Hospital bill: Remedy is worse than the disease

Protests have erupted against the Karnataka Private Medical Establishments (Amendment) Bill, 2017, which seeks to bring more accountability to the booming healthcare sector. Doctors in private practice are understandably furious and demand that government hospitals be brought under the law's ambit, too. While public facilities have checks and balances in place already, they are in pathetic condition, a problem that regulations in the private sector won't address, reports Joyeeta Chakravorty

The government’s decision to amend an existing law to help it regulate private medical establishments has kicked off a row with hospitals going on the warpath against its “interference” in their affairs and decrying its attempts to fix the amounts they can charge their patients.  

While  protests have broken out over the  Karnataka Private Medical Establishments (Amendment) Bill, 2017  in the streets,  things were no better for the government in the legislature on Tuesday with MLAs cutting across party lines, finding it unacceptable. Bowing to their demands, it referred to the Bill to a joint legislature panel for a re-look.

The private hospitals are expectedly unhappy as the Bill allows the  state government to fix the rates or charges for each class of treatment  and even penalise them for collecting more than it prescribes. But the new law in the making also attempts to put a stop to hospitals demanding advance payment from patients in emergencies and demanding any dues when handing over dead bodies to families.

While there is a lot to say in its favour as a result, those against the Bill are putting up a pretty strong argument too. Whatever anyone might believe, the fact of the matter is that  every year some 60 to 70 complaints are brought to the notice of the Karnataka Medical Council and almost 70 per cent are against private practitioners.

"The Karnataka Medical Council focuses on doctor negligence and  the hospital if it is  party to it.  Under Section 15 of the KMC Act we can set up an inquiry,” explains  KMC president, Dr H Veerabhadrappa, who, however, believes that the biggest problem lies not in the law but in its implementation.

Regretting that only  tertiary inspection is done for the registration of private medical establishments in the state under the existing law and there are no surprise inspections, he stresses that proper and systematic enforcement of the law can help eradicate quackery and malpractices in the private sector. In his view the current amendments to the Act are both ill-construed and misconstrued.

But a member of the Public Health Foundation of India says the medical fraternity does not appear to have read the amendment properly. “The government is trying to introduce a universal health coverage programme under which the economic status of a person should not stop him or her from having access to the best treatment,” he maintains. Opposing the idea of bringing government hospitals under the ambit of the   amended Act, he says,  “Government hospitals are not for profit and are short of funds and resources. Asking for them to  be brought under the Act is  not required as they already have checks and balances in place. Also, when the government is reimbursing private hospitals under various health insurance schemes it is responsible for checking how the taxpayer's money is spent."

Mr Vinay Sreenivasa of the Alternative Law Forum says what the protesting doctors don’t seem to realise is that the government will not fix hospital charges but  a sub- committee, which will have representatives from private hospitals as well. “I don't see any reason for the protest," he adds.

But former Supreme Court judge and former Lokayukta of the state, Santosh Hedge is entirely against the government interfering in the affairs of private medical establishments in the manner described in the amendment.

“ It is completely irrational and also dismissive of the corruption and issues long prevailing in the government hospitals. When I was part of the judiciary  in various capacities and roles, I have  seen the pathetic state of affairs in government hospitals. The government must first  address this. This amendment will not stand scrutiny in the court of law even for five minutes,” he contends.

Dr Edmond Fernandes, founder and CEO, Centre for Health and Development (CHD Group), Mangaluru too argues that affordable healthcare cannot be achieved by merely regulating the private sector and leaving the public sector un-regulated, “often vacant, cockroach infested and with crumbling infrastructure.”  He argues that health is too complex a problem to be settled by merely  amending the law.

‘Bill is good, but needs tweaking’
Faced with strong opposition to the Private Medical Establishment Bill in its present form in the Legislative Assembly, the government on Tuesday agreed  to refer it to the Joint Legislature Committee.

While most members felt the government’s intentions in introducing the Bill were good, they believed some of its provisions could upset doctors  and leave  private hospitals at the mercy of some "unruly elements."

Moving the Bill, Health and Family Welfare Minister, Ramesh Kumar, explained it was meant to come to the rescue of the poor, who were fleeced by private hospitals. Pointing out that the government had paid over '1000 crore to private hospitals since the Yashaswini health care insurance scheme was launched, he argued it had a right to regulate their charges. “The private hospitals get away with a lot. Some  even misuse the health insurance scheme. Recently, insurance companies  blacklisted over 349 private hospitals,” he recalled.

Giving the instance of a child, Kauser, who was left disabled due to wrong medication administered by a private hospital, he said,”Her parents don’t want any money, but only for the guilty to be punished.”

While assuring doctors that the Bill did not intend to target them, he said small and medium hospitals would not be affected either.

BJP member, Dr Ashwathnarayan however, argued that the Bill was not legally sustainable and accused  the government of doing little to improve its own hospitals while targeting the private.

Private healthcare unregulated, needs checks and balances: Dr Sylvia Karpagam, Public health doctor and researcher
The government’s decision to regulate private medical establishments, introduce a charter of patients rights, create a grievance redressal committee and fix a cap on hospital rates should be strongly applauded and supported. It should not give in to the pressure exerted by the private sector lobby and the doctors , who  have suddenly become the new victims and feel they are justified in shutting shop and coming out onto the streets against the  Karnataka Private Medical Establishments (Amendment) Bill, 2017, that was tabled in the state Assembly.

While they want to see the Vikramjit Sen (VS) Committee recommendations implemented, they  fail to mention that the committee had deliberately excluded patients’/citizens’ rights groups from having any say and allowed the private sector to completely take over of decision making , which is not surprising as it is entirely in favour of promoting the interests of private medical establishments.

 Karnataka has seen a massive growth of the private sector, which has neither self-regulated nor allowed any form of government control. This has led to rampart overcharging, denial of patients’ rights, negligence, unnecessary procedures and tests.

The criticism that government hospitals are not accountable is untrue. They are much more accountable than the private sector when it comes to training guidelines, standard treatment protocols, reporting morbidity/mortality and referrals. While no one can claim that government hospitals are perfect, they are much more within the ambit of regulation and control.

 The clamour by private hospitals to bring  government hospitals within the ambit of the VS committee is not borne out of concern for the patient, but to ensure that there is a handle to shut them down so that people are completely and absolutely at their mercy.

 It is well known that private hospitals have no mechanism of reporting data on morbidity, mortality, caesarean sections, hysterectomies and other surgeries. There is poor documentation and maintenance of records giving the rationale (if any) behind investigations and treatment, referral patterns and cause of death. Patients therefore have very little access to information if they would like to have a second opinion, which they are entitled to, or if they suspect negligence and would like to pursue the case legally.

On the other hand, the public health system has a more rigorous system of data collection and transmission, which helps to understand disease and mortality, as well as diseases of public health concern.

 Under the Vajpayee Arogyashree Scheme (VAS), private empanelled hospitals have demonstrated how they are ready to manipulate the government for economic gains, pick and choose lucrative patients, while closing the door on patients who are terminally ill or who require protracted care. They have also been seen charging patients over and above the money received through VAS. This has created a burden on patients, with out of pocket expenditure under the scheme ranging between Rs. 10,000 and Rs. 1 lakh.

 One has never seen doctors out on the street protesting this violation of patients’ rights and misuse of public money.