Kept patient in general ward but charged for ICCU, hospital ordered to refund Rs 2 lakh

The case dates back to May 1, 2021, when Chakraborty was admitted to Ispat Cooperative Hospital at 8.56pm during the Covid-19 pandemic and remained there until May 6. According to his complaint, his family presented a valid Swasthya Sathi Card, but the hospital declined to accept it. He further alleged that although he stayed in a general ward, the final bill included intensive-care charges and Rs 2 lakh was paid to secure his discharge.

Denial of Swasthya Sathi benefit

Chakraborty contended that the hospital’s refusal to honour his Swasthya Sathi Card amounted to deficiency in service. He also argued that levying ICU charges despite his admission to a standard general bed amounted to an unfair trade practice under Section 2(47) of the Consumer Protection Act, 2019.

Denying the allegations, its counsel, advocate Suraj Roy, submitted that the record did not contain documentary evidence showing that Chakraborty had lodged a formal protest over the alleged rejection of the Swasthya Sathi Card.

The hospital also argued that during the Covid-19 crisis, general wards had been converted into intensive-care units to meet the circumstances prevailing at the time. It further submitted that the discharge certificate contained an inadvertent clerical error concerning the bed occupied by the patient.

Government respondents submitted a written brief questioning Chakraborty’s status as a “consumer” under the Consumer Protection Act and said that medical care sought under the Swasthya Sathi Card amounted to free treatment.

Contradiction in hospital records

Disagreeing with the district consumer commission’s assessment of the case, the state commission said that the discharge summary and final invoice showed a discrepancy between the bed recorded for Chakraborty’s stay and the charges levied on him.

The state commission also found fault with the district commission for focusing on the alleged absence of documents showing that Chakraborty had complained to the competent authorities about the refusal of his Swasthya Sathi Card. It noted that the district commission’s own order had taken into account a complaint dated February 21, 2022.

The state commission further referred to grievances lodged on January 24 and February 21, 2022, copies of which, according to the order, were communicated to the hospital administration. It said the claim regarding the alleged refusal of the Swasthya Sathi Card could not be brushed aside.

It also rejected the district consumer commission’s reasoning concerning the alleged conversion of general beds into ICU or ICCU facilities during the pandemic. The commission said the district commission had proceeded on “conjecture and assumption” without seeking corroborative proof of such conversion from the hospital.

On the billing issue, the commission said hospitals are required to provide accurate and transparent bills corresponding with their treatment records. It noted that the discharge certificate recorded a regular bed while the final bill charged for an ICCU bed.

Beneficiary can approach consumer body

The commission also rejected the objection to Chakraborty’s status as a consumer. It held that a patient can file a consumer complaint against a hospital or nursing home for refusal to provide treatment under a Swasthya Sathi Card.

Although the patient does not pay cash out of pocket, the commission said, the government pays the empanelled healthcare provider on behalf of the cardholder, creating a consumer-provider relationship.

The commission concluded that Chakraborty had established deficiency in service concerning the denial of the Swasthya Sathi Card and unfair trade practice over the ICCU billing. It therefore set aside the March 28, 2024 order of the district consumer commission and allowed the appeal.

Eight weeks to comply

The commission directed Ispat Cooperative Hospital and its chairman to refund Rs 2 lakh to Chakraborty, while giving them liberty to seek due reimbursement of the amount against his Swasthya Sathi Card.

They were also held jointly and severally liable to pay Rs 50,000 as compensation and Rs 25,000 towards litigation costs. The commission directed that all the directions be complied with within eight weeks from August 25, 2026.

Takeaway

A patient covered under a state health scheme can approach a consumer forum over alleged denial of scheme benefits or billing discrepancies, with the commission holding that government payment to an empanelled hospital creates a consumer-provider relationship.

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