RMO Visits included in Bed Charges, Cannot be charged Separately: Columbia Asia told to pay Rs 50,000 for inflated billing

"When a patient is admitted in a hospital, the bed charges should be inclusive of the charges on account of RMO particularly when the patient is in ICU. Moreover, the fees of RMO charged on a particular day with an interval of only 30 minutes is quite abnormal. This would indicate inflated billion as the RMOs are usually on the regular pay roll of the clinical establishment"

Kolkata: Holding the Columbia Asia Hospital guilty of lack of counselling about inflated hospital bills, the West Bengal Clinical Establishment Regulatory Commission (WBCERC) has directed the hospital to pay Rs 50000 as compensation for the inconvenience caused due to improper intimation about the hospital bill.

The direction came following a complaint filed by one Anirban Ghosh over the death of his mother, Jyostsna Ghosh, who had come to the hospital after experiencing shortness of breath. The case dates back to 2017 when the patient was admitted to the hospital under the care of one doctor (consultant) on October 26 2017.

The patient's haemoglobin level was noted low that further went down. Blood transfusion was started but it was halted in between without stating any reason to the patient's family. The doctor examined her and thereafter she was shifted to the ICU. She was also checked by a pulmonologist the same day, who left for abroad on October 27th.

Dissatisfied with the service at the Columbia Asia Hospital, the complainant got the patient discharged under DAMA (Discharge Against Medical Advice) after a couple of days. However, she succumbed soon after.

Following this, the complainant moved the commission, alleging deficiency of service and medical negligence and narrated his experience for six days hospitalization of the patient.

On the other hand, the Columbia Asia Hospital denied all the allegations stating that the complaint was “false, frivolous, vexatious” and with the “sole motive to unjustly enriching himself’.  It was “gross abuse of the process of law”, the hospital added.

The hospital stated all efforts were made from their end to provide all treatment and close monitoring of health condition through appropriate investigation at their end. The health condition was timely updated to the complainant and his family members present at the hospital. The hospital added that when the patient was advised the need to shift the patient to ICU they refused ICU management and for the patient discharged

Examining the matter, the commission considered the complainant's contentions as well as the hospital rejoinder along with the opinion on behalf of the medical experts present in the panel- Dr Saha. His observation noted the allegations of the complaint that while the patient was seen by a good number of consultants through referrals, the complainant was not counselled regarding so many referrals. Besides he also alleged on the charges of differed investigations being high as well as large number of consumables being used. Consultation of one doctor (an RMO) was charged twice on a single at a span on 30 minutes

The expert's observations highlighted the various infirmities, wherein, medical record submitted by the Clinical Establishment did not show that the petitioner was counselled by the consultant neither was there much advice about the treatment planning.

The observation noted that the primary consultant was merely depending upon advice given by other consultants. However, he kept charging fees every day twice. Moreover, two consultation fees being charged with a gap of 30 minutes is considered unusual.

"In fact, levying 2 fees for one RMO at an Interval of 30 minutes amounts to gross malpractice by the CE," it noted

Expert opinion also added;

"Consultation fees were charged against the Resident Medical Officers on duty that in our view, was not justified as it is always inclusive of the bed charges in ICU."

Further, it was noted that the patient should have been charged for six days whereas they had to pay for seven-day accommodation. The expert also added;

Large number of surgical consumables were billed. We are not sure whether those were at all used by and / or for the patient. The blood sugar was tested by glucometer. However, a separate charge was levied for a glucostrip and the lancet used for test. This was an unethical practice."

The expert clearly noted that the medical records did not show that the patient party was counselling by the doctor regarding the various referral as also the patient deteriorating condition

Summing up the entire issue, the commission noted that these were primarily billing issues 

" When a patient is admitted in a hospital, the bed charges should be inclusive of the charges on account of RMO particularly when the patient is in ICU. Moreover, the fees of RMO charged on a particular day with an interval of only 30 minutes is quite abnormal. This would indicate inflated billion as the RMOs are usually on the regular pay roll of the clinical establishment. The comment of Dr Saha on consumables cannot be brushed aside."

Subsequently, the commission held;

"The hospital was also guilty of lack of counselling as it is apparent from the medical records, particularly the bed head ticket. It is difficult to actually assess the amount that was charged in excess."

The Commission then instructed the Columbia Asia Hospital to pay a compensation of Rs 50,000 within a month