In a significant step toward reforming healthcare delivery in Maharashtra, last week, several citizens, activists and healthcare experts formed the Medical Services Transparency Forum against the backdrop of Pune’s Deenanath Mangeshkar Hospital issue wherein the delay in attending to an emergency patient had created an uproar.
The opaqueness with which hospitals offer their services, be it a government, private or a charitable one—despite the hospital managements coming under the RTI Act—has led to various kinds of medical malpractices, patient harassment and a lack of accountability and transparency in private and charitable hospitals.
Hence, it is pertinent to recall a comprehensive central information commission’s second appeal order of 3 November 2014 regarding the request of documents relating to the death of the RTI applicant’s father who was admitted to Fortis Hospital. The then central information commissioner (CIC) Prof M Sridhar Acharyulu (Madabhushi Sridhar) had sternly ordered the directorate of health services, Delhi to furnish all the information sought by the grieving son/ RTI applicant Prabhat Kumar.
Mr Kumar, whose father, the late Shri Kailash Prasad Singh, was admitted to Fortis Hospital on 3 November 2012 and died a month later on 3 December 2012, had challenged the Hospital’s medical documentation as vague and incomplete. Despite invoking the RTI Act, he did not receive sufficient details.
In his second appeal hearing, Mr Kumar stated that his father had been admitted with a complaint of constipation but was immediately placed in the intensive care unit (ICU) and subjected to several tests that, he claims, were unnecessary. Despite incurring nearly Rs18 lakh in medical expenses, his father did not survive.
Mr Kumar argued, during the second appeal hearing, that, as a son, he had a legal and moral right to access full details of the diagnosis, treatment and prescriptions administered by the doctors involved. When the central public information officer (CPIO) contacted Fortis Hospital for the relevant details, the Hospital refused to provide the information. The FAA too upheld the reply of the CPIO.
Prof Acharyulu, in his CIC order, noted that he had to decide on three key issues—whether the information sought by the appellant qualifies as 'information' under Section 2(f) of the RTI Act; whether the CIC has the authority to enforce an individual’s right to information against a private entity through a public authority using its regulatory powers and; whether private hospitals can be treated as deemed public information officers (PIOs) and held accountable under the RTI Act for denying access to patient-related information. He referred to several High Court decisions, one of them by justice Sanjeev Khanna (which extensively quoted various sub-sections of Section 4 of the RTI Act) and a CIC order which noted candidly that providing the patient and his/ her family with all the medical documents/ correspondence comes under suo motu disclosures.
During the hearing, Mr Kumar pleaded before the commission that health services include—protection from medical negligence, punishment for medical negligence as a crime, compensation for damage caused by negligence and enforcement of contractual obligation coming under contract law.
He also pointed to the Consumer Protection Act, which aims to prevent negligence and deficient services, ensured the right to information about medical treatment and provides for compensation in case of violations.
CIC Prof Acharyulu ordered:
- The Directorate of Health Services, Delhi, to compel Fortis Hospital with its regulatory power provided under the law to comply with the provisions of the Nursing Homes Registration Act or Clinical Establishment (Registration & Regulation) Act, MCI Act and RTI Act or any other rule or provision under any law, and provide the entire information to the appellant within 21 days from the date of receipt of this order.
- That the Commission recommends the Government of India, states and Union territories, besides the respondent authority in this case, to take necessary steps to enforce the right to information, i.e., forcing the private hospitals to give medical records of the patients on day to day basis, because this daily disclosure will prevent undesirable practices of altering records after damage caused to patient.
- That, the private hospitals provide dailywise medical records will also act as a check on some hospitals from resorting to extortionist, inhuman and ruthless business of prescribing unnecessary diagnostic tests, unnecessary surgical operations, caesarean deliveries, unwarranted angioplasties, inserting stents, without need, or of substandard nature, or putting low quality stent while collecting price of high quality stent, and several such malpractices amounting to medical terrorism, etc.
- That hospitals should not be allowed to (follow) such malpractices with all impunity and get away without any legal consequences as if there is an absolute immunity.
- That the Government, Medical Council of India and the health regulatory has to see that licence to practice medicine will not become licence to kill and extort and come to the rescue of helpless patients.
Public participation invited by the Medical Services Transparency Forum
The forum encourages citizens to report instances of medical malpractices, patient harassment, or inflated bills. Complaints can be sent via email to
[email protected] with full case details and a contact number.
Anonymous complaints will not be entertained.
Objectives of the Medical Services Transparency Forum
1. Monitor and address malpractices: Vigilance over medical malpractices and patient harassment in both government and charitable hospitals, and proposing actionable solutions.
2. Promote awareness of government schemes: Ensure that all patients benefit from government-provided healthcare schemes and facilities.
3. Enforce the Maharashtra Nursing Home Act: Advocate for strict and consistent implementation of the Act across the state.
4. Increase and audit healthcare funding: Demand greater allocation to healthcare in the state budget and ensure judicious expenditure.
5. Push for transparency in patient rights and CSR utilisation: Promote fair use of patient rights funds and corporate social responsibility (CSR) contributions.
Key demands to the state government:
1. Public disclosure of charitable hospital data: Daily online updates of free bed availability and poor patient funds in charitable hospitals. Strict action, including suspension, should be taken against negligent officials.
2. Regulation of hospital charges: Legally fix private hospital charges in line with Central Government Health Scheme (CGHS) and insurance company rates. Collaborate with the centre to reduce medicine prices.
3. Proper naming of charitable hospitals: Enforce the mandatory inclusion of the word "Charitable" in hospital names, with legal action for non-compliance.
4. State health policy: Declare a comprehensive state health policy through a committee of secretaries, health commissioners, and medical experts.
5. CSR fund utilisation: Ensure CSR funds are directed toward the treatment of poor patients in private hospitals.
6. Standard treatment protocols: Develop standardised treatment guidelines to prevent unnecessary tests and surgeries.
7. Increase budget allocation: Significantly enhance funding for the department of public health and the department of medical education.
8. Crack down on fake doctors: Identify and take action against bogus medical practitioners.
(Vinita Deshmukh is consulting editor of Moneylife. She is also the convener of the Pune Metro Jagruti Abhiyaan. She is the recipient of prestigious awards like the Statesman Award for Rural Reporting, which she won twice in 1998 and 2005 and the Chameli Devi Jain Award for outstanding media person for her investigation series on Dow Chemicals. She co-authored the book "To The Last Bullet - The Inspiring Story of A Braveheart - Ashok Kamte" with Vinita Kamte and is the author of "The Mighty Fall".)
