Although doctors are highly respected in Indian culture, there has been a rise in the number of individuals who have questionable values and put their financial gain above ethical standards. Some private hospitals offer incentives for overcharging, resulting in conflicts of interest for physicians who have financial relationships with pharmaceutical companies, laboratories, or healthcare institutions.

In some cases, doctors may prescribe unnecessary medical procedures or tests e.g. heart stent placement in exchange for commissions, inflate bills with unnecessary hospital stays or procedures, and take advantage of patients by performing unnecessary surgeries or facilitating organ donation for monetary gain.

Unethical Practices:
The various ways in which some private hospitals may engage in unethical practices are noted below:

• Delay in Emergency Attention: Some hospitals may be ethically negligent when they fail to promptly provide emergency attention, which can have dire consequences for patients, causing additional suffering and even preventable harm or death.
   
• Providing Misleading Information on Kidney Failure: It is highly unethical and a violation of medical ethics and professional integrity for hospital authorities to deliberately misinform a patient that both of their kidneys have failed for their own financial gain. Few hospitals may resort to this practice for financial gain.
   
• Unnecessarily Performing Caesarean Sections: Some obstetricians working in private hospitals may pressure pregnant women into choosing more expensive caesarean sections over the more affordable option of vaginal deliveries, solely for the sake of higher profits.
   
• Swapping of Newborns: The act of carelessly switching newborns in healthcare facilities is a grave violation of patient safety, resulting in significant emotional turmoil for both sets of parents. This mistake is typically a result of inadequate procedures, insufficient staff education, or systemic problems within the hospital's management, ultimately resulting in a loss of faith in the medical system.
   
• No Patient Hearing to Patient: Failure of doctors to pay attention to the concerns, symptoms, or medical background of their patients can result in detrimental consequences for their overall health. These may include inaccurate diagnosis, insufficient treatment, and dissatisfaction on the part of the patient.
   
• Resorting to Operation instead of Medication: Choosing surgeries over medication for monetary gain disregards the well-being of patients and goes against the principles of medical ethics, trust, and beneficence. However, some hospitals may indulge in such malpractice with the help of doctors.
   
• Administration of Incorrect Blood Group: The potential consequences of a hospital's negligence in administering the incorrect blood type can be severe, putting the patient at risk for life-threatening reactions.
   
• Illegal Kidney Extraction: Some hospitals may engage in conducting a kidney removal without a patient's permission or knowledge while performing stomach surgery or by any other means.
   
• Overbilling and Price Inflation: Hospitals may engage in overcharging patients for services, medications, and supplies, artificially inflating prices in order to generate higher revenue.
   
• Unnecessary Procedures and Tests: In some cases, hospitals may perform unnecessary medical procedures or tests on patients in order to increase their billing, putting patients at risk for potential harm.
   
• Upcoding and Billing Fraud: The practice of upcoding involves billing for more expensive services or treatments than those actually provided, resulting in higher costs for patients and insurers.
• Balance Billing Practices: Patients may be surprised by unexpected bills as a result of balance billing, where they are charged for amounts not covered by their insurance, causing financial strain.
   
• Opaque Pricing and Hidden Fees: Hospitals may lack transparency in their pricing, with hidden fees and unclear billing practices, leaving patients unaware of the true costs of their care.
   
• Kickbacks and Referral Schemes: Some hospitals may engage in kickback schemes, receiving financial incentives for referring patients to specific providers or facilities, potentially compromising the quality of patient care.
   
• Overprescribing and Overuse of Medications: Healthcare providers may overprescribe medications or recommend unnecessary treatments in order to increase profits, resulting in unnecessary expenses for patients.
   
• Unbundling Services for Higher Charges: Hospitals may unbundle services and charge separately for each component at higher rates, artificially inflating costs for patients and insurers.
   
• Falsification of Medical Records: In rare cases, hospitals may falsify medical records in order to justify unnecessary treatments or inflate reimbursement rates, jeopardizing patient safety and trust.
   
• Prolonged Hospital Stays for Financial Gain: Hospitals may extend patients' hospital stays unnecessarily in order to generate greater revenue, resulting in higher healthcare costs and potentially exposing patients to additional risks.
   
• Encouragement of Unnecessary Emergency Room/ICU Visits: In an effort to boost revenue, some hospitals may encourage patients to make unnecessary emergency room/ICU visits or admissions, putting strain on healthcare resources and driving up costs.
   
• Price Gouging for Services and Supplies: There have been instances where hospitals engage in price gouging by excessively charging for services, medications, or supplies, taking advantage of vulnerable patients.
   
• Misleading Advertising and Promotions: In order to attract patients, hospitals may use misleading advertising tactics that promise low prices or high-quality care that may not reflect reality, leading to patient dissatisfaction.
   
• Inadequate Charity Care and Assistance Programs: Hospitals may fall short in providing sufficient charity care or make it difficult for eligible patients to access financial assistance programs, leaving vulnerable individuals without necessary support.
   
• Understaffing and Compromised Patient Care: Understaffing in hospitals can compromise patient care and safety, resulting in longer wait times, medical errors, and reduced quality of care.
   
• Inflated Facility Fees for Outpatient Services: Hospitals may impose inflated facility fees for outpatient services without valid justification, increasing costs for patients and insurers.
   
• Unethical Conduct in Clinical Trials: There have been cases of hospitals engaging in unethical conduct during clinical trials, such as inadequate informed consent or manipulation of study results, risking harm to participants and the integrity of research.
   
• Overcharging for Medical Supplies and Equipment: Some hospitals may overcharge for medical supplies, equipment, and devices, passing inflated costs onto patients and contributing to overall healthcare expenses.
   
• Denial of Coverage for Necessary Treatments: Hospitals may refuse to cover necessary medical treatments or procedures based on financial reasons rather than clinical need, leaving patients without vital care.
• Absence of Price Transparency: The lack of transparency in healthcare pricing allows hospitals to exploit patients by charging unjustified, inflated prices, creating a feeling of being deceived.
• Failure to Provide Itemized Bills: Failure to provide itemized bills can make it challenging for patients to comprehend and dispute charges, potentially resulting in overpayment.
   
• Manipulation of Diagnosis Codes: Manipulation of diagnosis codes by hospitals in order to justify unnecessary procedures or increase reimbursement rates can lead to improper billing and financial strain on patients.
   
• Discriminatory Practices in Charity Care: Discriminatory practices in the allocation of charity care may occur, with eligible patients being denied assistance based on factors such as race, ethnicity, or socioeconomic status.
   
• Inadequate Infection Control Measures: Hospitals may also neglect to implement sufficient infection control measures, resulting in hospital-acquired infections that extend hospital stays and incur additional costs for patients.
   
• Failure to Provide Language Interpretation Services: Failure to offer language interpretation services to non-English speaking patients can jeopardize patient safety and understanding of medical treatment options.
   
• Lack of Accessible Facilities for People with Disabilities: Inadequate accessibility for people with disabilities in hospital facilities can impede their ability to receive care and violate their rights.
   
• Inadequate Nutritional Support: Hospitals may also fail to provide adequate nutritional support to patients, leading to malnutrition and delayed recovery, ultimately causing an increase in healthcare expenses.
   
• Non-disclosure of Treatment Options: Hospitals may not fully inform patients of all available treatment options, limiting their choices and potentially resulting in suboptimal care. This can lead to negative outcomes for patients.
   
• Inadequate Follow-up Care: After discharge, hospitals may not provide sufficient follow-up care, which can result in readmissions and increased healthcare costs for patients.
   
• Failure to Obtain Informed Consent: Patients have the right to give informed consent before any medical procedures or treatments are performed, but hospitals may fail to obtain this consent. This not only violates patients' rights, but also compromises the legality of the interventions.
   
• Inadequate Mental Health Services: Hospitals may not have adequate mental health services, resulting in inadequate treatment for patients with mental health conditions and leading to higher healthcare costs in the long run.
   
• Underreporting of Adverse Events: To avoid liability, hospitals may underreport adverse events or medical errors, which compromises patient safety and hinders efforts to improve healthcare quality.
   
• Failure to Address Patient Complaints: When patients have complaints or concerns, hospitals may not address them in a timely and appropriate manner, leading to patient dissatisfaction and erosion of trust.
   
• Inadequate Staff Training and Supervision: Staff at hospitals may not receive sufficient training and supervision, resulting in medical errors, compromised patient safety, and increased healthcare costs.
   
• Overuse of Medical Imaging Tests: Hospitals may also overuse medical imaging tests such as CT scans and MRIs, which exposes patients to unnecessary radiation and increases healthcare costs without improving outcomes.
   
• Failure to Provide Culturally Competent Care: Hospitals may fail to adequately meet the unique needs of patients from diverse backgrounds, resulting in misunderstandings, mistrust, and compromised outcomes.
   
• Inadequate Pain Management: The provision of subpar pain management due to cost-cutting measures can lead to unnecessary suffering and a decrease in the quality of care.
   
• Failure to Provide Palliative Care: Similarly, the lack of palliative care for patients with serious illnesses can result in avoidable pain and increased healthcare costs.
   
• Conflict of Interest in Physician Relationships: Furthermore, conflicts of interest within physician relationships can influence medical decision-making and undermine the quality of care provided to patients.
   
• Keeping Patient in ICU after Death: One particularly concerning and unethical practice is the intentional prolonging of a deceased patient's stay in the intensive care unit (ICU) for financial gain in some cases. Not only does it violate medical ethics and legal standards, but it also demonstrates a disregard for the dignity and well-being of the deceased and their loved ones.
   
• Not Treating in one Visit: Some doctors/hospitals don't complete treatment intentionally on one visit of the patient and compel the patient to pay more than one visit to the hospital for financial gain.
   
• Other Negligence: Negligence by hospitals during patient treatment can take various forms, including diagnostic errors, medication errors, surgical errors, inadequate monitoring, lack of informed consent, failure to follow standard protocols, understaffing leading to compromised care, delayed or improper treatment, inadequate infection control measures, and failure to provide appropriate follow-up care.

Conclusion:
The repercussions of medical malpractice are severe and can result in charges of fraud, revocation of licensure, and harm to one's reputation. It is crucial for healthcare establishments to prioritize the well-being of their patients and promptly address any concerns regarding unethical conduct. Patients have the option to report any negligence to the State Medical Council or seek recompense through civil or consumer courts.

To combat the high costs and delays associated with legal proceedings, India's healthcare system requires a no-fault liability system with limits on compensation, especially considering disparities in healthcare between urban and rural areas and financial limitations. It is imperative to make timely investments for successful reform.

Written By: Md.Imran Wahab, IPS, IGP, Provisioning, West Bengal
Email: [email protected], Ph no: 9836576565

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