Can emergent care be denied to a hospitalized patient if he cannot afford?

Quite often we see that a patient is being told by a hospital, especially in cases of coronary blockages, that your blockages are severe enough to be tackled immediately. You need a bypass or stenting without delay and any second opinion, transfer to another Centre will be at your risk.

In this way, they force the patient to get a surgery or an intervention done there and then irrespective of whether the patient can afford or not.

I recently saw a patient where the hospital did stenting without giving any time to relatives to think. They collected 2.8 lakhs, but the bill handed over amounted to Rs 5 lakhs.

What can be done in such cases?

I feel any emergency must be tackled by the hospital and if the patient cannot afford, then the hospital needs to provide free and safe transfer to another hospital or do a free intervention.

Many Supreme Court decisions have made it clear that in a life-threatening emergency the hospital cannot wash its hands off the situation and will need to provide emergent treatment (free if the patient cannot afford).

The emergent situation does not mean a patient in the ER but also means hospitalized patients, who develop an emergency during their hospital stay.

Emergency is a life-threatening condition, which requires immediate action; it’s not the same as urgency, which requires urgent care, but where you have time to decide.

Debate

·         This is a  common situation not only for coronary but also for so many medical situations. Issues bothering the patient would be: Do I really need stent as advised by a doctor; do I have time enough for the second opinion, can I afford it? I think in most cases there is adequate time for patient to have a second opinion, so attending physician must guide the patient properly. In life-saving and urgent situations, decision has to be taken on a case to case basis. Do whatever you can do, but patient should not die due to want of money. Dr Arun Gupta MD, President, Delhi Medical Council

·         I agree with you. The option to get treated elsewhere or redirected to a hospital where the treatment can be afforded by the patient e.g. a lower star facility or public healthcare facility, after understanding the paying capacity of patient needs to be politely explained to patient and courtesy ambulance provided after initial assessment and first aid and basic medical management. Forceful medical care being opted for a patient by some corporate hospitals for those who don’t have the buying power to avail that treatment in lakhs leads to ugly situations of non-payment, violence and breeding lack of trust with the historically respected medical profession. A defined code for urgency differentiated from a medical emergency and opting to treat these few patients under emergency under an insurance or Ayushman Scheme will ensure that the hospital gets some level of reimbursement and it’s not total cost is borne by the hospital for humanitarian treatment of some emergency cases. Rajiv Nath, Forum Coordinator, AiMeD 

·         The only solution is to bring all health care under the Clinical Establishment Act. Dr Jagdish Prasad, Professor (Cardiac Surgery), Director General of Health Services

·         In safe transfer, what is safe or really safe in all situations? The patient might become a shuttle cock between govt. hospitals and eventually die on road. Govt has to spend more money to treat all patients in govt. hospitals then it reimburses the private hospitals and patient gets timely attention. So "treat and not transfer" should be the policy but this can only be sustained by reasonable and timely hassle-free reimbursement. Dr Kamal Parwal

·         In some countries, such emergencies are immediately tackled and if the patient is very poor then the hospital subsidies it out of its fund....In India too, we must ask our hospitals to earmark some funds for this purpose (though most poor must be covered by HI in which case they should draw the amount from the HI agency and pay for the rest) ...and only after fully stable should or can they transfer for follow up to a more affordable centre as chosen by the patient.  Several systems like these need to be thought through and worked out. I am not sure what the NHA is doing in this regard. But it’s a major problem and needs attention. Sujatha Rao

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA