Delhi High Court ex­empts 4 hos­pi­tals from treat­ing the poor for free

Delhi High Court ex­empts four pri­vate hos­pi­tals from treat­ing the poor for free. Ex­perts fear other hos­pi­tals will fol­low

Down to Earth - - CONTENTS - JYOTSNA SINGH

Many a poor pa­tient has ben­e­fit­ted from the Supreme Court’s 2011 or­der which man­dates that all pri­vate hos­pi­tals which re­ceived land at a lower price from the govern­ment have to treat a cer­tain num­ber of people from the eco­nom­i­cally weaker sec­tions ( EWS) for free.

Take the case of four- year- old Sh­a­gun, born with a heart de­fect. For surgery in a pri­vate hospi­tal in Delhi, her fam­ily would have had to shell out a few lakh ru­pees. Her fa­ther, a tai­lor in Farid­abad who earns ` 6,000 a month, could only take her to a govern­ment hospi­tal—All In­dia In­sti­tute of Med­i­cal Sci­ences— where there is al­ways a long wait­ing pe­riod for ad­mit­tance.

But Sh­a­gun is now leading a healthy life. With the help of Lalit Bha­tia of char­i­tybeds.com, a non-profit that helps needy pa­tients get a bed and treat­ment in pri­vate hos­pi­tals, she was treated at Fortis Es­corts Heart In­sti­tute in Delhi in early April for free.

The hospi­tal is among the 47 pri­vate hos­pi­tals in Delhi that are obliged to pro­vide 25 per cent of out- pa­tient ser­vices ( OPD) and 10 per cent of in­door ser­vices to pa­tients from EWS— those who get less than the min­i­mum wages for un­skilled work. The min­i­mum wage in Delhi is ` 8,554 per month and will be re­vised in Oc­to­ber this year. Reser­va­tion of 10 per cent beds for EWS trans­lates into 682 hospi­tal beds in the city.

How­ever, a Delhi High Court or­der of April 28 has set a bad prece­dent. Four pri­vate hos­pi­tals—Moolc­hand Med­c­ity, St Stephen’s, Rock­land and Sitaram Bhar­tia In­sti­tute of Sci­ence and Re­search— had filed sep­a­rate cases in the high court in 2012 and 2013 say­ing they did not re­ceive land on con­ces­sional rates and hence are not obliged to pro­vide free ser­vices to the poor. The court, which de­cided to hear the cases to­gether, has ex­empted the four hos­pi­tals from pro­vid­ing the free ser­vice. Ac­cord­ing to the court, the govern­ment could not prove that St Stephen’s and Moolc­hand Med­c­ity got land at con­ces­sional rates. For Sitaram Bhar­tia and Rock­land in Qutab In­sti­tu­tional Area, the court did not ac­cept any pos­si­bil­ity of such con­ces­sion.

Ashok Agar­wal, founder of So­cial Ju­rist, a Delhi- based group of hu­man rights lawyers, says, “It is clear that St Stephen’s and Moolc­hand got land at prime lo­ca­tions at cheap rates. St Stephen’s got 0.74 hectares ( ha) in North Delhi for 99 years on lease for less than ` 10,000 in the early 1970s.” He adds that the hospi­tal is pay­ing only ` 500 ev­ery year for the land as rent. “Moolc­hand Med­c­ity was given land in 1949. In the aftermath of In­de­pen­dence, cheap land was be­ing al­lot­ted for schools and hos­pi­tals in the name of pub­lic good,” Agar­wal says. He adds that the other two hos­pi­tals fall in an in­sti­tu­tional area where land is usu­ally given at one-tenth of the mar­ket price.

Agar­wal fears that other pri­vate hos­pi­tals might also try to get such ex­emp­tion,” he says. “I know of at least two more hos­pi­tals which will ben­e­fit from the judge­ment.”

How it started

In June 2000, a com­mit­tee un­der Jus­tice A S Qureshi was formed by the Delhi govern­ment to find out the modal­i­ties of free treat­ment for the poor in pri­vate hos­pi­tals.

Till that time, no clear guide­lines for the pur­pose had been framed. In 2001, Jus­tice Qureshi sub­mit­ted his re­port, rec­om­mend­ing 25 per cent of OPD and 10 per cent of in­door ser­vices for EWS in pri­vate hos­pi­tals and nurs­ing homes which had re­ceived land on con­ces­sional rates. The re­port spec­i­fied that the con­di­tion will ap­ply even if the agree­ment signed with the govern­ment does not spec­ify them. The govern­ment ac­cepted the rec­om­men­da­tion.

In 2002, So­cial Ju­rist filed a pe­ti­tion in the Delhi High Court against poor im­ple­men­ta­tion of the EWS quota in pri­vate hos­pi­tals.

In 2007, the court in­structed the state govern­ment to en­sure that 20 hos­pi­tals, which had chal­lenged the pe­ti­tion of So­cial Ju­rist, should pro­vide the ser­vice. The govern­ment iden­ti­fied six more such hos­pi­tals and formed a mon­i­tor­ing com­mit­tee, on court or­ders, to su­per­vise the reser­va­tion of beds in these 26 hos­pi­tals. Af­ter the or­der, the Delhi govern­ment de­cided to put a clause re­gard­ing free treat­ment in all agree­ments. Max Su­per Spe­cial­ity Hospi­tal in Shal­i­mar Bagh and Rock­land’s new branch in Dwarka re­ceived land on auc­tion at con­ces­sional rates and were added to the list. Soon, the govern­ment, in con­sul­ta­tion with the mon­i­tor­ing com­mit­tee that com­prises govern­ment of­fi­cials and so­cial ac­tivists, added more pri­vate hos­pi­tals in the list.

The govern­ment won a case against a pri­vate hospi­tal that re­fused to pro­vide free treat­ment to the poor. Sun­der Lal Jain hospi­tal had claimed that with­out a spe­cific clause in its MoU, the pro­vi­sion of free treat­ment can­not be bind­ing on the hospi­tal. But in 2011, the Supreme Court passed an or­der against the hospi­tal and asked it to com­ply with the pro­vi­sion. An­other 10- odd hos­pi­tals were added to the list.

Fi­nally, af­ter a Cen­tral govern­ment no­ti­fi­ca­tion of 2012 that said all hos­pi­tals al­lot­ted land by Land and De­vel­op­ment Of­fice should ex­tend free ser­vices to the poor, the num­ber reached 47. “It has been a tough bat­tle. Our ar­gu­ment was sim­ple. If a hospi­tal gets land at a cheaper rate, it should pro­vide some free ser­vices to the poor,” Agar­wal says.

In 2013, ap­prox­i­mately 1.1 mil­lion poor pa­tients availed free treat­ment in pri­vate hos­pi­tals in Delhi

“Moolc­hand Med­c­ity, St Stephen’s and Sitaram Bhar­tia were not pro­vid­ing any ser­vice. Rock­land was the worst per­former among the hos­pi­tals giv­ing such ser­vices,” says an of­fi­cial with Delhi govern­ment’s health depart­ment.

Mum­bai ex­pe­ri­ence

An­other city which has a sim­i­lar pro­vi­sion is Mum­bai. All hos­pi­tals reg­is­tered un­der the Pub­lic Char­i­ta­ble Trust Act, 1950, have to pro­vide 10 per cent beds for free and an additional 10 per cent at sub­sidised rates to the poor. There are 50 such hos­pi­tals in the city.

“The­o­ret­i­cally, hos­pi­tals can be reg­is­tered as businesses too. But prac­ti­cally all hos­pi­tals are reg­is­tered un­der the Act to en­joy tax waivers,” says Mi­hir De­sai, a hu­man rights lawyer who prac­tises in the Bom­bay High Court and Supreme Court. “We filed a case a few years ago be­cause the pro­vi­sion for free beds was not be­ing im­ple­mented any­where. The Mum­bai High Court formed a com­mit­tee but it is de­funct,” De­sai adds. He plans to ap­proach the court again.

In April 2013, the Ma­ha­rash­tra govern­ment had sent notices to 31 hos­pi­tals for not com­ply­ing with the pro­vi­sion. “We are look­ing into the mat­ter,” says a Ma­ha­rash­tra govern­ment of­fi­cial.

Analysing the Delhi High Court or­der, De­sai says it is not just about land. “Pri­vate hos­pi­tals get nu­mer­ous con­ces­sions. They get sub­sidised wa­ter and elec­tric­ity; con­ces­sions on im­port of equip­ment and many other ben­e­fits in­clud­ing tax waivers. They can­not shy away from the re­spon­si­bil­ity of treat­ing the poor,” he says.

But ap­a­thy on the part of gov­ern­ments is vis­i­ble across the coun­try. Most states, in­clud­ing Kar­nataka, do not even know if they have given land on con­ces­sion to hos­pi­tals. Agar­wal, there­fore, says, “The Cen­tral govern­ment should is­sue an or­di­nance and make it manda­tory for the en­tire coun­try,” he says.

Ba­tra hospi­tal is one of the 43 pri­vate hos­pi­tals in Delhi that pro­vide free treat­ment to the poor

Four-year-old Sh­a­gun was born with a hole in her heart. She was treated for free at Fortis Es­corts Heart In­sti­tute in Delhi

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