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Abu Dhabi, UAEMonday 17 December 2018

Outrage in India over massive hospital bill

Father of dengue victim questions demand for 1.8 million rupees for 15 days of treatment

Indian health minister Jagat Prakash Nadda has promised to look into the case of a family being charged 1.8 million rupees for the treatment of their seven-year-old daughter who died from dengue. Sonu Mehta / Hindustan Times via Getty Images
Indian health minister Jagat Prakash Nadda has promised to look into the case of a family being charged 1.8 million rupees for the treatment of their seven-year-old daughter who died from dengue. Sonu Mehta / Hindustan Times via Getty Images

A private Indian hospital has come under scrutiny after the family of a young dengue victim went public with complaints about the handling of her case and the massive bill presented to them for 15 days of treatment, including charges for 2,700 pairs of medical gloves.

The health minister, J P Nadda, said he had asked for the medical report of the case from the hospital while the national pharmaceutical pricing authority has demanded copies of the bills presented to the family.

“It was a very unfortunate incident,” Mr Nadda said. “We will look into it. If required, action will be taken.”

Seven-year-old Adya Singh died in September after being treated for 15 days at the Fortis Hospital in Gurugram near Delhi, a branch of a nationwide privately owned chain of hospitals. The girl’s father was issued a 20-page itemised bill amounting to 1.8 million rupees (Dh102,000).

The bill provoked an uproar after one of the father's friends posted it on Twitter last week. Besides the 2,700 pairs of gloves, it includes 660 syringes and charges of 200 rupees each for blood-sugar test strips that are listed at 13 rupees apiece on the hospital’s website.

Jayant Singh said his daughter was unnecessarily kept on a ventilator and a dialysis machine for all 15 days, and that less expensive drugs were swapped for costlier brands, even though their effects were the same.

After a scan taken two weeks into her hospitalisation confirmed that Adya had suffered damage to 80 per cent of her brain, the doctors suggested a new blood plasma transplant procedure which would have cost between 1.5m and 2m rupees, he said.

“My first question was, why perform the procedure? Will it help her?” Mr Singh told reporters on Wednesday. “With 80 per cent brain damage, what would her life be like? The doctors said they can save the other organs.”

When Adya’s family decided to take her home, the hospital made Mr Singh sign a form declaring that the patient was leaving against medical advice, before the doctors would disconnect her from the ventilator. He claimed this was done to ensure that Adya's death, which happened just minutes after she was taken off the ventilator, could not be registered as occurring under the hospital's care, which would have raised its official mortality rate.

For the same reason, Mr Singh had to hire an ambulance from elsewhere to take his daughter's body home. The final straw, he wrote in a Facebook post, was the hospital billing him for the disposable gown his daughter had worn and for the sheet in which her body had been wrapped.

Fortis insists Adya was treated according to standard medical guidelines. “The family was kept informed of the critical condition of the child and the poor prognosis in these situations,” the hospital said.

“Care of ventilated patients in ICU requires a high number of consumables as per globally accepted infection control protocols,” it said. “All consumables are transparently reflected in records and charged as per actuals.”

Concerns over the costs and practices of private hospitals have grown as more and more Indians are forced to seek an alternative to government clinics and hospitals that are struggling with inadequate funding and manpower.

In August, the government allocated US$20 billion (Dh73bn) to run its public health programme until 2020 — $5bn less than required, according to its own statistics. And while the government plans to increase its healthcare spending to 2.5 per cent of GDP from the present 1.4 per cent, this is still far lower than the global average of about 10 per cent.

At the same time, India is not able to regulate private hospitals and their treatments robustly enough, resulting in escalating costs and unnecessary medical interventions, according to Arun Gadre and Abhay Shukla, two doctors who wrote about India's health system in their 2016 book Dissenting Diagnosis.

Two out of every three hospital admissions are now to private hospitals, and the cost of hospitalisation has doubled between 2000 and 2014, according to government figures.

In September, the investigative website Cobrapost reported that 20 big private hospitals in three cities — including Fortis — offered doctors and smaller clinics commissions of 10-30 per cent of the billings of patients referred to them.

The medical profession in India, Dr Gadre and Dr Shukla wrote, was first transformed “into a market-driven commodity, and then into a corporate-led, profiteering industry”.