Fortis Controversy and Managing Adverse Media Events in Hospitals

Truth the First Casualty

Year 2017 hasn’t been a particularly lucky year for the healthcare industry, annus horribilis of sorts to be precise.

Another hospital is in the eye of the storm, ostensibly for overcharging a ‘dead’ patient.

The jury is already out on the case without even ascertaining the facts on ground. The social media has gone hammer and tongs after the hospital citing high costs of treatment, lack of counseling of dependents on the deteriorating clinical condition of the patient and ostensibly excessive use of consumables and not providing ambulance vehicle to take the body away after expiry.

Sensationalism Sells

It is alleged that Fortis Memorial Research Institute, a prominent hospital in Gurgaon charged a dengue patient more than Rs 15 lakhs for the treatment. Unfortunately, the patient did not live to see the light of the day. The fact that it was a child has heightened the gravity of the situation, since strong emotions are attached to paediatric cases.

The patient allegedly was charged for more than 600 syringes and 750 pair of gloves for 15 day long treatment and did not survive the ordeal at the end of it. Ventilator usage, CRRTs (continuous renal replacement therapies), multiple blood transfusions, ICU rent added on to the cost of treatment, pegging the final bill at Rs 15,79,322.

The Haryana government, on Tuesday, 21 November, ordered a probe into the allegations against the hospital, soon after the state was asked by the Union Health Ministry to urgently look into the case.

Media loves sensationalism because it sells; unwary hoi polloi is only too naïve to lap it up. Some of the media houses have, in fact, mastered this art.

Legal & Clinical Angle

It was alleged that the doctor did not carry out an MRI or CT to ascertain clinical condition of the patient in this case.

The question arises as to whether the treating clinical team carried out the correct line of treatment and followed the laid down clinical protocols?

Did the team keep the patient’s dependents fully informed on the deteriorating clinical condition of baby Adya?

Was there any negligence on the clinical or managerial side that led to the adverse outcome?

Was it the duty of the hospital to provide ambulance vehicle to ferry the body home after the patient’s expiry?

Has the hospital charged for something for which it should not have?

Could the hospital have done anything more to save the life and to bill a lower amount in this case?

These are some of the legitimate questions that come to one’s mind while analyzing the unfortunate incident.

Fortis team has consistently maintained that correct clinical protocols have been followed in this case and the statement from the hospital asserted that “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.”

Fortis has also asserted that the dependents were kept informed at all times on the patient’s condition and that they have not defaulted on billing or post incident support to the family.

Role of Indian Medical Association (IMA)

IMA came out in support of the hospital and maintained that “a controversy was being whipped up for the wrong reasons, as the cost of treatment in such severe cases is bound to be high.”

It is the duty of IMA to maintain professional propriety of providers and clinicians and usually they are quick to come out heavily against any malpractices. On this case they maintained a much nuanced approach, since the government entered early in managing the situation, given the strong media backlash.

Who Should Decide the Line of Treatment and What Should be Charged for That

Clearly, once a patient is brought to the hospital, it is the bounden duty of the treating doctor(s) to provide the best treatment, maintaining ethical and clinical propriety. Such complicated cases require a multidisciplinary approach to patient management. The team is the best judge to ensure rightful treatment and consequently ensuring the best possible outcome.

Clearly, once a patient is brought to the hospital, it is the bounden duty of the treating doctor(s) to provide the best treatment, maintaining ethical and clinical propriety.

The clinical team in this case maintained that “this was not a simple case of dengue; the patient was serious and was shifted from a tertiary hospital to a bigger hospital. It was a severe dengue case, child was serious, patient was in ICU for 13 days and on ventilator for 11 days. If you have to revive a patient, doctors must try every possible treatment available.”

Are Hospitals Resorting to Undue Profiteering?

Public perception is that hospitals tend to charge exorbitantly for the treatment and resort to excessive profiteering. The fact on the contrary is that hospitals have very high fixed costs. They spend a fortune on hiring of doctors & key staff. Administrative costs, consumables and other overheads take away bulk of their revenues, leaving small margins. A quick glance at the publicly listed hospital groups would reveal the fact that very few have EBITDA margins in excess of 15%, a decent figure considering the healthcare industry norms. So, excess profiteering is more of a myth but then perceptions matter and negative publicity fuels this misconception.

Lessons for Hospitals

This unfortunate episode has obvious lessons for hospitals.

Regular Counseling of Patients/ Dependents: In such high risk cases, the clinical and managerial teams work synergistically to offer continuous and comprehensive feedback/ counseling to the patient and his/ her dependents on the progressing clinical condition and expenses involved in the delivery of treatment. In fact, it is always safer to even record such counseling sessions for any future medico-legal requirements.

Training of Staff: There is no replacement to constant training of the patient facing staff. The staff has to be very transparent, objective and empathetic in communicating with the patient and his/ her dependents. Paediatric cases have to be handled more sensitively.

Media Proactiveness & Reputation Management: Unfortunately, Indian hospitals do not carry a great reputation in the minds of the larger public, a fact buffeted by Indian movies and social media, and portraying hospitals as places that fleece hapless patients. Constant media scrutiny therefore is the new reality to which the sooner the hospitals adapt, the better they will be. Adverse events will continue to occur because most quaternary care and tertiary care hospitals continue to receive high risk cases, wherein at times the chances of survival are extremely low and mortalities high. Ergo, we must know how to handle the dependents in such cases and be prepared for post event fallouts. Hospital PR and communication machinery too has to work proactively to contain the damage and reestablish the image.

Constant media scrutiny therefore is the new reality to which the sooner the hospitals adapt, the better they will be.

Conclusion

Hospitals will continue to receive high risk patients and are willy-nilly easy targets for flak and adverse publicity. Treatment in private hospitals in India though being cheaper than its more advanced Western counterparts is way more expensive than the government hospitals in the country. The costs also vary from hospital to hospital and patients must weigh their options before taking such treatment. Hospitals on their part have to be sensitive to the patient’s requirements and work out packages that are effective and affordable, not an easy task under the current highly regulatory market conditions. Things may even get worse from here!

Indian government must take necessary steps to reduce the cost of treatment to the common man and make it easier for hospitals to reduce the costs of medical devices, consumables, implants and pharmaceutical products, so that they can pass on the benefits to patients while maintaining their own profitability.

Media should be more sensitive to such incidents and not add fuel to the fire. Moreover, its scrutiny must be based on authentic information gleaned from all parties before arriving at a conclusion rather than feeding on the public frenzy and high octane sentiments alone.

Hospitals must be transparent in all their billing and counseling activities and keep the patient’s family well informed at all times to help them tide over unavoidable adversity. Give financial relief wherever feasible, based on the merit of the case.

In view of the constant media glare and the rising consumer activism, it’s going to be more and more difficult for hospitals to manage such events in broad media glare. Staying ethical, transparent, empathetic and above aboard is the only way forward.