In W.P.(MD) No.21095 of 2022-MAD HC- Madras HC takes note of necessity for effective implementation of Health Insurance Scheme by private hospitals, issues directions to State Empowered Committee
Justices R. Mahadevan & J.Sathya Narayana Prasad [20-12-2022]

Read Order: DR.KARTHICK V. UNION OF INDIA & ORS

Mansimran Kaur

Chennai, December 27, 2022: Reaffirming that the right to health is a part of right to life under Article 21 of the Constitution, the Madras High Court has asked the State Empowered Committee to conduct periodical review meetings to consider complaints and irregularities related to implementation of the Health Insurance Scheme and deaths of patients covered by such schemes.

The Division bench of Justice R. Mahadevan and Justice  J.Sathya Narayana Prasad disposed of the instant petition by observing that 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 were issued to the authorities concerned, for effective implementation of the insurance Scheme. 

The petitioner, in the present case who  was  a Cardio Thoracic Surgeon, in the larger public interest,  preferred this writ petition, alleging that while he was working in SRM Medical College Hospital and Research Centre at Trichy / eighth respondent, he performed a surgery on a patient, who is a beneficiary of the Chief Minister’s Comprehensive Health Insurance Scheme,  at the time of which, the anaesthetist by name Dr.M.Vijay Kanna / seventh respondent, left the surgery mid-way to cater to another patient, not covered by the said scheme, under the directions of the Hospital Management, as a consequence of which, the patient covered by the scheme (scheme patien) died. 

Though the petitioner made efforts to bring the issue with the Hospital Management, it went unnoticed. Rather, he was relieved of his duties. Further, his attempts by lodging complaints with the police and Tamil Nadu Medical Council against the respondents seventh  and eighth for appropriate action, did not evoke any fruitful result. According to the petitioner, the Government introduced various insurance schemes to provide world class health care to the people, especially designed for poor, through government and empaneled private hospitals, however large number of people are not aware of the same and that, 65% of the state population, who have the right to avail medical benefits, are denied admission under these schemes.

 Therefore, the petitioner approached the Court with the present writ petition.

After considering the submissions from both the sides, the Court deemed it appropriate to refer to the Constitutional basis for right to health and duty of the State to ensure health care services. The Constitutional provisions which expressly relate to healthcare under the Directive Principles of State Policy, are Articles 39(e), 39(f) and 47. 

The Bench referred to the judgments in State of Punjab v. Ram Lubhaya Bagga and  State of Punjab v. Mohinder Singh Chawla and opined that the Apex Court has consistently held the right to health as a part of right to life under Article 21. In view of the same, the Court noted that the state-sponsored insurance schemes are indispensable 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.

This court was  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 was 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 Court further stated. 

As per the Bench, the inadequacies in the implementation and monitoring of the scheme have 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 must be issued to the authorities concerned, for effective implementation of the insurance Scheme.

Thus, the Court directed  the  concerned authorities to complete the enquiry and pass appropriate orders, on merits and in accordance with law, after affording due opportunity of hearing to all the parties, as expeditiously as possible. Considering the need and necessity for effective implementation of the Health Insurance Scheme by the private hospitals, the Bench also issued certain directions  constituted under G.O. (Ms) No. 49 dated February 4, 2009.