A commission observed that even though a doctor and his wife's test results were negative, the hospital still administered treatment.
Published Jan 15, 2024 | 8:00 AM ⚊ Updated Jan 15, 2024 | 8:00 AM
Testing plays a crucial role in identifying and tracking the prevalence of COVID-19 variants within a community at an early stage.(Creative Commons)
During the Covid-19 pandemic, if a patient exhibited symptoms suggestive of the virus and sought treatment, some hospitals went ahead with treatment despite a negative test result — and billed them for it.
However, Prathima Hospitals in Hyderabad took it to a different level, leading the local District Consumer Disputes Redressal Commission to order it to compensate a doctor and his wife ₹1.5 lakh.
The compensation was for the hospital overcharging them during the treatment of suspected Covid-19 pneumonia.
The commission observed that even though the doctor’s Covid-19 test results were negative, the hospital administered treatment, leading to unjustifiable costs.
The doctor and his wife filed two separate cases against the hospital, and the commission ruled in favour of the couple in both instances.
The court highlighted that the hospital violated Government Order (GO) 248 issued by the Telangana Health Department, which specified the maximum allowable charges for Covid-19 treatment.
Upon reviewing their grievances, the commission mandated that the hospital provide ₹1 lakh in compensation to the doctor and ₹50,000 to his wife.
Additionally, the hospital has been instructed to cover the ₹15,000 litigation costs for each complainant.
The case is from 2020, when Ganji Mallaiah, a resident of Gajwel in the Siddipet district and a practising doctor, experienced symptoms of fever and headache.
Despite testing negative for Covid-19 through a Reverse Transcription Polymerase Chain Reaction (RT-PCR) test on 23 June, 2020, Mallaiah — as a precautionary measure — sought consultation at Prathima Hospitals in Hyderabad on 29 June, accompanied by his wife Ganji Sukanya.
In separate complaints, the couple alleged that the hospital administered them Covid-19 treatment without justification.
Both were admitted as in-patients, with the doctor incurring a treatment cost of ₹4.76 lakh while his wife was billed ₹2.67 lakh. Both were discharged on 6 July.
The complainants claimed that the hospital charged an exorbitant amount, violating the guidelines outlined in GO Rt No 248 issued by the Telangana government.
They argued that government guidelines suggested asymptomatic and mild cases didn’t require hospitalisation, and instead recommended home isolation.
However, the hospital allegedly admitted the complainants contrary to these guidelines, violating both state and national directives, they alleged.
The complainants emphasised that the unnecessary hospitalisation caused distress, instilling fear amid the pandemic’s severe consequences.
The case underscored concerns about adherence to protocols and fair medical practices during the Covid-19 crisis.
Meanwhile, the hospital contended that despite the complaining doctor testing negative for Covid-19, a CORADS-5 score indicated a high suspicion of typical viral pneumonia.
Citing the complainant’s comorbid conditions, the hospital asserted that admission and treatment followed established medical protocols. They emphasised the patient’s right to refuse treatment at any stage if dissatisfied.
The hospital also argued that the complainant was well-informed about individual hospital tariffs, asserting that the GO in question did not apply as the complainant had chosen an air-conditioned deluxe sharing room.
They further claimed that the treatment focused on pneumonia, high blood sugar, and other comorbidities, not exclusively on Covid-19.
The hospital maintained strict adherence to its tariff, contending that the complainant did not raise objections.
Consequently, they refuted claims of deficient service and unfair trade practices, urging the dismissal of the complaint.
Similar arguments were presented concerning the separate plea filed by the doctor’s wife. The hospital’s stance revolves around justifying its actions based on medical necessity, adherence to established protocols, and the patient’s awareness of associated costs.
In its deliberation, the consumer court scrutinised pertinent sections of the discharge summary. For the complainant doctor, the court observed that the final diagnosis indicated suspected Covid pneumonia.
The document highlighted that the High-Resolution Computed Tomography (HRCT) scan exhibited a high suspicion for Covid-19 (CORADS-5) as per the RT-PCR test.
Regarding the doctor’s wife, the discharge summary outlined chief complaints such as loss of appetite, mild shortness of breath, and a history of fever. The provisional diagnosis recorded for her was suspected Covid-19.
These findings from the discharge summaries played a crucial role in the court’s consideration, shedding light on the medical assessments and diagnoses made during the complainants’ hospitalisation.
After perusing the documentary evidence, the commission noted that:
“It is also clear from the discharge summary that the opposite party, despite there being a negative result, treated the complainant for ‘suspected covid pneumonia’ with the reason that reports showed CORADS-5. When the final diagnosis included ‘suspected covid pneumonia’, not adhering to the ceiling rates as mentioned in GO Rt No 248 (Ex.A10-Ex.B5) amounted to the adoption of unfair trade practice on the part of the opposite party.”
It added: “In the present case, the opposite party, on one hand, submitted that the test reports of the complainant showed CORADS-5 and on the other hand, they submitted that the GO Rt No 248 was not applicable as the complainant received treatment for comorbid conditions. When the complainant’s HRCT report showed high suspicion for Covid-19 (CORADS-5), the opposite party failed to explain how & why GO Rt No 248 was not applicable,” the consumer court further noted.
Nonetheless, the consumer court noted that the complainants did not sufficiently demonstrate their entitlement to the refund amounts of ₹4,48,794 and ₹1,24,825. Consequently, the court awarded a lump-sum compensation of ₹1 lakh to the doctor and a monetary compensation of ₹50,000 to his wife.
In addition to the compensation, the hospital was directed to bear the litigation costs, amounting to ₹15,000 each for both the doctor and his wife.
