PATIENTS RIGHTS AND RESPONSIBILITIES By Dr.

Arun Bal, President, ACASH

Health is a subject closer to everybodys heart. Improvement of ones health and health of ones family is a universal aspiration. However health has been always given a low priority status in the nations 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. WHOs 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 patients rights. These codes of ethics are based on various international codes like The Nuremberg Code, The World Medical Associations Declaration of Geneva, The World Medical

Associations Declaration of Helsinki, The World Medical Associations 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 patients 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 postoperative recovery, expenses likely to be incurred for the surgery, the risks involved, whether there is any non-surgical treatment for your ailment etc. 1)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.
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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.

3)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. 4)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. 5)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. 6)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. 7)8) In case of invasive/costly investigations, you have the right to know of the alternatives as well as the necessity of the investigations. 8)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. 9)10) Please always preserve all the bills of the purchase of medicines. 10)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. 11)12) If you find that your complaint remains unresolved, then please write down 12)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 patients 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 councils 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 CourtUp to Rs 20 lakh State CommissionRs 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 of

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 patients 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.

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 ones illness. To keep the doctor informed if the patient wants to change the hospital/doctor.

Patient's Bill of Rights What is the Patient's Bill of Rights? Here you will find a summary of the Consumer Bill of Rights and Responsibilities that was adopted by the US Advisory Commission on Consumer Protection and Quality in the Health Care Industry in 1998. It is also known as the Patient's Bill of Rights. The Patient's Bill of Rights was created to try to reach 3 major goals: 1. To help patients feel more confident in the US health care system; the Bill of Rights:

 Assures that the health care system is fair and it works to meet patients' needs Gives patients a way to address any problems they may have Encourages patients to take an active role in staying or getting healthy 2. To stress the importance of a strong relationship between patients and their health care providers 3. To stress the key role patients play in staying healthy by laying out rights and responsibilities for all patients and health care providers This Bill of Rights also applies to the insurance plans offered to federal employees. Many other health insurance plans and facilities have also adopted these values. Even Medicare and Medicaid stand by many of them. The 8 key areas of the Patient's Bill of Rights Information for patients You have the right to accurate and easilyunderstood information about your health plan, health care professionals, and health care facilities. If you speak another language, have a physical or mental disability, or just don't

understand something, help should be given so you can make informed health care decisions. Choice of providers and plans You have the right to choose health care providers who can give you high-quality health care when you need it. Access to emergency services If you have severe pain, an injury, or sudden illness that makes you believe that your health is in danger, you have the right to be screened and stabilized using emergency services. You should be able to use these services whenever and wherever you need them, without needing to wait for authorization and without any financial penalty. Taking part in treatment decisions You have the right to know your treatment options and take part in decisions about your care. Parents, guardians, family members, or others that you choose can speak for you if you cannot make your own decisions. Respect and non-discrimination You have a right to considerate, respectful care from your doctors, health plan representatives,

and other health care providers that does not discriminate against you.

Confidentiality (privacy) of health information You have the right to talk privately with health care providers and to have your health care information protected. You also have the right to read and copy your own medical record. You have the right to ask that your doctor change your record if it is not correct, relevant, or complete. Complaints and appeals You have the right to a fair, fast, and objective review of any complaint you have against your health plan, doctors, hospitals or other health care personnel. This includes complaints about waiting times, operating hours, the actions of health care personnel, and the adequacy of health care facilities. Consumer responsibilities In a health care system that protects consumer or patients' rights, patients should expect to take on some responsibilities to get well and/or stay well (for instance, exercising and not using tobacco). Patients are expected to do things like

treat health care workers and other patients with respect, try to pay their medical bills, and follow the rules and benefits of their health plan coverage. Having patients involved in their care increases the chance of the best possible outcomes and helps support a high quality, costconscious health care system. Other bills of rights This bill of rights focuses on hospitals and insurance plans, but there are many others with different focuses. There are special kinds, like the mental health bill of rights, hospice patient's bill of rights, and bills of rights for patients in certain states. Insurance plans sometimes have lists of rights for subscribers. Many of these lists of rights tell you where to go or whom to talk with if you have a problem with your care. The American Hospital Association has a list of rights along with patient responsibilities that can help a person be a more active partner in his or her health care. (See the "Additional resources" section below.) Health insurance problems If you have concerns about your insurance, it is sometimes helpful to start with customer service or a case manager at your health insurance company. For information about dealing with

insurance claims, see our document Health Insurance and Financial Assistance for the Cancer Patient Top of Form

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