4. Can hospitals detain patients for unpaid bills?

• A detention: A 60-year-old man was last week tied to a hospital bed in Madhya Pradesh’s Shajapur after his family failed to pay the medical bill of Rs 11,200. After media reports, the local administration suspended the licence of the private hospital and booked the hospital manager for wrongful confinement. That’s not how most such cases end though the law doesn’t say much on the issue.
• A draft charter: In 2018, the Union health ministry came out with a ‘charter of patient rights’ prepared by the National Human Rights Commission, laying down the basic rights of a patient. The draft said that hospitals cannot detain a patient, or the dead body of a patient, over procedural grounds such as dispute in payment of hospital charges. The plan was to implement the provisions of the charter through state governments as health is a state subject.
• A draft rule: Draft rules issued by the Maharashtra government last year that seek to amend the state Nursing Home Registration Rules said patients cannot be detained for non-payment of hospital bills and “under no circumstances a dead body be withheld for non-payment of hospital bill or any other reason”.
• A problem: These rules and guidelines are still ‘drafts’ and unless they are made into a law backed by sanctions for non-compliance, getting hospitals to fall in line would be difficult.
• The only option: Various courts have ruled time and again that hospitals can’t hold patients hostage for unpaid bills. However, these judgments have been on a case-to-case basis with courts refusing to pass general directions. In 2018, the Bombay high court, ruling in favour of a patient, observed: “How can a hospital detain a person who is declared fit otherwise on the ground of non-payment of fees? Such a hospital is curtailing the personal liberty of a person. Every member of the public must be made aware that such action on the part of a hospital is illegal.” However, the court refused to issue any specific regulatory order against hospitals, saying it is the government’s job. A year earlier, the Delhi high court had asked for the release of a patient held hostage over a disputed bill saying, “even if dues are outstanding, custody of patients cannot be withheld to extract money towards unpaid bills. We deprecate this practice.”
• Bottomline: It’s up to the patient’s family to either hope that its case gets noticed by authorities or approach a court.

The Indian authorities have responded with new measures following concerns over the country’s medical preparedness.

• The central government has asked states to engage with the private sector and consider pooling public and private healthcare facilities. States have also been asked to negotiate with local private healthcare providers and arrive at reasonable rates, while factoring in cost elements for personal safety equipment. Some states such as Maharashtra and Tamil Nadu have already capped the cost of Covid-treatment at private hospitals.
• In Delhi, the High Court cleared the use of two hotels as Covid-19 facilities, based on recommendations of an expert panel. A court-appointed committee of AIIMS director Randeep Guleria and Niti Aayog member V K Paul informed the court that “it is advisable as well as infrastructurally feasible to use Hotel Surya, New Friends Colony, and Hotel Crowne Plaza in Okhla as (such) facilities.” They are suitable for use as “Covid care centres” to treat asymptomatic patients who have no home-quarantine facility or patients with mild ailment, the panel said. It also recommended a hospital to be “attached” on who the responsibility of clinical care shall rest. On Sunday, Delhi Lieutenant Governor had inspected the campus of a religious organisation, Radha Soami Satsang Beas, to set up a 10,000-bed makeshift facility.
• In Chennai, where the number of cases is over 33,000, only behind Mumbai and Delhi, the immediate response was another lockdown. The Tamil Nadu government on Monday announced a lockdown in Chennai and adjoining parts of three neighbouring districts for 12 days, beginning June 19.
• The Indian Council of Medical Research has recommended the use of an antigen-based testing kit to enable faster diagnosis without laboratory examinations of samples. The antigen test, developed by private biotechnology firm SD Biosensor, can detect the presence of SARS CoV-2 in swabs collected from the nose alone.

But… the country needs to increase testing by roughly 10 times, Rakesh Mishra, director of the Centre for Cellular and Molecular Biology, said during a video conference with Telangana governor Tamilisai Sounderajan. “One million tests per day is possible, but by using different technologies of testing,” Mishra told TOI. India tests around 150,000 samples a day.

And the outbreak? India recorded 396 coronavirus-linked fatalities on Monday, the highest yet. 10,373 new cases were also reported, a six-day low. Maharashtra reported 178 fatalities; Delhi 73; and Tamil Nadu 44. Cumulative figure: Nearly 343,000 cases and 9,914 fatalities.

• Pakistan on Monday detained two Indian officials working at the High Commission of India in Islamabad, before releasing them in the evening after New Delhi summoned Pakistan’s chargé d’affaires to the external affairs ministry and delivered a demarche demanding their release.
• Pak publication Dawn reported the two non-diplomatic staff “ran over a pedestrian and subsequently attempted to flee”, citing an FIR registered at the Secretariat Police Station, Islamabad. The FIR also noted that “counterfeit currency notes were found in the possession of one of the officials,” the report added.
• Indian authorities denied that the two men were carrying any fake currency and expressed apprehension that they were held for hours on trumped-up charges to declare them persona non grata, reports Times of India. The two were reportedly questioned by Pakistani authorities for 12 hours.
• India had earlier rushed to register a protest after the two were reported “missing” in the morning. That the incident occurred a fortnight after India deported two Pakistani officials working at the Pak High Commission in New Delhi on espionage charges heightened the significance. In the demarche, India demanded there should be no interrogation or harassment of the Indian officials and that the responsibility for the safety and security of the diplomatic personnel lay squarely with the Pakistani authorities, TOI reports. India asked Pakistan to immediately return the officials along with the official car to the High Commission.
• India contends this was a tit-for-tat for the expulsion of Pakistani officials. Early this June, India’s charge d’affaires Gaurav Ahluwalia was tailed by Inter-Services Intelligence (ISI). The TOI on Monday had reported that Pakistan’s ISI had subjected Indian officials to aggressive tailing since May 31. On Friday, India had registered a formal protest accusing Pakistan of violating the Vienna Convention and the 1992 bilateral Code of Conduct for diplomats.

“Historic, spiritual” ties with Nepal: Defence minister Rajnath Singh on Monday said differences between India and Nepal were only a misunderstanding, which “would be solved through dialogue”. “Indo-Nepal ties are not an ordinary one. We have a relation of roti and beti which cannot be broken by any power of the world,” he said. “We don’t have just geographical, historical or social relations with Nepal but a spiritual one also.”

• Nukes headcount: Well, the good news is that the world this year has about 465 less nuclear warheads than it did last year — the not-so-good news is that their total number is still enough to wipe out the world several times over, if it ever came to that. The annual count of nuclear weapons by the Stockholm International Peace Research Institute (SIPRI) puts the total nuclear weapons count in 2020 at 13,400 — down 3.35% from last year’s count of 13,865. Of course, these figures are estimates since many countries do not reveal their exact count of nuclear warheads for strategic reasons.
• Home defence: India’s nuclear count, according to SIPRI, has shown a slight upward tick after languishing in the 130-140 range for the previous two years. However, New Delhi appears to have fewer nukes than Pakistan and less than half the nuclear warheads possessed by China. That may not be of much concern though, as SIPRI believes that all three nations are increasing the size of their nuclear arsenal — though interestingly, Pakistan, which had earlier used highly enriched uranium (HEU) for building its nukes, is now shifting to plutonium, the same fissile material used by India and Israel. Moreover, India maintains that it has enough nuclear deterrence capability. It may be noted that unlike the US, Russia, UK and France, none of the other nuclear weapons powers have deployed their warheads.
  

• Figure it out: SIPRI admits to the unreliability of its figures, citing the non-transparency of data from the nuclear powers. While in India’s and Pakistan’s case, it says that even though the governments of both countries “make statements about some of their missile tests”, they “provide no information about the status or size of their arsenals”. Israel, in fact, has never officially acknowledged its status as a nuclear weapons power until earlier this year, when Israeli PM Benjamin Netanyahu ‘admitted’ to possessing nuclear weapons in an apparent slip of the tongue. Even the US, which till 2019 was open about its nukes, has “ended the practice of publicly disclosing the size of the US stockpile”, a la Russia. Only France, UK and China give out some information about their nukes in the public domain, SIPRI said.

• Facebook on Monday rejected calls by Australian authorities to share advertising revenue with news publishers and, instead, threatened to drop news content from its platform altogether. “If there were no news content available on Facebook in Australia, we are confident the impact on Facebook’s community metrics and revenues in Australia would not be significant,” the company said. “Given the social value and benefit to news publishers, we would strongly prefer to continue enabling news publishers’ content to be available on our platform,” it added, a thinly veiled warning that news companies need Facebook more than vice versa.
• Tell me more: Last month, Australia ordered content aggregators such as Google and Facebook to share advertising revenue with news publishers for distributing or publishing (in part or full) their news articles. The order issued by the Australian government follows a report by the Australian Competition and Consumer Commission, based on an 18-month inquiry, that called for 23 recommendations to improve media competition.
• Google and Facebook together control over 60% of the US online ad revenue; in other markets even more. The rise of these behemoths has coincided with the fall of traditional publishers, as the latter no longer became the sole gateway to the eyes and ears of the public. It doesn’t help either that companies like Google control nearly all facets of digital advertisement — its suite of products and services make it is the buyer, seller and auctioneer in the complex chain of online ads.
• This pushback against tech companies increased following the online disinformation campaigns that impacted democratic processes in the US, UK and elsewhere; and politicians from the left and right acknowledged the importance of traditional media. France’s competition watchdog, last April, ordered Google to pay publishers to display snippets of their content. And this April, Australia enacted a law on revenue sharing.
• But Big Tech is fighting back. Google and Facebook have rejected the Australian demand, leaving open the possibility that they may drop news content from their platforms; Google cannot stop indexing websites on Search (due to antitrust rules) but could drop Australian content on Google News. Can they squeeze publishers into submission? Watch this space.

• The fall: India’s wholesale price index (WPI)-based inflation fell 3.21% in May, the lowest in over four years. The fall was led by a sharp decline in prices of fuel and power (by 19.83%), even as food articles turned expensive (by 1.13%). Manufactured products saw a deflation of 0.42%.
• The freeze: The commerce ministry, which publishes the wholesale prices data, had released truncated WPI data for April due to the nationwide lockdown. The statistics ministry, which publishes consumer price data, has withheld retail inflation numbers for the last two months, citing the lockdown.
• The bad news: While retail inflation is about your expenses, borrowings and investments (affected by interest rate changes), wholesale inflation, which captures prices at the factory, could be an indirect indicator of your salary increments and job opportunities. The collapse in the manufactured products inflation component within WPI means that manufacturers (who are big employers) are unable to raise prices of the goods they make — a key determinant of the fate of any industry.
• The risk: A 5% contraction in gross domestic product in 2020-21 may lead to a 15% fall in corporate India’s revenues and poses an “existential threat” for small businesses, a report by ratings agency Crisil said on Monday. The micro, small and medium enterprise (MSME) sector will have to face a sharper decline in revenues of up to 21%, while operating profit margins will narrow to 4-5%, said the report.
• What next? The fall in WPI is bigger than expected. A Bloomberg poll of economists had forecast WPI to fall 1.2% in May. This, experts say, could mean a further cut in interest rates by the Reserve Bank of India to support the economy headed for its first annual contraction in over four decades. The central bank had last month cut policy rates by 0.40%, taking the key repo rate to its lowest ever 4%.

Meanwhile, India’s exports fell 36.47% in May to $19.05 billion, the third fall in three months. Imports too plunged 51% to $22.2 billion, leaving a trade deficit of $3.15 billion.

• Police said an accidental death report for Sushant Singh Rajput was filed at Bandra police station and the provisional cause of death is asphyxia due to hanging. They said they had not found any indications of foul play. DCP (Zone IX) Abhishek Trimukhe said Bandra police have got the provisional postmortem report. “A team of three doctors [at RN Cooper Hospital] conducted the autopsy and the provisional cause of death is asphyxia due to hanging,” he added. No suicide note was found.
• This even as the 34-year-old actor’s maternal uncle RC Singh and brother-in-law OP Singh alleged foul play. However, Maharashtra home minister Anil Deshmukh tweeted on Monday: “… there are media reports that he allegedly suffered from clinical depression because of professional rivalry. @MumbaiPolice will probe this angle too.”
• Police have recorded statements of six people so far, including one of his sisters who lives in Goregaon, his actor friend Mahesh Shetty, actor-friend Rhea Chakraborty, his managers and cook. A separate four-member team of experts from Kalina Forensic Science Laboratory visited Sushant’s Bandra house on Monday afternoon. The team looked at the crime scene and gathered evidence to conclude whether it was a homicidal or suicidal hanging.
• Cooper doctors also sent his viscera to JJ Hospital in Byculla for histopathology while another set of samples have been sent to the Kalina laboratory, where routine chemical analysis will be carried out to check for intoxication, poisoning, among other tests. An officer from Kalina laboratory said the reports are expected in a week’s time. The actor’s phone has been sent to the forensic laboratory to extract his call details and other information to find out what could have led to his death.
• Sushant’s father KK Singh flew in from Patna and performed his last rites along with two of his four sisters at Pawan Hans Vile Parle Sewa Samaj Shamshan Ghat on Monday evening. Fellow actors Kriti Sanon, Shraddha Kapoor, Varun Sharma and Chakraborty were also present.

• Who? Maria Ressa, an award-winning journalist from the Philippines and the editor-CEO of Rappler, an independent news website, is facing up to six years in prison after she was found guilty of “cyber libel” charges on Monday. The verdict was issued by a Manila court. Ressa and writer Reynaldo Santos Jr were accused of cyber libel (defamation) in 2017 for an article investigating a former chief justice’s links to several businessmen, some of them into illegal activities. Ressa denies the charges and claimed they were politically motivated.
• Why it matters? Rights activists say the case is pushed through due to Rappler’s critical coverage of Philippines President Rodrigo Duterte, a self-avowed nationalist. Rappler gained international acclaim for its investigative reports that exposed extrajudicial killings and abuses by security forces under Duterte’s controversial “war on drugs”. Duterte’s government has also alleged Rappler of violating the country’s foreign investment rules; the company rejects the claim.
• Tell me more: According to the Philippine Drug Enforcement Agency, 4,948 suspected drug users and dealers died during police operations from July 1, 2016 to September 30, 2018. The Human Rights Watch says the actual figure could be much higher. According to the Philippine National Police 22,983 such deaths since the “war on drugs” began are classified as “homicides under investigation,” says the rights watch. In 2018, the International Criminal Court (ICC) opened a probe into possible human rights violations; in response, Duterte took the Philippines out of ICC.
• What they say: “The court has become complicit in a sinister action to silence a journalist for exposing corruption and abuse. This conviction is an affront to the rule of law, a stark warning to the press, and a blow to democracy in the Philippines.” That was Amal Clooney, who is leading a team of international lawyers representing Ressa.

• It’s a war: Beijing on Monday reported 36 new cases of Covid-19 positive patients, taking the total count of confirmed cases to 79 — just a couple of days after the city shuttered its largest wholesale food market. The fresh outbreak, the first in nearly two months, has raised fears of a second wave of infections and introduction of “wartime measures” to control the virus’ spread. What’s worse is that the source of the infection — patient zero — has still not been traced.
• Control measures: With the total number of new cases over 100, the city administration has instituted a lockdown in 11 residential localities in the vicinity of the market, which is 20 times larger than the seafood market in Wuhan, from where the first outbreak of the Covid-19 pandemic is thought to have originated. The authorities are also conducting mass nucleic acid tests for the city’s 20 million residents — desperate to stem the spread. In the first wave of the infection, Beijing saw 420 cases and 9 deaths.
• Not just China: Fears of a second wave have been gaining currency in the US too, with a medical professor saying that it has already begun in the country — this, after several states in the US last week reported a fresh surge in new cases. According to William Schaffner, professor at the Vanderbilt University School of Medicine, speaking to CNBC, “many people are simply not being careful, they’re being carefree” — alluding to the mass gatherings, religious services, lack of physical distancing and not wearing masks. This, in a country that has the highest count of Covid-19 cases, at almost 2.1 million with over 115,000 deaths. Even Hong Kong is on alert, with its Centre for Food Safety ordering the testing of salmon samples as a precautionary measure.

Tata Motors. The automaker expects to shed about 1,100 temporary jobs at Jaguar Land Rover after it raised the cost-cutting target at its luxury unit by £1 billion (Rs 9,554 core) to ride out the disruptions caused by the Covid-19 outbreak. On Monday, Tata Motors reported a consolidated net loss of Rs 9,894.2 crore in the three months through March compared with a Rs 1,117 crore profit a year ago. It is also reviewing all its businesses and would consider exiting those that do not add strategic value, as part of a broader effort to save Rs 6,000 crore in its domestic business in FY21.