The death of seven-year-old Adya Singh in Gurugram in September 2017 sparked a national conversation in India about the perfidy of private hospitals. But a year later, the police investigations into her family’s accusations of medical negligence against Fortis Memorial Research Institute have petered out. has reviewed the chargesheet filed before the sessions court in Gurugram by Haryana police on September 25, 2018. No charges have been made against the hospital.

The child was admitted to the Fortis hospital in Gurugram on August 31 with symptoms of dengue. Fourteen days later, on September 14, she died and the hospital presented her family with bills of Rs 16 lakh.

A social media post about inflated medical bills caught the attention of India’s health minister and the Punjab and Haryana High Court. As the case snowballed in the national media, the Haryana government appointed a committee to examine the allegations.

On December 5, 2017, the committee recommended the team of three doctors that treated Adya be held accountable for medical negligence. One of them had allegedly removed life support from the child while she was being taken home in an ambulance.

The committee also found forgery charges against Fortis to be credible – Jayant Singh, Adya’s father, had accused the doctors of forging his signature on the consent form that allowed them to put her on ventilator support. The police filed a case against the hospital on December 10, based on the report.

Ten months later, the Special Investigation Team of the Haryana police concluded its investigation and filed a chargesheet. It restricts the charge of medical negligence to Vikas Verma. No charges have been brought against the other two doctors, Krishan Chug and Vikas Taneja.

Fortis Memorial Research Institute and its director Jasbir Grewal, who was indicted by the committee, have also not been charged. There is no mention of the alleged forgery.

‘Where is the justice?’

The news has come as a shock to Adya Singh’s family. “We are told to put our faith in the system, if we want justice,” said Jayant Singh, the child’s father. “Where is the justice?”

He alleged that Haryana police had been trying to dilute the case from the start of the investigation.

But the police defended the chargesheet. “We brought charges against one doctor because there was evidence for it,” said Assistant Commission of Police Karan Goyal. “The family can move court against this, if they feel like charges were watered down.”

Email messages sent to Fortis Hospital were not answered. The hospital’s spokesperson said it was not interested in commenting on this story.

Malini Aisola, a health rights activist associated with All India Drug Action Network, expressed disappointment with the outcome of the police investigation. “Jayant’s case was a best case scenario,” she said. “There was conclusive evidence, the case had the media’s attention, and the family has been vocal and relentless in their pursuit for justice. We have an exhaustive government inquiry report establishing forgery by the hospital. If they can dilute the case so much, what chance do other families have?”

Adya Singh with her father, Jayant.

Withdrawal of life support

Singh’s main allegation against the hospital was that it withdraw life support from his child while he was taking her home. The government committee upheld this charge.

“When the family agreed to take the child home, the hospital stopped all medical support and switched off all machines supporting her,” said the family’s lawyer, Jai Dehadrai. The hospital refused to provide them with a well-equipped ambulance to take the child home and Dr Vikas Verma removed the ventilator support in the ambulance, after which Adya died, he added.

The committee appointed by the Haryana government found these charges credible. “Withdrawal of life support by the hospital staff in the ambulance amounts to negligence and is against the law of the land,” it said.

The police has charged Verma under Section 304A which prescribes upto two years of imprisonment as punishment for causing death by negligence. Singh’s lawyer said the police should have pressed stronger charges under Section 304 Part II under which an act done with the knowledge that it is likely to cause death is punishable with ten years in prison.

Verma is still working at Fortis. He was unavailable for comment.

The committee also found Fortis guilty of medical malpractice – it had over-diagnosed and over-treated the child to inflate bills. At the end of 14 days, it had presented a bill of Rs 16 lakh. The family was charged Rs 6.7 lakh for drugs and disposables that the hospital had purchased at Rs 3.22 lakh – a markup of 108%. The bill included the cost of 2,700 surgical gloves and 660 syringes that Fortis claimed to have used during the 14-day treatment.

Singh’s statement to the committee notes that the price gouging continued even after the bill was settled. “We went to our place with the baby’s body in the ambulance. We paid Rs 5,500 for the ambulance,” he said. On reaching home, the attendant said the bedsheet in which the child was wrapped had to be returned to Fortis – or Rs 700 had to be paid. The family paid the money.

Why the case grabbed attention

Medical negligence cases in India rarely get the attention that Adya Singh’s case drew. Part of the reason, say health activists, was because it tapped into anger over rising healthcare expenses in such facilities.

The bills presented to the child’s family began to circulate on Twitter. On November 20, 2017, health minister JP Nadda saw them and promised to take action.

The tweet from the minister set off an investigation by National Pharmaceutical Pricing Authority, which found Fortis hospital had marked up the prices of drugs and consumables by 200%-1,700% of the wholesale price. The concerns over price gouging also led to the suspension of Fortis’ blood bank and pharmacy licences.

The hospital, on its part, tried to assuage Adya Singh’s family by offering them money. According to Singh’s lawyers, the director of Fortis, Jasbir Grewal, initially offered Rs 10,37,889 as refund, throwing in an additional Rs 15,00,000 as compensation. The amount was later increased to Rs 25,00,000, in a bid to secure a settlement out of court.

Grewal admitted in a signed statement to the police that he had offered money to the family. He justified the monetary compensation as a “humanitarian gesture” to help Singh with his second daughter’s education.

Singh argues the police should have used this admission to press bribery charges against Grewal. But the chargesheet is silent on this.

Jayant Singh speaks to journalists in Delhi. (Photo: Menaka Rao)

The legal fight

Sixteen months after Adya Singh’s death, it is business as usual at Fortis hospital. It has reopened its in-house pharmacy and continues to charge marked-up rates for drugs and diagnostics. Since the blood bank licence has not been renewed, it has tied up with Paras Hospital for blood components.

Singh went on to set up a digital platform called All India Patients Rights Groups to bring together families fighting medical negligence cases. “When hospitals, government and police work against the patients’ interest, we need form an alliance,” he said.

In his own case against Fortis, he is counting on two things: an application in the trial court to bring the deficiencies in the police chargesheet on record, and a public interest litigation in the Supreme Court.

In March 2018, Singh filed a public interest litigation in the Supreme Court based on Adya Singh’s case. The petition sought to turn the spotlight on “a larger systematic and structured loot of desperate patients... which is engineered by and between pharmaceutical companies, diagnostic labs, doctors and ultimately corporate hospitals.”

It demanded regulation of India’s private healthcare sector under Article 21 of the Indian Constitution, which guarantees the Right to Life and Personal Liberty. On March 23, the Supreme Court sent notices to the Union Health Ministry, the Haryana health department, the Medical Council of India, among others.

The fear of the Supreme Court, said the family’s lawyer Dehadrai, is “the best guarantee that Adya’s death will not go in vain”.

Read more:

Two fathers have shown how arduous it is to fight medical malpractice and corruption in India

Can the charter of patients’ rights provide real protections against hospital malpractices?