Supreme Court notice to Centre, States over free treatment to poor patients at private hospitals

New Delhi: Accepting a PIL on the lack of free treatment for Economically Weaker Section (EWS) and Below Poverty Line (BPL) patients in private hospitals built on government lands or with government concessions, the Supreme Court issued notices to the Centre, states and Union Territories asking for a response on the matter.

A bench of Chief Justice B R Gavai and Justices N V Anjaria and Alok Aradhe was considering a PIL that raised serious concerns about private hospitals refusing free treatment to poor patients, despite receiving land and benefits from the government on the condition that they would do so.

The petition, filed by social activist and Magsaysay Award winner Sandeep Pandey, points out that many hospitals across states like Delhi, Maharashtra, Haryana, Odisha, Telangana, and West Bengal were given prime government land at concessional or token lease rates, or additional Floor Space Index (FSI) under state development control regulations.

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In return, they were supposed to keep aside a fixed share of beds and outpatient services for people from Economically Weaker Sections (EWS) and Below Poverty Line (BPL) families.

Usually, this meant 10% of inpatient beds and 25% of OPD consultations should be free. However, the petition highlights repeated reports of hospitals disregarding these rules and authorities failing to check or enforce them.

"In multiple States—including Delhi, Maharashtra, Haryana, Odisha, Telangana, West Bengal and others—successive audit reports, court-monitored inquiries, and govt notifications have revealed persistent and systemic non-compliance by hospitals with the stipulated percentages of free treatment, ranging typically from 10% of inpatient beds and 25% of outpatient consultations," said the petitioner, reports TOI.

"As per CAG report on Maharashtra, out of 113 state-aided public trust hospitals, only 11 were tested and most were in default. Specifically, Bombay Hospital, Lilavati Hospital, Saifee Hospital and PD. Hinduja Hospital, which received additional FSI (Floor Space Index) under Development Control Regulations (DCR) on the condition of providing 20% free IPD and 10% concessional OPD treatment, were instead providing only 10% IPD and 10% OPD under a court-approved scheme, thereby violating their lease and FSI-based obligations. The CAG also noted underutilisation and diversion of Indigent Patients' Funds (IPF) in hospitals such as Bethany Hospital, which short-credited Rs 1.43 crore to the IPF," the petition said.

The petitioner further added, "In Delhi, hospitals like Indraprastha Apollo and others were required to reserve one-third of their beds for free treatment. Repeated defaults led to the landmark judgment in Social Jurist v. GNCTD (2007) where the Delhi High Court directed strict penalties against defaulters, later upheld by the Supreme Court. Despite this, complaints of denial to poor patients continue to surface. In Haryana, a 2018 legislative committee report revealed shocking data—one private hospital treated only 118 EWS patients free of cost out of 64,000 admissions in 2017. Worse, no monitoring meeting was held for nearly a decade. In Odisha, the 2013–14 CAG Report flagged hospitals that had received land worth nearly Rs 45.68 crore at concessional rates but failed to provide the required free services. Six promoters even diverted hospital land to build residential and commercial complexes, violating lease conditions."

As per the Law Advice media report, the petitioner argues that these examples highlight a nationwide failure of governance, monitoring, and enforcement mechanisms, which has resulted in large-scale denial of healthcare benefits promised to the poor.

As a result, the petitioner sought the court's intervention and asked the bench to order uniform enforcement of lease/policy conditions across all States/UTs requiring hospitals to provide free medical care to EWS/BPL patients, constitution of empowered monitoring authorities in each State/UT with powers to audit compliance and publish periodic reports, recovery of monetary value equivalent to the denied free treatment, and cancellation/resumption of land allotments in cases of persistent violations, creation of a centralized digital dashboard for real-time public display of free bed availability and compliance data, strict directions against segregation or differential treatment of EWS patients within hospitals and any other directions to ensure that public resources are not abused and healthcare rights of the poor are protected.

The PIL also underlines that failure to enforce these obligations not only deprives the poor of their right to healthcare under Article 21 (Right to Life) but also amounts to a breach of public trust since valuable government land and concessions have been granted to these hospitals.

Taking note of the significant violations, the Court has issued notices to the Union Government, all States, and Union Territories, asking them to respond. It also noted that in a recent related matter, it had already asked the Centre and Delhi Government to check whether Indraprastha Apollo Hospital had given free treatment to EWS patients in the last five years.

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