Unpaid bills leads to death of patient in Christian hospital in Kolkata

Unpaid bills led to a Christian hospital in Kolkata, West Bengal, denying further treatment to a patient who died soon thereafter, raising concerns of medical ethics practised nationwide.

According to local daily The Telegraph, Patrick Cranston, 57, passed away at 1.45 am, April 21, at Mission of Mercy Hospital — formerly Assembly of God Church Hospital — in Park Street, Kolkata, less than 24 hours after its authorities asked medical staff to stop his treatment and medicine supply as his dues had not been cleared.

He was admitted to the ICCU in extremely serious condition on April 18 afternoon after he suffered a stroke.

Cranston was suffering from diabetes, cardiac disorder and a host of other ailments.

On April 20, the hospital authorities sent a note to the ICCU sister–in–charge, asking her to stop all services to Cranston. The reason: his treatment dues were "much higher than the stipulated norms of the hospital."

According to the hospital's rules, services to a patient have to be stopped if the dues run up are anything above Rs. 5,000 (about $110). Cranston owed the hospital Rs. 24,000 (about $533).

The note signed by Mariamma George, assistant to medical administrator Jatrik Biswas, said "Please stop all services and indenting medicine for bed no. ICCU 2 — Patrick Cranston from now onwards until further intimations."

A doctor said the sister–in–charge was "horrified" when she got the note. "She is a human being and cannot stop services to such an ailing patient," the doctor said.

But with the pharmacy stopping supplies, there was little the doctors could do. As Cranston started sinking, they began gathering free medical samples and injections to revive him but to no avail.

Cranston, a former employee of Shipping Corporation of India, was a resident of Picnic Garden Road. He was brought to hospital by his niece, Andrea Walsh, who stays in the same building.

"I heard screams from his apartment and rushed in. He used to live alone and the door was ajar. I saw him frothing at his mouth and he was stiff. I immediately took him to hospital," she said.

A doctor said Cranston had high blood sugar and was comatose when he was admitted.

"Later, we found he was suffering from meningitis. There was also a possibility of encephalitis but we could not establish it as we don't have MRI facility and the patient wasn't in a condition to be taken away."

State Health Minister Surjya Kanta Mishra said an inquiry would be started after a formal complaint was lodged.

"Earlier, we have cancelled the licence of medical institutes guilty of negligence," he said.

Police said the family had not lodged any formal complaint. "We are still to receive the original copy of the note. We are not doctors, so we can't comment," said Ajoy Kumar, DC (south).

Though Cranston's family has not filed any official complaint, his death on Saturday has brought the issue of patients' rights to the centre stage.

"Once a patient is accepted by a hospital on its premises, it has to treat the patient," asserted Ajay Kumar, national president of the Indian Medical Association.

"We keep getting complaints against private hospitals for harassing patients because they can't pay bills and overcharging," said Amitabha Bhattacharya, the secretary of the Indian Medical Association's Bengal branch.

Citing Cranston's death due to medical negligence, Bhattacharya said, "If it has happened, the state health department must intervene."

Kunal Saha, president of People for Better Treatment, a healthcare rights body, said the way Cranston was treated is "legally, morally and ethically wrong and against the Medical Council of India code of ethics and regulations."

Amit De, who heads the Association of Hospitals of Eastern India, said, "This kind of thing normally does not happen. We will find out what exactly took place.... Authorities of private hospitals have to run the establishments and so they have to charge patients. But if a patient cannot pay, we normally grant concessions."

The hospital's doctors have denounced the decision to stop treatment. They have threatened to quit if the hospital does not assure them such incidents will not be repeated.

Meanwhile, at Mission of Mercy, a showcause has been slapped on Mariamma George, assistant to medical administrator J. Biswas, for issuing the note which led to 'miscommunication.'

According to Biswas, Cranston's treatment was not stopped. "Only the direct supply of medicine from the pharmacy was stopped," he said, adding that emergency medicine was given to Cranston from the stock maintained in the ward.

Biswas said there had been "a mistake" in the note. "Instead of 'all non–emergency services,' it was mistakenly written 'all services' in the note," he said.

Cranston's death has also exposed the darker side of healthcare in private hospitals. From over–billing to unexplained demand for deposits, the complaints against private hospitals keep on growing.

In a recent case at a multi–speciality hospital in south Calcutta, the relatives of an elderly patient had lodged an FIR with the local police station, accusing the hospital of slapping an inflated bill and forcibly keeping the patient even after she had recovered.

"Disputes over bills in private hospitals are rising," said a doctor, blaming a lack of transparency in the process.

Some institutions are trying to address the problem. Ruby General Hospital, for instance, has introduced a patients' Bill of Rights.

"It clearly states what the patient can expect from the hospital by way of treatment and what the hospital should provide," said an official.

Incidentally, Ruby General Hospital was ordered to pay a compensation of Rs. 10 lakh by the National Consumer Disputes Redressal Commission to the family of 20–year–old B.Tech student Sumanta Mukherjee who died in 2001 because the hospital refused to admit him as the people who had brought him to the hospital could not pay Rs. 15000.

Following Sumanta's death, the government had cancelled the hospital's licence for a while. It also amended the Clinical Establishments Act, making it mandatory for all medical centers, hospitals and nursing homes to have emergency facilities.

Other methods — like tying up with NGOs to bail out poor patients — are also being explored as medicare expenses shoot up.

"The private hospitals have to charge patients for maintaining the high cost of infrastructure," said Brigadier (retd) S.B. Purkayastha, president of AMRI Hospitals.

So, most of the private hospitals request patients' relatives to pay part of the bill during treatment when the accumulated amount goes up.

"But it is unethical to stop treatment at any stage," said V. Satyanarayana Reddy, CEO, Apollo Gleneagles Hospitals.