Jayant Singh from Delhi and Gopendra Singh Parmar from Rajasthan, are not related. But they now share a brotherhood – last year, both their seven year-old children died from severe dengue after treatment in private hospitals in Gurgaon, with bills of nearly Rs 16 lakh each.
It is not uncommon for families to feel aggrieved by private hospitals in India. The awareness of the shrewd practices of these big corporate hospitals has risen over the last two years, as the government has been regulating their prices and practices. Families usually cut their losses, both familial and financial, and try to get on with life.
Normally, it is uncommon for families to fight back. And that is what these two fathers have been doing, both in their personal cases, and in supporting each other.
When Jayant Singh’s seven year-old daughter Adya Singh died last September, it might have been just another “routine” death for Fortis Hospital in Gurgaon, more so since dengue is an annual occurrence. But an anonymous Twitter account with the name DopeFloat, began to post a string of tweets along with photos of Jayant’s bills from Fortis hospital in November – his little girl died from dengue shock syndrome after being in Fortis for several days. The family was given a bill of nearly Rs 16 lakh. Jayant’s sister-in-law also posted on Facebook. The two posts were shared over 40,000 times. The media swarmed and Jayant was on national television for many nights after that.
The health minister, JP Nadda, himself took cognisance of DopeFloat’s tweet. “Please provide me details on hfwminister@gov.in. We will take all the necessary action,” he tweeted.
Please provide me details on hfwminister@gov.in .We will take all the necessary action. https://t.co/dq273L66cK
— Jagat Prakash Nadda (@JPNadda) November 20, 2017
And they did take action- The government, usually slothful and unconcerned to even issue clarifications on important issues, began activating its machinery to probe the death of Jayant’s seven-year-old daughter.
In December, another family went through a similar tragedy. Gopendra Singh Parmar, a resident of a small town in Rajasthan, took his seven-year-old son to Medanta Hospital in Gurgaon. The boy had dengue as well. He died after days of treatment at the hospital and the family was also handed a bill of nearly Rs 16 lakh.
The two families are currently grieving very similar tragedies, but they have had very different outcomes from it. While the fathers have been united in their pursuit for justice, coming together to hold press conferences and demand action, events this year have shown just how differently the system can work for people in India.
Medanta Hospital pays off bereaved father, Gopendra, if he withdraws his criminal case against them.
He did.
Rs15lak+ was the price for Medanta’s impunity.
Gopendra’s son Shourya died last yr with a bill of Rs 15lak+. pic.twitter.com/5dNvVzIksG— Anoo Bhuyan (@AnooBhu) March 29, 2018
On the one hand, Jayant has just had a writ petition admitted in the Supreme Court which is calling for wider reforms. The Haryana police has reluctantly begun a criminal investigation in the case after the state government itself filed an FIR. None of this was easy for Jayant, but with persistence, support and knowledge, he has been pushing the system open.
On the other hand, there is Gopendra – even four months after he wrote an eight page complaint to the Haryana police, they have not filed an FIR. Now he says he cannot.
As The Wire reported last week, a letter from the union health minister’s office was sent to Medanta asking them to refund his money. Medanta did, but they used their upper hand to silence Gopendra. He says he signed a letter saying he would withdraw his police complaint in exchange for Rs 15.6 lakh. Gopendra told The Wire, “If we had pursued a legal case, we would have been living on the street.” He has now taken the money and withdrawn his police complaint.
Similar yet different tragedies
When tragedy hit Jayant, he mustered the strength to speak up and oppose what happened with his family. It was not easy, but the media was on his side. The central and state governments made some public statements of acting on his case, but Jayant said the real process he underwent was, in fact, harassment. But Jayant had an understanding corporate job which allowed him time off and had access to top lawyers who prepared him for what lay ahead.
Gopendra said he was not even planning to go to Medanta Hospital that fateful day when the tragedy struck. He had, in fact, taken his son to the district hospital in Dholpur, Rajasthan. “If the district hospitals had decent facilities, we would not have had to financially drain ourselves out in Medanta,” he says.
When the district hospital was found to be lacking, Gopendra got into an ambulance to head to Ram Manohar Lohia Hospital in Delhi. On the way, the ambulance driver kept telling Gopendra, that Medanta hospital in Gurgaon was much closer and easier and that he should instead take his son there. So he did.
Gopendra and his family live in Dholpur, a small town in Rajasthan. Rajasthan’s chief minister Vasundhara Raje is considered the ‘bahu’ (daugther-in-law) of Dholpur, as her husband is from this town.
Gopendra often says he is not ‘paddhe-likhe’ (not educated). In good faith, he wrote to authorities all over the country, including the prime minister, hoping that they might actually pick up his letter among hundreds, and help him. With his meagre educational background, he works as a life insurance agent. It is not predictable income for him, and he depends on commissions he can wrangle for himself.
Over the last few months, Jayant and Gopendra have begun working together and supporting each other. They have both pursued different tracks to justice but with the same end goal in mind – fixing some of the big ills of Indian healthcare.
A hospital accused of medical negligence
The protocol in India for medical negligence allegations is that a “committee of peers” has to first conduct a preliminary inquiry, with members of the accused hospital as well as external doctors, including a government doctor. This committee examines the line of treatment which was administered to the patient and takes a call on if a case of medical negligence can be made out.
This committee of peers is crucial and powerful to the process. Their report can in fact determine if a criminal case can be made. Police is usually reluctant to file FIRs until their report is published and greenlights the possibility of medical negligence.
Patients and their families can choose either criminal or civil recourse. If they choose the civil route, families hope for compensation from consumer courts. With a criminal case, victims can hope for imprisonment of the convicted for up to two years.
The System and the fathers
In Jayant’s case, the committee was not promptly formed. When they finally submitted their first report, he was unhappy with it. The case was the centre of media attention for days and Haryana’s health minister made loud statements regularly. Vij called for the committee to rewrite the report. He flamboyantly told the press, “It was murder” and that Fortis Hospital should be removed from the government’s list of empaneled hospitals.
When the committee submitted its report again, it was nearly 50 pages long with at least 40000 pages of annexures, says Jayant.
Gopendra’s experience with this preliminary medical committee was very different from Jayant’s.
When the report for Gopendra’s son finally came out, it was a flimsy three page long document. And it had nothing substantial to say to Medanta, even though it found deficiencies which were similar to Jayant’s case.
“In my case, Fortis doctors and administrative staff were never in the room when I was giving my statements. In Gopendra’s case, Medanta’s staff themselves were there while he deposed, which would have been intimidating for him. I had the opportunity to speak to lawyers and understand the process well. Gopendra was practically on his own,” says Jayant.
But when Jayant tried to get his own report from the committee, they refused. They told him to file an RTI to access it. When he went to the police to file an FIR, now that a prima facie case of medical negligence had been made out, they too refused, saying they could not get the report from the committee, and he would have to get it himself through RTI and give it to the police.
Fortis “disposes off (sic) the patients in unethical manner” said the four-member committee on Jayant’s daughter’s death. The Wire reported this in December. They also recommended that his case was fit for action against the doctors, by the Medical Council of India. Jayant had told the committee that Fortis had refused to give them an ambulance to take their baby home and the committee said that hospitals cannot disown families in these circumstances.
The six-member committee in Gopendra’s case said they found “no medical negligence done in the treatment and care” of his son at Medanta. But they said that Medanta had not provided detailed bills to the family, had overcharged the family at the blood bank and for a number of drugs and had also not provided an ambulance for them to take their child out of the hospital. Just before the committee submitted their report, the National Pharmaceutical Pricing Authority (NPPA) analysed four bills including Jayant’s and Gopendra’s and came out with startling facts: private hospitals were marking up prices by as much as 1737% on just these four bills studied. The committee did not acknowledge the NPPA’s report at all.
With these committee reports being so key in moving along the legal process, where even the police won’t act until the committee completes their inquiry, Gopendra’s hopes for legal resolution were waning. The three-page report did nothing to reassure him of the path ahead.
Gopendra applied through RTI to get the documents which Medanta had given to the NPPA for their analysis of the four bills. The NPPA rejected his request saying that Medanta’s information on Gopendra’s case was “confidential and sensitive” in nature.
There were other actors who also pushed along Jayant’s case. As The Wire reported, the central health secretary herself wrote to the Haryana government, asking them to investigate both the issues of negligence and overcharging. She said the government would need to take “exemplary action.” Six days later, she again wrote to all states asking them to get a move on implementing the Clinical Establishments Act, which provides mechanisms to regulate the prices of private hospitals.
Gopendra got on overnight buses, shuttling between Delhi and Dholpur as he tried to lodge letters in different government departments. The Wire reviewed letters which Gopendra sent to the following officials: Prime Minister Narendra Modi, Union health minister JP Nadda, Union minister for women and child development Maneka Gandhi, chief minister of Haryana Manohar Lal Khattar, central government health secretary Preeti Sudan and health minister of Haryana Anil Vij. Maneka Gandhi’s ministry forwarded his letter to the National Commission for Protection of Child Rights who forwarded his letter all the way back to the Union health ministry.
The road ahead
Neither Medanta nor the health ministry has replied to calls and emails from The Wire, about their brokering of the refund to Gopendra. While the health ministry engaged in a highly arbitrary action, asking for Medanta to favour just this one family with a refund, Medanta used the opportunity to hush Gopendra up completely and kill his criminal complaint against them. For now and in this case, the hospital appears to have succeeded.
“I had never been asking for money. That’s why I had been trying to file a case in the police station and wasn’t chasing money. But after the health ministry itself got involved, I did not know what to do,” says Gopendra.
“If they had not offered this money, I would have kept fighting to pursue my case with the police,” he says. He says he will continue to be part of the community pushing for institutional change, but not in his own case.
Gopendra lost his son, lost his money, and has not been working for months while pursuing his son’s case. His wife has been mentally disturbed, initially taking medication for her mental health but has discontinued since. The couple has another son. “Sometimes he says he will fly into heaven and bring his brother back,” says Gopendra.
Jayant and his wife are also working towards stabilising their family. Their daughter Adya is survived by her twin sister.
Jayant is waiting for a hearing of his writ petition in the Supreme Court. His petition asks for the government to set up a tribunal that can appropriately look into medical negligence. He is also asking the government to set up a fund of Rs 100 crore for free medical care to children from economically weak sections of society and for the court to look into ways to break the nexus between hospitals, health professionals, diagnostic labs and pharmaceutical companies.
Led by these two bereaved fathers, the healthcare scene in India could be preparing for a critical turning point.