Theme: Patient Rights

Patients have the right to decide where they want to buy medicines from or where they want to get tests done from.¹.This ensures that no limit to a patient’s options while choosing pharmaceutical brands or medicines. For example, if a doctor forces you to buy overpriced medicines for the purpose of earning a commission, you have the right to refuse such medicines. Further, patients can get tests done from any diagnostic centre/laboratory accredited by the National Accreditation Board for Laboratories (NABL). You can check for a list of accredited laboratories here.

The doctor or hospital administration must inform patients regarding the information given above. No one can force a patient to buy medicines or do tests from a particular facility. Further, this should not result in unfair treatment if the patient decides to choose their own facility or medicine store.(( Charter Patient Rights, Ministry of Health and Family Welfare))

1. Charter Patient Rights, Ministry of Health and Family Welfare [↩]

It is the duty of medical establishments to provide a safe and clean environment for treatment. Infection control measures, safe drinking water and sanitation facilities should be provided in accordance with BIS(Bureau of Indian Standards)/FSSAI(Food Safety and Standards Authority of India) guidelines. The standard of care to be followed with regard to medical equipment and infrastructure has been mentioned in the Clinical Establishment (Central Government) Rules, 2012. The National Accreditation Board for Hospitals and Healthcare Providers (NABH) has released standards to be followed by hospitals for quality assurance.

If a doctor causes death of a patient due to a rash or negligent act, they can be punished for such death.(( Section 304 A, Indian Penal Code, 1860)) If hurt(( Section 319, Indian Penal Code, 1860)) or grievous hurt(( Section 320,  Indian Penal Code, 1860)) is caused to a patient as a result of the rash or negligent act of a medical professional, the medical professional can be punished with jail term up to 1 year((  Section 323, Indian Penal Code, 1860)) (in case of hurt)/7 years or fine or both(( Section 325, Indian Penal Code, 1860))

If patients or their caregivers 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. Further, they can do so if any of their other rights as patients have been violated. For instance, violation of privacy, discrimination against you etc.

Hospital’s Grievance Office

This can be the first place to approach when seeking redressal against professional misconduct(( Chapter 7, Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002)) by a doctor or hospital. A grievance redressal mechanism in a hospital works on resolving issues faced by patients. However, if the issue is not satisfactorily resolved at this level, the patient can approach the other authorities given below.

National, State or District Level Council of Clinical Establishments

Clinical establishments are government or private places that provide medical services. For instance, if there are any shortcomings of clinical establishments in meeting standards of infrastructure or care, you can approach the officer or authority of a State or Union Territory(( Clinical Establishment (Registration and Regulation) Act 2010)) to report issues. For example, you can complain if the medical equipment is not in a good working condition or if they lose or misplace your medical records.  You can find a list of officers in each State here.

State Medical Councils

You can approach State Medical Councils to seek disciplinary action against a doctor or hospital administration.(( Section 8.2, Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002))Further, to find a list of state councils, see here.

Police

In case of criminal conduct by the doctor or hospital administration, you can file an FIR against them. Further, you can also call on 100 (police helpline) to register a complaint.

Patients have the right to receive education about the facts relevant to their condition and healthy living practices. For instance(( Charter of Patient Rights, Ministry of Health and Family Welfare))

• Rights and responsibilities as patients(( Annexure 8, Clinical Establishments Act (Standards for Hospital Level 1A & 1B), 2010))
• Information regarding insurance schemes, entitlements (in case of charitable hospitals).
• Complaint forums and grievance redressal.

In addition, all this information must be provided in a language easily understood by the patient. Further, you can click on the links given below to learn more:

• Information about health-related schemes of the Government: Ministry of Health and Family Welfare website
• Public health initiatives and their e-resources: National Health Portal of India website
• Informational videos on topics like family planning and maternal health: National Health Portal of India website
• Information on blood donation and blood banks: E- Rakt Kosh Blood Centralized Blood Bank website
• Informational material on diseases: National Health Portal of India website
• Information on list of essential medicines: National List of Essential Medicines, 2015
• Information about fixed rates of drugs: Drug Price Control Order, 2013

 

During any point in the treatment, a patient is free to take discharge or leave from the hospital. For example, hospital authorities cannot force patients to stay in the hospital or restrict them from moving out of the hospital. Similarly, caretakers of a deceased patient have the right to receive his body from the hospital.(( Charter of Patient Rights, Ministry of Health and Family Welfare)). For example, while undergoing treatment, the hospital cannot withhold A’s body from his relatives. Even if the fees or medical bills are not paid for, the body is to be released to the relatives.

A hospital or medical professional cannot hold a living patient, or the body of a deceased patient for any reason including:

• Non-payment/delay in payment of charges,
• Dispute regarding any hospital charges.

Under the law,¹this is a crime of wrongful confinement. The punishment for wrongfully confining someone is a jail term of up to 1 year, fine up to  ₹ 1000 or both.(( Section 342, Indian Penal Code, 1860))

If the confinement extends to 3 -10 days,  the punishment is imprisonment of up to 2 years or 3 years respectively.(( Section 343 and 344, Indian Penal Code, 1860))

1. Section 340, 341, 342, Indian Penal Code, 1860 [↩]

A patient has the right to choose the treatment course once the doctor has informed the patient of all the options.(( Annexure 8, Clinical Establishments Act (Standards for Hospital Level 1A & 1B), 2010)).The patient or their caregiver cannot be forced to follow a certain treatment against their will, even if the doctor deems it necessary.

Refusing Treatment

The patient can even refuse treatment altogether after considering the options available. The patient will then take responsibility for his own condition.

Providing Information on Treatment Options

The hospital administration is duty-bound to provide clear and accurate information to the patient regarding the options of treatment available(( Charter of Patient Rights, Ministry of Health and Family Welfare)). The hospital or the doctor can only play an advisory role. They have to respect the patient’s final decision and treat him with fairness and respect regardless of the patient’s  decision.

Trigger Warning: This explainer contains information on violence and medical procedures which some readers may find disturbing.

Prompt and quality healthcare at a time of urgency can mean the difference between life and death. Article 21 of the Constitution of India, 1950 preserves the right to life all persons. This also extends to your right to access emergency medical care. All state governments have the duty to preserve the lives of patients seeking medical care.((List II, Schedule VII, Constitution of India, 1950 )). Further, all medical professionals and doctors in both private and government hospitals have a responsibility and duty towards the health of the community.((Parmanand Katara v. Union of India (1989) 4 Supreme Court Cases 286: 1989 SCC (Cri) 721 ))

No patient can be turned away from receiving emergency medical care if they cannot pay for it. Emergency care should be mandatorily provided and all standards of care and quality must be upheld while doing so. Doctors cannot put the life of a patient at stake while waiting for fees to be paid.(( Pravat Kumar Mukherjee v. Ruby General Hospital & Others 2005 CPJ 35 (NC) ))

Duty to provide emergency medical care

It is their duty((Sections 2.1.1 & 2.4,  Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002 ))to first render emergency medical care before receiving payment. Other duties of doctors in case of emergency care are:

• No physician can arbitrarily refuse treatment to a patient. It can only be done if the physician is not qualified to treat the condition in which case the physician must refer the patient to another competent physician.((Section 2.1.1, Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002 ))
• While referral in the normal course is acceptable, in case of an emergency the physician should treat the patient
• A physician is free to choose when and who he treats. However, in case of an emergency, he must respond when called upon.((Section 2.1.4,  Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002 ))
• Physicians should not neglect or withdraw from the case without giving prior and adequate notice to the caregivers of the patient((Section 2.1.4,  Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002 ))

Emergency healthcare to victims of sexual violence

Emergency medical care to child victims of sexual violence has been guaranteed under the law((Section 5(1), Protection of Children from Sexual Offences Rules, 2012 )).The same should be provided to them within 24 hours of receiving the  complaint. A hospital, doctor or other medical facility providing such care cannot demand a legal order as a requirement for starting treatment.((Section 5(3), Protection of Children from Sexual Offences Rules, 2012 )).Maintaining the privacy of the child and the child’s details is a duty of the doctor. Further, a parent or guardian who the child trusts has to be present for all the treatments.((Section 5(2), Protection of Children from Sexual Offences Rules, 2012 ))

In case of adult victims of sexual offences, all hospitals, whether public or private, have to provide first-aid or medical treatment free of cost.  Hospitals are also required to immediately inform the police of such incident.((Section 357C, Code of Criminal Procedure, 1973 )) Not following these rules will be punishable with jail time of up to one year and/or with a fine.(( Section 166B, Indian Penal Code, 1860 ))When medical practitioners are treating a sexual assault survivor, the presence of a woman during the treatment and with the consent of the patient or her guardian are essential.(( Section 164A, Criminal Procedure Code, 1973 ))

Emergency healthcare for abortions

If there is a need to conduct an immediate abortion to save a pregnant woman’s life, no matter how far along the pregnancy is (even if it is beyond the legally permitted period of 20 weeks), the doctor can conduct the abortion. Registered medical practitioner who do not have the required OB-GYN qualifications can perform abortions. Although this can only be done to save the life of the woman or the foetus. For example, if a woman who is 22 weeks pregnant was in a car crash, then a doctor can conduct an immediate abortion to save the woman’s life. The doctor will not be punished as they have acted in good faith.

Emergency healthcare for accidents

An accident victim can approach any hospital, public or private.((Parmanand Katara v Union of India AIR 1989 SC 2039 )) The doctor on duty has to immediately attend to the injured person and render medical aid without waiting for any procedural formalities.((Section 134(a), Motor Vehicles Act, 1988; Charter of Patient Rights, Ministry of Health and Family Welfare ))Every government and private hospital is duty-bound to accept accident victims and patients who are in critical condition. The hospital  cannot refuse treatment even if:

• The victim is not in a position to pay the fee or meet the expenses or
• There is no close relation of the victim available who can give consent for medical treatment.((Pravat Kumar Mukherjee v. Ruby General Hospital and Others 2005 CPJ 35 (NC) ))

The Supreme Court and the Ministry of Road Transport and Highways have made it easier for people to help victims of road accidents. Earlier, people hesitated to stop and help such victims for fear of the cumbersome medico-legal process. Realizing the adverse impact this can have on survival chances of accident victims, the Supreme Court gave effect to the Good Samaritan Law.(( Savelife Foundation and Anr v. Union of India (2016) 7 SCC 194 )).You can read more about it here.

If you need to help an accident victim, you can contact the National Highway Helpline at 1033. You can also report road accidents on the Sukhad Yatra App of the Ministry of Road Transport and Highways.

All procedures or treatments on a patient must be done only after he or she has provided consent. Now, this ‘consent’ has to be given:

• By a person who is conscious, of sound mind and above 12 years of age.((Section 90, Indian Penal Code, 1860 ))
• Free from any undue influence, threat, mistake.((Section 90, Indian Penal Code, 1860 ))
• For a specific intervention. For instance, a treatment or procedure that requires written consent.((Charter of Patient Rights, Ministry of Health and Family Welfare ))
• By a person who understands the risks, benefits and alternate treatments available.((Charter of Patient Rights, Ministry of Health and Family Welfare ))
• In a language and manner understood by all parties involved.((Charter of Patient Rights, Ministry of Health and Family Welfare ))

Consent of minors (children below the age of 18)

Before performing an operation, a physician should obtain the written consent of the patient or the patient’s caregiver, spouse or guardian (in case of a minor).((Section 7.16, The Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002 )).Further, such consent is necessary where the treatment is potentially dangerous.((Annexure 8, Clinical Establishments Act 2010 (Standards for Hospital Level 1A & 1B) )).The duty to ensure this falls upon the hospital administration and the doctor treating the minor.

Failure to take consent

Doctors have to take consent for all medical procedures. Otherwise, this may result in disciplinary action as well as a case against the doctor. If the doctor takes consent by causing fear or misconception, he or she is committing a crime under the law.((Section 90, Indian Penal Code, 1860 ))  However, if a doctor in good faith((Section 52, Indian Penal Code, 1860 )) believes that the situation is too urgent to wait for the patient’s consent or it is not possible to obtain it, he may proceed with the emergency treatment. An example would be an emergency abortion if the woman’s or fetus’s (unborn baby) life is in danger. Further, failure to take consent will result in disciplinary actions against the doctor. If you face such a situation, you can file a complaint.((Charter of Patient Rights, Ministry of Health and Family Welfare ))