The Price of Delay: When Process Outlives the Patient

A Reckoning With PGIMER

As we marked our father’s first death anniversary last week, we found ourselves remembering not only the man he was, but also the institution he trusted until his final breath. Dr Rajender Kalra was 89 when he passed away on April 7, 2025, at PGIMER, Chandigarh, while waiting for a TAVI, or Transcatheter Aortic Valve Implantation, procedure. The procedure had been delayed for months because of administrative and procurement processes. His death remains, for our family, a profound personal loss. With time, however, grief has sharpened into a larger and more uncomfortable reflection: what does it say about our public healthcare system when even a man who served one of its finest institutions for decades could not receive timely care from it?

Our father was not an outsider to PGI. He had served the institution for nearly three decades and retired as its Medical Superintendent. Even after retirement, he remained deeply attached to the place. Like so many of his generation, he believed not only in the doctors who worked there, but in the institution itself, in its values, mission, and promise of public service.

That faith was not misplaced. PGIMER is part of the collective heritage of Chandigarh and much of North India. Since its founding in 1962, it has served as a vital referral centre and has cared for countless patients in need and trained generations of doctors who went on to become specialists across India and abroad. There was also a time when PGI was the hospital to which much of the city’s elite turned for treatment. Its reputation was built not merely on academic distinction, but on public trust and clinical excellence.

Since economic liberalisation, private hospitals and speciality centres have multiplied, drawing away many who can afford greater speed, comfort, and convenience. Yet PGI remains what it has long been at its core: a lifeline for vast numbers of patients, especially the socially and economically underprivileged, who depend on subsidised, high-quality care. That is precisely why its strengths must be acknowledged and its weaknesses confronted honestly.

Our father was diagnosed with severe aortic stenosis in September 2024, a serious condition in which the valve opening between the heart and the aorta, the body’s main artery, becomes dangerously narrowed. He was evaluated at Fortis Mohali, where he had previously undergone coronary artery bypass surgery. Yet even there, the recommendation was that the TAVI should be performed at PGI. To him, this felt natural. PGIMER was his alma mater, his workplace, and the institution to which he had given some of the best years of his life.

In December 2024, he developed acute congestive heart failure and was admitted to PGI for a few days. His physicians advised TAVI. However, because the valve was expensive, institutional approval was required before the device could be procured and the procedure scheduled. A formal request was initiated by the treating cardiologist in mid-January. What followed was an agonising wait.

We assumed, perhaps not unreasonably, that an urgent case would be cleared within days, or at most a week or two. Instead, the file moved slowly through layers of approval. Calls were made, messages were sent, and every institutional contact we could think of was approached. Yet the file seemed to drift from desk to desk, never acquiring the urgency that his condition demanded. We were never clearly informed why the approval was delayed. If the valve could not be approved for any reason, whether cost, eligibility, or procedural limitations, it would have been prudent to tell us so that we could have arranged care elsewhere. He breathed his last nearly three months later, still waiting and still believing in the system.

That experience leaves behind a painful question: if this could happen to someone with deep institutional ties, intimate knowledge of the system, and access to people in authority, what happens to the ordinary citizen who has none of these advantages?

That, in truth, is the larger point.

In India, we all know, even if we rarely say it aloud, that systems often do not function on process alone. One still needs to know someone to move a file, secure a bed, or cut through delay. In overburdened public institutions, personal influence often becomes an unofficial substitute for institutional efficiency. We have normalised this not because it is acceptable, but because it has become woven into the fabric of everyday life.

Our father’s final day exposed those deficits with painful clarity. After a difficult night, his breathing had become increasingly laboured by the morning of April 7, 2025, and by around 9.30 a.m. his condition had worsened significantly. With no reliable, universal 911-style emergency response system in most of our cities, we were left to lift him into our car and rush him towards PGIMER. Fortis was closer, but our father insisted on going only to PGI. Even in distress, his faith in the institution remained unbroken.

The drive from Mohali took about 45 minutes. Traffic did not yield. In our country, even ambulances struggle for right of way. In a private car carrying a critically ill man, there is only panic, horns, and hope.

What unfolded at the hospital was not a single catastrophic failure, but a succession of smaller systemic breakdowns that laid bare how fragile, inadequate, and unprepared our emergency care systems remain. There was no clear receiving process for a crashing patient. The Advanced Cardiac Centre has no true emergency room and no visible protocol for the immediate transfer of a critically ill patient. The stretchers outside lacked even the most basic dignity. We had to seat our father in a wheelchair ourselves and take him upstairs, shouting for help and pleading with people to clear the way. When we reached the third-floor Coronary Care Unit and called out urgently for help, there was no immediate response and no staff member readily available to assist. No one appeared to take clear ownership of the situation. By the time we finally moved him onto a bed, he had lost consciousness and gone into cardiac arrest. CPR was performed. He was intubated. Shocks were delivered. But by then, the window had closed.

The tragedy was not one of individual incompetence, but of a system whose architecture could not meet the urgency of the moment.

Our father spent much of his life serving a public institution. There is a cruel irony in the fact that a man who once helped others navigate the system was ultimately defeated by its inertia.

We write this not to diminish PGIMER, but because institutions like it matter too much to be spared honest scrutiny. Their reputations cannot rest only on legacy, academic excellence, and public affection. They must also rest on their ability to reform themselves to meet urgent human need. The true measure of a health system lies not in its expertise or infrastructure, but in whether it can respond with urgency, dignity, and humanity when life is at its most fragile. If it cannot, then its reputation, however great, rings hollow.

Aman Kalra, MD MBA

Tarun Kalra BDS, MDS