Recently we visited a relative aged 89 years who was admitted to a private hospital in Surat. After two days of admission the doctor said his condition is critical and consent should be given to put him on a ventilator. Considering his age, various disabilities and the very poor chances of survival, the family said it is not keen on putting him on ventilator. However, the doctor and the hospital management are insisting that the family give consent. The management even said it won't issue a death certificate if the patient dies in the absence of the ventilator. What should the patient's family do?
What are the patient's and his family's rights and what are the duties of the doctors / hospitals in such a situation?
Shashank Parsanis, Malad (West)
The instance you have narrated is not uncommon. Some times doctors and hospital managements exploit the peculiar situation of the patients and their family members. There cannot be a better judge than the doctor. However, given the facts of your case the family does have the right to say 'no' to ventilator. It's the right of the patient and his family members. The doctor and hospital cannot coerce the family to give consent. In fact, 'informed consent' means that the doctor should explain to the family the pros and cons of the situation. While explaining this, the doctor should consciously refrain from scaring or misleading the family.
The patient and his relatives have a right to refuse any medical treatment, if they so desire. However, in such a case they should assume the risk that may arise (including, of course, death) and accordingly indemnify the doctor / hospital in writing, in such cases. Indiscriminate use of ventilator without proper informed consent is a known medical malpractice. Such malpractice is actionable in law. In your case the doctor went to the extent of informing you that they won't issue the death certificate. This is highly objectionable and inhuman. It's a grave actionable offence and gross professional misconduct. If you are in a position to prove this, you should complain to the state medical council.
It is often noticed that the medicines / injections obtained by the hospitals for their patients from the hospital chemist are billed at exorbitant rates. Same medicines/injections are available at nearby chemists at much discounted rates. In fact, since hospitals are buying these medicines / injections often in bulk, they should pass on this discount to the patients. Where should one complain against such practice?
Suhas Vichare, Dombivali
Your complaint is general. Nonetheless many of us have experienced such situations. In case of a specific instance of overcharging, the patient or his family will have to produce adequate evidence to prove the allegation. Very often, the MRP of the medicines is wilfully kept high by the manufacturers and the discounts offered to consumers at various shops do vary from 5% to as high as even 70-80%. The hospitals do get the best possible discounts but never pass on the same to the patients or at the most pass on some nominal discounts.
I do recall a case a few years ago when the Maharashtra State Consumer Commission had confirmed an order of the Pune District Commission directing a reputed hospital to refund Rs1.5 lakh so over-charged by the hospital, which had insisted that the patient buy only from the hospital chemist. The commission has not only held this practice as an unfair trade practice but also permanently restrained the hospital from adopting such practice in future.
(The author is the chairman of the Mumbai Grahak Panchayat)
