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Take Over 50% Beds From Private Hospitals : Kerala High Court Suggests

Lydia Suzanne Thomas
6 May 2021 9:07 AM GMT
Take Over 50% Beds From Private Hospitals : Kerala High Court Suggests
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"When the public is putting all their life savings (for treatment), the private hospitals can also sacrifice...This situation will continue only for a few months more", Justice Ramachandran expressed, on a note of optimism.

Following the High Court's emphatic declaration on Tuesday that it would take up the issue of COVID treatment with some seriousness, the Kerala High Court convened a special sitting to discuss measures to rationalise COVID-19 treatment tariffs across private hospitals, labs, and diagnostic centers in the state.A Division Bench of Justices Devan Ramachandran and Dr Kauser Edappagath touted a...

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Following the High Court's emphatic declaration on Tuesday that it would take up the issue of COVID treatment with some seriousness, the Kerala High Court convened a special sitting to discuss measures to rationalise COVID-19 treatment tariffs across private hospitals, labs, and diagnostic centers in the state.

A Division Bench of Justices Devan Ramachandran and Dr Kauser Edappagath touted a list of measures for the state government's consideration. 

Court's concern on rates charged on Covid beds in private hospitals

On the state's bid to reserve 50% of beds in non-empanelled private hospitals for Covid, Justice Ramachandran said, "We have few reservations on that.."

"The first reservation is, we are not sure whether the non-empanelled hospitals are keeping apart 50% beds..we want you find out..this will have to be scrupulously verified," the Court instructed State Attorney KV Sohan.

"50% of vacancies in empanelled hospitals are virtually unregulated - and 50% of vacancies the government has earmarked is also unregulated in private hospitals as of now. There is also another 50% in un-empanelled hospitals for which there is absolutely no rates fixed. In other words, 50% vacancies in private hospitals are completely unregulated even today", Justice Ramachandran pointed out.

"These are patients whom the hospitals call walk-in patients. When they walk-in, they do not walk in with full volition, they have no other option. They would love to go to a government hospital but there is no vacancy there, so they are forced to go to a private hospital. So, therefore, the walk-in will certainly have to be regulated", the Court stated.

The Court therefore directed the State Attorney to obtain instructions by the next hearing on rates charged on 50% of beds that were not reserved in the government's Covid-19 empanelled hospitals and the rates for Covid beds in non-empanelled hospitals. The bench mark rate can be that fixed by the State Health Agency, the Court volunteered.

Here is an outline of what else the Court suggested during the 50-minute session today -

Toll Free Number

The Court suggested the allocation of a toll free number exclusively for Covid-19 that people could telephone in case they needed details of beds available, or other information pertinent to Covid treatment. The Bench pointed out that presently there were a host of district helplines, but no single number that could easily be remembered and dialled for information. "Some number we are capable of understanding in case we have trouble...," the Court explained.

The petitioner's counsel, Advocate Sureshkumar submitted that there are no beds in private hospitals. "Patients are running from hospital to hospital!", he exclaimed. With this, he narrated the story of a patient in Ernakulam who had to be shifted to another district, Pathanamthitta, after his family failed to find beds for him in Ernakulam. Shortly after he was given a ventilator, the patient succumbed, Advocate Sureshkumar said.

Justice Ramachandran at this juncture declaring, "this is precisely what we were saying, this is why we need a helpline number!"

The State Attorney drew the Court's attention to the State's Covid web portal that mentioned the number of beds etc available in the state.

The Court said, "Only numbers (numeric details) are displayed on the website. This is why we need a (toll free) number to call for…this is very important, otherwise we will go in the way other states have been going"

Patient Management System

Additionally, the Division Bench proposed a system where patients could be grouped into categories, with each of these categories having its own management and treatment protocol to reduce stress on hospitals.

Consumables

Justice Devan Ramachandran, speaking for the bench, suggested that the rates for consumables such as oximeters, personal protective equipment (PPE) kits etc be fixed pro rata. The pathological rates should be charges as per actuals, the Court said.

Reading from certain patient bills that the Court received, the Bench stated that a certain hospital was charging its patients for 2 - 3 PPE Kits per day and taking Rs 40,000 for oxygen.

"This has to be regulated", the Court iterated.

Doctor and Nurse Consultation Charges

On this count, the Bench called for uniform rates.

The State's stance and the Court's appreciation for measures taken and proposed

At the outset of the hearing, State Attorney KV Sohan informed the Court that the State Government had convened a meeting with management of private hospitals on Wednesday, following which it was decided to fix the rates that private hospitals could charge for COVID-19 treatment.

This decision, with the rates that can be charged by each hospital will soon be notifed in a Government Order, the State Attorney said.

In an additional submission, he said that the government would be setting-up an authority at the district level and with an appellate authority to decide on infractions of these rates. The orders of the appellate authority would be amenable to judicial review under Article 226, he stated.

Lauding these measures, Justice Devan Ramachandran said, "Good! We appreciate the stand, we completely appreciate this stand!"

After this, the Court added that there were few more things to consider and highlighted listed the suggestions described in the previous section of this report.

"The Court can suggest so that I can put before the authority", the State Attorney affirmed.

Other suggestions proposed

Regulating Prices of Consumables sold outside hospitals

Advocate Hariraj for an impleader raised a suggestion that consumables sold outside hospitals, which are purchased privately needed regulation.

He narrated how he had purchased an oximeter for Rs 800 few months ago and that it is now being sold for Rs 2500.

In response to this, Justice Ramachandran said, "My brother (Justice Edappagath) tells me it is not available even!

Advocate Hariraj revealed that oximeters are available online.

Remarking that the issue of oximeters merited consideration, since it formed part of first line treatment, the Court instructed the State to look into the issue.

Appointment of Sectoral Magistrates to monitor how hospitals were charging their covid patients

Advocate Sureshkumar for the petitioner posited that the government could appoint sectoral magistrates to monitor situation in hospitals, so patients and others who had grievances could approach them if hospitals were charging rates higher than those mandated.

Taking over and regulating unused hospitals

The Court proposed utilising unused hospitals in the state for the treatment of Covid-19. 

The government mandated RT-PCR rate of Rs 500 to be charged by private hospitals 

Along with private diagnostic centers in the state, private hospitals would also have to price their RT-PCR tests at Rs 500, the Court charged. "If the rate is Rs 500, they (private hospitals) cannot go ahead and charge Rs. 501", Justice Ramachandran illustrated.

On the right to health and necessity of ensuring non-discriminatory access to treatment

The Court underscored that adequate and affordable treatment is necessary in Covid treatment policies. Non-discriminatory access to medical facilities was to be promoted, the Court emphasized additionally. Referring to Article 21 and how it encompassed the right to health, the Court pointed out that public health access during a pandemic and in ordinary circumstances was very different.

On efforts already taken

After lauding the state for its efforts so far, Justice Ramachandran remarked, "We are happy that the efforts of the Court are being recognised...Even the private hospital are not fighting it (fixing of charges)."

The Court added, however, that when the public is putting all their life savings (for treatment), the private hospitals can also sacrifice. "This situation will continue only for a few months more, Justice Ramachandran expressed, on a note of optimism.

The Court directed all counsel who had suggestions on Covid measures to hand them over to the State Attorney for the State's consideration.

"It should be to the point", the State Attorney cautioned.

On this note, the Court directed that the matter be posted to Monday, May 10, for additional deliberations.

The petition before the Court was filed by one Advocate Sabu Thomas through Advocates CN Sreekumar, Manju Paul and Sureshkumar C. His plea contended that private medical centers and testing centers charged high prices to "exploit the pandemic situation and fear of people in the society." 

Advocate Thomas' pleadings assert that the state government is bound to take appropriate action or remedial measures to control regularize the high charges imposed by Private Hospital for the treatment of Covid-19 patients.

The plea termed the effective denial of access to Covid facilities as a failure by the government to assure to citizens the right to good health under Article 21 of the Constitution of India, and said,

"The State Government should assure that every citizen should be provided with facility to get adequate treatment through Government Health Services or else assure the treatment through other private facilities in the present rapid spread of Covid-19 and unavailability of beds, ICU's and Oxygen supported beds etc. in the Government Hospitals."

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