Charity Begins In The Hospital

With the report on free medical treatment in charitable hospitals expected in April 2006, Shardul Nautiyal gives you a ringside view of the squabbling going on between charitable hospitals and healthcare activists regarding free treatment

The committee set up to formulate a scheme for providing free medical treatment to the masses at various trust hospitals in Maharashtra will submit its report by April 5, 2006 to the High Court. The scheme is the outcome of an interim order passed on October 14, 2005 by the High Court. (See box on page 16 for salient features of the Interim Order)

The committee has representations from the Association of Hospitals (AoH), Charity Commissioner’s office, Government representatives from the finance, legal and medical departments, representation from the Director General of Health Services (DGHS), government hospitals and all the concerned stakeholders. The committee is discussing various options within the framework of the terms of reference given by the court.

The interim order bears significance in the light of the dharna staged by the NGO Citizen’s Rights Group outside two charitable hospitals in the city, HN Hospital and Bombay Hospital, against the State Government’s inefficiency in providing healthcare facilities to the masses. The dharna once again brought to the fore the wrangling going on between activists and managements of trust hospitals regarding free and concessional treatment given to the common man.

Genesis Of The case

Sanjiv G Punalekar, a Mumbai-based lawyer filed an application in the High Court in December 2004 based on the refusal of charity for treatment to his father in the State Aided Charitable Hospitals, which get several concessions under the Bombay Public Trust Act, 1950. The hospitals maintained that neither Punalekar nor his father came anywhere near ‘poor’ or ‘weaker section’. However, the High Court, hearing the complainant and the respondent’s views converted the application into a PIL.

Punalekar had sought High Court’s order for formulating a scheme of centralised admissions to provide free treatment to patients up to a statutory quota in view of the concessions availed by them. This was opposed by the charitable hospitals saying that there should be no centralised admission and that admission of patients would be at their own discretion. The charitable hospitals had also expressed their inability to provide completely free treatment and raised objections over the definition of free treatment. They contended that free medicines would not be provided to the patients. The interim order states that the medicinal cost of Rs 3,000 per week should be borne by the hospitals till the Court finally decides the definition of free treatment.

Punalekar had pointed out that a number of leading hospitals such as Jaslok Hospital and Lilavati Hospital are running on land allotted to them at the rate of one rupee. The long term lease deed granted to these hospitals as also the benefit of extra FSI made available to hospitals such as Breach Candy Hospital, Harkisondas Hospital and Bombay Hospital brings them under the purview of Bombay Public Trust Act, 1950. This makes aided public trust charitable hospitals liable to reserve 10 per cent of the operational beds and 10 percent of the capacity for treatment of the poor free of charge, and 10 per cent of the capacity for economically weaker sections at concessional rate. (See box for details of concessions)

The Big Fight

"Hospital alone cannot control cost. Stakeholders and government hospitals have to pitch in to control the cost" - Joe Curian, Chief Spokesperson, AoH

AoH, an umbrella organisation for over 45 private charitable hospitals in the city, has condemned staging protest outside private charitable hospitals. Brig Joe Curian, Chief Spokesperson, AoH argues, “Since the Government has miserably failed in providing healthcare facilities to the common man, the Citizens’ Rights Group should rightly observe dharna outside the government offices and not private hospitals. As regards the obligations of the private hospitals based on State aid received, the court has already appointed a committee to look into the provisions of Section 41AA of the Bombay Public Trust Act, 1950 in its entirety.”

Speaking on the Citizen’s Rights Group plea on reducing the cost of the treatment, Curian, says that the cost of the treatment is the sum total of many cost inputs like high end equipment, drugs, land, building, personnel, technology, the rate of obsolescence, electricity and other hospital charges. “Hospital alone cannot control cost. Stakeholders, including government hospitals have to pitch in to control the cost. If hospitals are making exorbitant profits, they can be considered as the Billian of the piece in this, which they certainly are not.

"Charitable hospitals have so far been spared from penal action only due to the inefficiency of government machinery in fixing accountability on them" - Sanjiv Punalekar, Petitoner

To which Punalekar argues that misdeeds of trustees of private bodies are not committed in person but through paid employees, who are made to violate laws for saving their jobs.

“They are under a shell of privacy. Hence, there is a need to make their affairs more transparent. This is possible only through centralised admissions. It is strange that everyone including the industrial giants desire to do charity only in Mumbai and that too on plots at Peddar Road and Cumballa Hill,” says Punalekar. As regards the government, he says, “The lacunae in government reflect on all of us and we ought to fight against it through a democratic process.”

AoH believes such action would deter potential investors including foreign investors who may be considering investing in healthcare in India. “Instead of hospitals they will divert their funds to other profitable ventures or industries leaving the common man deprived of healthcare facilities,” Curian opines.

Punalekar refuses to buy the argument and states that, with regard to discouraging private investment in healthcare, the issue is being messed up. “Nobody can oppose a private investment. But then they should not take government patronage and at the same time refuse to be accountable to the people,” he says.

Punalekar feels that charitable hospitals have so far been spared from penal action only due to the inefficiency of government machinery in fixing accountability on them. “The huge aid from the coffers of Maharashtra, which is on the verge of bankruptcy, was used to subsidise the treatment of the rich people. Today, they are expressing apprehensions about efficiency of government and about likelihood of corruption. This very same government was efficient, when these people got lands allotted to them,” he adds.

Dr Ketan Parekh, former President, Association of Medical Consultants (AMC) feels, “The action of the Citizen’s Rights Group in targeting private hospitals is not justified as the onus of identifying people for free or concessional treatment lies with the Government, which has miserably failed. The quality of care which any hospital offers can be maintained only when the economics of running a hospital is properly understood. The government and the healthcare rights activists should realise this aspect in the interest of the common man.” Medico-legal consultants are also not in favour of attacking the private healthcare institutions. Says Dr Lalit Kapoor, Chairman, Medico-legal Cell, AMC, “The agitation of the Citizen’s Rights Group would make sense only if they make the Government realise that it should monitor the infrastructure and the healthcare facilities delivered in a proper manner.”

Experts claim that delivery of healthcare at out patient department (OPD), in-patient department, critical care and emergency is becoming more critical with technological advancement. Speaking on the delivery of healthcare in public charitable hospitals, Dr ME Yeolekar, Dean, LTMG Hospital, Mumbai says: “Much of the care has tended to become diagnostic based, requiring several investigations. This has its own financial implications, therefore healthcare providers/organisations have their own set of personnel and financial problems. If these are addressed too, many of the grievances or perceived grievances can be redressed.

An appellate board of non-judicial nature should therefore be formed for redressal of grievances of the patient. ”

shardulnautiyal@rediffmail.com