Regulatory action must to check exploitation by pvt hospitals

Pushpa Girimaji

Private hospitals misleading patients on the cost of treatment, issuing highly inflated, undecipherable bills and charging for items and treatment not administered, are legion. So also the practice of refusing to discharge the patient or hand over the body till additional demands for payment are met.

In a damning indictment of such crass commercialisation and violation of patients’ rights, the apex consumer court has directed a hospital to refund the unjustifiable amount collected from the patient, along with compensation and costs. The order, describing such practices as ‘gross professional misconduct’ and ‘deficiency in service’, gives hope to all those patients and their relatives who are victims of such exploitation in the private health sector. The consumer court’s observations that it was imperative to take measures to address and prevent such instances of misconduct, should also alert state governments to the need to regulate the private sector and protect the interests of consumers.

The order of October 12 has its origin in the admission of the complainant’s wife for a heart problem at Apollo BSK Hospital, Durg district. Chhattisgarh, on June 17, 2010. According to the complainant, at the time of admission, he was told that the treatment would form part of a package, costing a total of Rs 85,000, and was asked to deposit Rs 20,000. However, the very next day, he was told that the treatment would cost Rs 2 lakh and was asked to pay the entire amount. Two days later, on June 21, he was informed of her demise and asked to pay an additional Rs 74,260 before collecting the body. After much pleading, he got the body released after a delay of six hours, by depositing Rs 50,000. He was not given any details of the expenses, nor documents about the treatment given to his wife, despite several requests.

The detailed analysis of the treatment as well as the bills by the District Consumer Disputes Redressal Commission, Durg, and quoted by the apex consumer court in its order, gives an indication of how consumers are taken for a ride by hospitals. Besides raising several questions on the angioplasty performed on the patient, the commission pointed out that the hospital had not substantiated why an intra-aortic balloon pump (IABP) was required. While IABP was said to have been provided on June 18, the purchase, in the bill, was dated June 19. Similarly, while hospital records said the stent was inserted on June 17, the date of purchase of stent was recorded as June 18. X-ray expenses were listed on two separate dates, but no X-ray film was provided as evidence. Similarly, the complainant was charged for seven instances of blood transfusion, but there was no information on why the transfusions were necessary. An amount of Rs 38,480 was billed under the pharmacy category, but there were no names of the medicines purchased.

The district commission pointed out that even the CD containing the details of the patient’s angioplasty was not given to the complainant. Referring to the complainant’s statement that no type of operation or procedure was performed on his wife, the commission said this statement was noteworthy and cannot be ignored. “The significant issue at hand is whether the additional amount of Rs 2,09,260, which was later obtained from the complainant, was genuinely necessary for the patient’s treatment or not,” the commission said.

The commission also underscored the fact that the hospital did not give the complainant, at the time of admission, any breakdown of the treatment and services covered under the package and whether there were additional costs beyond the package, particularly when the term ‘package’ would imply that it covered the entire treatment. “Therefore, any attempt to recover additional amounts related to the patient’s treatment, apart from what is covered in the package, constitutes an inappropriate use of the package option,” the commission said. Reiterating that the behaviour of the hospital fell within the realm of gross professional misconduct, the commission directed it to refund the entire amount collected from the complainant, along with 12 per cent interest and costs of Rs 10,000 and compensation of Rs 20,000. This was upheld by the State Consumer Commission.

While endorsing the verdict of the lower consumer courts, the apex consumer court slightly modified the order to the extent that instead of refunding the entire amount paid by the complainant, the hospital was allowed to retain Rs 85,000 (which was the package amount) and return the remaining Rs 1,85,000. However, while the lower commission had awarded interest of 12 per cent from the date of the complaint, the apex commission directed the hospital to pay interest on the amount from the date of the final bill. The Commission also awarded additional costs of Rs 15,000 (Managing Director, Apollo BSK Hospital, District Durg Vs Bishan Lal, RP No. 1653 of 2016).

Orders such as these not only call for stringent regulatory action against exploitative practices, but also strict monitoring of private hospitals by state governments to ensure their compliance with patients’ rights. There is also an urgent need to enable consumers to understand and question hospital bills. This requires the Union Ministry of Health or Consumer Affairs to create a mobile software using Artificial Intelligence to help consumers check the veracity of the bills.

— The writer is a consumer rights and safety expert

Join Whatsapp Channel of The Tribune for latest updates.