'Hospitals Must Display Rates, Mustn't Deny Emergency Care For Not Paying Advance' : Kerala High Court Upholds Clinical Establishments Act

The Division Bench comprising Justice Sushrut Arvind Dharmadhikari and Justice Syam Kumar V.M. upheld the law, which was implemented in a phased manner from 2019, and dismissed the challenges to it being vague, arbitrary, impractical and disproportionate.

“Let this judgment serve not merely as a declaration of law but as a reaffirmation of the right to dignified, ethical, and equitable medical care,” the Bench had remarked.

The Bench further opined that it was in conformity with global standards, similar to those in the United States and the European Union.

The appellants had primarily challenged the mandatory requirement to disclose details of hospital employees and the obligation to publish the list of fees to be charged for each treatment item and for packages. They had also challenged the mandate under the law to compulsorily provide lifesaving treatments and safe transport to patients.

The State defended the law, which is intended to safeguard public health, uphold patient rights and safety, promote transparency and ethical standards in clinical practice, better equip hospitals and clinics for public health emergencies and for maintaining consistent and high standard, and to create a level-playing field within the healthcare sector.

Examining the provisions under challenge and the statutory framework, the Court observed that the Act merely lays down the manner of implementation of already existing constitutional duties:

“The Act does not create new constraints; rather, it operationalizes these constitutional duties through a registration-cum- standards regime, a transparency mandate, and enforceable minimum requirements for emergency care and stabilization.”

Mandatory price disclosure

Rejecting the argument that the terms “types of service” and “package rates” falling under Section 39 are vague, the Bench opined:

“The Act does not require clairvoyant pre-pricing of every possible clinical contingency; it mandates good faith baseline tariffs for identifiable services and packages, with itemized billing for add-ons, complications, and extended stays.”

The Bench further spoke in favour of the price disclosure mandate, which, in its opinion, is less intrusive than price-fixation for services and also serves a public interest by providing protection against exploitative charging.

Defining “package rates”, it observed that the same “refer to baseline tariffs for commonly performed procedures with standard inclusions. Unforeseen complications, management of co-morbidities, extended ICU stays, and high-end consumables may be billed separately, provided there is disclosure and clinical justification.”

Disclosure of details of doctors and other employees

The Court noted that there is no requirement to publish personal information of doctors and other employees to the public. In fact, it is necessary to be furnished only to satisfy about availability and competence of staff.

“the measure: (i) has legality, as it is grounded in a statutory source; (ii) pursues a legitimate aim, namely patient safety and quality of care; (iii) is proportionate, being limited to role-appropriate particulars and enabling audit or inspection; and (iv) carries procedural safeguards, including use limitation and the possibility of review or appeal of adverse actions,” the Bench remarked, referring to Justice Puttaswamy v. Union of India, the landmark decision on privacy.

It further opined that the State may issue guidelines for limitation of purpose for disclosure, data minimization, confidentiality, etc.

“Staff data (Form 2A) shall be collected and used solely for regulatory purposes. The authority shall frame guidelines on confidentiality, purpose limitation, access control, and retention. Publication to the general public is not required unless specifically authorised by law,” was the Court's direction in this regard.

Emergency care and safe transfer

The Court was of the opinion that the obligations are in conformity with global standards. It remarked:

“compliance is capacity-graded: all establishments must provide first aid and stabilization to the extent feasible and ensure safe transfer, including communication, documentation, and transport. No establishment shall deny initial lifesaving aid on account of non- payment or lapses in documentation.”

Court's guidelines

As a conclusion to the judgment, the Court had also issued certain guidelines for the effective implementation of the same.

“Consistent with the Single Judge's approach and past pandemic-era directions, we underscore the following:

• Visible rate display at admissions, billing counters, and on websites; itemised bills available on request.
• District-level grievance cells under the DMO/Registering Authority, with a time-bound complaints process; periodic compliance audits focusing on emergency care denials, exorbitant add-ons, and staffing minima.
• Digital registers/portals for registration status, inspection notes (appropriately redacted), and speaking orders in penalty actions.
• Training and drills on triage/stabilization, infection control, and safe transfer protocols, drawing on WHO/EUSEM materials.”

Capacity-graded emergency care

The hospitals are directed to stabilize emergency patients according to capacity and not to deny them life-saving aid for non-payment of advance or lack of documents. Further, there is a direction to hand over all test reports and discharge summary when a patient leaves the hospital's care.

Transparency and public display

The list of services, baseline and package rates, patients' rights and contact details of the grievance officers are to be prominently displayed in English and Malayalam at the reception as well as the official websites of the clinical establishments.

Updated patient information brochure

A brochure containing services offered, baseline and package rates, insurance claim procedures, discharge procedures, grievance redressal, etc. are to be provided in English/Malayalam at the time of admission. These have to be promptly updated.

Grievance redressal mechanism

Grievance redressal desks are to be maintained with reference numbers for each complaint, which shall be endeavoured to be resolved within 7 working days. Escalations for serious and unresolved issues are also to be provided.

Compliance filings

Every clinical establishment is required to file an undertaking of compliance with the Act within 30 days and the same has to be audited within 60 days, followed by periodically audits.

Patient remedies

Patient remedies can be achieved through complaints before the consumer commissions, the local police, the State Police Chief, legal services authorities, etc.

The Court also directed the Registry to forward the judgment to the Chief Secretary of the state government and to the State Police Chief, who are to issue appropriate orders to ensure strict compliance laid down under the Act and the judgment.

“State Government shall publicise the effective contents/directions issued in this judgment through visual media and print media, for a period of one month, in Malayalam and English daily, having wide circulation, so as to ensure broad public and to enable citizens to understand their rights regarding medical treatment,” the Court further directed and has asked for a compliance report in this regard.

Thus, it disposed of the writ appeals.

Guidelines

The Court's guidelines, as stated in the judgment, are extracted :

i. Capacity-Graded Emergency Care

Every clinical establishment shall, at a minimum:

(a) screen and stabilize emergency patients within its capacity; and

(b) ensure safe transfer, with proper documentation and communication, to a higher centre when indicated. No establishment shall deny initial life-saving aid on the ground of non-payment of advance or lack of documents.

(c) At the time of discharge of a patient from the hospital, the hospital authorities shall ensure that, along with the discharge summary, all investigation reports pertaining to the treatment, such as ECG, X-ray, CT scan, and other test reports, are also handed over to enable the patient to maintain proper records.

ii. Transparency and Public Display (Reception/Admission Areas and Website)

Each clinical establishment shall prominently display, in Malayalam and English, at the Reception/Admission desk and on its official website:

(a) the list of services offered.

(b) baseline and package rates for commonly performed procedures with a note that unforeseen complications or additional procedures shall be itemised.

(c) key facility information, including bed categories, availability of ICU/OT, imaging and laboratory facilities, and ambulance/contact details.

(d) a summary of Patients' Rights, including emergency care, informed consent, confidentiality, non-discrimination, access to medical records within 72 hours, itemised bills, and grievance redressal pathway; and

(e) the name, phone number, and email ID of the Grievance Officer, along with contact details of the District Registering Authority/DMO helpline and other escalation contacts.

iii. Patient Information Brochure

At the time of admission, and as a downloadable document from the establishment's website, every hospital shall provide a brochure or leaflet in Malayalam and English containing information on: -

services offered. -

baseline and package rates with inclusion deposit and refund policy. -

insurance/TPA empanelment and claim procedures. -

estimate and billing policy. -

discharge procedures. -

ambulance and transport charges. -

24×7 emergency care protocol;

and - grievance redressal and escalation mechanism.

iv. Grievance Redress Mechanism

(a) Every clinical establishment shall maintain a Grievance Desk/Helpline and register every complaint with a unique reference number, issuing an acknowledgement immediately through SMS, WhatsApp, or in physical form.

(b) The establishment shall endeavour to resolve all complaints within seven (7) working days. Unresolved or serious matters shall be escalated to the District Registering Authority/DMO without delay.

(c) Each establishment shall maintain a Complaint Register, in physical or electronic form, available for inspection. A summary of grievances and actions taken shall form part of the monthly compliance reports submitted to the competent authority.

v. Updates and Accuracy

All displayed rate lists, brochures, and website information shall be kept current. Any change in services, rates, or grievance contact details shall be promptly updated, with the date of revision clearly indicated.

vi. Compliance with the Kerala Clinical Establishments (Registration and Regulation) Act, 2018

(a) Every clinical establishment shall file an undertaking of compliance with Sections 39 and 47 of the Act and the above directions within thirty (30) days from the date of this judgment before the District Registering Authority.

(b) The said Authority shall conduct verification audits within sixty (60) days from the date of this judgment and thereafter periodically, taking appropriate action for any deficiencies detected, in accordance with the Act and Rules.

vii. Patient Remedies (Without Prejudice to Other Rights)

 Patients shall remain at liberty to:

(a) pursue remedies for deficiency of service before the competent Consumer Disputes Redressal Commission.

(b) lodge complaints with the local police where appropriate, including cases involving alleged fraud or cheating.

(c) escalate grave or systemic grievances to the Chief Secretary and the State Police Chief; and

(d) seek assistance from the District or State Legal Services Authorities for advice and facilitation. All establishments shall cooperate fully and issue receipts for all payments and complaints received.

viii. Language and Accessibility

All mandatory displays, notices, and brochures shall be provided in Malayalam and English, and shall be clear, legible, and prominently accessible at the Reception/Admission areas and other conspicuous locations within each establishment, as well as on the homepage of its official website.

 ix. Non-Compliance

Non-compliance with these guidelines shall attract regulatory action under the Kerala Clinical Establishments (Registration and Regulation) Act, 2018, including suspension or cancellation of registration and imposition of penalties, in addition to any civil, criminal, or constitutional remedies available to patients.

Case No: WA NO. 1621 OF 2025 and connected case

Case Title: Kerala Private Hospitals Association and Anr. v. State of Kerala and Ors. and connected case

Citation: 2025 LiveLaw (Ker) 779

Counsel for the appellants: V.V. Asokan (Sr.), K.I. Mayankutty Mather (Sr.), K. Anand, T.K. Sreekala, S. Parvathi, Nikitha Susan Paulson, Uthara Asokan

Counsel for the respondents: N. Manoj Kumar - State Attorney, S. Kannan - Senior Government Pleader, Ajith Joy

Click to Read/Download Judgment