Health is a subject closer to everybody’s heart. Improvement
of one’s health and health of one’s family is a universal aspiration. However health has been always given a low
priority status in the nation’s political and social agenda. With the increasing privatization of the
health care services in the country, the state is slowly abdicating its responsibility
to provide health care to the people.
Medical profession contributes to the healthcare to the extent of only
25-30%. Approximately 70% input in the
health care is by various sectors like the pharmaceutical industry, hospitals,
blood banks etc. This 70% inputs are
mostly managed on a commercial basis and therefore patient as a consumer must
have certain rights. These rights of a
patient as a consumer are more important than the rights of a general consumer
because patient usually has very little choice in the treatment.
WHAT ARE PATIENTS RIGHTS?
Patients rights emanate from human rights, constitutional
rights, civil rights, consumer rights, codes of ethics of medical and nursing
profession. The Indian Constitution bestows certain rights on the
citizens. One of them is Right to
life. Right to a healthy life is an
integral part of the Right to life.
WHO’s definition of health includes physical, mental, social,
environmental and spiritual aspects of health.
Any threat to health care must be considered as denial of the Right to
Life. Basic optimal health care is the
right of every Indian citizen and it is the responsibility of the state to
provide it. The Government in the
country has legislated certain laws to protect the citizens. Some of these are, The Drugs and Cosmetics
Act, The Medical Council Act and The Consumer Protection Act. The codes of ethics of medical and nursing
councils define the duties of the doctors and nurses towards the patients. Thus these duties form the basis of patient’s
rights.
These codes of ethics are based on various international
codes like The Nuremberg Code, The World Medical Association’s Declaration of
Geneva, The World Medical Association’s Declaration of Helsinki, The World
Medical Association’s Code of Medical Ethics, Declaration of Tokyo etc. There are certain rights which are for
certain special category of patients for e.g.; handicapped /disabled
persons. Certain healthy persons also
need the cover of patients rights. This
category includes women taking various contraceptive pills, healthy persons who
undergo vaccination, healthy persons who volunteer for drug trials etc. Thus rights of patients cover a wide spectrum
of ill as well as healthy persons.
WHAT PRECAUTIONS SHOULD PATIENTS TAKE TO PROTECT THEIR
RIGHTS?
In India there is very little perception about the rights of
the patients even amongst the educated persons.
Therefore blatant violation of patient’s rights is a routine
occurrence. However the situation can be
changed if every citizen takes certain precautions while undergoing treatment
or while taking drugs/vaccines etc.
1) In case of surgical treatment or
invasive investigations and procedures, please make sure that you have
understood the nature of the operation.
You have the right to know the details of the surgery as well as the
details like the expected time of post-operative recovery, expenses likely to
be incurred for the surgery, the risks involved, whether there is any
non-surgical treatment for your ailment etc.
2) Please make sure the details are
understood by you before you sign the consent form. The consent form should be in your mother
tongue or the language known to you.
3) At the time of discharge, please
make sure that you have been given copies of all the relevant records. As per the decision of the Bombay High Court
(Raghunath Raheja v/s Maharashtra Medical Council), every patient or his legal
heirs have the right to get the copies of all the case papers on payment of
relevant charges.
4) At the time of discharge from the
hospital, please make sure that you have received the bills for all the
payments made by you. You have the right
to get details of the bill like details of drugs administered to you, the
details of investigations etc.
5) In case of any treatment, you have
the right to ask for a second opinion.
However, the second opinion should be taken ONLY with the consent of
your physician.
6) If you have any doubts about the
treatment you should request the doctor to clarify them. Doctor-Patient communication is of vital
importance for the success of any treatment.
7) Please make sure that the doctor has
given you all the instructions for the medicines prescribed. You have the right to get all the relevant
information about the drugs prescribed to you.
8) In case of invasive/costly
investigations, you have the right to know of the alternatives as well as the
necessity of the investigations.
9) As a patient, you have the right to
take second opinion and/or change the doctor.
However, this right should be exercised very judiciously and
cautiously. ‘Doctor Shopping is not in
the interest of consumers and can cause serious harm due to irregular treatment.
10) Please
always preserve all the bills of the purchase of medicines.
11) If you have any complaints about the
treatment/investigations/drugs etc., first approach the concerned
doctor/hospital. Many times the
complaints are due to misunderstanding and failure in communication. These can be resolved at the local
level. Many hospitals have their own
patient redressal cell. You must first
approach such Patient Redressal Cell.
12) If you find that your complaint remains unresolved, then
please write down
Your grievance giving all the
relevant details in a sequential format and take the advice of a Consumer
Organisation in your area before taking any legal action. Please remember that most of the times the
complaints can be resolved at the hospital level.
13) In
case of substandard drugs, preserve the drug packages with labels/cartons/boxes
etc. The complaints about the drugs have
to be lodged with the local Food and Drugs Administration.
14) If you
are participating in any trial for drugs/therapeutic devise/treatment protocol,
you have the right to refuse to participate in the trial. Please make sure that you have understood all
the details like duration, risks involved, the expected complications etc. Also make sure that the doctor/hospital
conducting the trial has agreed to treat completely any complication arising
out of the trial, free of cost. Please
make sure that the consent form includes all the details.
15) As a
patient you have to expect the medical record pertaining to your illness be
treated as confidential. If the details
are to be used in a medical conference, please make sure that your consent has
been obtained by the doctor/hospital.
16) In
case of HIV positive patients, the details can only be disclosed with the patient’s
permission. You have to be vigilant to
see the HIV reports are not disclosed to the employers/friends/other
unauthorized persons.
AVENUES FOR REDRESSAL OF PATIENTS COMPLAINTS
MEDICAL COUNCILS:
Medical Councils are statutory bodies created by an
Act of the Parliament/legislature to monitor/govern the medical
profession. The council has only ethical
jurisdiction. The council cannot give
compensation to the complainant or punish the doctors. The only punishment the
councils are empowered to give is to cancel the registration either temporarily
or permanently. The complainant has to
file the complaint with the registrar of the Council and file a specific
declaration as per the prescribed format.
The council’s executive committee holds the preliminary hearing to find
out the prima facie veracity of the complaint.
At this meeting only the complainant and the doctor against whom the
complaint is filed are allowed to present their sides. Lawyers are not allowed to be present. If the executive committee finds prima facie
truth in the complaint, then the full council hears the case. The council meets only twice in a year. Therefore the complaints are not resolved
speedily. Also the preliminary hearing
is heavily weighed against the complaint who is usually a non medical person.
Therefore councils have been very ineffective in resolving the complaints of
consumers of healthcare.
CONSUMER COURTS:
The complaints against the medical profession can be
filed in the consumer courts. The
complaint should be written on a simple paper giving all the details and the
compensation demanded. These courts can
only give compensation.
Following are the monetary limits of compensation that can
be granted by the consumer courts
District Consumer Court
Up to Rs 20 lakh
State Commission
Rs 20 Lakhs to Rs 1 Crore
National Commission
Above Rs 1 crore
All the complaints against the doctor and the hospitals should
have an expert certificate/opinion from the doctors of concerned speciality,
stating that the complaint is prima facie true and needs further
investigations. In the absence off such
certificate the complaints against the doctors/hospital are usually not
admitted. Therefore the consumers must
have all relevant medical records. The
expert opinion can be obtained with the help of Consumer Organisation in your
area. ACASH along with the Forum for Medical Ethics (FME) has formed an expert
panel to help the consumers. It must
also be remembered that a fine of Rs 10,000/- can be imposed on the complainant
under the Consumer Protection Act if the complaint is found to be
vexatious/false. Though the Consumer
Protection Act has time limit of 120 days for disposal of cases, in reality,
the cases take anywhere between 2 to 3 years for disposal.
CIVIL COURTS:
The redressal of the patient’s complaints through the civil
courts is lengthy, time consuming and many times counterproductive. There is a tremendous backlog of cases and
the cases take anywhere between 10 to 15 years to complete.
CRIMINAL COURTS:
The redressal of the complaints under criminal law is not
very common and recourse to this method should be taken only in exceptional
cases.
RIGHTS OF THE PATIENT
Right to considerate and respectful care.
Right to information on diagnosis, treatment and
medicines.
Right to obtain all the relevant information about the
professionals involved in the patient care.
Right to expect that all the communications and records
pertaining to his/her case be treated as confidential
Right to every consideration of his/her privacy concerning
his/her medical care programme.
Right to expect prompt treatment in an emergency
Right to refuse to participate in human experimentation,
research, project affecting his/her care or treatment.
Right to get copies of medical records
Right to know what hospital rules and regulations apply to
him/her as a patient and the facilities obtainable to the patient.
Right to get details of the bill.
Right to seek second opinion about his/her disease,
treatment,etc.
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RESPONSIBILITIES OF PATIENTS:
To faithfully undergo the agreed therapy.
To follow the doctors instructions diligently.
To take necessary preventive measures in case of
infectious diseases as per the doctors instructions.
To be aware that doctors and nurses are also human beings
and are amenable to mistakes and lapses.
To make the payment for the treatment, wherever
applicable, to the doctors/hospital promptly.
To respect the autonomy of the doctors and nurses.
To treat doctors and nurses with respect.
To be punctual to attend the clinics/hospital/dispensary
for the treatment at the given time.
To preserve all the records of one’s illness.
To keep the doctor informed if the patient wants to change
the hospital/doctor.
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Notes adapted from Dr. Arun Bal, President, ACASH
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