RIGHTS OF PATIENTS

The concept of patients' rights is relatively new and largely unknown in India. Patients' rights often lie embedded in various laws. Patients are generally ignorant of their rights and without the know-how to claim them. There exists an urgent need to examine the relevant laws and conventions and extract from them a charter of Patients' Rights.

Dr. G.A.D'Costa, FRCS Edin, Mr. Raj Vaidya, M. Pharm and Ms. Deepali Naik, M. Phil have painstakingly compiled various aspects of Patients' Rights in a booklet entitled `Healthcare & Rights of Patients', which has been published by Voluntary Health Association of India, B-40, Qutab Institutional Area, New Delhi-110 016. The publication is nominally priced at Rs.70/-.

Excerpts from the booklet are reproduced below for the benefit of the readers:

WHAT ARE THE RIGHTS OF A PATIENT?

1. Rights to preventive measures

Every individual has the right to proper service by the Government/concerned Authorities in order to prevent illness or disability. This includes access to relevant information and scientific advances related to preventive measures against spread of diseases by the Public Health Department through the Directorate of Health Services and its subsidiary, the Department of Preventive and Social Medicine.

This Right thus includes the right to breathe clean air, free from contaminants, and the right to live in clean, hygienic surroundings, with proper sewage and waste disposal. Every individual has the right to be protected from misleading, or dubious information, such as misleading advertisements, and in particular, those that lead the patient to unqualified practitioners. An individual has the right to clean and pure drinking water, and food, and the right to immunization against disease (e.g. Tetanus, BCG, Polio vaccinations) at the right time, free of cost at government institutions. It is also the Right of every child to receive disease free, clean, breast milk from its mother. The government's policies and actions, and the goal and mission of every health care service and every individual should be towards PREVENTIVE HEALTH CARE!

2. Right of access to health care services

Every individual has the right of access to the health services concerning her or his health needs. Health services must guarantee equal access to everyone without discrimination on the basis of caste, creed, sex or social status, financial resources or place of residence, type of illness or time of access to services.

Any individual requiring treatment, but unable to sustain its cost, has the right to be served free of charge by the public health sector. Every human being, even without a residence permit, has the right to urgent or essential outpatient and inpatient care. Any individual suffering from a rare disease has the same right to the necessary treatment and medication as an individual with a more common disease.

3. a) Right to information on the patient's own health status

Every patient has the right of direct access to her or his clinical file and medical records, to make copies of their contents, to ask questions regarding all documents, reports and records contained within, and to obtain correction of any errors they might discover.

3. b) Right of access to information on health care

Every individual has the right of access to all information available with the health services regarding their state of health; and further information on the use of these services, along with all scientific research and technological innovation available to members of the public in need of health care.

Health care services, providers and professionals are duty-bound to provide patient-specific information, particularly taking into account the religious, ethnic or linguistic background of the patient. Health services are responsible for making all information easily accessible, removing bureaucratic obstacles and educating health care providers in preparing and distributing information. This information may come from either public or private sources, provided that it meets the criteria of accuracy, reliability and transparency.

4. Right to informed consent

Every individual has the right of access to all information that might enable her or him to actively participate in decisions regarding her or his health. This information is a pre-requisite for any procedure or treatment, including participation in scientific research. Health care providers and professionals must give the patient all information related to a treatment or surgery, including its associated risks and discomforts, side effects and alternatives. This information should be provided well in advance, the only exceptions being in the case of an emergency or life threatening situation (at least 24 hours notice) to enable the patient to actively participate in the therapeutic choices regarding her or his state of health.

Health care providers and professionals must communicate in a language known to the patient, in a manner that is comprehensible to persons with no technical background.

In all circumstances where a legal representative is required to provide informed consent the patient, whether a minor or an adult unable to fully comprehend, must still be involved as much as possible/practicable in decisions regarding her or his treatment.

A patient has the right to refuse a treatment or medical intervention and to change her or his mind during the treatment, refusing its continuation.

A patient has the right to refuse to provide information about her or his health status. However, the provision of as much information as possible is always in the best interests of the patient to.

5. Right to free choice.

Every patient has the right to decide which diagnostic examinations and therapies to undergo, as well as which primary care doctor, specialist or hospital to use. Health services are duty-bound to guarantee this right, providing patients with unbiased and factual information on the various centers and doctors competent to provide the necessary service. They must remove any obstacle that limits the exercise of this right.

A patient who does not have trust in her or his doctor has the right to change her/his doctor, always bearing in mind that frequent changes may affect the continuity of treatment.

6. Right to privacy and confidentiality

Every individual has the right to confidentiality of personal information, including information regarding her or his state of health and potential diagnostic or therapeutic procedures, as well as the protection of her or his privacy during the performance of diagnostic examinations, specialist visits, and medical/surgical treatments in general.

All data and information relating to an individual's state of health, and to medical/surgical treatments to which she or he is subjected, must be considered private, and as such, adequately protected.

Personal privacy must be respected, even in the course of medical/surgical treatments (diagnostic exams, specialist visits, medications, etc.) which must take place in an appropriate environment and in the presence of only those who are absolutely essential to the procedure (unless the patient has explicitly given consent or made a request).

7. Right to respect for the patients' time

Every individual has the right to receive necessary treatment within a swift and predetermined period of time. This right applies at each phase of the treatment.

Health services have a duty to fix waiting times, within which certain services must be provided on the basis of specific standards and depending on the degree of urgency of the case.

Doctors must devote adequate time to their patients, including the time dedicate to providing information.

8. Right to the observance of quality standards

Every individual has the right of access to high quality health services on the basis of the specification and observance of precise standards.

The right to quality health services requires that health care institutions and professionals provide satisfactory levels of technical performance, comfort and human relations. This implies the specification and observance of precise quality standards, which are subjected to regular peer review.

9. Right to safety

Every individual has the right to be free from harm caused by poor functioning of health services, medical malpractice and errors.

Every individual also has the right of access to health services and treatments that meet high safety standards.

To guarantee this right, hospitals and health services must continuously monitor risk factors and ensure that all medical devices are properly maintained, serviced and validated from time to time and operators are properly trained.

All health professionals must take full responsibility for the safety of all phases and elements of medical treatment.

Doctors must be able to prevent the risk of errors by monitoring precedents and undergoing continuous training. Healthcare staff that report existing risks to their superiors and/or peers must be protected from any adverse consequences or victimization.

10. Right to access to innovation

Every individual has the right of access to innovative procedures, including diagnostic procedures, according to international standards and independently of economic and financial considerations.

The health services are duty-bound to promote and sustain research in the biomedical field, paying particular attention to rare diseases. Research results must be adequately disseminated.

11. Right to avoid unnecessary suffering and pain

Every individual has the right to be spared as much suffering and pain as possible, in each phase of her or his illness.

The health services must commit themselves to taking all measures to achieve this end, such as providing palliative treatments and simplifying patients' access to them.

12. Right to personalized treatment.

Every individual has the right to diagnostic or therapeutic programmes tailored as closely as possible to her or his personal needs.

 

The health services must guarantee to this end, flexible programs, oriented as much as possible to the individual's needs, making sure that the criterion of economic sustainability does not prevail over the right to health care.

13. Right to complain

Every individual has the right to complain whenever she or he has suffered harm, or not received treatment/service to her/his satisfaction. He or she further has the right to receive an adequate response or other feedback to the complaint.

The health services ought to guarantee the exercise of this right, providing (with the help of third parties) patients with information about their rights, enabling them to recognise violations and to formalise their complaint.

A complaint must be followed up by an exhaustive and comprehensive written response by the health care provider within a fixed period of time.

Complaints must be made through standard procedures and facilitated by independent bodies and/or citizens' organizations and cannot prejudice the patients' right to take legal action or pursue alternative avenues for redressal.

14. Right to compensation

Every individual has the right to receive appropriate compensation within a reasonably short time whenever she or he has suffered physical, moral or psychological harm caused by treatment at a health care facility.

WHERE PATIENTS' RIGHTS MAY BE HELD IN ABEYANCE

A doctor is obliged to render services to a patient in an emergency. However, in certain situations the doctor may refuse/declare his inability to treat the patient. For example at such times as:

i. Are beyond his practicing hours.

ii. The case is outside his/her speciality, beyond the competence and qualifications of the doctor or beyond the facilities available in his/her practice.

iii. The doctor is unwell or a family member is ill.

iv. The doctor has an important social function in the family and the case is not an emergency.

v. The doctor has consumed alcohol or is mentally disturbed or under severe psychological pressure.

vi. The patient has been defaulting in payment and the case is not an emergency.

vii. The patient or her/his relations are un-cooperative, violent or abusive.

viii. The doctor suspects the patient to be a malingerer (A malingerer is a person who fakes symptoms with ulterior motives).

ix. The patient refuses to give consent/ accept risk.

x. The patient demands specific drugs like amphetamine, or athletes/ body builders demanding steroids, etc.

xi. The patient rejects low cost remedies in favour of high cost alternatives.

xii. At night, on grounds of security if the patient is not brought to him.

xiii. An unaccompanied minor patient or a patient of the opposite sex.

xiv. Any new patient, if she/ he is not the only doctor available and it is not an emergency.

Do not forget that the patient's rights become questionable when:

1. The patient arrives at a very late stage in the course of an illness some times in its terminal stages.

2. The patient finds that the consulting time/waiting time for consultation/treatment does not suit her/him and the complaint is based entirely on this issue, as she/he is free to approach another doctor.

3. The patient comes with no record whatsoever of treatment already received.

4. The patient hides facts from the doctor. The doctor does not have any foolproof method to know whether the history is true.

5. The patient unreasonably questions the probable diagnosis, drugs prescribed, their role, side effects, cost, interaction etc. and avoids taking the prescribed medicine.

6. The patient's behaviour subsequent to leaving the clinic is inappropriate, for example:

  • Medicines prescribed are not purchased
  • Medicines are not taken for the prescribed duration or dosage
  • Precautions advised, are not followed
  • Follow-ups are not attended at all, or done so at an inappropriate interval/time
  • Medicines of other systems are used without the doctor's knowledge or approval.

Courtesy: Voluntary Health Association of India

July - November 2007