Rs 15L Bill for 15 Days of Dengue: Fortis at Fault, or Healthcare?

Fortis was accused of giving the child, who succumbed to the Dengue Shock Syndrome, 500 injections in 15 days.

The family accused Fortis hospital of giving the seven-year-old child 500 injections in 15 days.

(Photo: Liju Joseph/The Quint)

On 31 August, a seven-year-old was brought to Fortis Memorial Institute in Gurgaon for treatment. The child was suffering Dengue Shock Syndrome, a syndrome caused by the same virus that causes dengue. It affects children under the age of 10 and is marked by bleeding, shock and abdominal pain.

The child left the hospital LAMA (Leave Against Medical Advice) after being on constant ventilator support until 14 September. The parents were asked to arrange for a private ambulance since she was leaving against medical advice. She died soon after. The family footed a bill of Rs 15 lakh for the treatment. The case came to light when a friend of the family tweeted about the exorbitant cost.

The tweets mentioned that the hospital switched to a treatment which was seven times more expensive than the initial treatment.

The Haryana government, on Tuesday, 21 November, ordered a probe into the allegations against the hospital, soon after the state was asked by the Union Health Ministry to urgently look into the case. Haryana Health Minister Anil Vij said in Chandigarh that a senior state officer would investigate the matter.

Earlier on Tuesday, the Health Ministry asked the Haryana government to take "exemplary" action against Fortis if "overcharging, negligence or malfeasance" was established in the case of the dengue patient.

Health Secretary Preeti Sudan asked for an action taken report within two weeks, in a letter to the Principal Secretary of Haryana's Health Department.

"l request you to urgently initiate an enquiry into the whole incident," she said in the letter.

Child Given 500 Injections in 15 Days, Claims Patient’s Family

The family claims they were charged Rs 200 for a sugar strip that is available for Rs 13 in the market. The family further said that the child was given 500 injections in 15 days.

Speaking to Zee News, Jayant Singh, father of the seven-year-old said:

When after seven days of treatment the child did not gain consciousness, they knew the brain has been affected. But they avoided an MRI or CT scan. I would ask them for it every day, but they would say the condition is not conducive. I had hope and complete support for them (doctors) for 15 days. In retrospect, however, it feels like they were deliberately avoiding it.

According to the father as reported in Hindustan Times, the doctors proposed a full-body plasma transplant (a procedure to remove, treat and return blood plasma), despite the brain damage.

My first question was, why perform the procedure? Will it help her? With 80% brain damage, what would her life be like? The doctors said they can save the other organs.

The father says that even as little Adya was discharged, they were called back to pay for the gown she was wearing since she couldn’t fit into the clothes she was brought in.

Standard Protocol Followed, Family Given Regular Updates, Claims Fortis

Responding to the allegations, Fortis issued a formal statement. When Fit reached out to them, they insisted on their statement being reproduced in full.

Regretting the death of the child, the hospital said:

We empathize with Baby Adya’s family in this difficult hour of sorrow and grief. Seven year old Baby Adya was brought in to Fortis Memorial Research Institute (Gurgaon), from another private hospital on the morning of 31st August, 2017. She was admitted with Severe Dengue which progressed to Dengue shock syndrome and was managed on IV fluids and supportive treatment as there was a progressive fall in platelet count and hemoconcentration.

The child’s condition continued to deteriorate, the statement claims, and they kept the family informed of implication at each stage.

As her condition deteriorated, she had to be put on ventilatory support within 48 hours. The family was kept informed of the critical condition of the child and the poor prognosis in these situations. As a process, we counselled the family daily on the condition of the child. On 14th September 2017, family decided to take her away from the hospital against medical advice (LAMA – Leave Against Medical Advice) and she succumbed the same day. All standard medical protocols were followed in treating the patient and all clinical guidelines were adhered to.

In terms of the costs involved, the hospital says that a 20-page document was provided to the family.

An itemized bill spread over 20 pages was explained and handed over to the family at the time of their departure from the hospital. Patient was treated in the Paediatric ICU (PICU) for 15 days and was critical right from the time of admission requiring Intensive monitoring. Treatment during these 15 days included mechanical ventilation, high frequency ventilation, continuous renal replacement therapy, intravenous antibiotics, inotropes, sedation and analgesia.

The hospital emphasised that all protocols required in the treatment of an ICU (Intensive Care Unit) patient were followed.

Care of ventilated patients in ICU requires a high number of consumables as per globally accepted infection control protocols. All consumables are transparently reflected in records and charged as per actuals. We have been in touch with the family to address their concerns and remain available for any further support required. We understand the grief of the bereaved family and our heartfelt condolences go out to them.

IMA Defends Fortis For Billing Exorbitantly

Indian Medical Association, the voluntary representative body of doctors across the country, defended Fortis Gurugram for billing the exorbitant amount. Speaking to India Today, Dr Agarwal, the President of the IMA opined that a controversy was being whipped up for the wrong reasons, as the cost of treatment in such severe cases is bound to be high.

This was not a simple case of dengue, the patient was serious and was shifted from a tertiary hospital to a bigger hospital. It was a severe dengue case, child was serious, patient was in ICU for 13 days and on ventilator for 11 days. If you have to revive a patient, doctors must try every possible treatment available.

He also added that the only way to find out if Fortis had indeed fleeced the patient was to approach AIIMS to see how much they would have charged for a similar treatment.

Meanwhile, a senior doctor at a private hospital in New Delhi who wished not to be named, had this to say about the situation:

The issue is a far bigger one - one that is of expensive private healthcare in this country. The MRP of consumerables in hospitals is often much higher than their price in the market. Sometimes it’s ten times higher. The price difference is huge but not illegal. The total bill that is footed for a patient in a private facility is often made up of 50 percent for medicine and consumerables, 10 percent for the doctor’s fee, 25-30 percent for labs and about 15 percent for room or ICU rent. 

He further added that in case of ICU, the usage of gloves is very high - often going over 50 pairs of gloves every day on average. The daily rent of the ICU also averages between 1 lakh to 1.2 lakh for most private hospitals.

The rates in private hospitals are high and the government should introduce checks and balances to regulate them - that’s absolutely necessary. The hospitals should assure transparency on the part of the hospital in terms of cost so that the family goes ahead with the treatment with full awareness.

Union Health Minister JP Nadda also tweeted, in response to the initial tweet thread which brought the issue to public attention, that “necessary action” would be taken.

(With inputs from PTI.)

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