Demonetisation or not, doctors have no business denying emergency healthcare services

Since Prime Minister Narendra Modi announced the demonetisation of Rs 500 and Rs 1,000 notes last week, people across India have been scrambling to get their hands on cash they can transact with. The government has directed government hospitals and pharmacies to continue accepting the notes till November 24. But in the past week there have been a handful of cases reported in which the lack of currency has had dire consequences.

In Mumbai, a hospital allegedly refused to admit a prematurely born baby because his parents did not have legal currency notes but only Rs 500 bills to pay the deposit, after which the child died. An 18-month baby suffering from fever died in Visakhapatnam because her parents could not pay for diagnostic tests in valid currency. Doctors in Mainpuri allegedly stopped treating a one-year-old with high fever, after his parents ran out of Rs 100 notes. The doctors advised them to take the child to a public hospital. The child died after he was taken home. In Rajasthan’s Pali district, the father of a new born child who needed specialised care was not able to pay for an ambulance to a bigger hospital in Jodhpur.

All this, despite the fact that no hospital or doctor can and should deny emergency healthcare facilities and services, whether the country is in the middle of a demonetization drive or not.

Normally leaky, now cracking

India’s public healthcare is woefully inadequate and that is no secret. While all public hospitals are meant to be free of cost, Indians spend large amounts on medicines and services like ambulances. Some of these costs have come down in recent years with the rise in medical insurance coverage but the individual expenditure is still significant and compounded by wage losses due to illness.

When the demonetisation was announced on November 8, the government ordered public hospitals to accept payments on older notes but not private facilities, despite the fact that most patients use private healthcare.

According to National Sample Survey data released this year 71.7% of people in rural areas and 78.8% people in urban areas accessed treatment from private facilities in 2014. This indicates the poor outreach of public facilities.

Nearly 24.9% of people in rural areas and 18.2% in the urban areas borrow money for hospitalisation. Almost 1% of both urban and rural populations sell their property for hospitalisation.

In this scenario, the decision to demonetise Rs 500 and Rs 1,000 notes, has wreaked havoc in the lives of those who seek healthcare, especially those who need emergency healthcare.

Under normal circumstances, the common practice among private doctors and hospitals is to insist on large sums of money as deposits before admitting or treating patients. Often, unsuspecting patients are charged hefty bills after treatment. Private medical facilities seem to have been continuing these exploitative practices in the middle of what is a monetary crisis for many families.

A doctor’s duties

As per the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations of 2002, a physician’s financial interests should not conflict with the medical interests of patients. The regulations also detail duties of physicians and their obligations to the sick.

“Though a physician is not bound to treat each and every person asking his services, he should not only be ever ready to respond to the calls of the sick and the injured, but should be mindful of the high character of his mission and the responsibility he discharges in the course of his professional duties. In his treatment, he should never forget that the health and the lives of those entrusted to his care depend on his skill and attention. A physician should endeavour to add to the comfort of the sick by making his visits at the hour indicated to the patients. A physician advising a patient to seek service of another physician is acceptable, however, in case of emergency a physician must treat the patient. No physician shall arbitrarily refuse treatment to a patient. However for good reason, when a patient is suffering from an ailment which is not within the range of experience of the treating physician, the physician may refuse treatment and refer the patient to another physician.”

In a landmark case that handled this question in 1989, Parmanand Katara an activist in Delhi, moved the courts when he was injured in a hit-and-run accident and then denied emergency treatment in a private hospital. The judgment held that every doctor, whether from a government facility or otherwise, “has professional obligation to extend his services with due expertise for protecting life”.

In 2006, the Bombay High Court pronounced that hospitals registered with the Charity Commissioner should offer 10% of their beds free of cost to the poor. These hospitals may not deny life-saving medical care until a patient has been stabilised. The hospital may not ask for deposits while admitting emergency cases. These hospitals had received land grants from the government for building their hospitals at concessional rates.

Even though there is an ethical code, however poorly followed, for physicians, there are no guidelines for other healthcare providers such as ambulance operators and pharmacists.

Band-aid from the government?

In the past week, little has been done by the government to ensure that private healthcare facilities do not deny healthcare to those in need. When Scroll.in asked Dr Jagdish Prasad, director-general of health services, if there were any plans to have a redressal system for conflict resolution in cases where emergency healthcare is denied, he said, “One hospital has given an undertaking that they will not stop surgeries if the patient does not have legal tender.” Prasad would not comment on whether there was a larger plan to private facilities provide emergency care.

Maharashtra seems to have acknowledged the problem but has not found a feasible solution for it. Chief Minister Devendra Fadnavis has asked private hospitals to accept cheques from patients who do not have the valid currency notes. But most people in emergency situations, especially those from low-income groups, are unlikely to be carrying cheques. The state health department helplines, set up to resolve complaints of payment difficulties, have been flooded with calls from patients and their relatives who do not have cheque books.

The onus to ensure that lives are not lost in medical emergencies lies with doctors in the private and public sectors as well as with the government, which must ensure that a drastic step aimed at cleaning up the economy does not take a toll in lives.