In the year 2002, several important amendments were made in the Consumer Protection Act (CPA). One of these amendments was section 14(1)(hb). To explain the importance of this section, let me illustrate a case Vishnu Priya Giri Vs The Principal Health Secretary, Health and Family Welfare Development & Ors. decided by Delhi States Consumer Disputes Redressal Forum (SCDRF) (order in 2016).
In this case, the patient, a lady, was diagnosed with mucocele of gall bladder and Mirizzi's syndrome on MRI. The patient consulted a surgeon who operated (Laparoscopic cholecystectomy with CBD exploration, along with laparoscopic assisted vaginal hysterectomy with bilateral salpino-oophorectomy was claimed to have been performed) upon her in a Central Government Health Scheme (CGHS)-empanelled hospital. The circumstances which arose subsequently (patient was later diagnosed with metastatic carcinoma of gall bladder, leading ultimately to demise within two years of surgery), resulted in the patient filing a complaint against the doctor and the hospital, first with the Directorate of Health, NCT of Delhi and the Delhi Medical Council. Delhi Medical Council found the doctor guilty of negligence and malpractice, and also remarked about the hospital being deficient in service. The doctor appealed against this to the Medical Council of India, which also pronounced the doctor guilty. Subsequently, the patient filed a case in SCDRF, New Delhi, which, found the doctor and the hospital negligent on following grounds -
--Not taking a separate informed consent for Laparoscopic assisted vaginal hysterectomy with bilateral salpino-oophorectomy.
--Performing common bile duct exploration without consent.
--Not actually performing oophorectomy but billing for the same under CGHS (Ovaries were seen on a post-operative MRI scan performed subsequently).
--No consent and records to prove that laparoscopic small bowel resection was additionally performed, but the same was billed under CGHS (It was claimed that salpingo-oophorectomy and small bowel resection were mentioned in the bill only so that patient could claim the same under CGHS scheme, since the package did not provide for CBD exploration).
--No records to prove that the gall bladder specimen had been sent for histopathological examination.
The SCDRF awarded a compensation of Rs. 50,00,000 along with interest of 9% per annum (for almost ten years) to be paid jointly and severally by the hospital and the doctor. In addition, the SCDRF said that since the hospital was found guilty of fraudulent practices in this case, it was very likely that the hospital may have engaged in similar practice of raising fraudulent bills for many other patients. Hence, the consumer forum ordered the hospital to deposit Rs. 1,00,00,000 in the State Consumer Welfare Fund, in accordance with section 14(1)(hb) of the Consumer Protection Act which provides for a penalty towards causing injury to a large number of other consumers who may not be identifiable and may not have approached the consumer forum.
There are lessons to be learnt from this case -
1. Doctors should never mention any surgery or procedure in the bill if that surgery or procedure has not been performed. Even if a doctor does so with the intention to help a patient claim money form an insurer / government, it would be deemed squarely unethical and illegal.
2. Doctors are well advised to keep records of samples sent for histopathological examination, and pursue and record the histopathological reports diligently. It is always better to perform histopathology on specimens / organs removed during surgery, unless the patient refuses for the same in writing.
3. Courts can award compensation towards:
--Expenditure incurred by the patient for further treatment
--Costs of litigation
--Penalty for causing injury or deceiving a large number of consumers who may have suffered similarly, under section 14(1)(hb) of the Consumer Protection Act, as has been done in the above-described case. Thus, doctors and hospitals may end up paying huge penalties if they are not diligent in patient management and record-keeping.
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