PIL IN SUPREME COURT OF INDIA AGAINST HOSPITALS & HOSPITAL PHARMACIES

IN THE SUPREME COURT OF INDIA

 

CIVIL ORIGINAL JURISDICTION

 

WRIT PETITION (CIVIL) NO. ______ OF 2018

 

(UNDER ARTICLE 32 OF THE CONSTITUTION OF INDIA)

 

 

PUBLIC INTEREST LITIGATION

 

IN THE MATTER OF:

1. SIDDHARTH DALMIA

S/O SHRI VIJAY PAL DALMIA

FLAT NO. 2101, OLYMPIA TOWER-II,

ELDECO UTOPIA, SECTOR-93A,

NOIDA, U.P.-201304

Email: dalmiasiddharth1994@gmail.com

 

 

2.   VIJAY PAL DALMIA

S/O LATE BANWARI LAL DALMIA

FLAT NO. 2101, OLYMPIA TOWER-II,

ELDECO UTOPIA, SECTOR-93A,

NOIDA, U.P.-201304

Email: vpdalmia@gmail.com.                              ...PETITIONERS

 

VERSUS

 

 

1.    UNION OF INDIA

THROUGH THE CABINET SECRETARY

CABINET SECRETARIAT

RASHTRAPATI BHAWAN,
NEW DELHI – 110001

 

Email id: cabinetsy@nic.in

 

2.    MINISTRY OF MINISTRY OF HEALTH & FAMILY WELFARE

THROUGH ITS Secretary (H&FW)

DEPARTMENT OF HEALTH & FAMILY WELFARE

‘A’ Wing, Nirman Bhavan, 

NEW DELHI – 110001

 

Email: secyhfw@nic.in 

 

3.   Government of Andhra Pradesh

Through its Principal Secretary,

Health Medical & Family Welfare Deptt.,

5th Block,  Ground Floor,

Room No. 157, A.P. Secretariat, Velagapudi, Amaravathi -522503

Andhra Pradesh

 

E-MAIL: prl.secy.hmfwap@gmail.com

 

 

4.   Andaman & Nicobar Administration

Through its Principal Secretary (Health)

Department of Health & Family Welfare,

Secretariat, Port Blair- 744101

Andaman & Nicobar Island

 

Email: udevelop.and@nic.in

 

 

5.   Government of Arunachal Pradesh,

Through its Commissioner

Department of Health & Family Welfare

Civil Secretariat building Block No.- 2

Unit No. - 5, 3rd Floor,

District Papumpare,

Ita Nagar-791111

Arunachal Pradesh

 

Email: kalingtayeng@gmail.com

 

6.   Government of Assam

Through its Principal Secretary (H&FW)

Department of Health & Family Welfare

C.M Block 3rd Floor Assam Secretariat, Dispur, Guwahati,

Assam – 781006

 

Email: samirksinha69@gmail.com

 

 

7.   Government of Bihar

Through its Principal Secretary (Health & FW), Department of Health

Vikas Bhawan, New Secretariat,

Patna – 800 015

Bihar

 

E-Mail: health-bih@nic.in

 

 

8.   Union Territory of Chandigarh

Through its Home Secretary-cum-Secretary (Health & Family Welfare),

UT Secretariat,

Deluxe Building, Sector-9,

Chandigarh- 160017

 

E-Mail: hs@chd.nic.in

 

9.   Government of Chhattisgarh

Through its Principal Secretary, Department of (H&F Welfare),,

R. N. S4-18,

Mahanadi Bhawan Mantralaya

New Raipur,

Chhattisgarh - 492 002

 

E-Mail: secretaryhealthcg@gmail.com

 

 

10.UNION TERRITORY ADMINISTRATION

OF DADAR & NAGAR   HAVELI

THROUGH ITS SECRETARY (HFW),

SECRETARIAT UT DADAR & NAGAR HAVELI

SILVASSA – 396230

DADAR & NAGAR HAVELI

 

Email: advadmr-dnh@gov.in

 

11.Union Territory Administration of Daman & Diu

Through its Secretary (HFW)

Office of the Adviser to Administrator

1st Floor, Secretariat

Motidaman- 396220

Daman & Diu

 

Email: devcom-dd@nic.in

 

12.Government of NCT of Delhi

Through its Secretary (Health & FW),

Department of Health & Family Welfare,

Room No:A-907, A Wing,

9th Level, Delhi Secretariat,

I.P. Estate, New Delhi – 110002

 

E-Mail: pshealth@nic.in

 

13.Government of Goa

Through its Secretary (Health & FW), Secretariat,

Porvorim,

Goa – 403521

 

E-mail: secycs-sect.goa@nic.in

 

14.Government of Gujarat

Through its Commissioner (Health) & Ex-Officio Secretary (Public Health & Family Welfare)

Block No 5, 1st Floor

Old Sachiwalay.

Dr. Jivraj Mehta Bhavan,

Sector No.10, Gandhinagar

Gujarat-382010

 

Email: cohealth@gujarat.gov.in

 

15.Government of Haryana

Through its Principal Secretary(H & FW),

Department of Health & Family Welfare,

R.No. 102, 1st Floor,

New Haryana Secretariat Building,

Sec-17, Chandigarh – 160017

 

Email: amitjha.principalsecretary@gmail.com

 

16.Government of Himachal Pradesh

Through its Principal Secretary

(Home & Health & FW & Medical Education) Department of Health & Family Welfare,

H.P. Secretariat, , Room No.623

ARMHDALE Building

Shimla, Himachal Pradesh- 171002

 

Email: healthsecy-hp@nic.in

 

17.Government of Jammu & Kashmir

Through its Commissioner & Secretary (Health & Medical Education)

Health & Medical Education Department,

Room No. 205 Civil Secretariat,

Jammu-180001

 

E Mail:admsecyhealthjk@gmail.com

 

18.Government of Jharkhand

Through its Addl. Chief Secretary (Health), Department of Health & Family Welfare, 

Nepal House, Doranda,

Ranchi, Jharkhand – 834002

 

Email: sec-health-jhr@nic.in     

and  

hlthdept.fdi@gmail.com

 

19.Government of Karnataka

The Addl. Chief Secretary (H&FW),

Health and Family Welfare Department,

Room No. 104, 1st  Floor, Vikas Souda,

Bangalore-560001

Karnataka

 

E-Mail: prs-hfw@karnataka.gov.in

 

20.Government of Kerala

Through its

Addl. Chief Secretary (Health)

Department of Health & Family Welfare

Room No- 656,  South Block,

3rd Floor

Government Secretariat Building, Thiruvananthapuram-695001,

Kerala

 

E-Mail:secy.hlth@kerala.gov.in

 

21.Union Territory of Lakshadweep

Through its Administrator,

Kavaratti

Lakshadweep – 682555

 

Email:lk-admin@nic.in

 

22.Government of Madhya Pradesh

Through its Principal Secretary (Health & FW), , Room No. 241,

Mantralaya (Vallabh Bhawan),

Arera Hills,

Bhopal-462 004, M.P.

 

E-Mail:pshealth@mp.gov.in

 

23.Government of Maharashtra

Through its Principal  Secretary

(Public Health Department),

10th  Floor, B Wing

GT Hospital Complex

Building Mumbai – 400001

Maharashtra

 

Email: psec.pubhealth@maharashtra.gov.in
and  
acs.pubhealth@maharashtra.gov.in

 

24.Government of Manipur

Through its Secretary  (Health & FW )

Departmentof Health & Family Welfare,

Manipur Secretariat,

Imphal, Manipur– 795 001

 

E-mail:secretaryrdpr01@hotmail.com

 

 

25.Government of Meghalaya

Through its Addl. Chief Secretary
(Health & Family Welfare)

Department of Health & Family Welfare,

R. N. 201,

Additional Secretariat Building,

Shillong- 793 001,

Meghalaya

 

E-Mail:   pwingty@yahoo.co.in

 

26.Government of Mizoram

Through its Commissioner & Secretary (Health & FW)

Department Health & FW,

RoomNo. 205

Mizoram New Secretariat,

Aizawl - 796001

Mizoram

 

Email:fanail@ias.nic.in

 

 

27.Government of Nagaland

Through its 

Commissioner & Secretary (Health) Department of Health & Family Welfare,

Nagaland Civil Secretariat 

Kohima- 797001, Nagaland

 

Email:ramkeeias@hotmail.com

 

28.Government of Odisha

Through its Principal Secretary

(Health & FW),

Departmentof Health & Family Welfare,

Secretariat Building,

Bhubaneshwar -751 001 

Odisha

 

E-Mail: orhealth@nic.in

 

29.Government of Puducherry

Through its Secretary (Health)

Chief Secretariat,

Puducherry – 605 001

 

Email:secyfin.pon@nic.in

 

30.Government of Punjab

Through its Principal Secretary

(Health & FW),

Departmentof Health & Family Welfare,

R. No. 314, 3rd Floor,

Mini Secretariat Punjab,

Sector 9, Chandigarh,

Punjab-160009

 

Email:pstca14@gmail.com

 

31.Government of Rajasthan

Through its Principal Secretary

(Health & FW),

Departmentof Health & Family Welfare,

Room No. 5208,

Govt. Secretariat, Main building,

Jaipur-302005, Rajasthan

 

EMail:phsrajasthan@gmail.com

 

32.Government of Sikkim

Through its Commissioner-cum-Secretary (Health),

Departmentof Health & Family Welfare,

Tashiling,

Gangtok – 737101

Sikkim

 

Email:healthsecyskm@yahoo.com

 

33.Government of Tamilnadu

Through its Secretary

(Health & FW)

Department of Health & Family Welfare

Governmentof Tamilnadu,

4th Floor, Fort St. George,

Secretariat,

Chennai – 600009

Tamilnadu

 

E-Mail:hfwsec@gmail.com

 

34.Government of Telangana

Through its Principal Secretary,

Health and Family Welfare Department,

Room No. 359 D-Block

Telangana Secretariat, Hyderabad- 500022

Telangana

 

E-Mail:tshealthpeshi@gmail.com

 

35.Government of Tripura

Through its Secretary (Health & FW),

Department of Health & Family Welfare, Secretariat, New Capital Complex,

P.O- Kunjban,

Agartala- 799006

Tripura

 

Email:secy.hfw-tr@gov.in

 

36.Government of Uttar Pradesh

Through its Principal Secretary (Health & FW), Department of Health & Family Welfare, 

5th floor, Room No. 516,

Vikas Bhawan, Janpath Market,

Vidhan Sabha Road,

Hazrat Ganj,

Lucknow –226 001

Uttar Pradesh

 

Email:psecup.health@gmail.com

 

37.Government of Uttarakhand

Through its Secretary (Medical, Health & FW), Secretariat 4 B ,

Subhash Road,

Dehradoon,

Uttarakhand -248001

 

Email:secynkjha@gmail.com

 

38.Government of West Bengal

Through its Principal Secretary (H&FW), Department of Health & Family Welfare,

Swasthya Bhawan,

4th Floor, 'B' Wing, GN- 29, Sector- V,

Bidhan Nagar,

Kolkata – 700091, West Bengal

 

E-Mail:  prin.secy.wbhealth@gmail.com

 

….RESPONDENTS

 

 

 

WRIT PETITION UNDER ARTICLE 32 OF

THE CONSTITUTION OF INDIA

 

 

 

TO

 

THE HON’BLE THE CHIEF JUSTICE OF INDIA AND HIS OTHER COMPANION JUSTICES OF THE HON’BLE THE SUPREME COURT OF INDIA.

 

          THE HUMBLE PETITION OF THE

                                         PETITIONERS ABOVENAMED

 

 

THE MOST RESPECTFULLY SHOWETH:

 

 

1.     This Writ Petition is in Public Interest under Article 32 of the Constitution of India against violation of the rights of the public protected under Article 21 of the Constitution of India by the Respondents, and for issuance of Writ of Mandamus or any other appropriate Writ, order or direction to the Respondents to ban the Hospitals and hospital pharmacies from compelling the patients to mandatorily buy medicines from hospitals and the hospital pharmacies only at MRP or manipulated and artificially inflated prices for profiteering also from sale of medicines, when the medicines are available at lesser and heavily discounted prices in the open market from the medical shops, retailers, dealers and distributors duly licensed and regulated by the Drug Control Department of state and central governments, by taking advantage of the ignorance, plight and adverse circumstances of the patients in the Hospitals all over India, and the Respondents despite knowing all these malpractices adopted by the Hospitals all over India, have shut their eyes and totally ignored the intetest of the patients, which they are bound to protect as over the Hospitals the Respondents have complete power and authority. These acts of financial malpractices by the hospitals all over India are against the humans, humanity, morality and the right of the citizens of Indian to live a dignified and respectable life, and the fact that it is also obligatory on the Respondents to provide best and affordable health care to the citizens of India. Such practices by the Hospitals, who are under the immediate control of the Respondents are against public health, right to live a dignified and healthy life, and public interest and morality.

 

1A. The Petitioners have not approached the Respondents with respect to the subject matter of the present writ petition as the matter pertains to wider public interest which requires the immediate intervention of this Hon’ble Court.

 

2.     The 1st Petitioner-in-person is a citizen of India. He is aged about 24 years, presently studying law at Jindal Global Law School, Sonipat, and is an EngineeringGraduate [B.Tech. (Information and Communication Technology)] from Dhirubhai Institute of Information and Communication Technology (DAIICT), Gandhi Nagar, Gujarat, and a resident of NOIDA, U.P. The mother of the Petitioner no.1 Smt. Neelam Dalmia, recently in the month of July 2017, was diagnosed with breast cancer for which she had to undergo surgery, and the surgery was followed by six chemotherapies, 20 sessions of radio therapy, and 17 adjuvant chemo therapies which are continuing during the course of which she will be required to be given  Biceltis (Trastuzumab (440mg)) injections every 21 days.The entire treatment has cost till date about 15 lakhs of rupees, and more money is likely to be incurred during the treatment, and it is expected that a total sum of around 30 lakhs of rupees will have to be spent on her treatment.  During the course of the treatment of his mother, the Petitioners for the first time realized that there is an organized methodology adopted by the Hospitals, nursing homes and health care service providing institutions which may be known by different nomenclatures (hereinafter collectively referred as “Hospitals”),for fleecing and looting the patients by compelling the patients and their attendants to buy medicines only from the Hospital and hospital pharmacies within the Hospital on MRP or highly inflated artificial prices in collaboration and connivance the drug manufacturers taking the advantage of the apathy of the Respondents, who, for the reasons known to them and despite this fact being in their knowledge and public domain, have left the people of India in lurch and at the mercy of Hospitals.Accordingly, the Petitioners are concerned, and being a responsible Indian Citizen, considers himself to have the locus standi as well as a duty to bring all the facts and issues raised in this petition to the kind attention of this Hon’ble Court, for the reasons that the Respondents have failed to take any concrete legal action to regulate, control and have become a part of the illegalities and fraud being perpetrated on the Citizens of India.The Petitioner No. 1 has no Civil, criminal or revenue litigation involving the Petitioners, which has or could have a legal nexus with the issues involved in the present Writ Petition (PIL). The Petitioner no. 1 in person has no personal or private interest in the matter. The Petitioner no. 1 in person has no personal or private interest in the matter. The address of the Petitioner No. 2 is Flat No. 2101, Olympia Tower-II, Eldeco Utopia, Sector-93A, NOIDA, U.P.-201304. The PAN Number of the Petitioner no. 1 is BJKPD4679J, and UID Number is 911540229099. The Petitioner’s annual income in last AY is Rs.3 Lac. (approx.). The email id of the Petitioner no. 1 is dalmiasiddharth1994@gmail.comand Mob. No. is 9971799250.

 

2(a)The 2nd Petitioner-in-person is a citizen of India. He is an advocate by profession, practicing for the last about 31 years. That Mrs. Neelam Dalmia is the wife of the Petitioner No. 2 and the mother of the 1st  Petitioner. The wife of the Petitioner no. 2 of the Smt. Neelam Dalmia, recently in the month of July 2017, was diagnosed with breast cancer for which she had to undergo surgery, and the surgery was followed by six chemotherapies, 20 sessions of radio therapy, and 17 adjuvant chemo therapies which are continuing during the course of which she will be required to be given  Biceltis (Trastuzumab (440mg)) injections every 21 days. During the course of the treatment of his wife, the Petitioner No.2 for the first time realized that there is an organized methodology adopted by the Hospitals, nursing homes and health care service providing institutions which may be known by different nomenclatures (hereinafter collectively referred as “Hospitals”), for fleecing and looting the patients by compelling the patients and their attendants to buy medicines only from the Hospital and hospital pharmacies within the Hospital on MRP or highly inflated artificial prices in collaboration and connivance the drug manufacturers taking the advantage of the apathy of the Respondents, who, for the reasons known to them and despite this fact being in their knowledge and public domain, have left the people of India in lurch and at the mercy of Hospitals. Accordingly, the Petitioner no. 2 is also concerned, and being a responsible Indian Citizen, considers himself to have the locus standi as well as a duty to bring all the facts and issues raised in this petition to the kind attention of this Hon’ble Court, for the reasons that the Respondents have failed to take any concrete legal action to regulate, control and have become a part of the illegalities and fraud being perpetrated on the Citizens of India. The Petitioner No. 2 has no Civil, criminal or revenue litigation involving the Petitioners, which has or could have a legal nexus with the issues involved in the present Writ Petition (PIL). The Petitioner no. 2  in person has no personal or private interest in the matter. The address of the Petitioner No. 2 is Flat No. 2101, Olympia Tower-II, Eldeco Utopia, Sector-93A, NOIDA, U.P.-201304. The PAN Number of the Petitioner no.2 in-person is AAPPD9699H and UID Number is 786938175364. The annual income of the Petitioner no.2 in last AY is Rs. 35 Lac. (approx.) The email of the Petitioner no.2 is vpdalmia@gmail.comand Mob. No. is 9810081079.

 

 

3.     The factsgiving rise to cause of action for filing the present Writ Petition are set out hereinafter:

 

A.    The mother of the Petitioner no.1, Smt. Neelam Dalmia, in the month of July 2017 was diagnosed with breast cancer resulting in operation of the breast of his mother followed by six chemotherapies, 20 sessions of radiotherapy, and 17 adjuvant chemotherapies which are continuing for which she will be required to be given  Biceltis (Trastuzumab (440mg)) injunctions every 21 days.The treatment has cost till date about 15 lakhs of rupees and about 15 lakhs of rupees more are likely to be incurred during the remaining treatment.  During the course of the treatment of his mother, the Petitioner No.1 for the first time realized that there is an organized methodology for looting and fleecing the patients is being adopted by the Hospitals by compelling the patients and their attendants to buy medicinesonly from the hospital and hospital pharmacies within the hospital premises on MRP or highly inflated artificially managed prices in collaboration and connivance the drug manufacturers.It is submitted that a part of the treatment cost of the mother of the Petitioner no.1 was covered through Insurance, still the prohibitive cost of the treatment is nightmarish and cannot be afforded by a common Indian, who may be a person belonging to below poverty line, poor class, lower middle class, middle class and even the higher-middle class (hereinafter also referred as “people”). India is a poor country and majority of its majority of the population is still poor. 

B.    It became an eye opener for the Petitioners when the Petitioners realized that Mrs. Neelam Dalmia, who is the mother of the Petitioner no.1 and wife of the Petitioner no.2 and being treated for breast cancer, has been given a medicine named Biceltis (Trastuzumab (440mg)) at MRP of about Rs. 61,132/-, whereas the said medicine manufactured and marketed by the same company (EMCURE) is being sold in the open market at a discounted rate of Rs.50,000/- for each injection, and on completion of purchase of four injections, one injection is being given free of cost to the patient towards the patient’s support programme by the company, thereby bringing the effective cost to Rs.41,000/- for each injection having MRP of approx.. Rs.61,132/-.  It is submitted that first seven injections out of which insurance covered six, were given to the mother of the Petitioner no.1 at the cost of Rs,.61,132/- for each injection by the hospital. No free injection was given. On immense persuasion involving 3 visits and threats of legal action the permission was granted by the hospital, where the mother of the Petitioner no.1 is being treated, for purchase of injection from the open market, despite the fact that the treating doctor had made the recommendation to allow purchase from the open market. On making further inquiries, it was also revealed to the Petitioners that even the MRP of this medicine in the open market was less. Therefore, there was at least a total difference of Rs.21,000/- in the price of each Biceltis injection. This has prompted the Petitioners to approach this Hon’ble Court in the interest of the people of India, who are suffering at the hands of the Hospitals and are a victim of the apathy of the Respondents without any legal recourse.

 

 

C.    That all over India most of the Hospitals, in the garb of various dubious excuses, compel the patients and their attendants to mandatorily buy medicines, medical devices and medical consumables (hereinafter collectively referred as “medicines”) only from the Hospitals and hospital Pharmacies at Maximum Retail Prices or artificially inflated and managed prices,  without giving any choice or opportunity to the patients and their attendants of buying medicines from other licensed and authorized pharmacies, retailers, dealers and distributors from the open market who may be selling such medicines at a discounted/ heavily discounted/ concessional prices, sometimes even with free medicines given by the drug manufacturers to the patients towards their schemes for “patient support” on purchase of a particular pre-defined quantity of medicines.

 

D.    India, even after 71 years of independence, is still a poor country and the Respondents being the state have miserably failed to provide medical care to the people of India, whose income and financial resources are limited and in the absence of active support from the state, i.e. the Respondents, medical treatment becomes unaffordable and unmanageable due to limited financial resources and means.  Even the insurance policies in India have limitations as the same are not people friendly, and insurance is still out of the reach of the common people in India.  Even in the emergencies, the insurance companies usually for various reasons in an arbitrary and dubious manner deny to honor the medical insurance policies and fulfill their commitment. Most of the insurance policies are not inclusive. The people are suffering at the hands of the Hospitals, insurance companies, and the Respondents. 

 

E.    The Respondents have become silent spectators in the fraud which is being perpetuated by Hospitals on the people of India, who come from different financial backgrounds and strata of life, thereby also becoming  perpetrator of the violation of the rights, guaranteed under Article 21 of the Constitution of India of a dignified, decent, healthy and free life including the right to live and die with dignity and honour, and this right is being violated every day with impunity by Hospitals because of the apathy and inaction of the Respondents, who have become collaborators of the fraud committed by the hospitals.

 

F.    As of now, there is no law or policy framework to prevent this misuse, fleecing and looting by Hospitals, and the Respondents have left the people of India in the unscrupulous hands and the regressive regime of Hospitals. It is a case of total failure of the Respondents to protect the people of India and ensure their welfare. Human life is being put at stake.

 

G.   The state i.e. the Respondents, by failing in performing their duty to protect the patients from the hands of the Hospitals, who are indulged in profiteering at the cost of the patients, their life and welbeing, have also failed to follow the Directive Principles as mandated under Article 38, Article 39 and Article 47 of the Constitution of India. 

 

H.    That the Hospitals compel the patients to mandatorily buy medicines, medical devices and implants and consumables from their own pharmacies in the Hospitals and Hospitals itself, without giving any choice or opportunity to the patients, or explaining or disclosing the prices of medicines, medical implants and consumables, including MRP to the patients, and offering them an option to buy medicines, medical implants and consumables from any other pharmacy or medical store of their choice at the same price or at a discounted price.

 

 

I.      The objective of the Constitution of India includes securing to all its citizen's economic justice. To achieve this, the relevant provisions of mechanism & principles for governments include the following:

Article 38, “The State (Government) shall strive to promote the welfare of the people by securing and protecting as effectively as it may a social order in which justice, social, economic and political, shall inform all the institutions of the national life. The State shall, in particular, strive to minimize the inequalities in income, and endeavor to eliminate inequalities in status, facilities, and opportunities, not only amongst individuals but also amongst groups of people residing in different areas or engaged in different vocations”.

 

Article 39, “The State shall, in particular, direct its policy towards securing that the citizens, men, and women equally, have the right to an adequate means of livelihood; that the operation of the economic system does not result in the concentration of wealth and means of production to the common detriment”.

 

Article 46, “The State shall promote with special care the educational and economic interests of the weaker sections of the people, and, in particular, of the Scheduled Castes and the Scheduled Tribes, and shall protect them from social injustice and all forms of exploitation.”

 

J.     To achieve the above mentioned Constitutional goals the responsibility lies with both the Central & the State Governments including ensuring adequate availability of all the Essential Commodities to the economically weaker families and common people of the country at a fair price. To achieve this national goal, regulation of the price, production, supply and distribution, and trade and commerce, in commodities essential to the general public as human beings, has to be ensured statutorily by the Central and State Governments. To serve this purpose, under Article 246, entry no. 33 of the concurrent list of the seventh schedule, the Parliament passed the Essential Commodities Act, 1955, assented by the President of India on 1st April 1955. The powers of Central Government under the Act, have been delegated, comprehensively, to the State Governments vide order dated 09.06.1978.

 

K.    That the rights of the consumers, which in the present case are the patients requiring medical treatment, includes the Right to Safety, Right to Information, Right to Choice, Right to be Heard or Right to Representation, Right to Seek Redressal and Right to Consumer Education; are being violated with impunity by the Hospitals, and ignored by the Respondents.

 

L.      In a news itempublished in the Times of India dated 24th April 2015  (https://timesofindia.indiatimes.com/city/nagpur/Hospitals-force-patients-to-buy-from-in-house-pharmacies/articleshowprint/47032880.cms), it has been reported that “Patients admitted in private hospitals are being made to suffer considerable financial losses through the forced purchase of drugs from in-house pharmacies. These drugstores sell drugs at much higher price than outside drugstores that typically offer discounts over MRP.  In the name of convenience, safety and efficacy of drugs these hospitals still pressure patients or their relatives who in any case are under stress over illness and unable to resist such pressure. Some hospitals have even put signboards saying medicines brought from outside will be returned. There is an obvious cut to be made by the hospital either through rent for the premises or in other ways. This often results in them prescribing brands having a higher retail price over relatively cheaper ones. It is unheard of for the hospital to prescribe generics. The drugs prescribed to patients admitted in the Intensive Care Unit (ICU) are the best example of this practice. One of the commonly used drugs is Meropenem, a broad spectrum antibiotic that most outside stores sell at prices ranging from Rs 899 to Rs 650 (with discount). However, a relative told TOI he bought the injection for a patient admitted in a well-known hospital from the in-house drugstore at Rs 2350 a piece. Surgical items like gloves, cotton, gauze, catheters etc also have a huge margin of profit. These too the hospitals insist must be bought from hospital store. Mostly the hospital uses own stock first and then asks the relatives to replace it. Since many patients at big hospitals have medical insurance, they also do not bother to negotiate and buy from an in-house pharmacy. Going a step ahead, some hospitals now do not even issue prescriptions to the relatives. The prescription directly goes from doctor to the hospital store and the medicine is made available at patient’s bedside.” News article dated 24 April 2015 is annexed as Annexure P-1 (Pg. nos. 45-50).

 

M.     In a news item dated 04.03.2016 published by the Times of India, it has been reported that Food and Drugs Administration (FDA), Maharashtra has directed all private hospitals across Maharashtra to display a board clearly outside their pharmacies stating there was no compulsion to buy medicines from their medical stores. However, no other information or notification in this regard, except various news items are available. News article dated 04.03.2016 is annexedas Annexure P-2 (Pg. nos. 51-53).

 

N.      The invoice dated 07.11.2017 pertaining to the sale of the injection BICELTIS 440 mg. for Rs.61,132/- by the hospital is annexed as Annexure-P-3 (Pg. nos. 54-60).

 

O.     The invoice dated 19.02.2018 pertaining to the sale of the injection BICELTIS 440 mg. for Rs.50,000/- is annexed as Annexure-P-4 (Pg. nos. 61-63).

 

P.    A report dated 20th February, 2018 in the form of an Office Memorandum of Government of India, Ministry of Chemicals & Fertilizers, Department of Pharmaceuticals, National Pharmaceutical  Pricing Authority (File No. 27(2)/ 2017-Div-lll/NPPA) is itself an eye opener and shows the fact that the Governments are aware of the plight of the patients, but they are not taking any action at all to prevent the menace of price manipulations and over-charging besides denying the patients their right as consumers.  The report mentions that “institutional bulk purchase by private Hospitals, which in most cases keep a pharmacy of its own, makes it easier for them to get very high profit margins and indulge  into  profiteering  on drugs  and  devices even without need to violate the MRPs which is already enough inflated.  Industry, to get bulk supply orders, is in a way 'forced' to print higher MRPs as per the ‘market requirements’.  This is a clear case of market distortion where manufacturers after accounting for their profits print inflated MRPs to meet out the demands of a distorted trade channel without getting any benefits from this 'artificial inflation' and patients have to incur huge out of pocket expenditure in hospitalization cases and also otherwise where they are not allowed to buy drugs from outside or go by the physician’s branded prescription”. This report further noted that “trade margins after selling medicines to stockists does not become part of the balance sheet of the  manufacturers or importers and this is how present pricing  system  based  on averaging  of price  to  retailers  (PTRs)  rarely  hurts the industry margins. The PTR (Price to Retailer) based

averaging method leaves even price control drugs with huge trade margins”.The same is annexed asAnnexure P-5(Pg. nos. 64-71)

 

Q.     The above Government report / office memorandum further states that “in most of the cases of scheduled and   nonscheduled  drugs  under formal monitoring of  NPPA (National Pharmaceutical Pricing Authority), the hospital  purchase  prices  are  invariably  often  lower than the 'prices to stockists' (PTS) offered by the manufactures in retail chain except for a few exceptions.This explains the variation in prices of drugs in open market and the retail shops and the hospitals and the truth behind various 'concessions' offered by retailers and in some cases even private hospitals on the overall bill as part of its 'charity'. The consumables, which are charged from the patients, used in the hospitals are not under any price control or monitoring of MRPs since these are not even listed as 'drugs' under Drugs & Cosmetics Act. NPPA can neither monitor the MRPs nor bring these disposables under price control even in the public interest under extraordinary conditions”.

 

R.      The above report further mentions that “the Diagnostics services constitute more than 15% of the total cost.  In random checks by NPPA, the charges were invariably found to be higher than diagnostics facilities provided by other independently run private centers. Diagnostics services along with all other charges by hospitals are beyond the purview of NPPA and the Central Government and can be regulated only through State-specific laws whether through adoption of central model 'Clinical Establishment Act, 2010 and corresponding  Rules'  or otherwise through  its own specific legislation by State Governments  which is already in existence  in  every  State  requiring  enabling statutory provisions. The profit margins in the non-scheduled devices used in  the three cases (syringes, cannula  and  catheters) are exorbitant and  clearly a case of unethical profiteering in a failed market system”.

 

S.      The above Office Memorandum of Government of India mentions that “the total expenditure on drugs and devices and diagnostics is substantially high (46%) and does not make part of the publicized 'estimate' or 'package' (in case of implants)  by the  hospitals  in  comparison  to  "procedures"  (11.42%),  room  rent (11.61%)  etc.  which  are  the  more  visible  components.  In all these cases, the patients have complained that the initial estimate of expenditure got inflated by 3-4 times. Most of the drugs, devices, and disposables were used and sold by the hospitals from their in-house pharmacies, and the patients were given no choice or opportunity to procure these articles from outside the hospitals where prices are supposed to be lower in most cases because of some  'discounts'. Last but not the least, the major beneficiaries of profits in all these cases because of inflated MRPs have been hospitals rather than drugs and devices' manufacturers”.

 

T.      The above Office Memorandum of Government of India, in its Table A also shows exaggerated price of some medicines which are charged by Hospitals:-

SL

Name of medicines / Injections

Price to Stockists

(PTS)asperthemarket-baseddata(Rs.)

The

purchasepriceofthehospital(Rs.)

Printed

MRPonthedrugs/devices/unit(Rs.)

Margin on

Procurementprice(%)

a

b

c

d

e

g

 

1

Propofol Inj 10mg/ml-20ml Vial

80.96

40.95

187.28

357%

 

2

Verfen 50MCG/ML 10ML INJ(Fentanyl) INJ

NA

49.84

225

351%

 

3

Nanzidone Solution 10% (Povidone-Iodine Solution)

NA

0.23

1.03

348%

 

4

Amlip 5mg Tab (Amlodepin)

0.47

0.56

2.5

346%

5

TRANEMIC,500MG/5ML

23.20

15.75

69.77

343%

6

Tazira Lyo

144.00

100.92

446.21

342%

 

7

Normal Saline 0.45% 500ml IV Glass Bottle

16.74

31.36

130.5

316%

 

8

Atacurium 50mg(Atracurium

Besylate)Inj1s

75

61.6

254.9

314%

 

9

FENSTUD,500MCG

NA

56.00

220

293%

 

10

Verfen(Fentanyl)10ml Inj.

NA

56.44

220

290%

 

11

Adrenor 4mg / 2ml (Noradrenaline)Inj

7.79

13.44

52.35

290%

12

Vanking 500mg Inj

72.90

69.30

267.45

286%

 

13

Verfen(Fentanyl)10ml Inj.

NA

60.20

225

 

274%

 

14

Pantodac Inj

40mg(Pantoprazole) Inj

19.26

 12.9

45.25

251%

 

15

Verfen 50MCG/ML

2ML(Fentanyl) INJ

NA

 12.99

45.1

247%

 

16

ATACURIUM,50MG

75.00

77.28

254.9

230%

 

17

Propofol Inj 10mg/ml-20ml Vial

80.96

43.68

143

227%

 

18

ADRENOR 2ML INJ (NOR- ADRENALINE)

13.64

15.68

51.19

226%

 

19

TAZACT,4.5GM

153.44

134.40

427.97

218%

 

20

THEMIPEN,40MG

NA

13.22

41.9

217%

 

21

PANSALVE,40MG

11.04

13.72

43.35

216%

 

22

Artacil 25mg (Artacurium Besyl) Inj

61.74

41.44

128.8

211%

 

23

Verfen (Fentanyl) 10ml Inj

NA

71.40

220

208%

 

24

Mucinac 5ml (N- Acetylcysteine) Inj

70.17

35.73

109.15

205%

 

25

Artacil 50mg (Atracurim

Besyl) Inj

113.22

84

256.6

205%

26

Mezolam

View Article / Presentation
Connect With Us Social Media

Copyright © 2016 India.All rights reserved with MoneyLaundering.Legal, Designed by: Star Web Maker