Medanta – The Medicity is a testimony to Dr Naresh Trehan‘s chutzpah and endurance. Now, the cardiothoracic surgeon-cum-entrepreneur has a five-year plan for his four-year old business. Will his strategy help him scale greater heights and usher a new era in India’s the healthcare sector? By Neelam Kachhap
It’s a hive of activity outside Dr Naresh Trehan’s office in Medanta Medicity, Gurgaon. I am awaiting my turn along with secretaries, patients, executives, department heads, and VIP guests for an audience with one of the most influential men in the Indian healthcare arena.
Dr Trehan (69), a cardio-thoracic surgeon and the Chairman of Medanta -The Medicity, is a known face at the state banquet and Delhi’s high life. He is known to command most of the dialogue in healthcare policymaking in India. Be it industry bodies like CII or PHFI or any committee influencing public policy, his presence is almost mandatory. Dr Trehan’s efforts have been appreciated with highest civilian awards like Padma Shri and Padma Bhushan by the government and Dr BC Roy Award by peers.
Back in his office, Dr Trehan expresses his dissent when I ask him about his influence on the healthcare sector. “I’m not influential in the sense that I can ensure favourable treatment from someone, especially using my wealth or contact,” says Dr Trehan. “I paid every penny for this land (Gurgaon), Rs 84 crores and Rs 150 crores for Noida,” he emphasises. “I’ve been working with the CII National Committee on Healthcare as Chairman since 2000. We have done a lot of progressive work. From starting point when there was no knowledge, the only thing we knew was that we were far behind in the basics. Interacting across the board with all stakeholders of healthcare system we have created know-how for healthcare development,” explains Dr Trehan. “I head the Healthcare Sector Skill Council, which is funded by the National Skill Development Council. We know skilling healthcare professionals in the allied healthcare space is required and we are doing that now.” he informs. “I may have shared the dais with the health minister or the Prime Minister on several occasions, but that does not mean I’m influential. My life’s philosophy has simply been to work hard with dedication towards my profession, everything else follows,” he adds.
Dr Trehan has dedicated his life to cardiac surgery and today is known as one of the most accomplished surgeons in the world. Although he does not come from a deprived background, his parents were physicians themselves, and he represents a generation of people who had enough fire in their bellies to make a mark for themselves despite difficult circumstances. Originally from Pakistan, Dr Trehan relocated to Delhi with his family after the partition and grew up with reinforced patriotism and new found enthusiasm just like the young India he represented. “When we were growing up, India was called underdeveloped. A few years later it was called a developing nation. Then a few years later, India was called almost developed and today it is known as an emerging market,” he recalls.
He earned his education from King George’s Medical College in Lucknow and shifted to NewYork for a better future. In 1973, cardiology was all the rage, most exciting and adventurous. And Dr Trehan wanted it. He wanted it so bad that he fought his way up the residency ladder and snatched the most coveted cardiology training of the time – under the legendary surgeon Dr Frank Spencer at the The New York University School of Medicine. Dr Trehan honed his surgery skills for seven years under Dr Spencer’s tutelage. He worked there till 1988 as Assistant Professor of Surgery.
“I had a successful practice in New York. Every year around 300 patients would come from India for treatment. At that time I knew that for every person who could afford to come to New York there were hundreds who could not afford. It propelled me to bring my practice back to India,” says Dr Trehan.
My thought process said that to have your own identity one must be masters of its own destiny,” Dr Trehan reflects. “And that is why I came back to India to create a distinct identity for healthcare delivery that India provides,” he says.
“However, at that time, private healthcare was not evolved and I did not find any hospital that had the infrastructure to support my work. That’s why I built Escorts Heart Institute and led it to be the largest heart centre in this part of the world,” he adds. But fate had its way, and Dr Trehan, after falling out with his business partner, decided to build his own hospital. The very public dispute between him and Shivinder Mohan Singh, MD, Fortis Healthcare resulted in Dr Trehan’s exit from the project he created.
In 2003, Dr Trehan started dreaming of an integrated centre of medicine which would produce new knowledge for people in India. “I was musing over the fact that India was missing institutes like Harvard, Mayo Clinic, Cleveland Clinic and Hopkins in US and Imperial College in London. These institutions are not only the providers of highest end of care in their part of the world but also the fountain heads of all new knowledge and therapy,” explains Dr Trehan.
“But this new knowledge was related to their own country and would therefore not be conducive for our people. So we needed an institute that could enhance science by fundamental research and work on minimising costs,” he explains.
This is how Medanta was born. Dr Trehan found a co-dreamer in entrepreneur, Sunil Sachdeva and set up Global Health, which owns and operates hospitals under the brand name Medanta.
DNA of Medanta – The Medicity
Spread over 43 acres, the integrated healthcare facility, houses six centres of excellence which provide medical intelligentsia, cutting-edge technology and state-of-the-art infrastructure with a well-integrated and comprehensive information system. It has 1250 beds with over 350 critical care beds and 45 operation theatres catering to over 20 specialities.
“There’s never been a hospital built of this variety before, we created an infrastructure in 2.4 million sq ft and matched it with highest technology to make it possible to do research along with treatment. We got human capital of the calibre that is matched anywhere in the world or better than anywhere,” claims Dr Trehan.
So, what is Medanta’s advantage over other facilities? “There is a leader in medicine in each department of equal quality of the world’s best benchmark,” says Dr Trehan. And rightly so. Be it Dr AS Soin, liver transplant surgeon or Dr Ashok Rajgopal, orthopaedic surgeon; each doctor is an expert in his/ her own right. They have all been brought together at Medanta. “We can tackle diseases together, that is what we do. We have a tumour board concept for every disease. We deliberate on all cases together and take a decision. This brings two things, quality and honesty. This is the difference we offer to our patients. This is our advantage,” beams Dr Trehan.
In four years, he has worked to establish Medanta as the place for superlative medical care. “My dream is that we have the highest standard of healthcare, not only in India but this part of the world. So, if a problem cannot be treated somewhere else then the patient can be sent to us and we will do our best. Medanta is positioned as a destination for complicated cases,” he says. “We give the best chance in the world. If you look at the kind of procedures we have developed you will be surprised. We do bypass for patients with 10 per cent ejection fraction and we do it every day. So, today we have gained that reputation that any body who cannot be fixed anywhere else can be fixed here. If you have complications we are the last stop,” divulges Dr Trehan.
Maybe this was the kind of enthusiasm that led Dr Trehan to take up former CJI, JS Verma’s case. However, not all lives can be saved. The patient died of multiple organ failure at Medanta and the family alleged negligence. The case was dismissed by the Delhi Medical Council and is now being appealed at the MCI. Yet, Dr Trehan is very passionate about upholding ethics in the medical profession. He says, “The subject of ethics in medicine is very close to my heart. We are forming a body called ‘Doctors for Ethical Practice’ within the IMA with help from Dr KK Agarwal. We will take it national very soon.”
So what is next? He says, “We should be able to do primary research here. We should be able to work on development of molecules, looking at disease processes.” In February 2011, Dr Trehan partnered with Duke Medicine, an academic health sciences system based in Durham, North Carolina, US, to conduct early phase clinical research at Medanta.
Medanta Duke Research Institute (MDRI) was instituted as a new joint venture company where Duke Medicine was to providing scientific, clinical research, and Medanta was to fund the creation and operation of the facility. “The aim was to develop new therapies for a large number of diseases. By performing “proof of concept” studies, the MDRI would have provided opportunities for Indian physicians and patients to participate in the clinical research process in ways that have not been previously possible,” says Dr Trehan. The 60-bed facility was to open in April 2011, but the project never took off. The clinical trial industry in India took a hit when reports of unethical practices surfaced and the Supreme Court, taking a stern view on the death toll associated with clinical trials, recommended the government to re look at the laws governing clinical trials in India. “We have put in a huge amount of resource into that (MDRI) it is a very costly business. But unfortunately so far we have not been able to progress. We lost a lot of money because of this but we haven’t lost hope,” says Dr Trehan.
In the last two years, the entire regulatory framework pertaining to clinical trials was overhauled. “It disrupted the whole research in all international galaxy. But in a way it’s very good because now we have a regulatory policy, clinical trials were being abused before. As much money as we have lost, I still feel it was a good thing. This was imminent. It should have happened and it did,” informs Dr Trehan.
“We will have to refine it (regulations) because we have, on one hand abuse going on, but as a knee jerk reaction, we have become holier than thou. Americans have a very mature system, the Europeans have an equally mature system for clinical trials. We should learn from those experiences and create a policy that is progressive,” opines Dr Trehan.
The partnership with Dukes Medicine is still on. “Actually, last year we slowed it down, but the partnership is still there. We are waiting for the policy to be finalised,” he adds.
Dr Trehan has not thrown in the towel as yet, he is still hopeful of integrating traditional medicine research with modern medical practice. “In addition to practicing modern medicine, we decided to leverage the strength of traditional medicine, basically Ayurveda and others, and see how we can combine the power of the two for creating therapies which will then become equally or more effective, less traumatic to human body and imminently less costly. We are engaged in frontier research, trying to combine Ayurveda and modern medicine and we have got some early success,” Dr Trehan informs.
Dr Trehan’s effort to create new knowledge is also gaining momentum. “Our clinical outcomes today are as good or better than anybody in the world mostly better,” says Dr Trehan. He says, “There are new things that we have done in all the different specialities, especially in robotics. Dr Rajesh Ahlawat and his team are doing robotic kidney transplant. We have done a lot in stem cells. We are doing some research on hepatocytes and on liver failure. So, the effort that we have made to create new knowledge across all specialities is happening now.”
It has been four years since the hospital opened its doors to the patients and it has already achieved break even. Medanta was started with an initial investment of Rs 1,000 crores, raised through a mix of equity and debt. “We had loan from banks, and investors like Punj Lloyd and Avenue Capital. We achieved fast break even and have paid back all our loan. We have seen a 20-25 per cent year-on-year growth,” says Dr Trehan.
“We are growing organically. My principle is, for every facility we can take 50 per cent debt. Today, we are moving at a pace that we can self finance ourselves, but our philosophy on debt is 50-50. So, we will have 4000 more beds in three to four years, financed 50 per cent by us,” he divulges.
Recently, Singapore’s state-owned investment firm, Temasek bought Punj Lloyd’s shares and invested about Rs 700 crores in Medanta. Earlier in December 2013, Avenue Capital sold its shares to private equity major Carlyle Group for an undisclosed sum.
Talking about his expansion plans, Dr Trehan says, “I’m not after number of beds. If we have created a system which is producing this kind of result then it should be available to people. I want to take that knowledge to places where it does not exist, so that everybody around can benefit from it. Today, I can say that I introduced modern cardiac surgery into India. I did it and I’m happy in 25 years we have started a movement. Now cardiac surgeries are available more easily in India. Now, the movement is in multi-speciality and quality, as well as collectively doing research in all this. My plan is to create more institutions like this.”
New facilities are already under construction at different locations in North India. “We already have one under construction in Lucknow. With 1000 beds it will be like Medanta,” shares Dr Trehan. Lucknow has always been close to his heart. “Utter Pradesh is undeserved. I’m from Lucknow, I studied at King George’s Medical College. There is a lot of knowledge there but they need a platform to participate in the new development of medicine. There are many practitioners of Ayurveda and Unani medicine which we will leverage,” he discloses.
“The second facility we are planning is in Noida because there is need in that area of this standard. Then another facility is coming up in Patna. These are the big ones with 1000 beds,” shares Dr Trehan.
“We have taken over Abdur Razzaque Ansari Memorial Weavers’ Hospital, Ranchi in Jharkhand and a hospital in Indore. We will upgrade the place and bring Medanta’s standard to these undeserved areas so that highest standard of healthcare can be provided to all at reasonable cost,” shares Dr Trehan. “What I would like to do is disseminate knowledge and provide services to people. We will train people in cardiology, orthopaedics, neurology and everything else they need. And we need to multiply. If you were to see how knowledge proliferates, today most of the cardiac surgeons in these cities or the vicinity are trained by me. A lot of people doing liver transplant are trained by Dr Soin,” reveals Dr Trehan.
“I’m not going to Chennai. I’m not going to Mumbai. Over capacity does not worry me. It exists here (Gurgaon) also. You can do better than most but that does not mean you are serving people Undeserved areas need that quality of medicine. Disseminate knowledge and provide services to other people, that’s what I’m after,” says Dr Trehan.
Besides this, Dr Trehan has other plans. “My biggest obsession today is to build a children’s hospital of the calibre of Boston Children’s Hospital or Great Ormond Street Hospital; not from profit but from my family funding and funding from other philanthropies,” discloses Dr Trehan.
“I see children are suffering today as their parents do not have the money or knowledge to provide good treatment. I want to create one of the best hospitals for children in this region. I want to offer subsidised to full free service, but with a good 500-bed hospital with world class infrastructure,” says Dr Trehan. He wants this children’s hospital to be close to the present day Medanta hospital.
Looking back at his life, Dr Trehan says, “Everybody chooses their own space. Mine is basically from the highest end of medical care to improved knowledge to create new medicine in India.” Reflecting on the healthcare scenario in India, Dr Trehan says, “My aim is to bring in new capacity building for India and try to bring everybody together to take every resource that is on the ground and use for Indians. If we do that and build trust between the government and the private sector, everybody will have to perform to keep up that trust. I think then people of India will benefit.”
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