To pull the plug or not ?

[HOPE CLINICS]

To pull the plug or not to pull it

At about 10 pm a distraught female of about 50 years brings her father to emergency in unconscious condition and  urges doctors to save him. Her panicked state and aggression towards hospital employees made the Emergency in charge doctor to bypass a few patients and attend to her father. The female begged him to do everything possible to save him and not to think of the cost of treatment involved since money was not a problem. Though normally suspicious of people who say not to worry about payment he was somewhat reassured once she had deposited Rs 50000 at the counter and signed all the relevant consent forms.  It seems he had an intracranial bleed so after getting a CT scan done he was shifted the cath lab for neurointervention using a coil to block the bleeding aneurysm. Patient was then shifted to Intensive care unit for further management. A further deposit of Rs 1 lac was requested to be made next morning so that  proper treatment could continue. The female assured the cashier that  money will be deposited once she goes home and gets it in the morning. 

In the morning at about 10 o clock the billing department called her to request her to deposit the payment of 1 lac which she assured she will deposit as soon as she reaches hospital. Till about 4 pm two more reminder calls were made by the billing office. She came to make payment at 4.10 pm very angry and upset that the hospital did not trust her even though her family could buy the hospital. She was given an estimate of the treatment cost and requested to deposit 1.5 lacs 2 days later.  Meanwhile she had multiple counselling sessions with the doctors involved where the gravity of the situation was explained to her. The second tranche of Rs 1.5 lacs was also deposited after multiple reminders and some heated exchange after 2 days. 

4th day she asked the doctors to remove the ventilator as there was no improvement and she could not afford the treatment cost as her brother was not financially assisting her.  Doctors asked her to give the request in writing which she declined. She did not come to the hospital for next two days despite multiple calls. On the 7th day she came to hospital accompanied by a “friend” and demanded that the ventilator be removed. She was counselled by the senior doctors again since there was no advance directive from the patient. She refused to make any further payments and remained adamant that the ventilator should be removed. The hospital did internal consultations and decided to discharge her father as “LAMA” (Left against Medical Advice) on ambu bag manual ventilation documenting meanwhile that the relatives wanted to go to a Government institution. After much negotiation she partially settled the final bill signed the copy of the discharge summary and took patient in ambulance on manual ventilation.

Next day  she came to the hospital and demanded the consultant incharge for  a death certificate claiming that it was being demanded by the cremation ground authorities. The Hospital refused to give a Death Certificate in this situation. After raising a lot of hue and cry she left making threats of suing the hospital for unnecessarily keeping dead body in ICU simply to make money. The hospital informed their insurers of the incident and told them that a claim may arise in this regard later.

 

2 weeks later a call from someone claiming to be the SHO of local police station was received by the treating consultant that a complaint had been filed by the  NRI son of the patient claiming that his sister in connivance with the doctors of the hospital had conspired to kill his father for the property. The consultant was asked to come to the police station and provide all medical records of this patient. 

A frequent situation seen in nearly all hospitals of the country has been described above. What is the practical as well as legally safe answer I wonder. Of course the SC judgment of Common Cause Society vs Union of India has laid down the law in 2018 reviewed by SC in 2023 because of the challenges posed, gives us the legal procedure. However if we follow the legal path the hospital will loose money because relatives refuse to pay while the legal formalities are being fulfilled. This still remains a knotty problem which needs further unravelling. 

Dr  Neeraj  Nagpal 

Managing Trustee,Medicos  Legal  Action  Group (MLAG)

Ex  President  IMA  Chandigarh

Director Hope Gastrointestinal Diagnostic Clinic,

SCO  1066-67 Aerodale  Market, New Sunny  Enclave Sector  123 Mohali 140301  

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