Govt to Doctors: Do not ask for Money                                                                               Friday, June 12, 2015 

The Ministry of Road Transport’s notification dated 12th May 2015 regarding Good Samaritans who bring roadside accident victims to the hospital is a welcome step. Section 10 of the notification specifically states that all public and private hospitals are not to detain bystander or a Good Samaritan or demand payment for registration or admission costs. It is unfortunate that once when amendments were being made to fill a lacuna which existed so far and resulted in countless deaths it could have been made more comprehensive and not left an important question hanging as to “Who will bear the cost of treatment?”

Medical treatment today is a costly proposition especially when you run a centre which is geared and capable of providing round the clock emergency medical services. Cost, however, is not something which is in the hands of doctors in general. To set up a private hospital land is exorbitantly priced, making required infrastructure and equipping it in accordance with requirements under the NABH (National Accreditation Board for Hospitals and Healthcare Providers) and the Clinical Establishments Act (CEA) takes a lot more investment.

A corporate hospital in Mohali recently conducted a study to know the cost to maintain one bed of the hospital without any patient. It was found (and this is some years ago) that it cost the hospital Rs 12,000 per bed per day to function without any patient admitted and expenditure made thereupon. We assess the cost of setting up a single inpatient bed in a surgical hospital with the required infrastructure in Chandigarh to be upward of Rs 2 crore. This cost is besides the running cost of the hospital. Medicines and disposables used today are again another factor to be considered when assessing cost. The proportionate cost goes down marginally per bed for larger hospitals.

Roadside accident victims require treatment and stabilization in the Golden Hour to make a difference in mortality statistics. In India, so far, public in general did not want to involve itself in police cases and litigation, and so no one used to come forward to help the victims. Rarely, someone would agree to dump the victim at the nearest private hospital. Aggressive treatment, which is needed in this scenario, is shirked by private hospitals due to the absence of accident victim’s relative, fear of the Consumer Protection Act but also because no payment for services is forthcoming. What first aid they provide is in the form of charity upto a limited extent only.

Putting a patient after aggressive resuscitation with fluids, drugs; controlling and replacing blood loss, vasopressors given to maintain vital parameters on ventilator is very expensive proposition, doing external cardiac massage, mask and ambu ventilation and maybe starting a DNS bottle only to declare patient dead after 10 minutes is cheap. The second scenario may give appearance of “treatment” but is more like the coat of a Babu hanging on a chair in any Government office to give impression of his being on duty.

Absence of a well-defined system by which private hospitals that provide treatment to accident victims are reimbursed for the same is a big dampener to what is ideally needed treatment. Our suggestions in this regard are as follows;

1) All accident victims brought to any hospital should automatically be covered under cashless treatment scheme within the motor accident insurance policy. All the vehicles on Indian roads are insured and if the Government passes on the liability of cashless treatment to these insurance companies, the scheme could be implemented nationally in one stroke. The hospital would only need the insurance document of the vehicle involved in accident, which could even be provided later by the police.

2) More than 99% of the victims could be saved with this decision and the purpose of insurance served. For the accident victims at present the insurance companies come into the picture only after six to ten years after an accident to pay a fraction of the compensation claimed. This is an insult to justice and shows how much we value human life.

3) Vehicle which has higher insurance premium should cover cashless hospitalization for accident victims.

4) In case of hit and run cases, the consortium of insurance companies providing vehicle insurance through an added cess should create a fund to provide cashless treatment to the victims to be recovered from the culprits later when caught. Otherwise hit and run cases should be handled only at government hospitals.

5) Any surgical hospital providing 24-hour emergency services and covered by any insurance company in mediclaim cases for cashless hospitalization should automatically be empanelled to treat roadside accident victims.

6) Insurance companies have an army of loss and claim assessors for the vehicles involved in the accident, and settle the claim immediately to repair the vehicles involved and bring it back on the roads within a week. Why the same insurance companies cannot have their own medical personnel as injury and disability assessors to look at the interests of accident victims and approve their proposed Bill at the private hospital? Let us not give the feeling that the car involved in the crash is more valuable than the life of victim as far as insurers are concerned.

The author, Dr Neeraj Nagpal, is Convenor of Chandigarh-based Medicos Legal Action Group.