Doctors cannot adopt pick-and-choose attitude while treating patients: Madras HC

Chennai: The Madras High Court recently observed that doctors cannot adopt a pick-and-choose attitude while treating patients and, poor patients receiving treatment from government-run hospitals cannot be treated differently. 

The HC bench comprising Justice S.M. Subramaniam made these observations while considering the pleas challenging the proceedings of the Director of Public Health and Preventive Medicine appointing the petitioner Doctors as Assistant Surgeon (Specialists) based on the bond agreement under Rule 19(1) of the Tamil Government Servants (Conditions of Services) Act, 2016.

Filing the plea, the doctors sought directions to the authorities to treat their one-year bond period as completed and hence, relieve them from the bonded service.

"The prime object of medical profession is to render service to humanity. Doctors cannot adopt a pick and choose attitude while treating patients. Especially poor patients receiving treatment from government run hospitals are entitled to receive the same level of specialised treatment as any other paid treatment. Denial of treatment to poor patients in government hospitals inspite of agreeing to the same under the bond goes against the ethos of medical ethics," observed the HC bench,

"It is not the case were the doctors are forced to treat patients for free throughout their career. The bond is such that it operates only for a particular period of time. And the petitioner Doctors are well aware of the terms in the bond and with full agreement to the same had agreed to abide by the terms in the bond. It is nothing but a service to humanity and to the poor sections of the society who due to financial constraints are unable to get paid treatment. Such limited services sought for from the petitioner doctors cannot be denied. It is not the case were the doctors are prevented from practising their profession but they have agreed to render their specialised services for a limited period to the less fortunate strata of the society," it further noted.

The petitioner doctors signed a Bond accepting the conditions to serve two years in a Government Hospital. In Compliance with the terms of the bond agreement, an appointment order was issued by the authorities to the petitioners. The Government executed the bond after considering the amounts spent for the Postgraduate Medical Course students to undergo the course. In order to compensate the Government expenditures and with an object to provide free specialised medical treatments to the poor and the needy people across the State of Tamil Nadu, the condition was proposed at the time of admission to Post Graduate Medical course and the condition was accepted by the students / petitioners. Signing the bond, they promised to serve two years in a Government Hospital after completing their Post Graduate/Speciality Medical Course.

However, after completing the course, the petitioners claimed that they had served during the COVID-19 Pandemic period and urged to reckon the said period for the purpose of calculating two years of service. They further said that the contemplation of two years period of service itself was untenable and argued that such conditions imposed in the Bond was not binding of them. Therefore, they requested to set aside the bond.

The counsel for the petitioners, Mr. M. Vijaya Ragavan submitted that similar claim of other persons were considered by the Court in some pleas. Further, he pointed out that it was not disputed that the petitioners served during the COVID-19 pandemic period. Therefore, he contended that the said period should be reckoned to calculate the total period of two years of service to be rendered as per the bond conditions.

On the other hand, the counsel for the Government opposed the plea stating that the Government did not concede its stand at any point in time. The COVID-19 pandemic was an emergency situation and the Postgraduate students were bound to attend the patients even while undergoing the Post Graduate Medical course. Therefore, it was part of their duty and the Government paid a monthly stipend to all the PG students, submitted the Government counsel, arguing that the plea by the petitioners was untenable.

The Court noted that considering the students' claim, the Government itself reduced the bond period from two years to one year dated 27.10.2023. Therefore, the petitioners had to complete one year of service in any Government Medical College and Hospital in compliance with the bond conditions. 

"It is nothing but a service to humanity and to the poor sections of the society who due to financial constraints are unable to get paid treatment. Such limited services sought for from the petitioner doctors cannot be denied. It is not the case were the doctors are prevented from practising their profession but they have agreed to render their specialised services for a limited period to the less fortunate strata of the society," the HC bench noted at this outset.

The Court observed that saving lives was unparalleled to none and the Government Hospitals require specialised Doctors. Noting that specialised treatments today have become an expensive affair, the HC bench observed that the economically weaker sections of society cannot be denied their fundamental right to health under Article 21 of the Constitution merely on the grounds of financial constraints. 

"It is no fault of his/her that they are unable to afford specialised treatments today. So the Bond scheme is an all conducive scheme whereby various layers of difficulties are addressed. Firstly, the Government pools in enormous financial resources on each and every student studying in a super speciality course. In order to ensure that the right of access to higher education is not denied to any section of the society, the government has formulated this Bond policy whereby, the government will bear the expenditure of the super specialised courses provided in government colleges and in return the students shall serve in government run hospitals for a period of 2 years and during this period the students are entitled to a monthly stipend," the HC bench observed.

"Secondly, the government run hospitals and other health care centres today are in need of more specialised doctors. Though there are many super speciality hospitals across the country not everyone is capable of affording the treatment at these hospitals. So the persons who will be most benefited from schemes like this will be the poorer sections of the society. They get an equal access to specialised medical treatment like any other financially stable citizen. So by gaining the services of the speciality doctors under the bond scheme the government hospitals across the State get an opportunity to provide affordable super speciality treatment to the economically vulnerable sections of the society," it observed.

"So instead of paying for the education, the PG doctors are asked to render their valuable services in government hospitals for a monthly stipend. The PG Doctors are only further benefited as they are providing their services and are also receiving the valuable experiences by treating patients who come in with different complaints," the bench noted.

The Court observed that PG doctors fully agreed to the terms in the bond and had agreed to render their services and it was only in the true spirit of the medical profession that their valuable services were rendered for those people who came to the Government hospitals in search of specialised treatments. The bench observed it to be the greatest form of service to humanity and a testament to being a true doctor.

"...it goes without saying that the medical profession is a noble one. This court is not suggesting that all medical services must be rendered free of cost to the citizens though the goal of any welfare state is to move towards affordable and easily accessible health care to all its citizens. Therefore the government is in need of qualified speciality doctors who can treat patients coming to government hospitals with quality and affordable healthcare," noted the court.

The HC bench disagreed with the petitioners' argument that their services during the COVID-19 period must be counted as two years of the bond period, making the bond policy unsustainable.

"It was a period were the country witnessed immense crisis. It was a period of test to the humanity. And many people suffered innumerable losses. But to use this period of selfless service as a way out of the bond policy is utterly unjustifiable and unacceptable. It was a time when people from different walks of lives contributed their services in their own way and the frontline workers like aforementioned risked their lives in the process," noted the bench.

Noting that Great Nation values human resources as an important facet of the economy, the bench observed, "More so than ever human resources play a vital role in the Nation building process. People from rural villages contribute a larger portion in this process. And it is the duty of any welfare state to protect the health and cater to the needs of these people. Bond policies play an important role in ensuring affordable specialised healthcare to these individuals from the rural backgrounds. Hence through theses bond policies the government will be able to seep in to the most vulnerable contributors of the economy and be able to provide quality health care services."

The Court referred to the pattern in cases whereby the students initially agreed and signed the bond and after completing their PG education, the bench noted that there is a common tendency to retract and approach the Court challenging the bond.

"The services of a doctor is far different from any other service. Saving one life is a contribution not only to the patient but his family, his dependants and even the economy of a country. It is a service to the Nation. Any poor person who is unable to afford paid treatment can in no way be treated differently. A life is a life and it has its value. No person should be denied quality treatment on economic grounds," the bench noted.

Therefore, the bench denied any relief to the petitioners and dismissed the plea. "In view of the fact that the petitioners have admittedly signed the bond and accepted the terms and conditions stipulated therein, they are not entitled to claim any concession for further reduction of period stipulated under the bond conditions. Therefore, the petitioners have to serve in Government Medical College and Hospitals as per the appointment order in compliance with the conditions and after completion of the period stipulated, appropriate decision may be taken by the respondents," it observed.

To read the order, click on the link below:

https://medicaldialogues.in/pdf_upload/madras-hc-order-241991.pdf

Also Read: Madras HC denies relief to doctors, says violating Bond Conditions results in Doctor shortage