can do all this in India? You’ll go alone, what will you accomplish?’ But here’s a living example of what we can do. No foreigner ever set foot here to help us create this.

• That’s the challenge in India: you can set up a world-class facility, but to maintain it is very hard. It’s in the Indian DNA, so to speak, to start taking things for granted after a while, to leave it to technology or even just the next guy, like our cricket line-up.

We’re fully capable of doing it. We do it around the world. But we don’t do it in India because the systems and processes are missing. That’s the first thing I put into place here. The housekeeping chief here has a glossmeter to check the condition of the floor, because bacteria grow if the surface is rough. We’ve made a programme for every floor — each one of them has to be cleaned with such-and-such thing, polished with so-and-so. And there’s a schedule for it so the floor never deteriorates. It begins there ... it’s one of the most important steps in infection control.

• Naresh, let’s go back. You said you had found commitment from Indira Gandhi, from Rajiv and from Mr Nanda as well. From then to now find your institute caught up in such a controversy — how does it look?

From one point of view, it’s a sad story. But, again, you can see it as a transition. First of all, Mr Nanda, who is the chairman of Escorts and the son of Mr H.P. Nanda, ran progressively into a financial crunch in his other businesses. They started losing money.

The Escorts Heart Institute was the main anchor for the healthcare business. We have, like I said, the best results and a very healthy bottomline. His compulsions to sell the place are another story; the problem is, he didn’t do right by me and the doctors. He broke every promise he had made.

• Tell me about some of these promises.

He was supposed to discuss all this, tell the doctors. He made commitments that he would let us know what would happen to the institute. Fortunately, we’ve landed up with the Fortis group, which is a very responsible, well-managed system by itself. They are a very respectable healthcare group. They have made promises ... We’re working together. It’s a well-working machine and they don’t want to change anything.

• So as a sweat-equity holding professional, you have no concerns going from the Nanda family to Fortis?

I’ve said this again and again — as long as we continue to work with the ethic, the integrity and the ethos with which we built this place and which brought us to number one, we have no problem. We’re quite happy with the working relationship we have with Fortis. They also want to build a responsible, large system. There’s no problem with that.

Our disappointment is with the way it was done. There were promises to talk it out, to say: ‘Naresh, this is how it is.’ To betray the whole team, which has worked here with me for 17 years ... They feel disappointed, they’re shaken.

But one thing that’s good is that the Fortis team and I have reassured them that nothing’s going to change. The management is the same, our working conditions are the same, our ethic is the same. And not only that, we will move this institute to higher levels.

• And, most important, Dr Naresh Trehan is here. He’s not going to leave.

Yes. Absolutely. There should be no anxiety about it. Some of our patients were calling to say: ‘Are you still here, is the system the same?’ The name is not changing; the quality is not changing. If anything, it will get better.

• This may flatter you, but if I know you, it may worry you — brand Trehan is bigger than brand Escorts in your business.

Well, it’s my baby. It’s something we’ve built with our sweat and blood and we’re very proud of it. I think the fact that Fortis has paid the price it has for the institute says that again — that they’re also happy to be stepping into a place where there is this kind of system, where 4,000 plus operations, 10,000 angiographies and 3,000 angioplasties are done every year. And with results better than in most of the rest of the world.

• And also possibly the only profitable business the Nanda empire had left — the jewel in the Nanda crown.

You could say that. What is our anxiety? There are three parts to it. On the one hand, I want to make it clear to the patients and the doctors that everything is the same. They should feel reassured, we are going to serve with the same dedication and integrity that we always have. That’s one thing I’d like to put at rest.

• And that’s a commitment you have from the new management as well.

The second thing is: there are no issues, no problems in working with the Fortis group which, as I said, is building up a responsible healthcare system that they also want to be proud of. So we have no conflicts there, we can actually enhance each other. If it wasn’t for this public controversy ... We all feel Mr Nanda’s actions have created an unnecessary controversy.

• You used a strong word just a while ago. You said you and your team of doctors feel betrayed by what Mr Nanda did. Is that deliberately chosen? Is it such a strong feeling here?

Absolutely. We are very disappointed. When things can be done right, why do them in a controversial way? Why in the dark of the night? That’s what’s unnecessary about it. Now of course, it’s all in the courts and it’ll be decided by them. We have a great judicial system!

• And a public-spirited one.

Exactly. And the matter being sub judice, the less said the better.

• But, personally and professionally, you do see it as a betrayal?

Yes. Definitely. It’s been 18 years. We built it, I built it with my own sweat and blood. I put my own money into it from the United States. I feel it, naturally. I’ve said it a hundred times: this is my baby and I’m never going to leave it.

And it’s not just me. There are 200 doctors here. The senior team has been here for 17-18 years. They feel let down. But that said, we’re saying good riddance and chin up. We’re looking ahead.

• ‘Betrayal’ ... ‘good riddance’. You’re an angry man now.

(Laughs) It’s not that. I have to say what’s true. On the one hand, as I told you, I’m welcoming the Fortis group and saying we can work together and take this place to new heights. On the other, I cannot not say what the true feelings of the whole team are.

It’s not only me, it’s the whole set of doctors. In the first few days, they were walking around with their chins to the floor. Now I think we’re back on track — they’re all up again, having been reassured, having seen that the functioning isn’t changing. And not only that, we’re going to help them enhance their skills.

• I think the first feeling was that this has happened in the dead of the night, and now Naresh Trehan is going to walk off to his new project, MediCity — that becomes his new baby. And it’s ‘See you later, Escorts’. That, I think, is what dismayed a lot of your staff and patients.

I’m right here. Not only that, our whole team is here. We are working day and night with the same enthusiasm. We’ll make sure that nothing changes, because that’s our pride.

• So if I have a funny feeling in the left of my chest, I can come to Escorts with the same confidence?

Please don’t have it, but we’re here if you need us.

• It had better not happen while you’re not here and while MediCity isn’t yet built.

No, no, there’s no question of it. It’s all a synergy. We’re talking about a synergy between Escorts and MediCity. I’m a person who wants to build positively, to take people along. I’m a people person — I love doing things in alliances, partnerships, provided everybody follows the rules of the game.

• Naresh, let me take you back to that night of the long knives, if I may call it that. What exactly happened? How did you find out? What was discussed with you beforehand? Did you have any premonition?

See, Mr Nanda had repeatedly told us: ‘I’m going through some things, I may have to sell ...’

• ‘Some things’ means financial trouble?

Yes. He’d given us assurances that he would talk to me and the doctors and would let us know whom he would sell to, so that we were on board. It’s lucky that the Fortis group and I have been working together for several years now, promoting the healthcare sector in India, bringing it together, actually, on the CII-India Healthcare Federation platform.

We’ve held roadshows for India overseas. We’ve made the accreditation process for India. We’ve also made the ethical rules for hospitals in India. We know each other very well. Fortunately that’s okay — that’s not my disappointment, that’s my pleasure.

• And that’s why you say good riddance to Mr Nanda?

What did he sell? He sold us, the doctors. It’s not just the shell, this is a well-oiled machine.

This is a man I’ve supported for 18 years. He owes it to us. To take such huge sums of money and to run away in the middle of the night? I think it’s a cowardly act, an unprincipled act. Why should he have done this? Why not sort it out with his brother? Why not make it legal, so that those who buy it or work here feel good about it?

• And if he’d discussed it with you, would this have been done in a different way?

It could have been done properly. There were many options. I just don’t know, I don’t know what drives the man. As you can see, I’m definitely disappointed. Fortunately, we’ve landed on our feet with a group with which we’re going to take this place to a new height. There’s always a silver lining.

• What he sold is the brand. A brand is built by its people. In the service industry, this really is the first in India, which went into the private sector and upper end healthcare, isn’t it?

You should see what we’ve been able to do. On the one hand, we’re working at the highest end of healthcare. On the other, we have such an active community outreach programme. We see hundreds of thousands of patients in their villages because we know they can’t get to us. We’re always on the road.

Just recently, I was in Srinagar where we had 1,000 patients who walked to the city, got whatever transport they could — poor people like you wouldn’t believe. We spent two days seeing them. It just gives you such a great feeling to touch the rural areas. That’s where, I think, we have so much work to do.

• Naresh, I know some of your plans for MediCity. I know that you want to bring in a portable installation for the poor and so forth. Looking at all of that, do you have morality questions about how the money generated from the sale of Escorts is being utilised?

Of course. Look, we have to give back to society. Somebody runs away with Rs 600 crore — there’s obviously no question of morality here. It’s absolutely immoral. These are twists that have been created. But they’ll unravel themselves.

• Inshallah. But tell me, did it genuinely take you by surprise? Did you find out about it as we did? In that morning’s paper and on our TV screens? Or did you know about it a few hours ahead?

I was actually at a judicial function. There were promises made by Mr Nanda that very morning that he would settle all the issues before he sold the institute. And that he’d give me three days. That was the promise given.

Then in the evening, I’m at this function, the phone is ringing ... It’s on the ticker and he’s sold it.

• So it was as much of a surprise as it was for the rest of us — arriving silently, just like a heart attack really? What happened when you came to the hospital, were there long faces?

As I said, there are two very distinct pictures. I want to make it absolutely clear that so far as the hospital goes we are here, undisturbed. The group we’re with was my fallback, I could say. The doctors and I still have the opportunity to continue the ethos of this place. That was a comfort, Fortis’ coming in ... But the disappointment on the other side was terrible. Mr Nanda’s acts were deplorable.

• Naresh, there are two things that all your friends and admirers want to know. One, how do you keep your cool? And second, how do you manage your time? In the middle of all of this, the morning after it happened, you came and conducted your usual 10-12 surgeries.

Of course. And I’ll continue to do it. If you’re doing positive things, it’s not stressful. It’s comforting. You can keep your stamina — I exercise, I jog and run, I do yoga ... All positive activity energises you.

• And you party!

Well I don’t know how late you stay at parties, but I’m in bed by midnight. I sleep for six hours; I’m up by 6 or 6.30 and I’m in Lodhi Gardens or in my gym, exercising for an hour. Or with my yoga teacher. This is a combined thing I do every morning. Then I come to work and I work for 12 hours a day.

The more positive things you do, the more energised you get. It’s just this recent disturbance in my life which threw me off balance for a bit. But I’m back to normal now. You pull the flush and it’s out of you.

• Seriously strong words, Naresh.

That is how I feel.