20/06/2026
Reflections on the Recent Controversy at GMC Anantnag
The recent controversy involving cardiac pacing procedures at GMC Anantnag has sparked significant discussion among healthcare professionals, administrators, and the general public. While much of the debate has focused on the clinical merits of Left Bundle Branch Area Pacing (LBBAP), the core issues appear to extend beyond medicine alone and encompass ethics, transparency, adherence to guidelines, and accountability in the use of public healthcare funds.
There is no denying that medical science continues to evolve. Newer procedures often provide advantages over older techniques and may improve patient outcomes in appropriately selected cases. LBBAP has been increasingly recognized worldwide as a promising pacing strategy, and many cardiologists consider it a valuable advancement in cardiac electrophysiology. However, the question raised in the present controversy is not merely whether LBBAP is a good procedure. Rather, the question is whether it was used in accordance with approved indications and whether the associated documentation and financial claims accurately reflected the treatment provided.
In publicly funded healthcare schemes such as PM-JAY and similar government-sponsored insurance programs, patients are entitled to specific procedures and benefits under predefined packages. These schemes are designed to ensure transparency, equitable access, and proper utilization of public resources. If a particular procedure is covered under a package, it can be provided without financial burden to the patient. If another procedure is not covered or requires a different reimbursement mechanism, the patient should be clearly informed about the available options and the financial implications of each.
In my view, the ethical approach is straightforward. If Procedure A is covered under a government scheme and Procedure B is more expensive but considered clinically preferable, the patient should be informed that Procedure A is available free of cost while Procedure B would require additional expenditure. The patient can then make an informed decision. What should never occur is any mismatch between the procedure performed, the procedure documented, and the procedure claimed for reimbursement. Transparency is fundamental to maintaining trust in both the medical profession and public healthcare systems.
Another aspect of the controversy relates to the expert opinion reportedly obtained from senior cardiologists. If the recognized expert body concludes that a particular procedure should be reserved for selected patients with specific indications, those recommendations deserve serious consideration. Individual clinicians may have differing views based on emerging evidence or personal experience, and scientific disagreement is a normal part of medical progress. However, until guidelines are modified through accepted processes, deviations from established recommendations should be supported by clear clinical justification and meticulous documentation.
The GMC Anantnag controversy therefore highlights a broader principle applicable to all healthcare institutions. Medical innovation and clinical excellence must go hand in hand with ethical practice, transparent billing, accurate documentation, and compliance with regulatory frameworks. The debate should not be reduced to whether one procedure is superior to another. Instead, attention should focus on whether patient care, financial claims, and professional conduct were fully aligned with accepted standards and applicable rules.
At the same time, fairness requires acknowledging that allegations contained in official notices do not by themselves establish wrongdoing. Every medical professional is entitled to due process, an opportunity to present evidence, and an impartial assessment of the facts. Final conclusions should emerge from a thorough examination of clinical records, procedural documentation, expert opinions, and applicable regulations rather than assumptions or public sentiment.
The episode serves as an important reminder that in modern healthcare, excellence is measured not only by technical expertise and successful procedures but also by integrity, transparency, and responsible stewardship of public resources. These principles are essential for preserving public trust in institutions such as GMC Anantnag and in the medical profession as a whole.
A useful way to understand the controversy is through the example of cholecystectomy. Suppose a government-funded health scheme covers Open Cholecystectomy for all patients. Laparoscopic Cholecystectomy is a newer technique and may offer advantages such as smaller scars, less postoperative pain, and faster recovery, but it is also more expensive.
Now imagine that health policy experts decide that, because public funds are limited, Laparoscopic Cholecystectomy will only be funded for younger patients or selected categories where the benefits justify the additional cost. For elderly patients, the government may conclude that the cosmetic advantage of smaller scars is less important and that the less expensive Open Cholecystectomy provides acceptable outcomes. Whether one agrees with this policy or not, it becomes the approved rule governing the use of public funds.
A surgeon may personally believe that laparoscopic surgery is superior and may prefer to offer it to all patients. However, if the procedure is not approved under the scheme for a particular patient category, the surgeon has an ethical obligation to explain the situation honestly. The patient should be informed that Open Cholecystectomy is available free of cost under the government scheme, while Laparoscopic Cholecystectomy is not covered and would require additional payment.
What would be difficult to justify is performing Laparoscopic Cholecystectomy, recording or claiming reimbursement as though Open Cholecystectomy had been performed, and then recovering the additional cost from the patient. In such a situation, the issue is not whether laparoscopic surgery is better. The issue is whether there has been accurate documentation, truthful billing, and proper utilization of public resources.
The same principle applies to any medical procedure. A doctor may genuinely believe that a newer technology offers advantages, but when public money is involved, treatment decisions must be accompanied by transparent documentation, adherence to approved indications, and honest financial practices. Medical innovation cannot come at the cost of accountability. The debate therefore should not be framed as old versus new medicine, but rather as innovation within an ethical and transparent framework that protects both patients and public resources.
Dr. Mohsin Hassan
