Charter of Patients' Rights: Time for govt to put in place mechanism to prevent medical malpractices, negligence in private hospitals
NHRC finalised a comprehensive 17-point charter of Patients’ rights in April last year and circulated this to the Union and State governments for comments
Health ministry needs to re-start the stalled process of developing standard rates for various medical services
The health ministry must move with utmost speed to implement the Charter for patients’ rights
There is a need to immediately legally notify standards for hospitals under the national Clinical Establishments Act
Mandar Velankar aged 41 was admitted to a renowned private hospital in Mumbai for elective surgery to treat narrowing of the spinal canal in his neck. The hospital gave the family an inflated picture of its facilities, which later proved inadequate for treating Mandar’s condition. His neurosurgeon operated on him without explaining the risks involved, and signatures were obtained on blank consent forms just as Mandar was being rolled into the operation theatre.
When serious complications developed after the operation, his wife Meenakshi was not given any information over the next week about her husband's deteriorating condition, despite her repeated queries. A second operation performed to release pressure on the brain caused further complications; Mandar never regained consciousness after the first operation and passed away after two weeks.
Despite an estimate given for Rs 1.5 lakhs, the family ended up paying Rs 6.5 lakhs. Meenakshi’s request for filing a complaint was treated with extreme rudeness by the hospital director; after providing evidence of gross medical negligence to two enquiry commissions, Meenakshi and her two children are still fighting a lonely battle for justice since the past one and half years, with no end in sight.
Such cases which we often read about in the media are examples of frequent medical malpractice and negligence in private hospitals. The number of news items on such instances is increasing by 110 percent every year, reflecting unchecked profiteering and lack of accountability of the private medical sector in India.
The fact that around 5.5 crore Indians are pushed below the poverty line due to inability to pay medical expenses, and the huge pendency of citizen’s grievances with state medical councils regarding unethical practices, are manifestations of the widespread nature of this problem.
Now the stage is being set for this situation to change, and patients might be enabled to access a range of rights in private hospitals. However, this requires the government to complete the process of adopting the Charter of Patients’ Rights which has been displayed on the Union Health Ministry’s website since over six months now.
The National Human Rights Commission (NHRC) finalised a comprehensive 17-point charter of Patients’ rights in April last year and circulated this to the Union and State governments for comments. This unique document specifies the following rights of patients, to be applicable for all medical establishments:
- Right to information, records and reports
- Right to transparency in rates, and care according to prescribed rates where applicable
- Right to emergency medical care, proper referral and transfer
- Right to informed consent, confidentiality, human dignity, privacy and non-discrimination
- Right to safety and quality care according to standards
- Right to choose alternative treatment options and right to the second opinion
- Right to choose the source for obtaining medicines or tests when admitted in hospital
- Right to protection for patients involved in clinical trials and biomedical research
- Right to take discharge of patient, or body of deceased, without being detained on procedural grounds
- Right to patient education, right to be heard and seek redressal
Each of these rights is accompanied by a detailed description, reference documents giving justification for the same, and identification of the duty bearer responsible for fulfilling this right in the context of any health care establishment. This is followed by a list of responsibilities of patients, including the obligation to provide relevant information to the doctor, and to respect the dignity of all health care providers, while never indulging in violence. Finally, a suggested mechanism for implementation of the charter along with a grievance redressal mechanism is described.
After receiving this charter circulated by NHRC, the Union Health Ministry displayed it on their website for comments in August 2018, asking for feedback within a month. While a number of comments would have been received, however after processing these suggestions it is now high time that this charter is adopted and implemented, which would provide much-needed protection to patients, especially in hospital settings.
Recently an online petition was launched by the civil society organisation SATHI, demanding prompt adoption of this charter without any dilution. The caveat of non-dilution is important due to fear that pressure by certain private medical lobbies could lead to major watering down and even stalling of this charter if the government decides to bend to powerful vested interests instead of upholding the human rights of patients.
The mentioned petition also asks for price control of medical services and making care in private hospitals affordable. This is a long pending measure awaiting implementation, despite the rules of central Clinical Establishment Act (passed in 2012) specifying that all hospitals should charge for procedures and services within rates determined by the government.
An immediate step in this regard could be capping of profit margins on medicines and consumables which are provided through the hospital. This is an area where huge inflation may be done, due to the difference between the cost to the hospital and the price charged to the patient. Whopping profit margins of up to 1700 percent are being extracted, as per a study done by NPPA on selected large private hospitals in Delhi.
Further, health ministry needs to re-start the stalled process of developing standard rates for various medical services, which was initiated in 2014 but was then stopped for reasons which are not clear. Another long overdue measure is the need to immediately legally notify standards for hospitals under the national Clinical Establishments Act, which would enable 11 states which have adopted the act to insist that hospitals start fulfilling these standards (including standard rates as they are fixed).
Since all the proposed hospital standards are already displayed on the health ministry website for several years, and basic work on standardisation of rates has already been carried out, now price control of rates in private hospitals needs to be ensured without further delay, which would prevent millions of patients from being pushed into poverty, and rescue even middle-class families from being bankrupted.
Although the current government is eagerly rolling out Pradhan Mantri Jan Arogya Yojana (PM-JAY), propelling millions of additional patients to seek care in private hospitals at public expense, it seems that comparable priority is not given to protect the rights of myriad patients who obtain care in private hospitals and suffer innumerable violations.
These skewed priorities must change, and the health ministry must move with utmost speed to implement the Charter for patients’ rights while taking steps to regulate costs of care in private hospitals. Due to life’s vagaries, each of us may be placed in the position of either caring for a patient or being a patient oneself, sooner or later. It is time that each of us supports the demand for protection and affordable care which is deserved by patients across the country today. Signing the online petition on patients’ rights is a good place to start.
(The writer is a public health physician, and one of the National convenors of Jan Swasthya Abhiyan)
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