MOHFW and NHRC release draft 'Charter of Patients’ Rights'
Ministry urges legislative bodies to frame guidelines
The Ministry of Health and Family Welfare (MOHFW) has recently uploaded a draft of 'Charters of Patient Rights' on its website which was prepared by the National Human Rights Commission. There is an expectation that this document will act as a guidance document for the Union Government and State Governments to formulate concrete mechanisms so that Patient’s Rights are given adequate protection and operational mechanisms are set up to make these rights functional and enforceable by law.
Here is a compilation of key excerpts from the charter and the duties of a treating physician/ health care provider. If you wish to read the original document released by the minstry you can find the access link at the end of this article.
Charter of Patients’ Rights
1. Right to information:
• The treating physician has a duty to ensure that this information is provided in simple and intelligible language to the patient to be communicated either personally by the physician, or by means of his / her qualified assistants.
• The hospital management has a duty to communicate the factual information regarding the expected cost of treatment based on evidence in writing to the patient and his/her designated caretaker and the identity of the Doctor / Consultant who is primarily responsible for his / care.
2. Right to records and reports:
The hospital management has a duty to provide the patient or his caregiver the originals / copies of case papers, indoor patient records, investigation reports (during period of admission, preferably within 24 hours and after discharge, within 72 hours) and to instruct the responsible hospital staff to ensure provision of the same are strictly followed without fail.
3. Right to Emergency Medical Care
• As per Supreme Court, all hospitals both in the government and in the private sector are duty bound to provide basic Emergency Medical Care, and injured persons have a right to get Emergency Medical Care. Such care must be initiated without demanding payment / advance and basic care should be provided to the patient irrespective of paying capacity.
• It is the duty of the hospital management to ensure provision of such emergency care through its doctors and staff, rendered promptly without compromising on the quality and safety of the patients.
4. Right to informed consent
• It is the duty of the hospital management to ensure that all concerned doctors are properly instructed to seek informed consent, that an appropriate policy is adopted and that consent forms with protocol for seeking informed consent are provided for patients in an obligatory manner.
• It is the duty of the primary treating doctor administering the potentially hazardous test / treatment to explain to the patient and caregivers the main risks that are involved in the procedure, and after giving this information, the doctor may proceed only if consent has been given in writing by the patient / caregiver or in the manner explained under Drugs and Cosmetic Act Rules 2016 on informed consent.
5. Right to confidentiality, human dignity and privacy
• Doctors have a duty to hold information about the patient’s health condition and treatment plan in strict confidentiality, unless it is essential in specific circumstances to communicate such information in the interest of protecting other or due to public health considerations.
• It is the duty of the hospital management to ensure presence of female attendants in case of female patients. The hospital management has a duty to ensure that its staff upholds the human dignity of every patient in all situations. All data concerning the patient should be kept under secured safe custody and insulated from data theft and leakage.
6. Right to second opinion
• The hospital management has a duty to respect the patient’s right to second opinion, and should provide to the patients caregivers all necessary records and information required for seeking such opinion without any extra cost or delay.
• The hospital management has a duty to ensure that any decision to seek such second opinion by the patient / caregivers must not adversely influence the quality of care being provided by the treating hospital as long as the patient is under care of that hospital. Any kind discriminatory practice adopted by the hospital or the service providers will be deemed as Human Rights’ violation.
7. Right to transparency in rates, and care according to prescribed rates wherever relevant
• It would be the duty of the Hospital / Clinical Establishment to display key rates at a conspicuous place in local as well as English language, and to make available the detailed schedule of rates in a booklet form to all patients / caregivers.
• Every hospital and clinical establishment has a duty to ensure that essential medicines under NLEM as per Government of India and World Health Organisation, devices, implants and services are provided to patients at rates that are not higher than the prescribed rates or the maximum retail price marked on the packaging.
8. Right to non-discrimination
The hospital management has a duty to ensure that no form of discriminatory behaviour or treatment takes place with any person under the hospital’s care. The hospital management must regularly orient and instruct all its doctors and staff regarding the same.
9. Right to safety and quality care according to standards
• The hospital management has a duty to ensure safety of all patients in its premises including clean premises and provision for infection control.
• The hospital management and treating doctors have a duty to provide quality health care in accordance with current standards of care and standard treatment guidelines and to avoid medical negligence or deficiency in service delivery system in any form.
10. Right to choose alternative treatment options if available
• Patients and their caregivers have a right to choose between alternative treatment / management options, if these are available, after considering all aspects of the situation. This includes the option of the patient refusing care after considering all available options, with responsibility for consequences being borne by the patient and his/her caregivers. In case a patient leaves a healthcare facility against medical advice on his / her own responsibility, then notwithstanding the impact that this may have on the patient’s further treatment and condition, this decision itself should not affect the observance of various rights mentioned in this charter.
• The hospital management has a duty to provide information about such options to the patient as well as to respect the informed choice of the patient and caregivers in a proper recorded manner with due acknowledgement from the patient or the caregivers on the communication and the mode.
11. Right to choose source for obtaining medicines or tests
It is the duty of every treating physician / hospital management to inform the patient and his caregivers that they are free to access prescribed medicines / investigations from the pharmacy / diagnostic centre of their choice. The decision by the patient / caregiver to access pharmacy / diagnostic centre of their choice must not in any ways adversely influence the care being provided by the treating physician or hospital.
12. Right to proper referral and transfer, which is free from perverse commercial influences
• When being transferred from one healthcare facility to another, the patient / caregiver must receive a complete explanation of the justification for the transfer, the alternative options for a transfer and it must be confirmed that the transfer is acceptable to the receiving facility. The hospital should inform the patient about any continuing healthcare requirements following discharge from the hospital. The hospital management has a duty to ensure proper referral and transfer of patients regarding such a shift in care.
• In regard to all referrals of patients, including referrals to other hospitals, specialists, laboratories or imaging services, the decision regarding facility to which referral is made must be guided entirely by the best interest of the patient. The referral process must not be influenced by any commercial consideration such as kickbacks, commissions, incentives, or other perverse business practices.
13. Right to protection for patients involved in clinical trials
All clinical trials must be conducted in compliance with the protocols and Good Clinical Practice Guidelines issued by Central Drugs Standard Control Organisation, Directorate General of Health Services, Govt. of India as well as all applicable statutory provisions of Amended Drugs and Cosmetics Act, 1940 and Rules, 1945. The charter also includes a series of provisions of patient's rights for their protection during clinical trials (Read the original drafts to know more about the provisions).
14. Right to protection of participants involved in biomedical and health research
Any doctor or hospital who is involved in biomedical and health research involving patients has a duty to ensure that the National Ethical Guidelines for Biomedical and Health Research Involving Human Participants, 2017 laid down by Indian council for Medical Research are followed and should be carried out with prior approval of the Ethics Committee.
15. Right to take discharge of patient, or receive body of deceased from hospital
A patient has the right to take discharge and cannot be detained in a hospital, on procedural grounds such as dispute in payment of hospital charges. Similarly, the dead body of the patient cannot be detained on procedural grounds, including nonpayment/dispute regarding payment of hospital charges against wishes of the caretakers. The hospital management has a duty to observe these rights and not to indulge in wrongful confinement of any patient, or dead body of patient, treated in the hospital under any circumstances.
16. Right to Patient Education
The hospital management and treating physician have a duty to provide education of major facts relevant to his/her condition and healthy living practices, their rights and responsibilities, officially supported health insurance schemes relevant to the patient, relevant entitlements in case of charitable hospitals, and how to seek redressal of grievances to each patient according to standard procedure in the language the patients understand.
17. Right to be heard and seek redressal
Every hospital and clinical establishment has the duty to set up an internal redressal mechanism as well as to fully comply and cooperate with official redressal mechanisms including making available all relevant information and taking action in full accordance with orders of the redressal body as per the Patient’s Right Charter or as per the applicable existing laws.
The draft document briefly touches upon the responsibilities of patients and their caretakers towards the caregivers.
Responsibilities of patients and caretakers:
1) Patients should provide all required health related information to their doctor, in response to the doctor’s queries without concealing any relevant information, so that diagnosis and treatment can be facilitated
2) Patients should cooperate with the doctor during examination, diagnostic tests and treatment, and should follow doctor’s advice, while keeping in view their right to participate in decision making related to treatment
3) Patients should follow all instructions regarding appointment time, cooperate with hospital staff and fellow patients, avoid creating disturbance to other patients, and maintain cleanliness in the hospital
4) Patients should respect the dignity of the doctor and other hospital staff as human beings and as professionals. Whatever the grievance may be, patient / caregivers should not resort to violence in any form and damage or destroy any property of the hospital or the service provider
5) The Patients should take responsibility for their actions based on choices made regarding treatment options, and in case they refuse treatment
The government has invited suggestions/ comments on the draft. It can be forwarded to Dr. Anil Kumar, Addl.DDG, DteGHS, Ministry of Health and family welfare, room no 560 A, Nirman Bhawan, New Delhi-110108 or emailed to firstname.lastname@example.org within 30 days from issue of notice (30th August 2018).
You may access the original draft released by the ministry here: https://pxmd.co/nXCgs