As families struggle to get basic healthcare, Charter of Patients’ Rights fails to get implemented

By Rishabh and Anubhav

Second wave of COVID-19 has been brutal for India. More than three lakh people have succumbed to the virus since the outbreak. As per Indian Medical Association, more than 500 doctors have died on the frontline too. Images of Ganga’s riverbed stuffed with dead bodies and news about India’s vaccine shortage are making global headlines. As active cases and positivity rate goes down in India, death rate continues to be cause of concern.

The pandemic has blatantly exposed the torpid state of public health system in the country. The sector remains to be poorly governed and struggle to realize the basic principles of robust public health service delivery. Amidst this, the common citizens continue to be casualties of such inefficient system, having little or no scope for justice. In times of pandemic too, there have been several instances of hospitals overcharging the patients or misbehaving with relatives under the garb of administrative policies.

Such instances take us back to the first ever Charter of Patients’ Rights (CPR) that was issued by Ministry of Health and Family Welfare and National Human Rights Commission. The Union Health Ministry urged the states to adopt the charter but states refused to take it up. As a result, the CPR continues to be a just another policy document with no real effects on public health administration in India. During the first wave, Oxfam India, a global NGO, undertook a campaign to push states and district administrations to implement the CPR.

What does the charter say?

In its preamble, the charter recognizes the principles of dignity and equality enshrined under the Universal Declaration of Human Rights (1948) behind the formulation of CPR. With different rules governing different aspects of patients’ rights in India, CPR was an effort to consolidate all the laws in one charter. It consolidated rights and duties of patients spread across various laws such as the Indian Penal Code, Constitution of India, Consumer Protection Act, Clinical Establishment Act and various directions/rulings of Supreme Court and National Consumer Disputes Redressal Commission.

The charter shares 17 types of rights that a patient and his/her family is entitled to. These are:

1- Right to information

Every patient has a right to adequate relevant information about the nature, cause of illness, provisional / confirmed diagnosis, proposed investigations and management, and possible complications to be explained at their level of understanding in language known to them.

Patients and their caretakers also have a right to know the identity and professional status of various care providers who are providing service to him / her and to know which Doctor / Consultant is primarily responsible for his / her care. The hospital management has a duty to provide this information routinely to all patients and their caregivers in writing with an acknowledgement.

2- Right to records and reports

Every patient or his caregiver has the right to access originals / copies of case papers, indoor patient records, investigation reports (during period of admission, preferably within 24 hours and after discharge, within 72 hours). The relatives / caregivers of the patient have a right to get discharge summary or in case of death, death summary along with original copies of investigations.

3. Right to emergency medical care

As per Supreme Court, all hospitals both in the government and in the private sector are duty bound to provide basic Emergency Medical Care, and injured persons have a right to get Emergency Medical Care. Such care must be initiated without demanding payment / advance and basic care should be provided to the patient irrespective of paying capacity.

4. Right to informed consent

Every patient has a right that informed consent must be sought prior to any potentially hazardous test/treatment (e.g. invasive investigation / surgery / chemotherapy) which carries certain risks.

5. Right to confidentiality

All patients have a right to privacy, and doctors have a duty to hold information about their health condition and treatment plan in strict confidentiality, unless it is essential in specific circumstances to communicate such information in the interest of protecting other or due to public health considerations.

Female patients have the right to presence of another female person during physical examination by a male practitioner. It is the duty of the hospital management to ensure presence of such female attendants in case of female patients.

6. Right to second opinion

Every patient has the right to seek second opinion from an appropriate clinician of patients’ / caregivers’ choice. The hospital management has a duty to respect the patient’s right to second opinion, and should provide to the patients caregivers all necessary records and information required for seeking such opinion without any extra cost or delay.

7. Right to transparency in rates

Every patient and their caregivers have a right to information on the rates to be charged by the hospital for each type of service provided and facilities available on a prominent display board and a brochure. They have a right to receive an itemized detailed bill at the time of payment. It would be the duty of the Hospital / Clinical Establishment to display key rates at a conspicuous place in local as well as English language, and to make available the detailed schedule of rates in a booklet form to all patients / caregivers.

8. Right to non-discrimination

Every patient has the right to receive treatment without any discrimination based on his or her illnesses or conditions, including HIV status or other health condition, religion, caste, ethnicity, gender, age, sexual orientation, linguistic or geographical /social origins.

9. Right to safety and quality care

Patients have a right to safety and security in the hospital premises. They have a right to be provided with care in an environment having requisite cleanliness, infection control measures, safe drinking water as per BIS/FSSAI Standards and sanitation facilities.

They have a right to be attended to, treated and cared for with due skill, and in a professional manner in complete consonance with the principles of medical ethics. Patients and caretakers have a right to seek redressal in case of perceived medical negligence or damaged caused due to deliberate deficiency in service delivery.

10. Right to choose alternative treatment options

Patients and their caregivers have a right to choose between alternative treatment / management options, if these are available, after considering all aspects of the situation.

11. Right to choose source for obtaining tests or medicines

When any medicine is prescribed by a doctor or a hospital, the patients and their caregivers have the right to choose any registered pharmacy of their choice to purchase them. Similarly when a particular investigation is advised by a doctor or a hospital, the patient and his caregiver have a right to obtain this investigation from any registered diagnostic centre/laboratory having qualified personnel and accredited by National Accreditation Board for Laboratories (NABL).

12. Right to proper referral and transfer

A patient has the right to continuity of care, and the right to be duly registered at the first healthcare facility where treatment has been sought, as well as at any subsequent facilities where care is sought. When being transferred from one healthcare facility to another, the patient / caregiver must receive a complete explanation of the justification for the transfer, the alternative options for a transfer and it must be confirmed that the transfer is acceptable to the receiving facility.

13. Right to protection of patients involved in clinical trials

Every person / patient who is approached to participate in a clinical trial has aright to due protection in this context. This includes:

A. Participation of patients in clinical trials must always be based on informed consent, given after provision of all relevant information.

B. A participant’s right to agree or decline consent to take part in a clinical trial must be respected and her/his refusal should not affect routine care.

C. The patient should also be informed in writing about the name of the drug / intervention that is undergoing trial along with dates, dose and duration of administration.

D. Privacy of a trial participant must be maintained.

E. Trial participants who suffer any adverse impact during their participation in a trial are entitled to free medical management of adverse events.

F. Ancillary care may be provided to clinical trial participants for nonstudy/trial related illnesses arising during the period of the trial.

G. Institutional mechanisms must be established to allow for insurance coverage of trial related or unrelated illnesses (ancillary care) and award of compensation wherever deemed necessary by the concerned Ethics Committee.

H. After the trial, participants should be assured of access to the best treatment methods that may have been proven by the study.

14. Right to protection of participants involved in biomedical and health research

Every patient who is taking part in biomedical research shall be referred to as research participant and every research participant has a right to due protection in this context. Any research involving such participants should follow the National Ethical Guidelines for Biomedical and Health Research Involving Human Participants, 2017 laid down by Indian council for Medical Research and should be carried out with prior approval of the Ethics Committee.

15. Right to take discharge of patient or receive body of deceased

A patient has the right to take discharge and cannot be detained in a hospital, on procedural grounds such as dispute in payment of hospital charges. Similarly, caretakers have the right to the dead body of a patient who had been treated in a hospital and the dead body cannot be detailed on procedural grounds, including nonpayment/dispute regarding payment of hospital charges against wishes of the caretakers.

16. Right to patient education

Patients have the right to receive education about major facts relevant to his/her condition and healthy living practices, their rights and responsibilities, officially supported health insurance schemes relevant to the patient, relevant entitlements in case of charitable hospitals, and how to seek redressal of grievances in the language the patients understand or seek the education.

17. Right to be heard and seek redressal

Every patient and their caregivers have the right to give feedback, make comments, or lodge complaints about the health care they are receiving or had received from a doctor or hospital. This includes the right to be given information and advice on how to give feedback, make comments, or make a complaint in a simple and user-friendly manner.

The charter also assigns certain responsibilities to patients and their caretakers:

1. Provide all health-related information.

2. Cooperate with doctors during examination, treatment.

3. Follow all instructions.

4. Respect the dignity of doctor and other hospital staff. Should not resort to violence.

5. Should take responsibility of their decision on the choice of treatment for the patient.

(Rishabh is a lawyer and an independent researcher. Anubhav is a LL.M. student in Constitutional Law at Maharashtra National Law University, Aurangabad. Both are Co-Founders at TA)

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