Over two months after the death of a seven-year-old girl due to dengue, the plight of her parents who were allegedly charged a whopping Rs 15.79 lakhs for the treatment—the final bill included 660 syringes and 1,600 gloves—and medical negligence on part of the hospital have led the Centre to take note of the incident. Union minister of health and family welfare, J.P. Nadda said on Tuesday that a report would be sought on the incident and necessary action would be taken in the matter. Following Nadda's comments, health secretary Preeti Sudan asked the state health department in Chandigarh to initiate an enquiry in the case. In a letter to the principal secretary of department, Sudan, citing media reports about the case, asked for "urgent enquiry" and promised "exemplary action" in case any "overcharging, negligence, or malfeasance" was found on part of the hospital.
Dr Jagdish Prasad, director general of health services told THE WEEK that the case underscored the need for regulation in the health sector. "If all states adopt and implement the Clinical Establishments (Registration and Regulation) Act, such cases would not occur. In the law, we have established treatment guidelines, and there would be no possibility of overcharging," said Prasad.
Parents of Adya Singh have alleged that Fortis Memorial Research Institute billed them for 15.79 lakh for her treatment that took place over 15 days in September. Post the treatment, the girl died, and the parents say that the hospital even denied them an ambulance to transport the body.
According to a Facebook post by her father, Jayant Singh, a Dwarka-based IT-professional, the ordeal began on August 27, when his daughter was admitted to Rockland hospital in Dwarka. The hospital “took the case very lightly...like normal dengue patient is treated”, and after two days of her admission, doctors at Rockland suggested that "Adya should be shifted to the Fortis Medical Research Institute in Gurgaon", which is the “best Pediatric ICU” in Delhi NCR. In his post, Singh claims that the Rockland hospital refused to arrange an ambulance “with the lame excuse that we don’t provide an ambulance for patients who are referred to other hospitals”. This, he says, was despite the fact that there were about five ambulances available at the hospital.
Singh says after shifting their daughter to Fortis on August 31, his wife and he were satisfied that the child was in "good hands". “Everyday... the entire family and friends used to stand...just to hear that your daughter is improving and will recover soon...which never happened,” he writes. After 15 days of a “hell like situation”, Singh says an MRI analysis revealed that the child’s brain had got “hugely damaged” and doctors suggested that recovery was not possible.
A friend of the family posted on Twitter that the family had been insisting on an MRI/CT scan for several days to check on her status, but their pleas were ignored. He also said that despite the CT scan declaring 70 per cent brain damage, the hospital even recommended a full body plasma transplant (that would cost about 15-20 lakhs). "When the family asked the rationale when the case was already hopeless, they said that the rest of the organs might recover," the friend posted on Twitter. The medicines that were used were expensive too – the hospital chose to inject the child with antibiotic injections costing Rs 3,000 each, instead of a cheaper brand that would cost Rs 500.
According to Singh, after the brain damage was detected, the parents were asked to “choose” whether they wanted to continue the medical treatment in the hospital or to "opt for LAMA i.e. leaving against medical advice."
“We were not able to understand the conspiracy behind such an advise then. But now when this amount of time has passed thinking about the loss of Adya, we have understood that if they would have removed Adya from ventilator it would then have been compulsory for them to report the death due to dengue in their hospital premises,” he says in the post.
Singh says they were also advised to arrange their own ambulance and “to pay for the cloth [hospital gown]” that she was wearing during the treatment. “The last nail was when the ambulance attendant asked for the sheet in which Adya was wrapped as it had a GPS chip for hospital records. We had to pay for that sheet as well,” he says. “It was no less than a shock to us that the hospital refused us to provide an ambulance to take our dear daughter’s body back home. It was on us, to run for all possibilities, to get an ambulance arranged. This is our system where we had already made payment of Rs 18 lakh to the hospital for falsely pumping her heart and inflating the lungs through machine support for a total of fifteen days," says Jayant. Adya was shifted to Rockland, where she was declared brought dead.
Fortis hospital, however, denied all charges. In a statement, the hospital said that Adya 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".
"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, 17, family decided to take her away from the hospital against medical advice (LAMA – Leave Against Medical Advice) and she succumbed the same day," it said.
The hospital claimed that all standard medical protocols were followed in treating the patient and all clinical guidelines were adhered to. "An itemised 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. 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."
