The Kerala Clinical Establishment Act was a law introduced by the first Pinarayi Vijayan government to regulate institutions such as hospitals, clinics and laboratories based on medical systems recognised by law in the country. It was a comprehensive law covering everything from registration of medical institutions to determination of fees for services. The said law, which was sufficient to regulate the quality of hospitals and testing labs from time to time and to avoid exploitation, was expected to bolster the public health sector in Kerala. Using the Clinical Establishment Act approved in 2010 by the second UPA government led by Dr Manmohan Singh as a model, the Oommen Chandy government first introduced this bill in Kerala three years later. The draft bill was prepared, but since it could not be introduced and passed in the assembly, it later lapsed. In 2016, the Pinarayi Vijayan government, which came to power, passed the said bill in the assembly the very next year. Later, when the rules were formulated and tried to be implemented in 2019, there were objections from some centres. The Kerala Private Hospital Association and the Kerala Medical Association challenged the law in court, which requires hospitals to display details of treatment fees in English and Malayalam. A single bench of the High Court, which first heard the case, dismissed the petition. The matter then came before the division bench. The other day, the division bench, in a verdict that fully supported the government's stance on healthcare, dismissed the petition of hospital managements and the doctors' association.
Along with controlling the quality of medical institutions, bringing such centres under the ambit of social responsibility and bringing effective and cost-effective treatment to the private sector has been a matter raised by health workers and voluntary organisations in this domain for long. The government has framed the Kerala Clinical Establishment Act in a way that takes this at face value. Despite some shortcomings that may be pointed out, this law in general has largely covered the above-mentioned needs. Naturally, it was a setback for profit-motivated health centres and individuals. That is how it led to litigation. However, when the court understood the essence of the law framed by the government keeping in mind the sentiments of the people, that became a crucial intervention which the time demanded. The court has reiterated the provisions of the Clinical Establishment Act almost exactly in its judgment. It gully supported the ultimate motto of the law that treatment is a right. This is made clear by the court’s directive that emergency treatment must not be denied at any stage, even if there is paucity of no money. Treatment fees and package prices should be displayed in hospitals and on the website, details of patients’ rights must also be displayed, safe transport with vehicles should be ensured for those who opt to be shifted to another hospital with facilities, bills and test reports should be handed over at the time of discharge, and the name and other details of the official to whom complaints should be lodged should be provided — all the recommendations put forward by the court are in fact provisions already contained in the law. Therefore, the court's verdict is definitely an endorsement of the government's health policy.
In the unique situation of Kerala today, this court ruling has other dimensions too. A state that has made great achievements in the health sector, Kerala has extensive network in the public health sector. Its benefits also have been felt by Keralites. High life expectancy and low maternal and infant mortality rates comparable to Scandinavian countries are all indicators of the Kerala health model. At the same time, Kerala is also the state with the highest number of non-communicable diseases (NCDs) such as diabetes and heart disease. Therefore, the number of people seeking treatment is also high in Kerala. According to the ‘Kerala Study’ report of the Sasthra Sahithya Parishad, Keralites are the people who spend the most money on treatment per capita in India. It is a reality that a large number of private medical institutions here are taking advantage of this situation too. Now another trend has emerged. Large private medical centres in Kerala are being taken over by corporates from the country and the world. Currently, the major share of many private hospitals that are familiar to the public, is under the control of such corporates. Naturally, the treatment rates are rising in all these centres. In this situation, even private hospitals that operate in the health sector with social commitment have found themselves unable to cope. The court has intervened to breathe new life into the Clinical Establishment Act while the medical sector is slowly moving into a state of uncertainty. Now the ball is in the government's court. What the government urgently needs to do is implement the court’s verdict in its true spirit. It is hoped that it will happen.