Patient treated in general ward charged for ICCU: Consumer court slaps hospital with Rs 2.75 lakh payout
Kolkata: The State Consumer Disputes Redressal Commission (SCDRC), West Bengal, recently directed a private hospital, empanelled with the 'Swasthya Sathi' scheme, to refund Rs 2 lakh to a patient after it found that he was billed for an ICCU bed while being treated in a general ward.
Further, the Commission directed the hospital to pay Rs 50,000 as compensation to the patient and Rs 25,000 as costs of litigation.
Case Background:
The history of the case goes back to 2021, when the complainant/patient was admitted to the treating hospital and was diagnosed as COVID-19 positive. The patient presented with fever and pneumonia and was released with advice for home isolation for 10 days and medication for post-COVID treatment.
In the final bill, Rs 2 lakh was mentioned against the bed/room as "ICCU-2-44". Filing the consumer complaint, the patient alleged that the hospital had refused to honour the Swasthya Sathi card and levied exorbitant charges for an intensive care unit (ICU) stay, despite his admission to a standard general bed.
Alleging that the hospital's conduct fell under unfair trade practice u/s 2 (47) of the Consumer Protection Act, 2019, the complainant relied on previous judgments in the case of Cpl. Chauhan (Retd.) v. Commanding Officer & Ors., Rao v. Nikhil Super Speciality Hospital, Dutta v. United India Insurance Co. Ltd.
On the other hand, the counsel for the hospital authorities vehemently averred that the record remained utterly barren of any documentary evidence demonstrating that the complainant ever lodged a formal protest regarding the alleged rejection of the Swasthya Sathi Card.
The counsel for the hospital further submitted that under the unprecedented duress of the COVID-19 crisis, the hospital was compelled to metamorphose all general wards into intensive care units (ICU). Consequently, amidst the turbulent peak of the pandemic, the discharge certificate was issued with an inadvertent clerical error, mistakenly designating the occupancy of bed no. 1002.
Observations by State Consumer Court:
After the District Consumer Court dismissed the complaint, the patient filed an appeal before the State Commission. The bench took note of the argument that while the DCDRC acknowledged the doctor's advice within the discharge certificate dated 06.05.2021, it overlooked other facts.
It was argued that a meticulous examination of the discharge summary alongside the final invoice would reveal a stark and troubling contradiction- while the complainant was accommodated in a general bed for the duration of his 5/6 day stay, the hospital levied charges for an ICCU bed. The counsel contended that this glaring discrepancy and exploitive invoicing by the hospital administration undeniably constituted a textbook instance of "unfair trade practice".
Further, it was submitted that the DCDRC proceeded on a flawed trajectory of mere conjecture and assumption, erroneously presuming that under the prevailing policies of the Directorate General of Health Services (DGHS) and allied authorities, general beds and medical facilities were seamlessly converted to ICCUs/ICUs to optimize emergency coverage during the pandemic. It was argued that the DCDRC chose to rely on this presumption without seeking a shred of strict, corroborative proof of such conversion from the Hospital administration.
While considering the matter, the SCDRC noted, "...it strains judicial credulity to accept that the complainant would proactively lodge formal grievances against denial of Swasthya Sathi Card benefits with the appropriate authorities on 24.01.2022 and 21.02.2022 – with copies duly communicated to the hospital administration – without simultaneously and vigorously demanding cashless treatment against the said Swasthya Sathi Card from the hospital itself. Consequently, the poignant claim regarding the outright refusal of the Swasthya Sathi Card by the hospital authority cannot be brushed aside or lightly ignored, as it remains deeply embedded in the factual matrix of the case."
According to the State Commission, the hospitals are legally required to provide accurate, transparent billing that matches their treatment logs.
"Charging a patient for a high-cost intensive coronary care unit (ICCU) bed while officially documenting that he stayed in a regular general bed, in our humble opinion, is a form of fraudulent and manipulative billing. By putting a regular bed no. on the discharge certificate but charging for an ICCU bed in the final bill, the hospital is misrepresenting the services actually delivered to inflate the bill. It is needless to mention here that Consumer Courts in India have consistently penalized health care providers for such deceptive practices," it noted.
"It is no doubt that a patient can file a consumer application against a private hospital or nursing home for refusing treatment under the Swasthya Sathi Card under the Consumer Protection Act, 2019, healthcare is considered a “service”. Even though patient is not paying cash out of pocket, the Govt. pays the empanelled on behalf of the holder of Swasthya Sathi Card. This creates a legal consumer–provider relationship. Turning away a patient who holds a valid card constitutes a deficiency of service," held the Commission.
The Commission also referred to the landmark judgment of the Supreme Court in the case of Indian Medical Association vs. V. P. Shantha, which established that health insurance or Government-sponsored schemes where payments are made on behalf of the patient fall strictly under the Consumer Protection Act.
Accordingly, the Commission concluded, "In contemplation of the exhaustive deliberations set forth in the preceding paragraphs, it shines forth with absolute clarity that the appellant has triumphantly established a profound deficiency of service regarding the denial of the Swasthya Sathi card. Furthermore, the appellant has laid bare the unfair trade practices of the institution, which unconscionably raised invoices for intensive coronary care unit (ICCU) services while patient/appellant herein reposed within the confines of a general hospital ward."
The Commission directed the hospital administration to restore and refund Rs 2 lakh to the complainant, granted with the distinct liberty to seek due reimbursement of the said evaluation against the complainant’s Swasthya Sathi Card.
"The opposite parties no. 1 & 2, bound in joint and several liability, are hereby commanded to bestow compensation to the tune of Rs.50,000/-, accompanied by litigation costs in the sum of Rs.25,000/-, payable directly to the complainant...The entirety of the aforementioned directives shall be meticulously executed and complied with within a span of Eight (8) weeks from this day," ordered the Commission.
To view the order, click on the link below:
https://medicaldialogues.in/pdf_upload/2026/08/27/scdrc--367622.pdf
