Unpaid hospital bills

A recent case in which a patient died after a heart attack and kidney failure at Hiranandani Hospital in Powai, Mumbai, has raised several ethical issues. The patient was in the hospital for one month. The bill came to Rs 7.3 lakh. When he died, the hospital refused to hand over the body to the family unless the bill was cleared. There was a shortfall of about Rs 4 lakh.

Did the family opt for Hiranandani hospital? Or did a third party administrator (TPA) direct the family? Was the family told at some stage that the bill would run into several lakh rupees? Was a transfer to a cheaper or municipal hospital offered? Did the hospital act correctly in keeping the body till the bills were cleared? Does the hospital have an ethics committee that can decide on such issues rather than force the issue into court?

In my opinion, TPA panels must not include doctors, nursing homes, or hospitals. The insured person must be free to choose her/his doctor or hospital so long as each is qualified and registered. Hospitals must have a medical audit system. Repeated investigations and procedures, which are often negative and non-contributory, must be avoided. It is better to give the patient the correct treatment irrespective of the cost. At the time of discharge, the hospital can settle the bill with what the patient can pay. The hospital may write off the balance or file a civil suit for recovery of dues.

Correction

The July 2007 issue carried an article by Einollahi Behzad, Nourbala Mohammad-Hossein, Bahaeloo-Horeh Saeid, Assari Shervin, Lessan-Pezeshki Mahboob, and Simforoosh Naser. (Deceased-donor kidney transplantation in Iran: trends, barriers and opportunities Indian J Med Ethics 2007; 4: 71-3). The correct affiliation of Dr Simforoosh is: Urology and Nephrology Research Center & Shaheed Labbafinejad Medical Center, Shaheed Beheshti University of Medical Sciences, Tehran, Iran.