New Delhi: A senior Fortis executive landed at Abhinav Verma’s house in July 2017, and allegedly offered the family money. Abhinav’s 57-year-old mother had just died after 54 harrowing days of treatment at Fortis Hospital in Bangalore.

Abhinav’s mother had been admitted to Fortis for stones in her gall bladder. He says Fortis began treating her for cancer instead, introduced a temporary pacemaker in her heart, followed by a permanent one. She contracted a host of infections, her organs began failing, and then she died. “We followed all medical protocols and adhered to clinical guidelines,” a Fortis statement read. They also handed the family a bill for Rs 43 lakh.

Jasbir Grewal is the executive vice president at Fortis, and part of his job involves travelling around India, meeting grieving families, and offering them out-of-court settlements. He denies having offered the Verma family any money and said to The Wire, “I visited them only to offer my condolences.

Verma tells a very different story: “Grewal came all the way from Gurgaon to Bangalore for one whole week. He came to my house and kept persuading me, my father and sister, to take money from Fortis. He said they would refund all our expenses. He kept calling and messaging us through that week and even after he returned to Gurgaon, asking if we had made a decision.”

Verma and his family rejected the money. He asks, “Does Fortis send senior executives just to offer condolences to all the hundreds who die in their many hospitals?”

“I can only call it medical-kidnapping. Once they take our loved ones hostage, they demand ransom from us. This is how private hospitals in India work,” he says.

Fortis offers payouts to some families

While Grewal denied offering money to Verma, he did admit offering money to Jayant Singh, father of seven-year-old Adya Singh, who died last year after treatment at Fortis in Gurgaon. The child was suffering from severe dengue.

Like Verma, Jayant rejected Grewal’s offer of a payout. He later posted a photo of Fortis’s cheque on Facebook.

Grewal says that during his 13 year career at Fortis, he has successfully closed about a dozen payouts. He likens the healthcare industry to the hospitality industry and says, “Like in the restaurant or hotel business, to keep a customer happy, you may have to refund their money or give them something complimentary. So we also return money like that,” he says.

To a question of whether the payouts are intended to stop a family’s pursuit of their case, he says it is often understood by the families. “It could happen that the money is given in the hope that the family withdraws their case,” he says, choosing not to specifically confirm if Fortis has entered into such contracts with patients.

Grewal goes on to talk about dengue-related deaths, how in the annual dengue season deaths are routine, and in cases of severe dengue like with Jayant’s daughter, how the chances of recovery are very slim.

But that brings up the question of why it is in Fortis’s interest to offer Jayant money for this “routine” death, but not to Verma (as per Grewal’s own denial).

To this apparent double-standard, Grewal says there is no pattern or policy for deciding which cases are offered money by Fortis, but one of the criteria could be when a particular case garners a lot of attention.

“We give this money by cheque and it is all above board. This money does not come from our insurance policy or from the doctor’s professional indemnity but from Fortis’s own funds,” says Grewal.

The case of Medanta’s hush money

Verma and Jayant rejected the money, opting instead to pursue the matter in other ways. Jayant has in fact filed a writ petition in the Supreme Court and is working to escalate his case. But this is simply not an option for everyone, as The Wire reported this week.

The use of these informal monetary inducements outside the framework of a legal settlement – essentially hush money – came to public notice recently following a recent case involving Gopendra Singh Parmar from Dholpur in Rajasthan, and Gurgaon’s Medanta Hospital.

Gopendra’s seven-year-old son was taken to Medanta hospital in Gurgaon, also with severe dengue. His son finally died after being hospitalised in Medanta for a few days, leaving the family with a bill of nearly Rs 16 lakh. The family, already struck by grief over the death of their son, was further devastated by the bill.

Gopendra tried to file a police complaint with a reluctant Haryana police. He wrote letters to a range of public officials including the prime minister, and finally reached out to the member of parliament from his constituency, Manoj Rajoria. Rajoria, trying to help one of his constituents, asked the health ministry to look into the matter.

As The Wire reported in March, the health ministry had a range of options available, but instead chose to behave highly arbitrarily – the private secretary to Union health minister J.P. Nadda wrote a letter to Medanta’s chairman Naresh Trehan asking him to refund the money spent on the child’s treatment.

Medanta used the opportunity to hush Gopendra up. He was told he could have his money back, if he withdrew his police complaint. Gopendra withdrew his complaint and encashed the cheque.

“If we had pursued a legal case, we would have been living on the street,” he told The Wire.

When reached for comment, Medanta’s Naresh Trehan said, “You have already read about it in the papers. There is nothing more.”

“In Jayant’s case, the media pressure really worked to activate authorities but hospitals themselves don’t come forward to settle unless there’s scrutiny on them,” says Malini Aisola of the All India Drug Action Network (AIDAN).

She says there is a “policy vacuum” at present and as long as legal recourse remains an unviable option for patients, settlements will always be around in the backdrop.

If patients, civil society, courts and the government come together, the policy vacuum could potentially be filled. In the meantime, Abhinav Verma from Bangalore, Jayant Singh from Delhi and Gopendra Singh Parmar from Rajasthan are all coming to terms with the arbitrary ways of India’s corporate hospital landscape.