Fortis and Medanta: 2 cases that show India's crumbling private healthcare system

Shock and anger swept the country on Monday when it emerged that the parents of seven-year-old girl Adya, who died of dengue at Gurugram's Fortis hospital, were billed Rs 16 lakh for 15 days of treatment. The bill also included the costs of over a thousand gloves and 660 syringes. The father alleged that the hospital even refused an ambulance after her death, and went on to charge for the gown on her body. As the media flashed images of the cherubic child, the family also alleged that it was made to purchase the costliest brands of medicines.

As the Central government was writing to states on Thursday to warn them of action for such cases, reports poured in that Gurugram's Medanta Hospital billed an insurance agent Rs 15.88 lakh for his seven-year-old son's 22-day dengue treatment. The father said he mortgaged his house to pay the bill but did not have money for further treatment. He shifted his son, Saurya Pratap, to the Central government's Ram Manohar Lohia (RML) Hospital in Delhi where the child died on Wednesday.

The two cases have brought the spotlight back to private hospitals who milk families in a country where millions continue to grapple with a crumbling and corrupt public healthcare system. As if losing a loved one is not enough, every item — even hand sanitisers, hair oil or wet wipes — is charged most exorbitantly by private hospitals.

A 14-year fight

Octogenarian BR Saini recounts his 14-year struggle to seek justice for his eldest son, who died due to the alleged medical negligence of Lions Hospital & Research Centre in South Delhi's New Friends Colony. On November 19, 2001, Trilok Nath (37) was admitted to the hospital. He had been complaining of a headache for five months and had vomiting bouts 10 days prior to the admission. He had been brought from state-run GB Pant Hospital. A former Pant surgeon was heading the neurosurgery at Lions. A brain surgery was conducted on November 20. Trilok's condition worsened. He became drowsy, and slipped into a coma. Five days later, he died.

A resident of West Delhi's Najafgarh, Saini had been billed approximately Rs 1 lakh. He had no insurance cover. Dr Brahm Prakash, who performed the operation, was insured for professional risks — if a botch up is proved, the insurance agency will pay for the doctor. And records show that the hospital had botched up the case.

An expert medical opinion was sought from RML Hospital, which said, "The surgery was uneventful. The patient was conscious and oriented, and obeyed verbal commands in the immediate post-op period. Vitals were normal. However, in the evening, the patient became drowsy. At the first sign of deterioration, an immediate NCCT (Non-Contrast Computerised Tomography) of the head should have been done for an appropriate management, which was not done in this case."

Saini moved the Delhi State Consumer Disputes Redressal Commission in 2003. He spent thousands of rupees and made numerous visits to the Commission. In 2017, the Commission asked the hospital to pay Rs 24,56,000. The judgement says, the hospital conducted neurosurgery without CT scan/NCCT facilities. In response to an RTI application filed by Saini, RML Hospital confirmed, "A neurosurgical centre should have all the required facilities, including CT scan, for diagnosing as well as follow-up."

"The hospital has now moved the National Consumer Disputes Redressal Commission. A fresh battle has started. I am not sure if I will live to see justice," rues Saini, a former Central government employee, who has submerged himself in papers despite his poor health.

'What EWS quota? Pay Rs 10 lakh'

While Saini has been fighting a losing battle, the healthcare scene in India is plummeting. "National Sample Survey findings show a decline in the share of public hospitals treating patients," says Denny John, a Delhi-based health economist. In India, 64.21 per cent of patients end up paying through their nose at private facilities because government systems fail them at each step, as is the case with 49-year-old Mandawali resident Subhash Chand. On the night of October 19, he met with a road accident. The police took him to two government centres and finally admitted him to Max Hospital in Saket. Less than a week ago, Max discharged him because bills soared to Rs 10 lakh in a month.

Items such as gloves, tubes and syringes alone cost over Rs 1 lakh. Drugs, lab tests meant another Rs 1.5 lakh; the Intensive Care Unit (ICU) rent was Rs 1.76 lakh. And then there were ambulance, blood bank, surgery, physiotherapy, radio diagnosis and consultation charges. Chand, who is a driver, earns Rs 8,000 a month but has a family of four to feed. He was certified an "Economically Weaker Section (EWS) member by Delhi Health Minister Satyendra Jain's office. "We asked for free treatment mandated under a Delhi High Court order but the hospital refused," says his wife, Rama.

Chand had suffered extensive brain damage, is in a semi-conscious state and does not recognise anyone. Now at Bal Kishan Memorial Hospital, he has a feed tube in his mouth and an air pipe in the throat. "The hospital made me sign an undertaking that I must pay the bill otherwise legal proceedings would be initiated. Should I take care of him or fight the system?" Rama asks. Responding to DNA's question, Max Hospital authorities said: "The patient was admitted to Max Super Speciality Hospital, Saket, West Block after a road accident, and was treated by Dr. Bipin Walia and the neuro critical care team. The patient subsequently stayed in the ICU of the hospital for several days. The patient’s insurance company approved an expense of INR 5 lacs. Seeing the patient’s weak financial background and realizing his inability to settle the rest of the bill, Max Hospital discharged the patient from the hospital without final settlement of the bill. Max Healthcare does not intend to pursue the matter any further."

Dwarka resident and former Delhi University professor KC Malhotra (83) is a man with slow movements but a strong voice. He has spent a decade seeking justice for his dead wife. Krishna was admitted to Escorts Heart Institute & Research Centre in 2006, and diagnosed with diabetes and coronary artery disease, for which she was operated upon. Soon, she developed a diabetic foot and the hospital amputated her left leg up to the thigh. This led to a total handicap, as the veins from the right leg had been removed for a bypass surgery.

Malhotra filed a complaint in 2008 at the Delhi State Consumer Disputes Redressal Commission. She died in 2010. He paid a bill of Rs 4 lakh. After seven years, the Commission has held the hospital guilty of medical negligence and asked it to pay Rs 20 lakh in damages to Malhotra, and Rs 75,00,000 to a consumer welfare fund. The case is in the High Court now. "So many years and I am still running around at this age. At 83, a man breaks down, but this is for my wife and I will fight till the end. As of now, there has been no conclusive decision but I am hopeful," says Malhotra.

Complaints abound

At least three private hospitals — BL Kapoor, Rockland and Gupta Multi-speciality Hospital — in Delhi have been indefinitely barred from providing services under the Central Government Health Scheme (CGHS) after complaints were received against them. In 2016-17, 143 complaints were received across India against CGHS-empanelled private hospitals for denying admissions and cashless facilities, inflated bills and medical negligence. The CGHS was started under the Union Health Ministry to provide comprehensive medical care to Central government employees, pensioners and their dependents at fixed subsidised rates at empanelled private hospitals.

Of the 1,114 private hospitals, diagnostic centres and clinics empanelled with CGHS, 300 are in Delhi. "So many pensioners complain that they did not get beds, they were forced to take loans or sell their property. They are overbilled or are discharged against their wishes. Often the hospital staff have been rude to them," CGHS director Dr DC Joshi tells DNA.

In December 2016, a CGHS beneficiary patient died in an empanelled hospital in Kanpur. "A death certificate was issued and his details were updated in our records. A month later, we received a fraudulent bill raised by the hospital in his name. Private hospitals don't even spare the dead for their greed," he says. This, despite Rs 600 crore being disbursed towards settling bills of private hospitals since April 2017.

This is exactly what happened in Adya's case. Fortis hospital procured 21 vials of the costlier brand of Meropenem injection —Merocrit— by Cipla, per vial priced at approximately Rs 3,100 billed at Rs 65,362, and 9 vials of cheaper brand of the same Meropenem injection — Merolan —by Mylan, per vial costing approximately Rs 500 billed at Rs 4,491. "Both the brands were pumped into my baby's body. Clearly, more vials of the expensive injection, up to seven times the price but said to have the same effect, were administered. We were not even asked our preference for drugs which is an essential right of the citizen," Jayant Singh, deceased's father told DNA.

Centre cracks the whip

The Health Ministry has asked the Haryana government to launch an urgent inquiry and submit an action taken report in Adya's case and written to all states to implement the provisions of the Clinical Establishments (Registration and Regulation) Act under which effective action can be taken against healthcare establishments for fraudulent and unethical practices.

The Centre has advised that lessons be learnt from widespread cases and a meeting with all important healthcare establishments, including private hospitals, of each state be held, and they be clearly warned against any such practices, failing which strict action will be taken.

The government has said exorbitant charges, deficiencies in service, violation of standard treatment protocols resulting not only in compromised patient safety but also concerns about transparency and accountability in healthcare costs have an extremely deleterious impact on the faith of general public of the country.

"It is our duty to ensure that such incidents don't recur, quality care and treatment is provided to persons in need and that it is provided at a fair and affordable price," a ministry letter has told states.

CASES REGISTERED IN THE LAST 3 YEARS

• 68 cases against hospitals before Delhi State Consumer Disputes Redressal Commission
   
• 19 cases against private doctors before the Commission
   
• 156 cases against private hospitals in Delhi’s 10 district consumer forums
   
• 57 cases against private doctors in Delhi’s 10 district consumer forums