On September 14, Jitendra Pal Singh, 32, a kidney patient in Delhi’s Institute of Liver and Biliary Sciences, was allegedly told to sign an undertaking by the hospital authorities.

Singh has chronic kidney failure and has received treatment at ILBS for nine years. For the last six months, his haemodialysis treatment has been provided free of cost under the EWS category, referring to the economically weaker section. As per a Supreme Court judgement of 2011, 25 percent of outpatients and 10 percent of inpatients must be given treatment free of cost. ILBS’s guidelines for the same can be viewed here.

But the new undertaking said Singh now “understands” that haemodialysis for EWS patients is “kidney transplant oriented”. And since Singh does not have a “suitable family donor at present”, he’ll allegedly have to pay for his treatment until a donor is found.

At least four patients, all belonging to the EWS category, at ILBS told Newslaundry they too were asked to sign these “undertakings” stating that they will pay themselves for dialysis since they do not have donors lined up. They alleged at least 10 patients in total were told to do so.

Singh, a resident of Sitapuri, was shocked. “My process of transplantation with my mother is still ongoing,” he told Newslaundry. “How could they ask me to sign the undertaking? I refused to sign it.”

A day later, Singh approached the Delhi government’s directorate general of health services, which had referred him to ILBS for treatment under the EWS category. He also approached Delhi’s health ministry, where the health coordinator of the camp office under the health minister issued a letter asking ILBS to “consider the appropriate action as per the rules”. Newslaundry has a copy of this letter.

ILBS allegedly refused to even read the letter, Singh alleged. “They said, ‘EWS ka nahin hoga.’ They refused to entertain my plea.”

Singh is now worried about having to pay for his dialysis, which he needs twice a week, with each session costing around Rs 2,500. This works out to approximately Rs 20,000 a month. His family runs a paan shop while Singh himself is unable to work.

“Due to my bad health, I don’t earn anything,” he said. “My 70-year-old father and my mother work day and night at the shop. My brother is still studying. From where will I get Rs 20,000 a month for my dialysis? I spent whatever I had as a deposit for my treatment.”

However, Dr SK Sarin, director of ILBS, told Newslaundry he is “not aware” of dialysis patients under EWS category being asked to sign undertakings to pay for their treatment.

“Few days ago, our kidney department told me they are going to prioritise transplant patients,” said Sarin. “But I am not aware of any such undertaking...It is not like we will not do dialysis of patients who don’t go for transplantation.”

After this conversation on September 17, Sarin promised to look into the matter. He texted this reporter, “Stopped this. Looking into it.”

But on September 19, EWS patients told Newslaundry they were still asked to pay for their treatment. When this reporter tried contacting Sarin, there was no response.

ILBS, an autonomous institute, was set up in 2009 by the government of the national capital territory of Delhi. Its website indicates that it reserves 10 percent of its beds in the inpatient department, and 25 percent in the outpatient department, for EWS patients.

“Any EWS patient who comes here for daycare gets free treatment, including dialysis,” said a doctor at the institute on condition of anonymity. The doctor also said they were unaware of patients being asked to sign an undertaking.

Apart from Singh, the other EWS patients told Newslaundry they signed the undertaking because they were frightened about “losing out on the treatment”.

“What could we do?” said a relative of one of the patients. “We had no other option but to sign it. If we don’t do dialysis, the patient’s condition gets worse.”

Another EWS patient who was allegedly asked to sign the undertaking said he had telephoned the Delhi government’s helpline, 1031, at least six times since September 14 but no action has been taken. “Patients are really upset,” he said. “But the hospital authority is not addressing our concerns.”

He showed Newslaundry a copy of his income certificate through which he is applicable for free treatment under the EWS quota. He also sent this reporter a copy of his bill at ILBS dated September 19 when he had to pay Rs 2,605 for one round of dialysis.

Ashok Agarwal, a public health activist and advocate at the Delhi High Court, said this alleged undertaking is an “illegal, unethical, arbitrary, unconstitutional and inhuman” device.

“Whether the patient has a donor or not, how can a government hospital deny them dialysis?” Agarwal said. “Patients without a donor are more vulnerable as dialysis is the only means for their survival. By denying them this basic life-saving facility, the hospital is committing a crime against humanity.”

On September 20, ILBS’s Sarin continued to maintain that he doesn't know about the undertaking, adding, “I have told the concerned department to follow the Supreme Court of India guidelines.”

He added, “You have been calling me for the last two days on this same issue…If you know any individual patient and it's an emergency, let me know I will look into it.”