Holding Hospitals Accountable – Patients Rights

Holding Hospitals Accountable - Patient Rights
Constitutional Directive :-

Our Constitution in Article 47 has made a specific directive :
“State has to raise the level of nutrition and the standard of living and to improve public health & shall consider this responsibility as among its primary duties in particular…”

ModiCare :-

Recently, the Union government has announced a scheme called Modicare, which
was appreciated as a shot in the arm for the healthcare sector with following characteristics :-

  • Increasing the insurance cover per family by over 1500% from Rs30,000 under the existent Rashtriya Swasthya Bima Yojana (RSBY) to Rs 5lakh.
  • Beneficiaries number about 500 million individuals from financially vulnerable households, a demographic that accounts for 41.3% of the population.

Heritage Index of Economic Freedom 2018 :-

It measures the degree of economic freedom in the world’s nations. Here are top 7 nations among top 10 in the list that had universal healthcare schemes :-

  • Hong Kong
  • Singapore
  • Australia
  • New Zealand
  • Canada
  • Switzerland,
  • Denmark

India :-

  • India is ranked 130 out of 180 countries in the study.
  • It is authentically surveyed that there are 79.7 doctors per one lac people
    in India.

Ancient Quote on Health was “Health is wealth” but modern medical merchandise proves that ill-health of the people is the wealth of the health corporate enterprises. Whether state ensures public health or not,it has to at least ensure people’s right to medical/health information of their own.

Question is “Do we have Right to Health and Right to Health information ?”

Patient Rights :-

Patients’rights in US :-

The Association of American Physicians and Surgeons (AAPS) came out with ‘Patients’ bill of rights ’ 

  • To seek consultation with the physician(s) of their choice
  • To contract with their physician(s) on mutually agreeable terms
  • To be treated confidentially, with access to their records limited
    to those involved in their care or designated by the patient
  • To use their own resources to purchase the care of their choice
  • To refuse medical treatment even if it is recommended by their physician(s)
  • To be informed about their medical condition, the risks and benefits of treatment and appropriate alternatives
  • To refuse third-party interference in their medical care, and to be
    confident that their actions in seeking or declining medical care will not result in third-party-imposed penalties for patients or physicians.

Rights in India :-

The Medical Council of India published, in 2002, a Code of Ethics Regulations
(COER). This code does not represent patients’ rights because those mentioned are incidental to the duties and responsibilities of physicians.

The Consumer Guidance Society of India (CGSI) has a more comprehensive charter on its website listing eight specific rights of patients :-

  • You have a right to be told all the facts about your illness :-
    To have your medical records explained to you and to be made aware of risks and side effects, if any,of the treatment prescribed for you do not hesitate to question your doctor about any of these aspect.
  • When you are being given a physical examination, you have a right to be handled with consideration and due regard for your modesty.
  • You have a right to know your doctor’s qualifications. If you cannot evaluate them yourself, do not hesitate to ask someone who can.
  • You have a right to complete confidentiality regarding your illness. If you are doubtful about the treatment prescribed and especially an operation suggested, you have a right to get a second opinion from any specialist
  • You have a right to be told in advance what an operation is for and the possible risks involved. If this is not possible because of your being unconscious or for some other reasons, your nearest relatives must be told before they consent to the operation.
  • If you are to be discharged or moved to another hospital, you have a right to be informed in advance and to make your own choice of hospital of nursing home in consultation with the doctor
  • You have a right to get your case papers upon request.

But these rights are only expectations, legally not guaranteed.

Clinical Establishment Act 2010 :-

The Clinical Establishment Act 2010 offers a major health regulatory regime both in public and private sector. It seeks to regulate all clinical establishments in India. The Act requires all clinical establishments to register themselves and provides a set of standard treatment guidelines for common diseases and conditions.

Certain disclosure related provisions of the Act are as follows :-

S26….“the authority shall cause to be displayed for information of the public at large & for filing objections,if any,in such manner, as may be prescribed, all evidence  submitted by the clinical establishment…(after obtaining provisional registration, the CE should give info to the authority,which has to display the same for objections of people) :-

  • Maintenance of records and submission of reports and returns as prescribed
  • The rates charged for each type of service/facility provided shall be displayed in local and English language conspicuously
  • The establishment shall maintain and provide electronic health records (EHR) & electronic medical records (EMR) of every patient as may be prescribed by the Central or the State Govt
  • Publishing the particulars of the clinical establishment for public comments / objections /observations after grant of provisional certificate.

There is a penalty provision:

S 42 (2) “Whoever being required by or under this Act to supply any information wilfully with holds such information or gives information which he knows to be false or which he does not believe to be true, shall be liable to a monetary penalty which may extend to five lakh rupees.”

Rule making powers :

S 54 Power of Central Government to make rules for :

  • (f) The minimum standards of facilities & services under clause (i) of sub-section (1) of Section 12
  • (h) The maintenance of records and reporting by the clinical establishment
    under clause (iii) of sub-section (1) of Section 12.

Weaknesses of this law :-

  • Maintenance of records should have been emphatically stated as statutory duties breach of which should have resulted in deterrent penalties.
  • It also does not specify the rights of patients against hospitals.
  • If a patient is over billed, or killed by negligence or for any wrong of the doctors, this law does not provide any quick mechanism to remedy.

Conclusion :- Hospitals are happy ,not the patients.

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