Gopendra Parmar wanted justice for his seven-year-old son Shaurya’s death. Instead he had to settle for a refund from the hospital where his son died and which, Parmar alleges, overcharged him.

Shaurya died of complications due to dengue. He had received treatment for 20 days of treatment at Medanta Hospital in Gurugram, which billed Parmar Rs 15.68 lakhs. After his son’s death, Gopendra did not return to his home in Dholpur, Rajasthan but continued to stay in a small room in Delhi’s Chandni Chowk.

Between December and March, Parmar made the rounds government health offices in Delhi and Haryana between, and wrote scores of letters to various state and central government authorities, including to Prime Minister Narendra Modi. He alleged that doctors of Medanta hospital committed medical negligence and that the hospital “cheated” him by charging higher rates for medicines than prescribed standard rates of state government. He sought financial help from government authorities and that appropriate action be taken against the hospital.

Speaking to in mid-March, 35-year-old Parmar, who works as an LIC agent in Dholpur, said, “I stayed in Delhi for 20 days straight after my son’s final rites to understand what legal action I could take against Medanta. I then filed a complaint against the hospital authorities at the Sadar Police station in Gurugram.”

However, at the end of March, Parmar withdrew the criminal complaint against Medanta Hospital officials after they refunded Rs 15.68 lakhs to him. The hospital’s offer of refund came after Manoj Rajoria, the BJP MP from Parmar’s constituency, wrote to the Ministry of Health and Family Welfare on his behalf. An officer from the ministry then wrote a letter to Medanta founder Dr Naresh Trehan asking him to review the case and refund the hospital charges. Parmar said that he had run out of money and owed his relatives nearly Rs 16 lakhs. He said he had no option but to accept the settlement.

“I wanted the government to help me get justice and provide financial assistance, but they did not,” said Parmar. “I was helpless and had to withdraw complaint. But the government can still take action based on the earlier complaints I made. I will continue to support those complaints.”

Unsustainable fight

Aggrieved patients have few options to bring hospitals and doctors to book. They can file cases of medical negligence – like in the event of wrong diagnosis, surgery on the wrong part of the body, transfusion of blood that does not match the patient, etc – in a consumer court, arguing that services were “deficient” or against breach of standard medical practice by a doctor. They can also file complaints with the Medical Council of India against a doctor. Patients may also file cases with the police alleging criminal medical negligence under certain sections of the Indian Penal Code.

Often in cases of medical negligence, families are unable to sustain the fight against doctors because cases drag on for years. Moreover, members of the medical community are unwilling to give evidence against their colleagues, said Shirish Deshpande, the president of Mumbai Grahak Panchayat that works on consumer rights.

Even when patients receive medically adequate and even good treatment, hospitals and doctors often overcharge their patients, as is evident from several consumer court cases filed against private healthcare providers against overpricing.

“In these cases, [some] patients have got waiver of fee, or even compensation,” said Mahendra Bajpai, an advocate in Mumbai who specialises in medical negligence cases.

US resident Kunal Saha fought a landmark case against a hospital that lasted 15 years. Saha’s wife Anuradha died allegedly due to wrong treatment provided for a skin condition while she was visiting Kolkata in 1998. Sahainitiated a legal battle against the doctors of the city’s AMRI Hospital and was awarded a compensation of more than Rs 5 crore in 2013 and received this money from the hospital. He set up the People for Better Treatment in Kolkata, which works with victims of medical negligence or any unethical practices and focuses on what he believes are the corrupt practices of Medical Council of India.

“Often patients are discouraged by their relatives from continuing to fight,” said Ratna Ghosh, an activist with the People for Better Treatment. “Often relatives are paid off by the doctors and [the relatives] decide to withdraw the complaint. But in the recent times, I have seen more people angry with the way hospitals are treating them.”

Ghosh said that the organisation does not encourage settlements, and would rather see doctors brought to justice.

Battling on

Like Parmar, 40-year-old Jayant Singh lost his seven-year-old daughter Adya, to dengue related complications at Fortis Hospital in Gurugram last September. The hospital billed Singh Rs 18 lakh for her treatment. Singh, who works at an information technology company, filed a writ petition in the Supreme Court seeking a regulatory mechanism for the running of private hospitals.

The petition states that Adya’s death at Fortis Hospital shows “a larger systematic and structured loot of desperate patients... which is engineered by and between pharmaceutical companies, diagnostic labs, doctors and ultimately corporate hospitals.” The petition also alleges that the Medical Council of India does not have effective regulatory powers to intervene in such situations and has managed to only take action against 146 doctors from 1963 to 2015. It asks that the Supreme Court set up guidelines to regulate or monitor targets set by corporate hospitals, differential pricing of drugs, and the functioning of pharmaceutical companies and diagnostic laboratories.

Jayant Singh and Gopendra Parmar speak to journalists. (Photo: Menaka Rao)

The Supreme Court on March 23 issued a notice to the concerned parties including Central and Haryana Health department, Fortis Healthcare Limited among others to reply to the petition.

Unlike many earlier cases of overpricing by hospitals, Singh’s and Parmar’s cases have received much media attention. The National Pharmaceutical Pricing Authority or NPPA took cognisance of the press reports and investigated the claims of overcharging. The NPPA in itsreport based on four hospital bills, including those of Gopendra and Jayant’s cases, said private hospitals were making profits up to 1737% on drugs, consumables and diagnostics.

“This is probably the first time we have evidence from a government report (referring to NPPA report) about overpricing of drugs, consumables and diagnostics in a private hospital,” said Dr Mira Shiva, who works with the All India Drug Action Network or AIDAN, an independent network of several non-governmental organisations working to increase access of medicines.

However, the NPPA did not choose to disclose the names of the hospitals being investigated in its report after the hospitals “requested confidentiality.” This has resulted in a lack of action based on the report, which, Parmar alleges is evidence of the private healthcare sector’s clout with government bodies.

In May last year, the Haryana government set up medical boards for each of its districts to decide the complaints of medical negligence against private and government doctors and hospitals. The newly constituted Gurugram Medical Board for Negligence investigated Parmar’s and Singh’s cases and found several instances of overpricing in each case.

Adya Singh’s case: Findings of the Medical Negligence Board, Gurugram

  • Signatures of Adya Singh’s parents forged on consent forms
  • Hospital authorities withdrew Adya Singh’s life support on the ambulance, when the family decided to leave the hospital. 
  • The board said this amounts to medical negligence.
  • Differential pricing of medicines: The hospital charged Rs 3112 for one brand of the antibiotic Meropenem and Rs 499 for another.
  • The hospital overcharged for platelet transfusions billing the family Rs 12,800.
  • The board noted that the government needs to fix prices of non-schedule drugs.

On the basis of the report filed by the Gurugram Medical Board for Negligence in Parmar’s case, the Gurugram Drug Controller suspended the license of Medanta Hospital’s in-house pharmacy for a week on April 5. On th basis of the report on Singh’s case, the drug controllerwithdrew Fortis Hospital’s licence to operate it pharmacy and suspended blood bank operations.

Ball in the states’ court, says centre

While some action has been taken in these two cases, the larger problem that India has failed to address is the regulation of private hospitals.

The Union Government passed the Clinical Establishment Act in 2010, but only 11 states and six union territories have adopted it so far. The Act sets out minimum standards of care and facilities hospitals must provide. It also mandates that the union and state governments determine a range of rates for medical procedures.

In January, after Singh and Parmar’s cases came to light, Haryanapassed an ordinance notifying the Act. However, the state has restricted the Act only to hospitals that have more than 50 beds. The health ministry has put the onus of regulating private medical establishments squarely on state governments. “Government is aware of reports appearing in different fora about the high cost charged by private clinical establishments,” said Minister of State (Health) Anupriya Patel in a written reply in the Lok Sabha in December. “However, health being a State subject, it is the responsibility of State Governments to regulate hospitals.”

Reform required

Health rights activists like people working with AIDAN feel that these Parmar and Singh’s battles cases could steer the government towards reform in the private health sector, especially related to pricing.

“We want regulatory oversight of charges and costs,” said Malini Aisola, convenor of AIDAN, which advocated heavily for price caps on medical devices.

Aisola said that the government should fix healthcare charges, including diagnostics, procedure costs, and drugs including non-schedule life-saving medicines.

Amit Sengupta, Associate Global Coordinator, People’s Health Movement said capping of prices can help to some extent, pointed out that private hospitals find a way such price caps.

“When cardiac stents prices were fixed, the hospitals increased other costs,” said Sengupta. “The benefit did not pass on to the customers”.

The problem is more complex and can only be solved by strengthening the public healthcare sector in the long run, Sengupta said. “With a functioning public sector, the private sector will have to compete for quality of care.”