"Referral letters typed in India!"

Internal referral letters are sent to India to be typed, so internal referrals can take up to 12 weeks to reach the relevant department, i.e., in addition to regular waiting times. Why on earth don't the doctors/hospital secretaries simply email the relevant departments during consultations? Most of the secretaries' voicemail announcements seem to indicate that they work only two days per week which is probably part of the problem. Where on earth are the Hospital Administrators?