Case Study

Treatment Costs And Hospital Billing

Nh Mmi Narayana Multi Specialty Hospital v. Champa Lal Baid,

Facts: The complainant, Champa Lal Baid for his cardiac ailment underwent Balloon Angioplasty procedure in NH MMI Narayana Multi Speciality Hospital at Raipur & was hospitalized from 4.1.2016 to 7.1.2016.  The complainant had paid amounts before discharge included Rs.25,000/- and Rs.10,000/- on 5.1.2016 and 7.1.2016, respectively, however, at the time of discharge, Rs.50,000/-was paid but no receipt was issued by OP/hospital.  Thereafter, complainant personally approached the OP for refund for Rs.50,000/- but of no avail.  The District Forum directed the OP to pay a sum of Rs.50,000/- with interest @9% per annum from the date of complaint to the date of payment; a sum of Rs.20,000/- as compensation for mental agony; and a sum of Rs.2,000/- as advocates fee and litigation expenses & State Commission confirmed the order of District Forum and dismissed the appeal being devoid of merits.

Observations: The main question in the instant revision petition is whether the OP/hospital had charged Rs.50,000/- in excess, if so, whether the non-issuance of receipt for the same amounts to unfair trade practice.   As per medical record, patient was discharged on 7.1.2016, AS PER discharge summary:

“DIAGNOSIS CAD, ACUTE AWMI KILLIP-I POST PTCA STATUS (LAD)  MODERATE LV SYSTOLIC DYSFUNCTION PROCEDURE CAG & POBA + LAD (04.01.16) REASON FOR ADMISSION Non diabetic, normotensive admitted with the complaints of prolong rest angina since 2 hrs on 04.01.15.  Patient admitted for further evaluation & management.”
On 4.1.2016, the angioplasty procedure done was ‘PTCA + POBA to LAD’ was performed by Dr. Sunil Gouniyal, Cardiologist, (AS PER NOTES:)

” PTCA + POBA  TO LAD LM hooked with 6F XB 3 cordis guiding.  Lesion in LAD crossed with Cross-IT-0.14 x200 cm, Sion blue-0.14 x 200 cm wires.  Lesion predialted with SAPPHIRE 2.0 X 10 mm @ 8 ATM, followed by multiple times thrombosuction.  Re-check angio showed TIMI-3 flow in LAD.

We have perused the final bill which indicates the details of expenses incurred by the complainant.  The total bill was for Rs.1,22,767.10.  There is a mention about hospital discount for Rs.37,767.03.  The final bill was round off to Rs.85,000.00.  The said bill shows the details of payment received from the complainant, as below:-  Held: In our considered view, the OP/hospital has provided the details of total bill including the payment of Rs.50,000/-, made by the complainant.  However, it is not clear whether the OP/Hospital has issued a separate bill for Rs.50,000/-.  On perusal of the final bill, it is clear that receipt No. RCP1571602189 was raised on 7.1.2016 at 18.48 hrs. for Rs.50,000/-, we do not see any ill intention of the OP hospital.  It was not a deficiency in service or unfair trade practice. It is clear that the Revision Petitioner/Hospital has maintained the transparency with respect to payments received and issued valid receipts for every payment.    On perusal of the medical record, admittedly the patient had undergone balloon angioplasty.  Also, OP had allowed a discount of Rs.37,767/-.  Therefore, it would be wrong to hold the petitioner guilty of deficiency in service or unfair trade practice for non-issuance of separate receipt for payment of Rs.50,000/-.  We could locate in the final bill that the details of amounts received by the hospital have been mentioned including the disputed amount of Rs.50,000/-.  Thus, we do not agree with the submission / criticism raised by the complainant against the petitioner. We may note that this is not a case of alleged medical negligence.  The only short point in this case is a question of fact, whether the disputed sum of Rs.50,000/- was wrongly charged and not billed.  The hospital has admitted that the disputed sum of Rs.50,000/- was duly charged.  And it is clearly evident that the said sum was duly included in the final bill (which is a computerized print – out).  We also note that the total amount (inclusive of the disputed sum of Rs.50,000/-) is reasonably commensurate with the procedure undertaken by the hospital – opposite party on the patient – complainant.  We further note that a discount of Rs.37,767.03  was provided by the hospital to the patient (and the same is also reflected in the final bill).  If that be so, there can be no question of deficiency in service or unfair trade practice on the part of the hospital.  Within the scope of Section 21(b) of the Act 1986, we, thus, find grave error in appreciating the evidence by the two fora below, which, if not remedied, would lead to miscarriage of justice.

Hence, the impugned Order dated 18.05.2017 of the State Commission is set aside.  Resultantly, the complaint is dismissed

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