SHA rejected GMC’s plea for advanced cardiac procedures before doctor’s suspension

Srinagar, Jun 23: Government Medical College (GMC) Anantnag sought approval from the State Health Agency (SHA) for advanced cardiac pacing procedures at the centre of the Ayushman Bharat controversy involving suspended senior interventional cardiologist Dr Syed Maqbool, but the request was turned down, documents accessed by Greater Kashmir show.The documents further show that several patients who underwent advanced Left Bundle Branch Area Pacing (LBBAP) submitted affidavits stating they had voluntarily opted for the procedure and agreed to bear the additional cost after being informed that it was not covered under the Ayushman Bharat PMJAY-SEHAT scheme. According to a communication dated May 12, 2025, then GMC Anantnag Principal Prof. Dr Rukhsana Najeeb wrote to the Chief Executive Officer (CEO) of the SHA seeking approval for five LBBAP procedures, each estimated to cost Rs 1.70 lakh, after pre-authorisation requests were rejected.“I am writing to kindly request your intervention in the matter of rejected pre-authorisations for cardiology cases - LBBAP procedures under the Ayushman Bharat scheme,” the letter read. Describing the cases as clinically urgent, the principal said the patients required potentially life-saving intervention.“These cases are of utmost clinical urgency as they involve life-saving interventions for patients with severe cardiac conditions. The rejection of pre-authorisation has caused significant delays in treatment, adversely affecting patient outcomes,” the letter said.The SHA, however, approved only the conventional Dual-Chamber Pacemaker implantation package, which carries a PMJAY reimbursement of around Rs 1 lakh, and did not clear the higher-cost LBBAP procedure. According to doctors, some patients chose to undergo LBBAP after the SHA declined approval for the procedure.While the PMJAY scheme covered the Rs 1 lakh Dual-Chamber Pacemaker package, patients paid the additional amount required for the specialised LBBAP hardware, which the hospital procured from private suppliers through official channels, including the Accounts Section and AMRIT Store.“Without this arrangement, patients would have borne the entire cost of the procedure, estimated at Rs 1.70 lakh,” a doctor said.“The PMJAY benefit covers up to Rs 5 lakh. Had SHA approved LBBAP where medically indicated and advised by cardiologists, patients would have received the procedure under the scheme instead of paying extra,” the doctor added. A complainant was among the patients who underwent the procedure.Affidavits submitted by him and several others state that they opted for LBBAP after being informed about the available treatment options.“LBBAP was conducted on a number of such patients without any coercion,” his affidavit reads. “At no point were we forced to pay an extra amount of Rs 70,000.”The affidavits further state that no doctor, hospital official or intermediary received any “cut,” commission, or undue financial benefit from the payments.The development comes days after Health and Medical Education Minister Sakina Itoo ordered Dr. Maqbool’s suspension pending an inquiry into cardiac procedures performed at GMC Anantnag.The Health and Medical Education Department subsequently issued an order placing him under suspension and attaching him to Government Medical College (GMC) Jammu pending further proceedings. According to findings of the inquiry made public last week, Dr. Maqbool allegedly recorded 101 LBBAP procedures as dual-chamber pacemaker implantations to claim benefits under the PMJAY-SEHAT scheme.Investigators said Cath Lab records showed that patients underwent LBBAP procedures, procured through private suppliers while claims submitted under the government insurance scheme were made under the dual-chamber pacemaker category. The Health and Medical Education Department also cited a technical assessment attributed to a panel of cardiologists from SKIMS, which reportedly found that 27 of 55 patients had normal ventricular function, rendering implantation “completely unindicated or unnecessary.”Senior SKIMS officials later distanced the institution from the assessment, saying the administration had no role in preparing the report and that the government had sought opinions from cardiologists who are now retired. According to the memorandum, the State Anti-Fraud Unit conducted an unannounced inspection at GMC Anantnag after a preliminary audit detected unusual patterns in cardiology claims.The team reviewed hospital records and interviewed officials, including the Medical Superintendent, Cath Lab in-charge, Accounts Section and AMRIT Store management.The inquiry alleged discrepancies between claims submitted through the Transaction Management System (TMS) and entries recorded in Cath Lab records. Dr. Maqbool denied the allegations and said his response had already been submitted to the authorities.“We replied to every allegation with documentary evidence. The matter is under consideration and we have full faith in the system,” he said.The inquiry has also drawn criticism from some cardiologists, including Dr. Khalil Kajwal, Director of Electrophysiology and Electrophysiology Laboratory at McLaren Greater Lansing Hospital, Michigan, USA who questioned the conclusions reached by the investigators.“Left bundle pacing is a form of dual chamber pacing. You don’t put more leads or any different form of pacemaker, just the same dual chamber pacemaker but the lead is deployed in a more favourable position,” Kajwal wrote on social media. The suspension order has directed Dr. Maqbool to submit a written response within seven days and indicate whether he wishes to be heard in person.It states that proceedings may continue ex parte if no response is received within the stipulated period.