Private hospitals built on concession lands must earmark beds for the poor: SC bats for right to medical aid

[dropcap]I[/dropcap]n the case of Union of India v. Moolchand Khairati Ram Trust (Civil Appeal No. 3155 of 2017), the Supreme Court has ruled that private hospitals built on land obtained at concessional rates in Delhi must earmark beds for patients belonging to poorer social strata, at a ratio of 10 % for those living in Delhi and 25 % for those living outside. The apex court quashed a Delhi High Court order which had dismissed the imposition of the conditions on the respondent hospitals to provide mandatory free treatment in the abovementioned ratio to those belonging to economically weaker sections.

The present petition was filed in order to determine the validity of a circular issued by the Government of NCT of Delhi (GNCTD) on February 2, 2012 to give effect to the judgment passed by the Delhi High Court in the case of Social Jurists v. Government of NCT of Delhi, Writ Petition (Civil) No. 18599 of 2007 dated March 22, 2007 with regard to free treatment to the economically weaker sections of the society.

The circular issued by the GNCTD pursuant to this judgment mandated the hospitals who had acquired land by the Land and Development Officer (L&DO) to follow the judgment and to provide free treatment to 10% indoor patients and 25% to outdoor patients belonging to the weaker strata of the society. The respondent hospitals were not a party to the said judgment and hence challenged the applicability of the circular on them and thus subsequently reached the Delhi High Court. The Delhi High Court quashed the imposition of the conditions on the respondent hospitals and against this the present appeal was preferred to the Supreme Court.

The Supreme Court after hearing the parties at length determined the meaning of the term “Charity”. They defined that charitable is the public purpose for the benefit of the needy people, who cannot pay for benefits received

The Bench of Justices Arun Mishra and Uday Umesh Lalit referred to the recommendations made by the Committee headed by Justice AS Qureshi which suggested the earmarking of beds as per the abovementioned ratio for the provision of free treatment to the people from the economically weaker sections of the society in the private hospitals that were allotted land on concessional rates in Delhi.

The Supreme Court after hearing the parties at length determined the meaning of the term “Charity”. They defined that charitable is the public purpose for the benefit of the needy people, who cannot pay for benefits received. As per the various definitions referred by the Bench, the relief of the poor was considered to be one of the essential requirements of charity. Also, the definition of “charitable purpose” in the Charitable Endowments Act, 1890 included the relief of the poor, education and medical needs. The Medical Council of India also in its regulations have stated that “the medical profession has to render service to humanity; reward or financial gain is a subordinate consideration. The doctor is supposed to be noble in all actions of his life.

In lieu of the observations made by the Court with regards to the Regulations framed by the Medical Council of India and the relevant provisions of the Universal Declaration of Human Rights (UDHR), it was held that,

the State can impose such obligation when the Government land is held by such hospitals and it is the constitutional obligation imposed upon such hospitals.”

The Apex Court also expressed the unfortunate state of affairs which are largely turning hospitals into centers of commercial exploitation and how unethical conduct is being practiced by them in order to extract more and more monetary benefits from the patients.

The Apex Court also expressed the unfortunate state of affairs which are largely turning hospitals into centers of commercial exploitation and how unethical conduct is being practiced by them in order to extract more and more monetary benefits from the patients

Referring to the basic Fundamental Rights and the Directive Principles of State Policy enshrined in the Constitution of India, the Court said that “the poor cannot be deprived of the treatment by the best physician due to his economic disability in case he requires it and that it is the obligation on the medical professionals, hospitals, the State and all concerned to ensure that such person is given treatment and not deprived of the same due to poverty.

The court while addressing to the contentions of the Respondents that such provision for free treatment amounted to restriction under Article 19(6) on the right enshrined under Article 19(1)(g) held that it was not restrictive and rather there even wasn’t a necessity for a statutory provision by the Government in view of the policy/rules/statutory provisions as to ethical standards and other statutory provisions already in force.

The Court in its concluding remarks while quashing the judgment and order of the Delhi High Court held that the hospitals in question and also other similarly situated hospitals have to observe the conditions framed in the order dated February 2, 2012 by the L&DO, GNCTD. Further it also stated that if in case any violation is reported, the same shall be viewed sternly and the lease shall be cancelled.

Right to medical aid

The recent judgment has been pleasantly welcomed and widely applauded as it addresses to the need of the hour which was the provision of free medical aid to the people belonging to economically weaker sections of the society in Delhi. The mandate which has been put upon the private hospitals which had acquired land at concessional rates to have a provision for providing free treatment including medicines and consumables to 10% of indoor beds and 25% of the OPD patients for the said category is surely a step towards ensuring economic equality in the society.

The intention of the Court while passing the judgment is very clear that it is striving to provide the adequate medical facilities to the ones who don’t have access to the exorbitantly high expenditures owing to the motive of commercial gains that has taken place with regards to the medical industry rather than the public service motive which should have been in fact the primary motive.

While the government hospitals were facing shortage of beds for the free treatment of the poor, the private hospitals built on government land at concessional rates with the underlying object of charity had vacant beds which were not being utilized by the poor owing to the sky high expenses charged by them against the five-star facilities provided.

While the government hospitals were facing shortage of beds for the free treatment of the poor, the private hospitals built on government land at concessional rates with the underlying object of charity had vacant beds

It has been very well established in the infamous case of Parmanand Kataria v. Union of India, (1989) 4 SCC 286 that, “when a man in a miserable state hanging between life and death reaches the medical practitioner either in a hospital (run or managed by the State) public authority or a private person or a medical professional doing only private practice he is always called upon to rush to help such an injured person and to do all that is within power to save life. It is a duty coupled with human instinct which needs no decision nor any code of ethics nor any rule of law.

The landmark judgment recognises the right to medical aid that has derived its constitutionality from Article 21 and 14 of the Constitution of India and which is also included as a Directive Principle of State Policy under Article 47 which makes improvement of public health as the primary duty of the State. Right to medical care has been also regarded as an obligation taken by the government being a Welfare State by the Apex Court in the case of Paschim Banga Khet Mazdoor Samity & Ors. v. State of West Bengal & Ors., (1996) 4 SCC 37.

In the present case, addressing the issue of public health vis-à-vis the status of a private hospital, the requirement of having the set of beds reserved for the people belonging to the economically weaker sections of the society have been put on such hospitals who have acquired land on concessional rates by the Government of NCT of Delhi. Thus, the reasonable restriction has been put while considering the objective which they had laid down while acquiring the land at such rates which were significantly lower than the market rates.

The judgment is indeed a favorable one as it would open the doors for the underprivileged sections of the society to avail the treatment by a private hospital free of charge. It is now upon the authorities to ensure that the benefits that the have-nots have been assured by the Supreme Court of India with reference to the Circular issued by the GNCTD reaches the beneficiaries. There needs to be adequate dissemination of the information regarding the same to the people for whose welfare the provisions have been made so as to ensure that it just doesn’t remain a beneficial judgment with no one to take benefits of it!

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