Absence of Treatment Package Brochure: Chhattisgarh hospital overcharges patient by Rs 185000, ordered to refund adjustment

The case reached the apex commission after a Revision Petition was filed by the Managing Director of the hospital, located in Bhilai, Chhattisgarh against the complainant contesting allegations of medical malpractice and violations of consumer rights.

On June 17, 2010, the complainant admitted his wife to Krishna Nursing Home in Bhilai due to her heart-related illness. The doctors at Krishna Nursing Home recommended transferring her to Apollo B.S.R. Hospital for specialized cardiac care. The same day, the patient was admitted to Apollo B.S.R. Hospital, and an initial deposit of Rs 20,000 was paid. Initially, the estimated treatment cost was R. 85,000, a figure that the complainant agreed to.

However, the situation took a turn the following day, when the attending physician, allegedly demanded an additional Rs 2,00,000, leaving the complainant shocked and confused. When he questioned this sudden increase, the doctor insisted on immediate payment, emphasizing its critical nature for his wife's well-being. On June 19, 2010, the complainant reluctantly paid the requested amount. The patient was placed in the Intensive Care Unit (ICU), and he was only allowed to observe her from a distance.

Despite the patient's critical condition, the complainant alleged that he was not kept informed about her true status. Until June 20, 2010, the doctor and hospital staff assured him that her health was improving. On June 21, 2010, he received the devastating news of her sudden demise. The hospital then informed him that the total expenses amounted to Rs 2,94,260, and they would only release her body upon the payment of the remaining Rs 74,260. After pleading extensively, the complainant managed to retrieve the patient's body by depositing Rs 50,000.

When he sought a detailed breakdown of the expenses and information about the treatment provided, the hospital allegedly failed to provide any documents or explanations. the complainant perceived this lack of transparency, combined with the substantial fees, as a violation of his consumer rights, constituting a deficiency in service and professional misconduct. He alleged that the hospital had exploited his vulnerability and lack of medical knowledge, charging him Rs 85,000 for a package deal and an additional Rs 2,09,260 for various services and treatments through misleading and deceptive means.

He filed a consumer complaint with the District Consumer Disputes Redressal Forum, Durg. The Forum, in its order dated March 11, 2015, ruled in favor of the complainant  and directed the hospital to pay him Rs 2,70,000, with an interest rate of 12% per annum, and an additional Rs 20,000 as mental compensation.

Aggrieved by the District Forum's decision, the hospital appealed to the State Consumer Disputes Redressal Commission. However, the State Commission, in its order dated February 4, 2016, upheld the District Forum's decision and dismissed the appeal.

The Hospital subsequently moved the NCDRC and challenged the State Commission's order primarily on the following grounds:

a.) The State Commission's order is based on incorrect premises, alleging that the hospital held the patient's body for six hours and demanded additional payment. The hospital vehemently denies making such a statement, claiming that the body was released promptly upon request without any unauthorized extra charges.

b.) the complainant failed to provide sufficient evidence to support his claim that the hospital withheld his wife's body. The hospital explicitly denied making any such demand. The lack of specific details in his complaint raises questions about who requested the payment and whether it was linked to the release of the body.

c.) The State Commission erred in claiming that the hospital increased the bill with the intention of profiteering. In reality, patients diagnosis was a severe myocardial infarction, requiring immediate and specialized care. The hospital contends that their actions were in line with the standard of care in such critical cardiac cases.

d.) The State Commission failed to recognize the technical aspects of the medical procedures performed. For example, during the primary angioplasty, when the left anterior descending artery was 100% blocked, the clot was removed using an Export Thrombus extraction catheter. In such cases, Direct Stenting is considered a reasonable approach to avoid complications with balloon dilation. Additionally, when the patient's blood pressure is low during primary percutaneous coronary intervention, intra-aortic balloon pump (IABP) support is standard to ensure the patient's well-being.

e.) The State Commission overlooked the fact that Rs. 85,000 was spent solely on the high-risk angioplasty procedure. The hospital claims that they regularly communicated the details of the remaining expenditures to the complainant. Furthermore, they assert that he was regularly informed about his wife's critical illness and condition during her 3.5-day stay in the ICU.

The counsel for the petitioner hospital argued that the patient suffered from a severe heart condition, and the medical team followed standard procedures for her condition. This included primary angioplasty and the use of an Intra-Aortic Balloon Pump (IABP). These procedures were considered the standard of care in such cases. The medical team followed established protocols, and the actions taken were in line with best practices.

The petitioner asserted that in cases of alleged medical negligence, the burden of proof rests on the party alleging negligence, which is the complainant in this case. The District Forum, according to the petitioner, accepted the complainant's claims without sufficient evidence and failed to consider the medical procedures and records presented by the petitioner. The petitioner maintains that the medical team followed standard protocols and provided the necessary treatment to the patient.

The counsel further argued that the complainant did not provide concrete evidence to support their case of negligence before the District Forum. The forum accepted the complainant's claims solely based on their statements, without the support of medical literature or expert opinion. Additionally, no medical expert's opinion or medical literature was referenced in the judgment. The allegations of withholding the patient's body for monetary reasons were questioned, and the absence of criminal proceedings raised doubts about their veracity.

The petitioner's counsel pointed out that the State Commission accepted the complainant's version of events without adequate evidence and appeared to have accepted their averments at face value. The State Commission also relied on affidavits submitted by the complainant while refusing to accept the petitioner's affidavit on technical grounds.

The petitioner's counsel referenced several legal precedents to support their argument that the complainant's case lacks evidence of medical negligence. The counsel further addresses the issue of the hospital withholding the patient's body for monetary reasons. They argued that the hospital's actions were in line with their policies. They also suggested that the State Commission's observations on the billing dispute were not adequately supported by evidence.

On the other hand, the counsel for the complainant argued that the hospital withheld the release of the patient's body for six hours, waiting for the remaining payment from the complainant. They reference a legal precedent to support their argument that outstanding dues should not be a reason to withhold the release of a patient when the family is willing to take responsibility.

The counsel further contended that the hospital increased the bill by adding incorrect and excessive amounts with the intention of earning unfair profit. This was seen as a deficiency in service and maltreatment toward the complainant.

Perusing the records and hearing the contentions, the apex consumer commission noted that the case revolved around two main issues, allegations of medical negligence and a billing dispute. The petitioner argued that the medical team provided the standard of care and that the complainant failed to provide concrete evidence of negligence. On the other hand, the complainant claimed that the hospital overcharged and delayed the release of the patient's body.

The Commission opined that the resolution of the case relied on the evaluation of evidence and the application of relevant legal precedents. The main question was whether the hospital provided the appropriate standard of care, and whether the billing was justified based on the services provided.

The Commission observed that;

"District Forum has gone at length to examine the issue of overcharging beyond the package amount of Rs. 85,000/- by OP (petitioner). However, we find that District Forum has allowed payment of Rs. 2,70,000/- i.e. full refund of amount paid by the complainant, along with interest, compensation and litigation expenses. During the hearing, the counsel for petitioner admitted that no brochure containing package details and its inclusions/exclusions were given to the complainant/respondent and/or placed on record before the District Forum/State Commission. Even with the RP, no such brochure/details were filed. It was on instructions from the Commission during the hearing that the petitioner filed a copy of such brochure/details of the package."

The relevant details of the package offered to the complainant were as follows:

Package Name: Primary PTCA (Angioplasty-High Risk) Done in Cath Lab

Length of Stay (LOS): 1 Day ICU & 2 Days Ward

Bed Categories: General Ward, Semiprivate, Private, Deluxe, Super Deluxe

Package Price: Rs. 65,000, Rs. 75,000, Rs. 85,000, Rs. 100,000, Rs. 160,000

The package included:

3-day stay in the hospital (1 day in ICU & 2 days in the ward)

Inpatient nursing & Dietician charges

Cath lab charges

Cardiologist fees

Consultation during the stay

Routine investigations (such as blood grouping, BT CT, blood sugar, etc.)

Cath Lab standards consumables & medicines

Contrast 150ml/200ml

Routine medication

The package excluded certain items and charges, such as additional inpatient stay beyond 3 days, take-home medication, fees for other doctors (in case of reference), extra Cath Lab consumables for patients with abnormal serology, and costs of high-value medicines or a PTCA balloon, if used. Notably, the cost of a stent was not covered in the package.

Subsequently, the Commission emphasized that during the hearing, the petitioner could demonstrate that the Rs. 85,000 package was not all-inclusive, and additional charges were applicable for specific items. However, the package details or brochure were never provided to the complainant or submitted to the District Forum or State Commission. Despite this, the District Forum's detailed analysis led to the conclusion that the maximum charge the petitioner could impose on the respondent was Rs. 85,000, not the final bill amount of Rs. 2,94,260 or the charged amount of Rs. 2,70,000 after applying a discount of Rs. 24,260.

As a result, it ruled that the petitioner had overcharged the complainant by Rs. 1,85,000 (Rs. 2,70,000 - Rs. 85,000). While the District Forum ordered a full refund of Rs. 2,70,000 to the complainant, the court modified the order to stipulate that the petitioner should refund Rs. 1,85,000 instead. Additionally, this amount would carry an interest rate of 12% per annum from the date of the final bill, June 21, 2010, rather than the date of the complaint, January 18, 2011, as determined by the District Forum. The other relief measures prescribed by the District Forum were upheld, and the complainant was awarded a litigation cost of Rs. 15,000 in addition to the Rs. 10,000 initially awarded by the District Forum. The review petition was thereby disposed of.

It held;

"No doubt during the hearing, based on the above said package details, the petitioner was able to show that Rs. 85,000/- was not an all-inclusive package, there were other items for which the patient/complainant had to pay extra, considering that such package details/brochure were never given to the complainant and/or placed on record before the District Forum/State Commission, and considering the detailed analysis done by the District Forum, as reproduced in the preceding paras, we are of the view that in the present case the maximum which the petitioner/OP can charge from the respondent/complainant is Rs. 85,000/- and not Rs. 2,94,260/- (the final bill amount) or Rs. 2,70,000/- (the amount actually charged after giving a discount of Rs. 24,260). Hence, we hold that petitioner/OP has charged excess amount of Rs. 1,85,000/- (Rs. 2,70,000- Rs. 85,000/-) from the complainant/respondent. However, District Forum has allowed full refund of Rs. 2,70,000/- paid by the complainant/respondent. Hence, we modify para 29(a) of the order of District Forum to the extent that petitioner/OP shall refund an amount of Rs. 1,85,000/- to complainant/respondent instead of Rs. 2,70,000/-. Further we also modify para 29(b) of the order, this amount shall be refunded to complainant/respondent with interest @ 12% p.a. (as awarded by District Forum),w.e.f. date of final bill i.e. 21.06.2010 rather than date of complaint i.e. 18.01.2011, as decided by the District Forum. Relief under para 29(c) and 29(d) of order of District Forum is maintained as such. In addition, the Respondent is awarded litigation cost of Rs. 15,000/- for the RP [over and above the litigation cost of Rs. 10,000/- awarded by District Forum under para 29(d)]. RP is disposed off accordingly."

To view the original order, click on the link below: