Madras High Court issues directions for surprise checks, toll-free helpline to ensure implementation of health insurance schemes in hospitals

The Madras High Court recently issued a series of directions to the Central and the Tamil Nadu government to ensure effective implementation of state sponsored health insurance schemes so that every needy patient gets access to adequate health care [Dr. Karthick v Union of India]..In a judgement passed on December 20, a bench of Justices R Mahadevan and J Sathya Narayana Prasad of the Madurai bench directed the Tamil Nadu State Empowered Committee that oversees the implementation of the Chief Minister's Insurance Scheme, to publicise details of the insurance scheme to create awareness among the public. The Court also directed the Committee to devise a system to conduct surprise checks at empanelled private hospitals, and to introduce a toll free helpline number for the public to communicate their grievances. The Court said that the State government must appoint nodal officers in every district to ensure the health insurance scheme is implemented both in government and empanelled private hospitals. The bench also directed the State to de-empanel hospitals in cases of "proved violations and irregularities." Citing the 2030 'Agenda for Global Health Coverage,' the bench said, "Thus, it is lucid from above stated provisions and international developments that the state-sponsored insurance schemes are indispensible in achieving the broader goal of universal health coverage and right to health. It also points out how deterioration in the quality of health care services provided under the scheme, has grave ramifications affecting the right to health under Article 21.".The Court was hearing a petition filed by a Cardiothoracic surgeon, who claimed that while he was working at a private hospital in the State, a patient, who was a beneficiary of the CM Health Insurance Scheme, had died after the anesthitist left the operation theatre mid-surgery to attend to a patient, who was paying for his treatment privately. The petitioner said he had raised a complaint with the hospital authorities and with the Tamil Nadu Medical Council as well. The hospital denied the allegations. The TN Medical Council, however, informed the Court that an inquiry committee had been constituted and it was investigating the matter. While the Court accepted the Medical Council's submission, it noted that instances of hospitals not giving equal treatment to patients who belonged to the economically weaker sections were rampant."This court is of the opinion that the government medical schemes are important for ensuring that the citizens have access to quality healthcare, however, the implementation of these schemes have come under threat due to the empanelled private hospitals, which have been attempting to exploit the system for their own personal gain. The incident alleged in this petition is one such case which highlights the lacunae in implementation of the scheme. Though there exist various guidelines, the goals for framing such schemes, have not been achieved due to a lack of proper monitoring framework and awareness among the public about the scheme. The inadequacies in the implementation and monitoring of the scheme has led to a decrease in the quality of healthcare available to the citizens, who are already struggling to make their ends meet. Therefore, certain directions necessarily be issued to the authorities concerned, for effective implementation of the insurance Scheme," the Court said. .Advocate L Infant Dinesh appeared for the petitioner. Centre government standing counsel V B Sundareshwar appeared for the Union of India. Advocate Subha Ranjani Anand appeared for the National Medical Commission. Government Pleader P Thilak Kumar appeared for the respondent TN government authorities..[Read Judgment]