For Nitin Kumar, 22, the battle was on two fronts. On June 29, Kumar said, he was admitted to Max Smart Super Specialty hospital for Covid treatment. On the same day, Kumar also decided to shift his mother, Biney Rani, to Max hospital in Saket. Not satisfied with the treatment and issues of overcharging in Rani’s case— who was then admitted to Goyal hospital and Urology centre in Delhi’s Krishna Nagar — Kumar said the family decided to shift her, hoping for better treatment at reasonable costs.
Kumar had reasons to be assured. On June 20, the Delhi government had prescribed the maximum per day charges for COVID-related treatment in private hospitals. According to the order, the new charges stood at Rs 8000-10000, Rs 13000-15000 and Rs 15000-18000 including PPE costs for isolation bed, ICUs without and with ventilator respectively. This was as opposed to the prevailing charges of Rs 24000-25000, Rs 34000-43000 and Rs 44000-54000 (excluding PPE cost). This was to be followed for an upper limit of 60 per cent of the total hospital beds.
However, when the hospital bills arrived at the time of discharge on July 2, Kumar was in for a rude shock. “At the time of my admission, I was informed that I would be billed as per the Delhi government COVID-19 package rates. A deposit of Rs. 50,000 was also paid for my treatment. But the final bill included various additional charges that, as per the government order, should have been included within the isolation bed package rate,” said Kumar.
He said that he was overcharged for the medicines, particularly, Fabiflu (favipiravir), which is prescribed for mild to moderate disease. “The tablets were given to me by a nurse a day after my admission, by when I was feeling almost fine. I was not given any informed consent form to be filled up, which should have happened according to the rules of the drug regulator,” said Kumar.
Moreover, Kumar said that while he had 26 tablets for two days, he was charged for two boxes of FabiFlu (34 tablets each), and billed Rs 6,998. Costs of other medicines (Rs 2,185) and routine investigations (Rs 8,850) that are part of standard care for Covid patients and included in the price cap were also billed to him extra, he said at a web-based press conference organised by civil society groups.
Like Kumar, a few other patients, too, spoke about being wrongly billed at several of Delhi's private hospitals—for instance, being charged Rs 6,500 for PPE costs per day, as opposed to Rs 1,200 fixed by the government.
Taking up the case of Kumar and several others, the civil society groups have written to Delhi Chief Minister Arvind Kejriwal and Lt Governor Anil Baijal, pointing to flouting of price caps, ambiguities over insurance coverage for Covid treatment, lack of monitoring compliance of the government’s order and an appropriate grievance redressal mechanism. The letter points to several issues ranging from not informing patients about government rates, obtaining false consent, not providing information about the exact availability and occupancy of rate capped beds in each category, not applying government rates for insured patients, and charging separately for medicines, investigations, PPE, that should be included within the government rates.
“Hospitals are also inflating bills by falsely billing patients for treatment they never received. For instance, a patient who was never given oxygen support was billed for oxygen at Rs 1,400 per day for nine days. In another case, the patient was billed for ICU admission even though she was in an isolation ward,” said Malini Aisola, co-convenor, All India Drug Action Network that has been helping Covid patients access healthcare.
The letter includes other organisation such as Hyderabad-based Anveshi Research Centre for Women’s studies and Jan Swasthya Abhiyan among others. Instances of differential care to patients paying hospital rates versus the government fixed rates, detaining patients until the bill amount is settled by the family, absence of doctors or medical staff in hotel rooms attached to private hospitals and inadequate support and redressal for patients who have contacted individual officials of the Delhi government or filed formal complaints, have also been pointed out by the activists.
“These grave violations are a result of the lack of any enforcement mechanisms or action from the Delhi government to ensure implementation of its own order pertaining to fixed rates for COVID-19 treatment,” the letter read.
The civil society groups have demanded that action be taken on the complaints, a formal grievance redressal be set-up, transparency be ensured on rates, real-time information be provided on fixed rate beds capacity on the Delhi government website and price caps be extended to all ICU beds given that they are in short supply. Besides, use of experimental drugs such as Remdesivir and Favipiravir should be monitored strictly, given that the pharma, chemicals and fertilisers ministry has already raised concerns over their indiscriminate use.
“Experimental treatments for COVID-19 (such as favipiravir, remdesivir, tocilizumab, etc.), which present huge costs to patients, are excluded from the Delhi government treatment rates. These treatments are being administered rampantly and often in violation of the treatment protocols, and without the informed consent of patients. The Delhi government must take proactive steps to put in place mechanisms to safeguard the welfare of patients and to control unnecessary expenses arising out of the irrational use of experimental drugs,” the letter said.
