Delhi hospitals freed of poor
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 Rs 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 Rs 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 Rs 10,000 in the early 1970s.” He adds that the hospital is paying only Rs 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.
“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.
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.