The heartbreaking story of the parents who jumped to their death in Delhi following the death of their 7-year-old son who succumbed to dengue after being turned away from two major city hospitals has shaken the public health establishment. Union health minister JP Nadda has ordered an enquiry into the incident.
Just last month, a man was made to wait for his infant son's dead body because he couldn't pay Rs4,000 at an upscale Delhi hospital.
While such incidents spark outrage, things inevitably go back to business as usual before long. This is doubly tragic because so many Delhi hospitals that adopt sharp practices towards Delhi's economically under-privileged sections are reneging on the obligations on whose basis they have leased prime land at concessional rates from the Delhi government and also continue to receive subsidies on utilities such as water and power.
It is not widely known that most major Delhi hospitals are required to set aside a certain number of beds to treat economically disadvantaged patients for free.
Activists have calculated that 51 private hospitals in Delhi together are required to set aside nearly 1,700 beds for treatment of patients from the Economically Weaker Section (EWS) of the society, under these agreements. Activists say that hardly any one of these hospitals are fully abiding by the lease agreement. Hospitals have now said in various courts that the government and they have interpreted the meaning of 'free' differently. The matter is now entangled in protracted legal proceedings while the disadvantaged get turned away routinely from hospitals that were built in their name.
Even as the 7-year-old was turned away by two private Delhi hospitals, leading to his parents taking their lives, 27% of the city's hospital beds earmarked under the EWS scheme were lying vacant, The Hindu reported. This includes Max Saket, one of the two hospitals that turned back the 7-year-old dengue patient. On Friday, 20 beds under the EWS scheme were vacant at Max Saket, according to data released by the Delhi government. It is unclear if the family was an EWS family, but the city certainly had vacant hospital beds when the 7-year-old was fatally turned away twice.
Subsidised hospitals, exorbitant costs.
Delhi's Indraprastha Apollo Hospital is the best case in point. Delhi government actually holds 26% stake in one of the largest private hospitals in the city. The Indraprastha Medical Cooperation Ltd (IMCL), which runs Apollo Hospital, has leased 15 acres of land on the Delhi-Mathura road, at the rate of Re.1 per year for a period of 99 years.
"It always comes as a surprise to people that the expensive private hospital was actually established to run on a 'no-profit, no-loss' basis on the land provided by the state government," said a public health specialist familiar with the issue who asked not to be named due to the sensitivity of the matter. "The biggest mistake by the government was that it did not specify the meaning of 'free treatment'. The hospitals now interpret 'free' as only doctor's consultations and free beds. Exorbitant charges are levied on EWS patients for all other services, medicines & diagnostic tests," the person added.
In 2009, the Delhi High Court imposed a fine of Rs 2 lakh on the Indraprastha Apollo Hospital for not providing free treatment to patients belonging to economically weaker sections of society.
An Apollo spokesperson declined comment saying the matter was sub-judice.
These agreements were signed as part of the health sector reforms that India adopted during the 1990s. The significant shift in policy was that the governments now invited a greater participation of the private sector in providing health care services. One of the ways of involving the private sector was by giving significant subsidies to the private sector to set up hospitals in return ensuring that certain services are provided to the poor free of cost.
In Apollo's case, 40 % of their out patient capacity and 1/3rd of the total beds were to be kept as free beds (around 230 beds) for the poor. Similar lease agreements were signed with Escorts Heart Institute and Research Centre, Max Balaji, Rockland Hospital, Indian Spinal Injuries Centre and Sir Ganga Ram Hospital.
The National Commission for Protection of Child Rights (NCPCR), in 2012, conducted a rapid appraisal of whether private hospitals in the city were honouring their lease agreements. The results were not surprising. Dr Vandana Prasad, Member of the Child Health, Welfare and Development, NCPCR, ruefully noted in the report that, "the appraisal clearly elucidates the fact that a very minor contribution is being made to the general health care requirements of children in the capital through the strategy of providing subsidy to private institutions as compared to the contribution of the public sector. Even this minor contribution has required prolonged legal battles which persist in the case of Apollo Hospital and constant monitoring is essential to ensure that the terms and conditions of these subsidies are met".
Without any clarity on the definitions regarding 'freeships' of free beds, litigations have become the only means to ensure hospitals honour their lease obligations.
In March 2015, the newly formed Aam Aadmi Party's government decided to rein in private hospitals not providing mandatory treatment to patients from the Economically Weaker Sections, a socio-economic category that includes all households with annual income of less than Rs1 lakh.
The Supreme Court had earlier ordered 41 private hospitals in Delhi to provide 25% of their outpatient services and 10% of in-patient services to patients from the EWS category. The cost of medicines and consumables will also have to be borne by the hospitals.
Soon after, Delhi Health Minister Satyendra Jain noted that almost 50 per cent of these beds remained unoccupied. He was quoted in The Indian Express as saying, "that occupancy levels are less than 50% in these hospitals. We have made a new scheme, by which we will refer patients from government hospitals. Nearly 25 per cent of cases at the out-patient department can be referred to private hospitals. We will seek a report from hospitals where the EWS occupancy is below 80% and appoint counsellors for it. For every 10 patients, there will be a government official monitoring the implementation of EWS quota in private hospitals," Jain said.
Ashok Agarwal, a member of a Delhi high court-nominated panel to oversee the implementation of the EWS scheme in private hospitals, say things have not changed all that much. "We have not had a single hearing for the last two years. Currently, we have 50 hospitals under this obligation. While things have improved over the years, it is quite a challenge to ensure these hospitals do not, blantantly, flout their lease agreements," said Agarwal, also a lawyer with Social Jurist, a non-governmental organization that filed a Public Interest Litigation in the matter. Next hearing on the case is on Tuesday.
Two of the most important factors under the lease obligations are that (a) a private hospital cannot ask for BPL (below poverty line) cards or income certificates from the patient and (b) the EWS patient/attendant cannot be asked to fill another undertaking other than what is already filled earlier in the government hospital from where the patient was referred. "In all cases, a self declaration by the patient is enough. But private hospitals use this to intimidate EWS patients & use this as an excuse to turn down patients. We need a massive information campaign telling the general public, EWS patients that they are eligible to walk in to private hospitals and demand facilities. You will be shocked to see how much of a difference adding 1,200 EWS beds can make to this city's EWS patients," added Agarwal.
Here is a list of 52 Delhi hospitals that are obligated (to varying degrees) to provide free treatment to those belonging to the Economically Weaker Section categorisation, which means a household income of less than Rs1 lakh per annum.
1) Gujarmal Modi (Saket City Hospital)
2) Venu Eye Institute, Sheikh Sarai
3) Guru Harkishan Hospital, Ashram
4) Action Cancer, Paschim Vihar
5) MGS Super Specialty, Punjabi Bagh
6) Janki Das Hospital, Pandav Nagar
7) Rajiv Gandhi Cancer Hospital, Rohini
8) Sita Ram Bhartiya Hospital, Qutub Institutional Area
9) RLKC Metro Hospital, Patel Nagar
10) Vinayak Hospital, Model Town,
11) Jivodaya Hospital, Ashok Vihar
12) Saroj Hospital, Madhuban Chowk
13) Jeevan Anmol Hospital, Mayur Vihar
14) Red Cross Hospital, Dilshad Garden
15) Indraprastha Apollo Hospital, Jasola Vihar
16) Fortis Flt Lt. Rajan Dhall Hospital, Vasant Kunj
17) Fortis Seth Jessa Ram Hospital, Karol Bagh
18) Fortis Escorts Heart Institute & Research Centre, Okhla Road
19) Max Super Speciality Hospital, Patparganj
20) Max Devki Devi Heart & Vascular Institute, Saket
21) Sir Ganga Ram Hospital, Rajinder Nagar
22) Moolchand Hospital
23) St Stephen's Hospital
24) Teerath Ram Hospital
25) Indian Spinal Injuries Centre, Vasant Kunj
26) Jaipur Golden Hospital, Rohini
27) Batra Hopsital & Medical Research Centre, Mehrauli Badadrpur Road
28) Delhi ENT Hospital & Research Centre, Jasola
29) Mata Chanan Devi Hospital, Janakpuri
30) Dharamshila Hospital & Research Centre, Vasundhara Enclave
31) Deepak Memorial Hospital, Vikas Marg Extension
32) Pushpawati Singhania Research Institute, Sheikh Sarai
33) Mai Kamli Wali Charitable Trust Hospital & Research Centre, Rajouri Garden
34) Saroj Hospital and Heart Institute, Rohini
35) Shanti Mukund Hospital, Karkardooma
36) Primus Super Speciality, Chanakyapuri
37) VIMHANS, Nehru Nagar
38) Bhagwati Hospital, Rohini
39) Arya Vaidya Sala, Karkardooma
40) Amar Jyoti Charitable Trust, Karkardooma
41) Bimla Devi Hospital, Mayur Vihar
42) Bhagwan Mahavir Hospital, Rohini
43) Sri Balaji Action Medical Institute, Paschim Vihar
44) Sundar Lal Jain Hopsital, Ashok Vihar
45) Rockland Hospital, Qutub Institutional area
46) Bensups Hospital, Dwarka
47) Maharaja Agrasen Hospital, Punjabi Bagh
48) Dr. B.L Kapur Memorial Hospital, Pusa Road
49) National Chest Institute, Neeti Bagh
50) Khosla Medical Institute and Research Society/Maharishi Ayurveda Hospital, Shalimar Bagh
51) National Heart Institute, East of Kailash