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

The Kerala High Court on Wednesday (November 26) dismissed the appeals preferred by the Indian Medical Association (IMA) and the Kerala Private Hospitals Association against a Single Bench's order upholding the provisions of the Kerala Clinical Establishment Act and Rules.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 disclosureRejecting 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 employeesThe 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 transferThe 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 guidelinesAs 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...

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

K. Salma Jennath

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