Theme: Patient Rights

The word ‘patient’ has not been defined anywhere under Indian Law. However, the term covers those people who receive healthcare services by doctors or medical professionals. The Government including state governments have a duty to provide healthcare services and improving public health(( Article 42, Constitution of India, 1950; Entry 6, List II, Schedule VII, Constitution of India, 1950)).

Laws governing Patient Rights

The laws governing rights of  people who approach healthcare establishments or medical professionals in India include:

• The Constitution of India, 1950
• Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002
• Drugs and Cosmetics Act, 1940
• Clinical Establishment(Registration and Regulation) Act, 2010
• Indian Penal Code, 1860 and Code of Criminal Procedure, 1973.

These laws guide medical health professionals in maintaining a standard of care and treatment of patients. Since there is no specific legislation covering patient rights in India, the Ministry of Health and Family Welfare, and the National Human Rights Commission released the Charter of Patient Rights. Further, this contains the rights protecting patients who access medical care. These include:

List of Patient Rights in India

The Ministry of Health and Family Welfare and National Human Rights Commission released the Charter of Patient Rights. It enumerates 17 rights that all patients in India are entitled to. These include:

Right to Information

A patient has the right to obtain authentic information regarding their medical condition or ailment, method and options for treatment.

Right to records and reports

Hospital authorities have a duty to provide medical records and reports to all patients or their caregivers.

Right to emergency medical care

No patient can be turned away from receiving emergency medical care from a government or private hospital.

Right to informed consent

A medical professional should obtain the consent of the patient or their caregiver, spouse or guardian (in case of a minor) in writing, before performing an operation.

Right to confidentiality, privacy and dignity

All medical professionals have to maintain the highest level of confidentiality regarding the private details of the patient.

Right to second opinion

A patient is free to go for a second opinion for any doctor of his or her choice.

Right to transparency in rates

All costs that are levied on patients for services, tests and treatments rendered by medical establishments have to be made available to the public.

Right to non-discrimination

Doctors and medical personnel cannot refuse treatment to patients on the grounds of gender, sexuality, caste, religion, race, place of birth or illnesses.

Right to safety and quality care according to standards

It is the duty of medical establishments to provide a safe and clean environment for treatment. 

Right to choose alternative treatment options if available

Once a patient or their caregiver are informed of their treatment options, they are free to choose the course ahead. They cannot be compelled to follow a certain treatment without their will, even if the doctor deems it necessary. 

Right to choose source for obtaining medicines and tests

When medicines or tests are prescribed to a patient, it is up to them to decide where they want to purchase it from. It is guaranteed as their right as a consumer to have access to a variety of goods or services at competitive prices. 

Right to proper referral and transfer, which is free from perverse commercial influence

All patients have a right to receive seamless service and quality of care being upheld when the patient is referred to a different doctor or the patient is  transferred to a different facility. 

Right to protection for patients involved in clinical trials

Participants of all clinical trials in India have rights such as claiming compensation in case of trial-related injury or death, confidentiality of personal information etc.

Right to protection of participants involved in biomedical and health research

The National Ethical Guidelines for Biomedical and Health Research Involving Human Participants have to be followed to ensure rights are given to the participants.

Right to take discharge of patient, or body of deceased from the hospital

During any point in the treatment, a patient is free to take discharge or leave from the hospital. They cannot be held without their will or kept in the hospital by force. Similarly, caretakers of a deceased patient have the right to receive their body from the hospital.

Right to patient education

Patients have the right to receive education about the facts relevant to their condition and healthy living practices.

Right to be heard and seek redressal

If a patient or their caregiver have a grievance against a doctor or the hospital administration regarding the quality of treatment provided, they have a right to seek redressal for the same.

Patients have the right to obtain authentic information regarding their medical condition or ailment, method of treatment and options for treatment(( Annexure 8, Clinical Establishments Act (Standards for Hospital Level 1A & 1B), 2010)). Patients have to be provided:

• Adequate information so that they can make an educated decision, give consent or withdraw consent for treatment.
• Medical information in a language that the patient understands, communicated to them in a manner that is not overly technical.
• Information regarding costs/additional cost of treatment or diagnosis at the completion of treatment. The patient or his caretaker has the right to receive an itemised receipt.(( Charter of Patient Rights, Ministry of Health and Family Welfare.))
•  Basic details of the doctors and medical staff treating the patient, including the identities,  qualifications and name of the primary treating doctor/consultant.

Doctors are required to maintain the records of patients they treat for 3 years from the date of starting the treatment(( Section 1.3.1, Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002)), in a format prescribed by the Indian Medical Council.(( Appendix 3, Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002))

Asking for Medical Records or Reports

Patients and their caregivers also have the right to ask for medical records and reports(( Nisha Priya Bhatia v. Institute of Human Behavior & Allied Sciences 2014 SCC OnLine CIC 5092)) of their case, which should be provided to them within 3 days.(( Section 1.3.2, Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002))

Hospital authorities have a duty to provide such information under the law.(( Right to Information Act, 2005; Consumer Protection Act, 1986 (now repealed by Consumer Protection Act, 2019); The India Medical Council Act, 1965; World Medical Ethics, World Medical Association )).Not maintaining such records or not complying with the patient’s request for records in the stipulated time will amount to professional misconduct.(( Section 7.2, Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002)). Further, the doctor shall be liable to disciplinary action.

The following documents can be obtained by the patient from the hospital(( Charter of Patient Rights, Ministry of Health and Family Welfare)):

• Originals and copies of case papers.
• Indoor patient record. For instance, this includes a repository of medical information and history of a patient.
• Investigation reports. For instance, this includes details of the methods including  tests and scans done to help with the diagnosis or management of a disease.
• Discharge summary. This is a document prepared by the attending physician detailing the diagnosis, course of treatment and follow-up (if any) of a patient when he is  discharged from the doctor’s care.
• Death summary, which is given to the caregiver in case of death of the patient.

Filing an RTI Application (Right to Information)

To obtain some of the information given above, you can file an RTI application to both government and private hospitals. Some examples of when you can file an RTI are:

• To claim related documents
• To get COVID-19(( Mr.Venkatesh Nayak vs. CPIO & CMO(EMR), Ministry of Health & Family Welfare and Ors. CIC/MOHFW/C/2020/668909-BJ)) related information such as treatment facilities.
• To access medical records of patients.(( Shri Prabhat Kumar v. Directorate of Health Services GNCTD 2015 SCC OnLine CIC 2742))

If you require any assistance on filing an RTI application to ask for medical records or information, then you can check out the Right to Information topic for further clarification.

Doctors and medical personnel are required to keep aside their personal beliefs while treating a patient. They cannot refuse treatment to patients only on the grounds of gender, sexuality, caste, religion, race or place of birth. Further, no one can refuse treatment on the basis of illnesses like HIV+ status or other socially stigmatized conditions.

Discrimination based on caste

If a doctor refuses you treatment based on your caste, it is against your fundamental right guaranteed under the Constitution, 1950(( Article 17, Constitution of India, 1950))(Right Against Untouchability). If such treatment is refused by a hospital or clinical establishment, a person can seek remedy by making a complaint to a SC/ST  Protection Cell.(( Section 4, Scheduled Caste and Scheduled Tribe (Prevention of Atrocities) Act, 1989; Charter of Patient Rights, Ministry of Health and Family Welfare))

Discrimination based on gender identity or sexual orientation

Persons of the LGBTQ+ community may find it difficult to access safe, secure, dignified medical care for a variety of reasons. However, no one can be denied or discriminated against while providing medical treatment  based only on their gender or sexual orientation. The Government has to((  Section 15, Transgender Persons (Protection of Rights) Act, 2019)) provide specific healthcare services and ensure access to existing ones for transgender persons. For instance, ensuring non-discrimination against a transgender person by denying or discontinuing healthcare services or unfair treatment to them.(( Section 3 (d), Transgender Persons (Protection of Rights) Act, 2019)). Doing so will be punishable with jail term between 6 months to 2 years, with a fine.(( Section 18 (d), Transgender Persons (Protection of Rights) Act, 2019)).

Please see here to know what you can do if you face any harassment. Further, you can also take help and support from lawyers, NGOs, etc who will guide you through any issues you may face.

If you face discrimination at the hands of a doctor or clinical establishment, you can go to several authorities. For instance, you can approach the police, National or State Consumer Protection forums etc. Read more here.

The law regulates all costs that are levied on patients for services, tests and treatments rendered by medical establishments.(( Charter of Patients Rights, Ministry of Health and Family Welfare)). This prevents overcharging and ensures that medicines are accessible for the public.

Transparency of Rates and Charges

All clinical establishments have to clearly display the rates that they charge for each service.(( Section 9 (i), Clinical Establishments (Central Government) Rules, 2012)).This creates transparency and helps patients take an informed decision about their treatment.  Physicians have to prioritise the interest of patients over their own financial gains.(( Section 1.8, Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002)).They should announce their fees before beginning a treatment so that the patient can make a well-informed choice. Further, patients have the right to receive a detailed, itemised receipt of the costs incurred in their treatment. For instance, details of treatment costs have to be provided by clinical establishments in the form of a brochure/booklet of rates of services.

Rates of Medicines

To protect patients from getting overcharged, clinical establishments should charge authorized rates for each type of procedure and service. An authorized range of rates is issued by the Central Government (with the help of National Pharmaceutical Pricing Authority) from time to time, in consultation with the State Governments.(( Section 9 (ii), Clinical Establishments (Central Government) Rules, 2012))

To secure quality healthcare for all, the Government releases Drug Price Control Orders from time to time.(( Section 3, Essential Commodities Act, 1955)).These orders control the prices of essential drugs at rates that are easily affordable for the average person.  The hospital administration has the responsibility to sell medicines, devices and implants at maximum retail price (MRP) rates and not at higher rates.

Further, India also has a National List of Essential Medicines (NLEM) which forms the basis of drug price regulation in the country.

Rates of Medicines

State governments also notify their own lists of essential medicines, depending on their requirements.  Additionally, the Central government notifies the fixed rates for medicines under its various health schemes:

• Life-saving drugs under the Central Government Health Scheme (list)
• Generic drugs under the Central Government Health Scheme (list)
• Branded drugs under the Central Government Health Scheme (list)
• Medicines available under the Pradhan Mantri Jan Aushadhi Yojana

Further, you can buy medicines online at reasonable prices from the Jan Aushadhi Sugam (Generic medicines available at affordable rates)

All medical professionals have to be patient and delicate with whomever they treat medically.(( Section 2.2, Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002)). Further, they have to maintain the highest level of confidentiality regarding the private details of the patient.(( Section 2.2, Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002;  Annexure 8, Clinical Establishments Act (Standards for Hospital Level 1A & 1B), 2010))

Examination of female patients

Female patients can request for the presence of another female in the room while being examined by a male doctor.¹ This person need not necessarily be another doctor but any female person.(( Charter of Patient Rights, Ministry of Health and Family Welfare)) This is to provide comfort to the patient, who may be uneasy in the presence of a male, and to ensure that she is treated with dignity. Further, the responsibility to do this lies with the hospital management.

Publishing photos or medical details

To ensure the privacy and dignity of patients, doctors cannot publish patients’ photos or case reports in any journal without their permission. However, if the identity of the patient is not clear from such publication, the consent of the patient is not required.(( Section 7.17, Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002))

Details of children 

Identities of deceased children and child victims of sexual offences are private and confidential. Any doctor or any other individual making this information public may face punishment.(( Section 74 (1), Juvenile Justice (Care and Protection of Children) Act, 2015; Section 19, The Protection of Children from Sexual Offences (POCSO) Act, 2012)) Not following this will make the person liable for a jail term of up to 6 months, fine up to ₹ 2 lakh or both.(( Section 74 (3), Juvenile Justice (Care and Protection of Children) Act, 2015))

Details of adult rape victims

Making the identifcation details of a rape victim public, in any manner to the media or on social media, is a crime.(( Section 228A, Indian Penal Code, 1860; Nipun Saxena v. Union of India 2018 SCC OnLine SC 3104)) For example, sharing the name and photo of a rape victim online is a crime.

Exceptions to confidentiality

A doctor cannot  reveal any secrets learnt about the patient during treatment. However, he or she can in the following situations(( Section 7.14, Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002; Charter of Patients Rights, Ministry of Health and Family Welfare)):

• By a Court of Law under the order of the presiding judge
• Where there is a serious risk to a specific person and/or community
• In case of notifiable diseases, like COVID-19
• If there is a risk of a patient spreading a communicable disease(( Section 2.2, Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002)). For instance, diseases like cholera, malaria etc.

1. Guidelines and Protocols Medico Legal Care for Survivors of Sexual Violence, Ministry of Health and Family Welfare (Medico Legal Guidelines [↩]

Every patient can approach another doctor to obtain a second opinion. In other words, if you want to explore more options or you are dissatisfied with treatment, you can obtain a second opinion. This right to second opinion protects the freedom of a patient to seek the medical care that the patient thinks is best and most appropriate.(( Section 2.2, Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002)). A patient is free to go for a second opinion to any doctor of his choice. The hospital/doctor where he received the first opinion have the following duties(( Charter of Patient Rights, Ministry of Health and Family Welfare)):

• The doctor cannot hold back a patient from asking for a second opinion by withholding medical records, reports or demanding to release them at a cost.
• The hospital administration is duty-bound to respect this right of a patient. For instance, if the patient comes back to the first hospital after obtaining a second opinion.
• The hospital/doctor should not discriminate or treat the patient disrespectfully.
• Any differences of opinion among doctors should be frankly and impartially explained to the patient or his family.

All clinical trials in India operate as per guidelines issued by the Central Drugs Standard Control Organization, Directorate General of Health Services in India.(( Schedule Y, Drugs and Cosmetics Rules, 1945)). Some of the main guidelines for clinical trials are:

• Application for permission to conduct such a trial must be sought according to the procedure laid out by the rules. The  Licensing Authority¹ has to give permission to start the clinical trial. Further, the Ethics Committee should also give approval.(( Section 2 (1)(i), Schedule Y, Drugs and Cosmetics Rules, 1945)).
• Conducting all phases of  clinical trials for a new drugs discovered in India, which have human participants, within India itself.
• All investigators conducting the trial must possess appropriate qualifications and should have access to the investigation facilities required for the trial.
• When any physician or dentist accompanies the trial, he should be responsible for all medical or dental decisions taken in the trial.
• The investigator should ensure that proper medical care is provided to participants of the trial for any adverse events. Ancillary medical care must be provided for any illness arising during the period of the trial, even if it is unrelated to the trial.
• Investigators shall provide information about the essential elements of the clinical trial to the participants. The information provided should be easily understandable.
• Participants have a right to claim compensation in case of trial-related injury or death.
• All participants have to provide free, informed, and written consent before they join the trial. Legal representative can give consent if the patient is unable to give consent. Similarly, parents or legal guardians can give consent for children who participate in trials.

Rights of Participants of Clinical Trials

The National Ethical Guidelines for Biomedical and Health Research Involving Human Participants was released by the Indian Council of Medical Research (ICMR) in 2017. The guidelines ensure the following rights for participants of such trials:

• Voluntary consent is paramount. Participants can choose to participate, not participate, or to withdraw from the trial at any time.
• Every trial has to provide safeguards as well as equal distribution of benefits to all participants or vulnerable groups.
• Confidentiality of the participants’ identities to protect their privacy is essential. However, this breach can happen only for medical or legal reasons, in consultation with the Ethics Committee.
• Such research should not lead to social, racial, or ethnic inequalities.
• Compensation for any direct physical, psychological, social, legal or economic harm faced by patients rights in the form of financial compensation or in any other manner.

1. Section 21 (b), Drugs and Cosmetics Rules, 1945 [↩]

All patients have a right to ‘continuity of care’. Service and quality of care given to a patient cannot change if a patient is:

• Referred to a different doctor
• Transferred to a different facility.

It is the patient’s right to get complete information while transferring including(( Section 3.6, Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002)):

• Reason for transfer
• Alternative options available
• Confirmation of acceptance of transfer from the other facility

Sometimes doctors may request consultation with specialists. In addition, during treatment with specialists, the attending physician must share the patient’s case summary. This will enable the specialist can give his opinion in writing to the physician.(( Section 3.6, Indian Medical Council Regulations, 2002)).

Regardless of favors, like monetary benefits, commissions, or any benefits in kind, doctors cannot have any commercial interests. For instance, the World Health Organization has put out guidelines that may be adopted to ensure efficiency in the medical referral system.