Guidelines for provision of free treatment facilities to patients of EWS category in private hospitals in pursuance of directions issued by the

Honble High Court of Delhi in WP ( C) no 2866/2002 in the matter of Social Jurist Vs GNCT Delhi Background: In the past DDA and Land & Development Office of Govt of India had allotted land to the registered societies and trust on concessional rates (predetermined and zonal variant rates) for establishment of hospitals and also stipulated the conditions that they would provide certain percentage of beds in the hospitals free for the poor /indigent category patients. Similarly in the OPD, it was stipulated that free treatment has to be provided to the patients belonging to the indigent category. These hospitals came into functional stages during different times and had the conditions varying from 10% of free beds in the IPD to 70% IPD beds in some of the cases, however in most of the cases it was 25% free IPD beds. There are some hospitals in which earlier there were no conditions imposed but the same were imposed later on and still there are some other hospitals where no conditions have been imposed by the land allotting agencies at all. Due to lack of proper guidelines for providing free treatment, and also there being no proper criteria of eligibility as who would be considered poor, and what constitutes the freeships on the free beds, and also due to unwillingness on the part of some private hospitals, it was not being implemented in a proper way, despite the government doing its best efforts. The govt. constituted different committees in the past in order to find out a solution to the problems being encountered by the private hospitals while giving free treatment and also the problems being faced by the govt. A high power committee under the chairmanship of Justice AS Qureshi was also constituted in the year 2000 and the recommendations made by the said committee regarding the conditions that there should be 10% free beds in the IPD and 25% of the patients in the OPD should be provided free treatment. It was also recommended that the conditions should be uniform and applicable to all the allottees with or without having conditions and the free treatment should be totally free. Delhi Govt found these recommendations reasonable and accepted the same and intimated the concerned land allotting agencies, to solve this whole gamut of problems. A lawyers Group filed a PIL writ petition being WP(C) No. 2866/2002 praying that conditions of allotment of land to hospitals, particularly in regard to free treatment to the poor and indigent persons are not being complied with. During the course of hearing of the said case the interim directions passed by the Honble High Court from time to time were implemented. Present situation Now in the aforementioned PIL, the Honble High Court of Delhi has pronounced the final judgment on 22.3.2007 and has taken into consideration the acceptance of report of Justice Qureshi Committee with regard to the recommendations that 10 % of total beds in the IPD should be free for poor and 25% of patients in the OPD should obtain free treatment. The court had considered the details of 20 such private hospital allottes during the hearings and directed that all other hospitals identically situated shall

strictly comply with the term of free treatment to indigent /poor persons of Delhi i.e 25% OPD and 10% IPD patients completely free of charges in all respects. The court had earlier also observed that only poorer and poorer categories of patients go to general public hospitals ,and they do not go to the private hospitals due to which the earmarked beds in the private hospitals remain unoccupied. Therefore the govt hospitals should refer the poor patients to the private hospitals where the requisite facilities are available. In pursuance of the said order and in order to implement the directions passed in the aforesaid case , the Pr. Secretary (H) GNCT Delhi called a meeting on 3.4.2007 with Additional Secretary Health, Medical Superintendents of Large Govt. Hospitals of differemnt agencies in Delhi . , Director Of Health Services, Delhi Govt , the concerned officers of DHS dealing with the issues pertaining to private hospitals, and the Govt Counsel Ms Zubeda Begum who represented the case on behalf of Delhi Govt. and the petitioner Sh Ashok Aggarwal advocate of Delhi High Court. After detailed discussions in the said meeting and the decision taken in the previous meetings convened in pursuance of the interim directions passed by the court from time to time , it was decided that guidelines should be issued to all private hospitals and govt hospitals in the light of the directions passed in the aforesaid court matter in particular to the referral of poor /EWS patients from Govt Hospitals to private hospitals. The details of the Judgment are available on Delhi High Court website and have also been made available at Delhi Govt website at www.delhigov.nic.in, may please be referred to if required. In the background of above, the following guidelines are being issued for all the private hospitals & govt hospitals functioning under the control of Central Govt, Delhi Govt, MCD, NDMC, AIIMS, IHBAS etc which are available for general population and Railways, ESI, Cantt. Hospitals etc.where besides their employees covered under their scheme, in case patients of general population are also being extended facilities by them and they find the eligible persons needing treatment in private hospitals. The guidelines framed in this regard are as below: (A) FOR PRIVATE HOSPITALS 1. The conditions of free patient treatment shall be 25% of patients for OPD and 10% of beds in the IPD for free treatment. This percentage of patients will not be liable to pay any expenses in the hospital for admission, bed, medication, treatment, surgery facility, nursing facility, consumables and non consumables etc. 2. The hospital charging any money shall be liable for action under the law and it would be treated as violation of the orders of the court. The Director/M.S./member of the trust or the society running the hospital shall be personally liable in the event of breach /default. 3. The hospital shall maintain the records which would reflect the name of the patient, fathers/husbands name , residence, name of the disease suffering from, details of expenses incurred on treatment , the facilities provided, identification of the patient as poor and its verification done by the hospital .

4. The hospital shall also maintain details of reference from govt hospital and the reports submitted by the private hospital to govt hospital in the form of feedback of treatment provided to the patient. 5. The records so maintained shall have to be produced to the Inspection team consisting of Sh Ashok Aggarwal . Ms Maninder Acharya and the MS of Dr RML Hospital , as and when required for its verification and quarterly details should have to be sent to DHS after expiry of three months within first week of 4th month. 6. The details shall have also to be made available to the monitoring committee constituted by Delhi Govt also as and when required. 7. Every private hospital shall have to establish a referral centre/desk functional round the clock, where the patients referred from Govt hospital would be able to report. The referral desk shall be managed by a nodal responsible person whose name , telephone , e-mail address and fax number is to be sent to the Govt Hospitals ,DHS and should be prominently displayed. The hospital shall also display the facilities available at the hospital and the daily position of availability of free beds quota, so that the patients coming directly to the hospital would know the position in advance. 8. In case of any change in the nodal person , the same should also be intimated within 24 hours to Govt Hospitals and DHS, the list of which shall be provided shortly. 9. The establishment of referral desk should be ensured within two weeks of pronouncement of judgment and the Director of the hospital shall be personally liable in the event of default.

10. The hospital shall send daily information of availability of free beds to this directorate twice a day between 9 AM -9.30 AM and at 5PM -5.30PM on all working days .and also to the concerned nearby govt. hospital to which the private hospital is proposed to be linked for general and for specialized purposes. The details of geographical linkage, the telephone numbers/fax numbers and the name of the nodal officer of govt hospitals shall be intimated shortly. In case no information is received with in the stipulate time from the private hospitals then it shall be presumed that the beds are available in private hospitals and the patient referred shall be accommodated. 11. The patient referred by Govt. hospitals/or directly reporting to the private hospital shall be admitted if required, and treat him totally free. As per courts directions, these patients shall not incur any expenditure for their entire treatment in the hospital. 12. After the discharge of such patients provided with the treatment, the hospital shall submit a report to the referring hospital with a copy to the DHS indicating therein the complete details of treatment provided and the expenditure incurred thereon. 13. The criteria of providing free treatment would be such person who has no income or has income below Rs 5000/- per month for the time being. 14. Besides admission of the patient referred from Govt Hospitals , the hospital shall also provide OPD/IPD/Casualty treatment free to the patients directly reporting to the private hospitals and would inform the nearest govt hospital and to the DHS within two days of his/her admission

15. The patients admitted in any other manner, not covered by the above guidelines shall not be entitled for claiming compliance of the conditions imposed. 16. Those hospitals which have the land allotted from the govt on concessional rates and have not yet completed the construction after taking possession shall be liable for not complying with the conditions and might be asked to repay to the authorities by a special committee constituted for this purpose. 17. The special committee referred above consists of Chief Secretary GNCT Delhi, The Finance Secretary GNCT Delhi and DHS GNCT Delhi and Medical superintendent of the govt hospital of that area, where the private hospital is situated and the said committee would work out the details of recovery of unwarranted profits. 18. As per directions of the court, all the 20 hospitals stated in the judgment and/or all other hospitals identically situated shall strictly comply with the term of free patient treatment to indigent/poor persons. 19. No benefits shall be applicable to such hospitals that had provided free treatment fully or partially in the past with the higher conditions as applicable for that time with regard to any set off of the expenses or otherwise on that ground. 20. The above revised conditions i.e 25% free OPD patients and 10% free IPD beds and treatment on these beds shall be prospective from the date of pronouncement of judgment in question. 21. Such hospitals which have not complied with the conditions at all and persist with the default, for them the conditions shall operate from the date their hospitals have become functional. 22. An Inspection Committee now constituted by the High Court consisting of Ms Maninder Acharya, advocate, Mr Ashok Aggarwal Advocates of Delhi High Court and Medical Superintendent of Dr RML Hospital , would also inspect any of the private hospitals. The inspection committee shall, have to be entertained and would be facilitated to carry out physical inspection of the hospital where the free treatment has been provided and would also be shown the records of having provided free treatment. The said committee has been given the liberty to revive the petition or for issuance of any directions from the court and wherever necessary for action against defaulters under the provision of Contempt of Court act read with Article 215 of the constitution of India.

(B)

FOR GOVT HOSPITALS

1. Every Govt. hospital shall create a special referral centre within two weeks of pronouncement of the said judgment, which shall be part of the casualty as well as the OPD. The Government hospitals shall intimate the establishment of the referral centre within one week of its establishment to DHS. 2. The referral centre shall have to be managed by a senior officer round the clock and shall have a dedicated phone no, the fax and also the e-mail facility

3. The patients having no income or income below Rs 5000/- per month shall be eligible for getting free treatment at the private hospitals. (now it has been modified to Rs.4000/- per family per month by the special committee vide order dated 2.11.2007) 4. For such eligible poor patients reporting to the casualty who needed immediate care and if it is found that the particular facilities are not available or the beds are not available and the patient need urgent care , such patients may be referred to the private hospitals where the requisite facilities are available. 5. Before referral, the patient shall have to be provided necessary treatment, and only after stabilization of his/her condition, he/she may be referred with proper life support, if required. 6. In case a decision has been taken by the treating doctor of the concerned department and the approval of the Professor/Senior doctor on duty to refer the particular poor patient to private hospital where the requisite facilities are available, has been obtained, the matter shall be referred to the nodal officer managing the special referral centre. 7. The nodal officer shall ensure that the Proforma I for referral in triplicate (i.e Proforma I-A to be retained by the referring hospital, , I-B to be handed over to the patient, and I-C to be provided to DHS) are filled properly and the Proforma II also has been filled by the eligible patient or by his/her nearest relative and the Discharge card containing the brief history of the treatment provided has been enclosed. 8. A Nodal officer shall also be designated at DHS who would be obtaining the details of beds available at the private hospitals twice a day, once in the morning between 9-9.30 AM and then in the evening between 5-5.30 PM on all working days and shall transmit the same to all the nodal officers appointed at govt hospitals . The private hospitals shall also be asked to send the availability of free beds to the govt hospitals directly in order to streamline the procedure in all the days.. 9. The nodal officer before finally shifting the patient shall make liaison with the nodal person at the concerned private hospital where such facilities are available regarding confirmation of availability of beds, and then shift the patient in the hospital ambulance. He would ensure that the proforma for referral and other enclosures are handed over to the patient, so as to cause minimum inconvenience to the patient/relative. 10. In case of a patient directly being admitted by the private hospital through its casualty , the private hospital shall be bound to intimate the DHS and the nearest govt hospital within two days of his/her admission. The nodal officer of the said govt hospital or any authorized officer of the concerned specialty for which the patient has been admitted shall be under obligation to visit the private hospital and verify the fact in regard to the genuineness of poverty of the person, the treatment provided to him, and the cost likely to be incurred by

the private hospital. He /She shall make record of his/her visit and send to DHS.

Note: If no information is received everyday in stipulated time the unrebuttal presumption will be that the beds are available for referred patients and the private hospital authority will be bound to receive and treat the patient irrespective of the vacancy. In case the same is not done serious consequences shall follow including contempt of order and judgment dated 22/3/2007 in WP(C ) No. 2866/2002.

XXX

UNDERTAKING I____________________________S/oD/oW/oSh.Smt. ____________________permanent R/o __________________________________________and presently residing at _______________ aged about _______ years do hereby solemnly affirms and declare that my monthly family income from all sources is less than Rs. 5000/- and the same may be subjected to verification. (now it

has been modified to Rs.4000/- per family per month by the special committee vide order dated 2.11.2007)

I have been informed that I shall be provided treatment against free beds facility at __________________________ Hospital, which I understand is available to only for the under privileged patients/poor patients. In case my above declaration is found to be false/or incorrect /suppressed by me in order to get free treatment, I would be liable to pay the entire cost of treatment and the Government/Hospital concerned would be at liberty to take legal/criminal action against me including recovery proceedings. I undertake to reimburse the amount spent on my treatment in case my declaration is found to be incorrect or false. Signature of Patient/Relative Thumb Impression Left Hand(in case of Male) Right Hand (in case of female) Name of Patient Relative

VERIFICATION Verified at Delhi on this ________ day of _____ 20___, that the contents are true and correct to my knowledge and nothing has been concealed. I I do hereby verify that the contents of the above declaration is true and correct to my knowledge. It conceals nothing and no part thereof is false . as signatory is responsible for all consequences entailing from the above declaration. Signature of Patient/Relative Thumb Impression Left Hand (in case of Male) Right Hand(in case of female) Name of Patient Relative

I would like to be treated in this very hospital with whatever facilities available here . I am not willing to be treated at a private hospital or referred to a private hospital. Patient/Relative Thumb Impression Left Hand Right Hand Name of Patient Relative

PROFORMA
Proforma I C (to be submitted to DHS, Govt. of Delhi along with proformsII)

PROFORMA FOR REFERRAL OF ECONOMINCALLY WEAKER PATIENTS FROM GOVT. HOSPITALS TO PVT. HOSPITALS AS PER DIRECTIONS IN PURSUANCE OF JUDGEMENT IN WP ( C) NO. 2866/2002 IN THE MATTER OF SOCIAL JURIST VS. GNCTD. OPD/IPD regn no. Name, age, Fathers/ sex of patient Husbands name Probable/ Permanent and present workable address with diagnosis tel. no. if any DOA ( admitted if Deptt./ concerned Enclosures

Referral proforma must be sent alongwith a brief treatment resumes of the patient. Name of the referring doctor.. Signature. Countersigned by HOD/ M.S.

Proforma I B (to be handed over to the patient alongwith proformsII)

PROFORMA FOR REFERRAL OF ECONOMINCALLY WEAKER PATIENTS FROM GOVT. HOSPITALS TO PVT. HOSPITALS AS PER DIRECTIONS IN PURSUANCE OF JUDGEMENT IN WP ( C) NO. 2866/2002 IN THE MATTER OF SOCIAL JURIST VS. GNCTD. OPD/IPD regn no. Name, age, Fathers/ sex of patient Husbands name Probable/ Permanent and present workable address with diagnosis tel. no. if any DOA ( admitted if Deptt./ concerned Enclosures

Referral proforma must be sent alongwith a brief treatment resume of the patient. Name of the referring doctor.. Signature. Countersigned by HOD/ M.S.

Proforma I A (to be retained by referring hospital alongwith proforma)

PROFORMA FOR REFERRAL OF ECONOMINCALLY WEAKER PATIENTS FROM GOVT. HOSPITALS TO PVT. HOSPITALS AS PER DIRECTIONS IN PURSUANCE OF JUDGEMENT IN WP ( C) NO. 2866/2002 IN THE MATTER OF SOCIAL JURIST VS. GNCTD. OPD/IPD regn no. Name, age, Fathers/ sex of patient Husbands name Probable/ Permanent and present workable address with diagnosis tel. no. if any DOA ( admitted if Deptt./ concerned Enclosures

Referral proforma must be sent alongwith a brief treatment resume of the patient. Name of the referring doctor.. Signature. Countersigned by HOD/ M.S.