Hyderabad hospital directed to pay Rs 1.5 lakh compensation to doctor for COVID treatment despite negative report
Insurance company slapped compensation for deficiency in Service
Hyderabad: The District Consumer Disputes Redressal Commission- I, Hyderabad, has directed a private hospital to pay Rs 1.5 lakh compensation to a doctor and his wife for overcharging during the treatment of suspected COVID-19 pneumonia. It was noted by the bench that the doctor's COVID-19 test report came negative and still he was administered COVID treatment by the hospital.
Two separate cases were filed by the doctor and his wife against the hospital. In both cases, the District Consumer Court ruled in favour of the couple and pointed out that the hospital failed to adhere to G.O. No 248, through which Telangana Health Department specified the ceiling rate that could be charged for COVID-19 treatment.
After considering their pleas, the District Consumer Court directed the hospital to pay Rs 1 lakh compensation to the doctor and another Rs 50,000 to his wife. Further, the hospital has been directed to pay Rs 15,000 as costs of litigation to both the complainants.
The history of the case goes back to 2020 when the complainant, who himself is a doctor, developed symptoms of fever and headache. Then he got himself checked through RTPCR on 23.06.2020. Although the test report came back negative, as a precautionary measure, the complainant along with his wife came to Hyderabad and consulted the treating hospital on 29.06.2020.
In two separate pleas, the couple alleged that they were administered COVID-19 treatment without there being any need. Both the doctor and his wife were treated as in-patient at the hospital. In the case of the doctor, he was billed for a treatment cost of Rs 4,76,000 and his wife was billed for Rs 2,67,514. Both of them were discharged on 06.07.2020.
They alleged that the hospital charged an exorbitant amount for the treatment, in contravention of the notification i.e. G.O. Rt. No. 248 issued by Telangana Government. Further, it was submitted that the guidelines issued by the Government of India provided that asymptomatic and mild symptoms cases did not need hospitalization and recommended to be kept under home isolation.
However, the treating hospital allegedly, contrary to the concerned guidelines, admitted the complainant and his wife to the hospital. It was further submitted that the charges levied by the hospital in the treatment of the complainant was in contravention of guidelines issued by the State Government.
It was further submitted that the unwarranted hospitalization of the complainant doctor and his wife created great pain and they were subject to unwanted fear amidst the raging dire consequences of the pandemic. Therefore, alleging deficiency of service and unfair trade practice by the hospital, the couple sought compensation from the hospital.
The complainant doctor sought a refund of Rs 4,48,794 from the hospital for charging an excessive amount of Rs 4,76,794 instead of Rs 28,000 in contrary to the G.O.Rt. No. 24 dated 15.06.2020. Filing a separate plea, his wife sought a refund of Rs 1,24,825.
On the other hand, the hospital submitted that though the complainant doctor was tested negative for COVID-19, the co-rads 5 score put him highly suspicious for typical viral pneumonia. Due to comorbid conditions of the complainant, he was admitted to the hospital and was treated as per the protocol adopted by the medical fraternity. It was also submitted that the patient had every right to reject the treatment at any stage, if he/she was not satisfied with the treatment.
Further the hospital claimed that the complainant was well aware that every hospital had their own tariff for treatment and it was further submitted that the complainant opted for an air-conditioned deluxe sharing room and therefore, the concerned G.O was not applicable. Besides, the hospital also argued that the question of COVID-19 treatment did not arise as the complainant received treatment for pneumonia, high blood sugar and other comorbid conditions. The hospital also claimed that it strictly followed its own tariff and the complainant did not object to the same. Therefore, denying allegations of deficiency of service and unfair trade practice on their part, the hospital prayed for the dismissal of the complaint. Similar submissions were made by the hospital in respect of the other plea filed by the doctor's wife as well.
While considering the matter, the consumer court took note of the relevant portions of discharge summary and noted that in respect of the complainant doctor, the final diagnosis mentioned suspected COVID Pneumonia. It was further mentioned in the document that the HRCT showed high suspicious for COVID-19 (CORADS-5) RTPCR.
In respect of his wife, the discharge summary mentioned about the chief complaints including loss of appetite, mild shortness of breath, history of feber etc and the provisional diagnosis was mentioned to be suspected covid.
After perusing the documentary evidence, the commission noted that
"It is also clear from the discharge summary that the opposite party, despite there being negative result, treated the complainant for ‘suspected covid pneumonia’ with the reason that reports showed corads-5. When the final diagnosis included ‘suspected covid pneumonia’, not adhering to the ceiling rates as mentioned in G.O. Rt. No 248 (Ex.A10-Ex.B5) amounted to adoption of unfair trade practice on the part of opposite party."
"In the present case, the opposite party, on one hand, submitted that the test reports of the complainant showed CORADS-5 and on the other hand, they submitted that theG.O. Rt. No. 248 was not applicable as the complainant received treatment for co-morbid conditions. When the complainant’s HRCT report showed high suspicious for covid-19 (CORADS-5), the opposite party failed to explain how & why G.O. Rt. No. 248 was not applicable," the consumer court further noted.
However, the consumer court observed that the complainants failed to show how they were entitled for the refund of Rs 4,48,794 and Rs 1,24,825. It granted Rs 1 lakh lumpsum compensation to the doctor and Rs 50,000 monetary compensation to his wife.
Further, the hospital has been directed to pay Rs 15,000 as costs to both the doctor and his wife each. "This order be complied with by the opposite party within 45 days from the date of receipt of the order, failing which the amount mentioned in Sr. No. (i) above shall carry interest@6% p.a. from the date of receipt of the order," the Commission mentioned.
To view the order, click on the link below:
https://medicaldialogues.in/pdf_upload/hyderabad-overcharging-rs-1-lakh-229544.pdf
https://medicaldialogues.in/pdf_upload/hyderabad-overcharging-rs-50000-229545.pdf
