AoH, Charity Commissioner suggest separate schemes to implement charity in trust hospitals

Shardul Nautiyal - Mumbai

In the wake of state government's withdrawal of concessions provided to 70 'state-aided public trusts or charitable hospitals' registered under the Bombay Public Trust Act, 1950, the Association of Hospitals (AoH) and the Charity Commissioner are preparing separate schemes to implement charity in these hospitals.

Refusing to divulge details of the scheme, Brig Joe Curian, chief spokesperson of AoH, said, "The objective of the scheme is to come to a consensus of how charity can be provided to the poor and weaker sections of the society." AoH comprises over 45 Mumbai-based hospitals. Meanwhile, Sanjiv Punalekar (who had filed a PIL in the High Court for not receiving free treatment for his father), Charity Commissioner and the Advocate General of High Court Ravi Kadam are also jointly working out a scheme to implement free and subsidised treatment for the poor, said Rajeev Pandey, counsel for the petitioner. "Suggestions from the AoH are also invited for the formulation of the scheme. Chief Justice Dalveer Bhandari have directed the AoH to give their suggestions before May 5, 2005, on the day of final hearing," he added.(see box 1).

The propriety of government functionaries or ministers making an announcement of withdrawal of concessions, at this point of time is debatable and questionable since the case is still pending in the court and is subjudice, added Curian. AoH has also asked HC to clarify the ambiguity in Section 41 A A (see box 2).

Curian argues that charity commissioner's office had certified the implementation of the charity, duly registered by these hospitals. "It is to be noted that the charity commissioner did not take penal action against any hospital for non-compliance during and after the course of certifying the hospitals, said Curian, adding, "Many of the concessions and benefits quoted in the PIL are available under Income Tax Act. Such concessions are available even to organisations that are not philanthropic, like religious bodies, sports clubs, etc. For instance, Section 10 (23c) (vi a) provides exemption to hospitals existing for philanthropic (not for profit) purposes."

The court had last year suo moto taken up the cause of poor patients after an ex-mill worker, the father of Sanjiv Punalekar was refused treatment in one of the charitable hospitals. Punalekar filed a PIL on 15 December, 2004 with twin purposes: firstly, seeking free treatment for his father and secondly in the form of a PIL against the charitable hospitals in Mumbai.

Subsequent to taking up the case on the PIL, the court asked the charity commissioner to probe into the laxity of charitable hospitals. Charity commissioner S B Dhumal submitted an affidavit to chief justice Dalveer Bhandari and Justice S A Bobade, which stated that the charitable hospitals did not properly display or disseminate information regarding free or concessional treatment to the public and charged regular rates irrespective of the patient's income.

According to Punalekar, hospitals like Jaslok Hospital and Mandke Heart Hospital have been granted land at a rate of one rupee. They are expected to reserve 30 per cent of beds for the poor and economically weaker sections, which these hospitals are not implementing.

Stating that the charity commissioner is not clear about the meaning of certain provisions in the Act, Curian cited the example of the petitioner Sanjiv Punalekar, who demanded free treatment even though his father is not entitled to. According to the Act, his father did not fall either under the category of 'free'(annual income of Rs 3,600) or 'concessional'(annual income Rs 15,000).

AoH has further sought clarification on the extent of concession to be offered to these hospitals. "The office of the charity commissioner is unable to spell out these rates, which are to be in conformity with the rates charged by the state government in medical centres maintained by it," Curian said.

"The hospitals have a system of evaluating the financial background of the concerned family and concessions are granted accordingly. These gradations may extend from level A (minimum concession) to level K (maximum concession) covering bed charges, investigations, surgeries, procedures and even certain cases, medicines," Curian informed.

AoH has also pointed out to the ambiguous definition of free service. In one of the clarifications given by Attorney General of India, it was stated that free service will not include medicines, consumables and such items. "However, it is a known fact that many of the hospitals actually give free medicines and totally free surgeries to financially poor, if and when such patients are admitted," Curian added.

According to J P Sharma, medical superindentent, Jaslok Hospital, before making such a pronouncement of withdrawal of concessions, the government should take into account the functioning and infrastructure of the hospitals. "The community service rendered by voluntary health services in our hospital for the past 20 years is a good example to cite. Jaslok Hospital offers 96 economy subsidised beds and 51 free beds out of 376 beds. We offer treatment to the patients according to two categories namely patients entitled for free treatment and patients entitled for subsidised treatment," added Sharma.

Endorsing government punitive action, Dr M E Yeolekar, dean, Sion Hospital said, "The charitable hospitals should follow the rules strictly. The charitable hospitals are accountable for their actions. There is a need to create public awareness about the concessions given to the poor by charitable hospitals."

Interestingly, the Directorate of Health Services is also working on a similar kind of scheme independently, according to sources.

— shardul@expresshealthcaremgmt.com