Consumer Protection Act in the

Healthcare Industry
Submitted By,

A Amal Cathrine -215119001

K Vijayalakshmi – 215119047

C Pradeeba - 215119061
Acknowledgements:
We would like to express our gratitude to God for helping us complete the project. We would
like to show our gratitude to our faculty for giving us good guidelines for the project. We are
grateful to our college management for providing us the best of the facilities. We stand
grateful to our family and friends for their immense support.
Table of Contents:
1. INTRODUCTION
2. CONSUMER PROTECTION ACT IN THE
HEALTHCARE INDUSTRY
3. CASE REVIEWS
4. MEDICAL NEGLIGENCE AND CONSUMER
PROTECTION ACT
5. COMPARISON OF PRACTICE IN INDIA AND THE
REST OF THE WORLD
6. CONCLUSION
INTRODUCTION:

The Consumer Protection Act of 1986 is an act to provide better protection of the interests of
consumers. The act also gives the guidelines to establish the customer councils and make
provisions to settle consumer disputes. The act provides an assurance to consumers against
anti-consumer trade practices by producers of goods, provider of services. The Consumer
Protection Act, 1986 was enacted to provide a simpler and quicker access to redressal of
consumer grievances. The Act for the first time introduced the concept of ‘consumer’. A
consumer, according to the act, is the person who buys and uses the product or hires a
particular service. The act does not apply when the product or the service is provided for free.
In this context, the act equally applies to hospitals the charges the patient for offering its
service. Private provision of health care is an important constituent of the health care delivery
system in India and its role has increased considerably over time. At present about 70% of
hospitals are in the private for-profit sector. This sector employs about 70% of qualified
doctors.

With the increasing commercialization of all spheres of life, all the professions have come
under the public scrutiny. Earlier the role and the service provided by the medical
professional were considered noble and charitable. But today with the increase in medical
negligence and malpractices this profession is looked upon with doubt and contempt. The
deterioration in the standard of patient care is considered to be due to interest in the monetary
gains. And more ever patients have become more aware of their rights and there have been
increase in the number of complaints against doctors in the consumer forums

The Right to Safety is one of the fundamental rights of consumers. This right ensures the
consumer to be protected against hazardous goods and services. The project attempts to study
the relationship between the healthcare laws and the Consumer Protection Act of the
Constitution.

CONSUMER PROTECTION ACT IN THE HEALTHCARE INDUSTRY

The application of Consumer Protection Act to private medical practice is considered an

important step in ensuring that patients receive an appropriate quality of care. The medical
associations have not welcomed this development. The medical councils have refrained from
making any comment on this Act. The findings of the current study reveal that private
providers believe Consumer Protection Act will be effective in minimizing malpractice and
negligent behaviour.

The Consumer Protection Act was passed in 24th December, 1986 for the better protection of
the interest of consumers and to make provisions for the establishment of consumer councils
and other authorities for the settlement of consumer’s dispute and for matters connected
therewith. Till 1995, even courts were not clear whether doctors are covered under consumer
protection act or not. In a landmark case in 1995, the Supreme Court decision in Indian
Medical Association vs VP Shantha, medical profession has been brought under the Section
2(1) (o) of Consumer Protection Act, 1986 and also, it has included the following categories
of doctors/hospitals under this Section.

Consumer, in the medical and dental profession, is:

1. A patient who pays to get services of doctor/hospital

2. Any person who pays for the patient

3. Legal heirs /representatives of such patients

4. Spouse, parents and children of the patient.

Dissatisfied consumer can file a complaint directly with the national commission or appeal
against decisions of the state commission within a month from the date of the order. The
court fee is Rs 5,000 and the demand draft should be in the name of The Registrar, National
Consumer Disputes Redressal Commission. There is no fee for filing an appeal before the
state or national commission. You can appeal against the orders of the national commission
in the Supreme Court within a period of 30 days.

Consumer Complaint as is provided under Section 21(a)(i) of COPRA, 1986, is to be filed

with the Registry of this Commission within a time span of two years from the date on which
the cause of action has arisen, where the value of the goods or services and compensation,
claimed, is more than Rs.10,00,000.

In case of health care industry, the courts have recognised the people’s right to proper
healthcare and have also spelled out standards for such care and standards for determining
negligence.
The definition of ‘Medical Negligence’ has remained unchanged over the time- “Failure to
exercise reasonable skill as per the general standards and the prevalent situation is termed as
medical negligence.”

Medical Negligence is the tort which takes cognizance of the following:

● A legal duty either express or implied to treat patient must exist.

● Breach of such legal duty, if any, in comparison to the expected conduct and
performance of the people from the same profession.

● Presence of damage caused by such breach which must result in injury which needs to
be compensated.

Impact of Consumer Protection Protection Act on Healthcare Services

Here are the negative impact on the medical sector:

● Administration and prescription of defensive medicines by doctors

● Increase in the cost of healthcare services

● Filing of frivolous lawsuits leading to unnecessary litigation

Hereunder are the positive impact on the medical sector:

● Quick grievance redressal

● Quality of healthcare services has become better

● Training of medical practice

● Improvement in introspection by the medical practitioners about their profession

Who is Liable to Consumer Protection Act?

1. Doctors with independent practice rendering only free services.

2. Private hospitals charging all.

3. All hospitals having free as well as paying patients, they are liable to both.
 4. Doctors or hospitals paid by an insurance firmfor treatment of a client or an employer
forthe treatment of an employee.

Who is not liable to Consumer Protection Act?

1. Doctors in hospitals, which do not charge their patients.

2. Hospitals offering free services to all patients.

Victims of medical negligence, considering action against an erring doctor, have three
options

1. Compensatory mode - Seek financial compensation before the Consumer Disputes

Redressal Forum or before Civil Courts

2. Punitive/Deterrent mode - Lodge a criminal complaint against the doctor.

3. Corrective/ Deterrent mode - Complaint to the State Medical Council demanding that
the doctor’s license be revoked. Jurisdiction of Civil Court was never disputed but its
scope was limited for damages only

CASE REVIEWS

Indian Medical Association v V.P. Shantha and others

In deciding this case of deficiency of medical service, the court held that the services
rendered by a medical professional fall within the ambit of ‘services’ under the section
2(1)(o) of the Act. It rejected the contention that a medical practitioner, being a professional
and falling under the scope of Indian Medical Council Act, stands excluded from the CPA.

Moreover, it held that provision of a token fee (for the hospital administrative purposes)
would not include an otherwise free service within the ambit of the definition of services.
Also, the cost of the services paid by the employer or the insurance company would be
deemed similar to paying for the service by the consumer itself.

Nizam Institute of Medical Sciences v Prasanth S. Dhananka & Ors.

In this case, the complainant claimed for compensation due to alleged medical negligence
before, during and after a medical procedure that led to a partial paralysis of the patient. The
National Tribunal ruled medical negligence stating various lapses in all three phases
mentioned including on the ground that consent of the patient was taken only for the
examination of the tumor and not for its removal.

In the appeal, the Supreme Court confirmed the findings of the Commission and stated that
the removal of the tumor was deferred through discussion on record and therefore an implied
consent cannot be inferred.

The court recognised that a balance has to be struck between the inflated demands of the
victim and the unreasonable claim of the opposition party that on compensation needs to be
paid. It recognised that sympathy for the victim should not come in the way while deciding
compensation but the court should not refuse to provide “adequate compensation”. In light of
this and the peculiar facts of the case, it increased the sum of compensation to twenty-five
lakhs each for the continuous medical expenses that need to be borne and the loss of
employment that the petitioner had suffered. Additionally, compensation for the pain and
suffering that the appellant had undergone amounting to ten lakhs, for the expenses of a
driver-cum-attendant for thirty years amounting to seven lakhs and twenty thousand, for
nursing care amounting of fourteen lakhs and forty thousand and physiotherapy expenses of
thirty years amounting to ten lakhs and eighty thousand along with interest of 6% was also
granted.

MEDICAL NEGLIGENCE AND CONSUMER PROTECTION ACT

The provision of Consumer Protection Act to include healthcare services provided by the
private sector can be considered as an important step to ensure an appropriate quality of care
to patients. This act can effectively minimize malpractices and negligent behaviour in the
healthcare industry. Since the healthcare industry is drastically different from other goods and
services, health and medical cases should be dealt differently from other cases. The role of
medical councils is very important in this regard. Some of the concerns of the patients are
lack of defined standards for private practice, difficulty in differentiating between mistaken
diagnosis and negligent behaviour, risks and uncertainty in the medical sector, and the
responsibility of the patient to prove medical negligence.

Medical negligence can be defined as the misconduct by a medical practitioner or doctor by

not providing enough care resulting in breach of their duties and harming the patients who are
their consumers. A medical practitioner is bound to do the following duties to the patient,

1. Duty of care in deciding whether to undertake the case,

 2. Duty of care in deciding what treatment to give,
3. Duty of care in the administration of that treatment.

A breach or failure to do any of the above duties is termed as medical negligence and the
doctor is bound to pay compensation to the patient. Medical negligence can also be called as
medical malpractice. It occurs when a healthcare provider does not provide the recognized
standard of care while treating the patient. The standard of care is defined as what a
reasonably prudent medical provider would have done in the same circumstances.

The Indian Medical Council (IMC) act provided membership guidelines for doctors and other
medical practitioners in India. The healthcare industry was not under the scope of the
consumer protection act as it was argued that the Consumer Protection Act reduced the
relationship between the doctor and patient as a mere buyer and seller. It was further argued
that all cases pertaining to the healthcare industry should be dealt with The Indian Medical
Council (IMC) act. In the landmark judgement of M/s. Cosmopolitan Hospitals and another
vs. Vasantha P Nair case, The National Commission stated that The Indian Medical Council
act enabled the council to issue membership guidelines to its members and take action against
the defaulters, by removing their membership and thereby restraining them from practicing
medicine, it does not consider the state of patients who suffered damage due to medical
negligence. In other words, the Indian Medical Council act does not have provisions to
protect the interests of persons who may suffer because of any negligence or deficiency in
services rendered by members of the medical profession, i.e. the rights of a patient.
Therefore, cases related to the healthcare industry where the patient has paid for the service to
be provided can be considered under the scope of Consumer Protection Act. The Indian
Medical Association also feared the possibility of misuse of Consumer Protection Act against
doctors. However, the data shows that most of the cases filed under the Consumer Protection
Act found the judgement to be in favour of the doctors and the hospitals.

To sum up, legislative rulings have ratified that private medical services are in the nature of
‘contract for services’ where the relationship between the patient and doctor is that of a
principal and agent. Since the doctor takes all decisions on behalf of the patient, the doctor is
the expert service provider to the patient, particularly when the patient is charged for services.
In this regard, the service falls within the domain of the Consumer Protection Act. The act
has also established that the relatives of the deceased (in case the patient died), are legal
representatives with all the rights of the deceased and are vested with the power of enforcing
the cause of action by pleading the case on behalf of the deceased.

One of the concerns raised in various cases filed in the consumer forums is that was it
possible to make a distinction between mistaken diagnosis and negligent behaviour of the
doctor and ascertain the real cause of death of the patient. There is a possibility of
uncertainties and imperfections in medical interventions and procedures which needed to be
taken into an account before deciding the guilt of the doctor and sentencing the judgement.

Considering the Vinitha Ashok vs Lakshmi Hospital and Others case, the complainant stated
that the doctors had performed an unnecessary operation which resulted in the removal of a
vital organ of the patient. The complainant alleged that the operation was conducted without
proper examination and diagnosis, the operation could have been avoided, and therefore the
doctor should be held liable for negligence. The consumer forum examined the case with the
help of an expert (professor and head of the department of obstetrics and gynaecology) and
ruled that it is not necessary to establish that the doctor should use the highest degree of skill.
It is enough for the doctor to show that he/she has acted according to the general and
approved practice. A mistaken diagnosis is not necessarily a negligent diagnosis. A
practitioner can only be held liable if his/her mistake is of a nature to suggest absence of
reasonable skill a qualified practitioner should possess. In this case the practitioner had the
necessary skills and had done the action, which he/she diagnosed to be best for the situation.

It can be observed that there is a grey line between error of judgement and medical
negligence and it makes it difficult to decide the reason for the medical complication. The
above case highlights the point that in medical practice, the right and generally action of the
doctor may still cause loss to the patient. The reason could be the imperfections in medical
science or may be due to an error in diagnostic procedures. In such a case, the doctor is not
usually held liable for the loss.

In certain cases, a doctor can be held liable for the act of another person who had actually
caused the suffering to the patient. This occurs when the person committing the act does not
owe a duty of care to the patient and therefore is not a breach on his part. For example, in
case of a surgery if a junior doctor is involved as part of the team, then he is supposed to
follow the advice of the senior doctor. On the advice of the senior doctor, if the junior doctor
commits an injury to the patient, the junior doctor is not liable as he has discharged his duty.
The senior doctor is held liable for the injury caused to the patient.
In the context of medicine, the commission has recognized two facts. First, almost all medical
procedures have inherent risks and secondly, doctors face a considerable amount of
uncertainty and the reason for this uncertainty could be the nature of a patient’ ailment. In the
medical profession, there is always a small probability of adverse consequences even if the
procedures are generally accepted by the experts. In other words, a procedure may be
successful in curing many patients but the same may have an adversary effect for a small
population of patients. It may not be possible for the physician to eliminate this possibility
completely and to predict the potential sufferer and the loss it may cause.

Furthermore, where the treatment of a patient is a race against time (e.g. in the case of an
operation, the consumer forums have made allowance in favour of the provider by applying a
risk-benefit test. If the doctor follows a course of treatment or procedures accepted and
followed by a responsible section of the profession, he/she is not guilty of negligence even if
another section of the profession does not subscribe to that practice. The National
Commission has recognized this fact. It has ruled that if a doctor has acted according to
general and approved practice, he cannot be charged under the Consumer Protection Act for
the inherent imperfections and risks in medical practice.

In C.J. Lawrence vs. Apollo Hospitals case, the complainant was admitted in a private
hospital for pain in the neck on the right shoulder. Investigations revealed that he was a
diabetic and had right hydronephrosis with obstruction at right uretrovesical junction. The
complainant underwent surgery by retroperitoneal approach. The affected portion of the
ureter was removed and uretric reimplantation was done. During the postoperative period, the
complainant developed high fever and further investigations showed that a stapler pin was
seen in the gastrointestinal tract. The complainant got discharged against medical advice. The
allegation was that the pin was left there during the operation. The surgeon stated that the
surgical staplers are V or U shaped and used in clusters in surgeries involving large intestine.
The stapler pin seen in the x-ray is not the surgical stapler pin. It resembles the stapler pins
used in food pockets. Evidently, this stapler pin should have been swallowed. The State
Commission held that there is no negligence or deficiency of service on the part of the
hospital and dismissed the complaint without costs. Considering the above case, it can be
noted that the medical practitioner was not at fault and eventually the case was dismissed.

On the other hand, in TMT. Chandra vs. Mahesh & others case, the case was dismissed due
to lack of evidences in spite of the expert opinion that the patient has died due to medical
negligence. The complainant’s husband had undergone two surgeries for lump on body after
proper clinical examination. After the first surgery the lump was diagnosed as lymphoma but
during the course of treatment after surgery it was suspected to be neurofibroma and excision
biopsy was done and the biopsy report revealed to be cancerous. He was advised radiotherapy
and chemotherapy. She argued that the doctors were negligent and the surgeries were done in
hurry. Subsequently the patient expired. She consulted doctors of the cancer institute Adyar,
Tamil Nadu and CMC, Vellore who opined that the patient expired due to the negligent
behaviour of the operating doctors, but no document certifying the above claim was issued.
Hence the complaint did not receive any compensation.

It can also be observed from the above cases that the consumer forums are not equipped with
the necessary expertise to handle medical negligence cases and, therefore, the practice of co-
opting a physician member in the forum has been developed to handle such cases. In spite of
that, most of the judgements are in favour of the medical practitioners highlighting the fact
that the patients are often in the disadvantaged position.

One of the major drawbacks of the considering medical negligence under consumer
protection act is that the onus of proving that the medical practitioner is guilty of medical
negligence is on the complainant. In the case of Vinitha Ashok vs Lakshmi Hospital case, the
complainant faced problems in getting qualified medical practitioners to testify on their
behalf, whereas the defendants did not have to face any such problems as they were medical
experts themselves.

In this case the doctors are in a more advantageous position than the patients because they
have more information on the case. The complainant on the other hand, had to get doctors to
explain the finer points of medical jargon. This is one of the greatest difficulties of the
complainants of medical negligence face. Under the present scenario, in most cases the
private hospitals do not disclose the diagnosis information to their patients. There are certain
situations where the patients are unaware of the medicines they are given. Thus, the patient is
not able to put together all the necessary information and documents as evidences and may
lose the case in the commission.

The medical practice in the country is primarily governed by the code of conduct laid down
by the medical council. The medical associations and the medical council also hold the
responsibility for implementing the code of conduct but doubts have been raised about the
capacity of these institutions in implementing the guidelines offered. There are no standards
norms for general and approved practice. The lack of such standards greatly affects ruling
and judgement in cases filed under the consumer protection act against medical negligence.
The judgement is influenced by the expert opinion and the party that makes the forceful
argument and that provided more evidence to substantiate their claims is at the advantageous
position. Therefore the procedures involved in examination of the cases against medical
negligence are prone to a considerable amount of subjectivity. Since the consumer protection
act does not ensure implementation of a code of conduct or code of ethics by the experts, the
party that could mobilize the expert opinion in his/her favour will have the advantage as the
final verdict is more likely be biased based on the expert opinion.

The recent judgment pronounced in Martin F. D'Souza Vs. Mohammed Ishfaqby the
Hon'ble Supreme Court of India quite explicitly addresses the concerns of medical
professionals regarding the adjudicatory process that is to be adopted by Courts and Forums
in cases of alleged medical negligence filed against Doctors.

In March 1991, the Respondent who was suffering from chronic renal failure was referred by
the Director of Health Services to the Nanavati Hospital in Mumbai for the purpose of a
kidney transplant. At that stage, the Respondent was undergoing hemodialysis twice a week
and was awaiting a suitable kidney donor. On May 20, 1991, the Respondent approached the
Appellant doctor with a high fever, but he refused hospitalization despite the advice of the
Appellant. On May 29, 1991 the Respondent who still had a high fever finally agreed to get
admitted into the hospital due to his serious condition. On June 3, 1991, the reports of the
urine culture and sensitivity showed a severe urinary tract infection due to Klebsiella species
(1 lac/ml) sensitive only to Amikacin and Methenamine Mandelate. Methnamine Mandelate
cannot be used in patients suffering from renal failure. Since the urinary infection was
sensitive only to Amikacin, an injection of Amikacin was administered to the Respondent for
3 days (from June 5, 1991 to June 7, 1991). Upon treatment, the temperature of the
Respondent rapidly subsided. On June 11, 1991, the Respondent who presented to the
hemodialysis unit complained to the Appellant that he had slight tinnitus (ringing in the ear).
The Appellant has alleged that he immediately told the Respondent to stop taking the
Amikacin and Augmentin and scored out the treatment on the discharge card. However,
despite express instructions from the Appellant, the Respondent continued taking Amikacin
until June 17, 1991. Thereafter, the Respondent was not under the treatment of the Appellant.
On June 14, 1991, June 18, 1991, and June 20, 1991 the Respondent received hemodialysis at
Nanavati Hospital and allegedly did not complain of deafness during this period. On June 25,
1991, the Respondent, on his own accord, was admitted to Prince Aly Khan Hospital. The
Complainant allegedly did not complain of deafness during this period and conversed with
doctors normally, as is proved from their evidence. On July 30, 1991, the Respondent was
operated upon for a transplant and on August 13, 1991, the Respondent was discharged from
Prince Aly Khan Hospital after his transplant. The Respondent returned to Delhi on August
14, 991 after his discharge.

On July 7, 1992, the Respondent filed a complaint before the National Consumer Disputes
Redressal Commission, New Delhi claiming compensation of an amount of Rs.12,00,000/- as
his hearing had been affected. The Appellant filed his reply stating, inter alia, that there was
no material brought on record by the Respondent to show any co-relationship between the
drugs prescribed and the state of his health. The National Consumer Disputes Redressal
Commission passed an order on October 6, 1993 directing the nomination of an expert from
the All India Institute of Medical Sciences, New Delhi (AIIMS) to examine the complaint
and give an unbiased and neutral opinion. AIIMS nominated Dr. P. Ghosh who was of the
opinion that the drug Amikacin was administered by the Appellant as a life-saving measure
and was rightly used. It is submitted by the Appellant that the said report further makes it
clear that there has been no negligence on the part of the Appellant. However, the National
Commission has come to the conclusion that the Doctor was negligent.

COMPARISON OF PRACTICE IN INDIA AND THE REST OF THE WORLD

The patient as a consumer -

Traditionally, patients in India have unquestioning trust in their doctors. Most doctors deserve
it. But in some cases, medical negligence has resulted in severe harm physical, mental and
financial. In addition, unqualified practitioners have brought suffering to gullible patients.
Doctors have been liable to prosecution in civil court, but few malpractice victims sue for
compensation, fearing years (even decades) of costly litigation. Fortunately, in 1995 the
Supreme Court decreed the medical profession to be a "service" under the Consumer
Protection Act; 1986.It set aside a writ Petition challenging the same by the Indian medical
Association.

The patient's rights in India-

In the interest of a healthy doctor patient relationship, A patient should Know his rights as a
consumer:
➢ Patient has a right to be told all the facts about illness; to have his/her medical records

explained to him/ her; and to be made aware of risks and side effects, if any, of the treatment
prescribed for he/ she should not hesitate to question patient‘s doctor about any of these
aspects.

➢ When patient is being given a physical examination, he/ she have a right to be handled

with consideration and due regard for his/ her modesty.

➢Patient has a right to know doctor's qualifications.

➢Patient has a right to complete confidentiality regarding his/ her illness.

➢If patient is doubtful about the treatment prescribed and especially an operation suggested,

he/ she have a right to get a second opinion from any specialist.

➢ Patient has a right to be told in advance what an operation is for and the possible risks

involved. If this is not possible because of his/ her being unconscious or for some other
reasons, his/ her nearest relatives must be told before they consent to the operation.

➢ If patient is to be discharged or moved to another hospital, he/ she have a right to be

informed in advance and to make his/ her own choice of hospital of nursing home, in
consultation with the doctor.

➢Patient has a right to get his/ her case papers upon request.

The Medical Council of India published, in 2002, a Code of Ethics Regulations (COER)
which deals with the duties and responsibilities of physicians in addition to certain rights of
patients. It must be emphasized that this code does not represent patient rights; those
mentioned are incidental to the duties and responsibilities of physicians. A distinction must
therefore be made between a duty-centric approach as represented by the COER and the
rights-centric approach of the AAPS. A medical professional may have issues with the rights-
centric approach of AAPS, but is duty bound to uphold the rights of patients that are
incidental to his/her duties.
Practitioners are required to sign a declaration, stating inter alia as follows:

I shall abide by the code of medical ethics as enunciated in the Indian Medical Council. The
Consumer Guidance Society of India (CGSI) has a more comprehensive charter on its
website listing eight specific rights of patients. Interestingly, the CGSI‘s charter does not
include the right to refuse treatment. Thus, if the physician decides on a particular course of
action, the patient can at the most ask for a second opinion. Apart from this, the rights of
patients are similar in the US and India. However, there is no automatic respect for patient
rights in India, and if they are violated, the only recourse for patients is to approach the
consumer courts. Violation of patient rights is not a cognizable offence in India.

The rights of patients in New Zealand-

The Medical Council of New Zealand has enforced the Code of Rights under aseparate law
under the Health and Disability Act 1994 (the HDC Act). Patients haverights as consumers of
health and disability services provided by doctors and other health professionals in public and
private services, for paid and unpaid services, withinhospitals and within private practices.
The code of rights is law under the Health andDisability Act 1994 (the HDC Act).

The rights of patients are-

1. Consumers should always be treated with respect.

2. No one should discriminate against consumers, pressure them into anything, ortake
advantage of them.

3. Services should help consumers to live dignified, independent lives.

4. Consumers should be treated with reasonable care and skill and receive wellcoordinated
services.

5. Service providers should listen to consumers and give them information in a waythey can
understand and that makes them comfortable to ask questions if theydon‘t understand. This
may require the services of an interpreter.

6. Consumers should have any treatment explained to them, including benefits,risks,

alternatives, and costs, and have any questions answered honestly.
7. Consumers can make their own decisions about treatment, and are free tochange their
mind.

8. Consumers can have a support person with them at most times.

The rights of patients in Zimbabwe -

The Patients Charter was developed from recommendations by the ConsumerCouncil of

Zimbabwe (CCZ) and the Ministry of Health and Child Welfare to offerprotection to
consumers and improve health service delivery. The Charter thereforespells out general
consumer rights to access and treatment. Patient’s rights can be described as social and
individual rights.

Social rights coveraspects such as the quality and accessibility of health care, while
individual rightsrelate to basic human and consumer rights

1. General rights to access and treatment -

1.1 Hospitality (Health Care)-A patient has the right to be accorded courtesy and to be
treated with respect in asafe and clean environment.

1.2 Confidentiality-Save for the requirements of the law, all information concerning a
patient‘s illness orpersonal circumstances will be kept in confidence and used only for the
purposes oftheir treatment. A patient has the right to details of his/her treatment and
diagnosis.

1.3 Privacy-A Patient has the right to privacy during consultation, examination and
treatment. Apatient shall therefore be interviewed and treated in surroundings designed to
ensureprivacy and shall have the right to be accompanied during any physical examinationor
treatment if they so wish.

1.4 Discrimination (Human Treatment)-Patient has the right to be received and attended to
without regard to sex, age, religion, colour, creed, tribe, race and socio-economic status. This
also means thatoptimal health care must be provided to all citizens at the right cost.

1.5 Choice-A Patient must exercise their right to choose health workers who provide them
withtreatment or advice, the place and type of treatment that is provided. After beinginformed
of the possible options, patients have the right to refuse or halt any medicalinterventions.
Patients are also allowed to seek a second opinion at any given timewhile consulting the same
medical or health care delivery system.

1.6 Redress of Grievances-Patients shall have access to appropriate grievance handling

procedures. They havethe right to claim damages of injury or illness incurred or aggravated
as a result of thefailure of the health professional to exercise the duty and standard of care
required ofhim or her while treating them. Patients shall have the right to legal advice as
regardsany malpractice by health care professionals.

2 SERVICES-

2.1 Admission and Stay in Hospital-In the event of an accident or emergency, patient will
be attended to by a HealthWorker immediately upon arrival, assessed and dealt with
appropriately.Whether patient is admitted as an emergency or not, hospital staff shall inform
relatives or next of kin or whoever they wish, was practicable.Keep patient kit and valuables
in a safe and clean place.Give patient clear information about his/ her illness and condition
and the treatment plan for recovery.

2.2 Consent-In some cases, treatment might necessitate the need for operative procedures.
This isan unnerving experience for most patients.In the event that surgery is anticipated in
treatment plan, patient has the right to beconsulted and to be informed about the nature of the
operation. If patient is 18 years of age and above, they have the right to give your consent
tosurgery recommended by health workers.If patient is 17 years of age and below, parent or
guardian will give this consent.

The rights of patients in United States -

In United States, in March 1998, the Advisory Commission on Consumer Protectionand

Quality in the Health Care Industry issued its final report, which included theConsumer Bill
of Rights and Responsibilities.The purpose of the Bill of Rights is:

➢ To build up consumer confidence in the health care system, by making iteasy for

consumers to participate actively in their own health care.

➢ To strongly support the importance of a good healthcare provider andthat of a good

provider-patient relationship.
➢ To emphasize and support the importance of the consumers' role inmaking sure they have

rights and responsibilities with regard to healthimprovement.

The following section, Consumer Bill of Rights, was developed by the federalgovernment.
This has been used as a foundation for many health plans, including thefederal-government-
sponsored health plans.Consumer Bill of Rights:

I. Information Disclosure-Patients have the right to receive accurate and easily understood
information about patienthealth plan, health care professionals, and health care facilities.
Language, have a physical or mental disability, assistance will be provided so patients can
make informed health care decisions.

II. Choice of Providers and Plans-Patients has the right to a choice of health care providers
that is sufficient to provide patients with access to appropriate high-quality health care.

III. Access to Emergency Services-If patients have severe pain, an injury, or sudden illness
that convinces patients that patients health is in serious jeopardy, patients have the right to
receive screening and stabilization emergency services whenever and wherever needed,
without prior authorization or financial penalty.

IV. Participation in Treatment Decisions-Patients has the right to know all treatment
options and to participate in decisions about patients care. Parents, guardians, family
members, or other individuals that patients designate can represent patients if patients cannot
make their own decisions.

V. Respect and Non-discrimination-Patients have the right to considerate, respectful and

non-discriminatory care from doctors, health plan representatives, and other health care
providers.

VI. Confidentiality of Health Information-Patients have the right to talk in confidence with
health care providers and to have health care information protected. Patients also have the
right to review and copy own medical record and request that physician amend their record if
it is not accurate, relevant, or complete.

VII. Complaints and Appeals-Patients have the right to a fair, fast and objective review of
any complaint on health plan, doctors, hospitals or other health care personnel. This includes
complaints about waiting times, operating hours, the conduct of health care personnel, and
the adequacy of health care facilities.

The rights of patients in Australia -

The Australian Charter of Healthcare Rights describes the rights of patients, consumers and
other people using the Australian healthcare system. These rights are essential to make sure
that, wherever and whenever health care is provided, it is of high quality and is safe.
Healthcare rights are the rights of patients, consumers and other people usinghealthcare
services.

The Charter allows patients, consumers, families, carers and services providing healthcare to
share an understanding of the rights of people receiving health care. This helps everyone to
work together towards a safe and high quality health system. A genuine partnership between
patients, consumers and providers is important so that everyone achieves the best possible
outcomes.

1. Everyone has the right to be able to access health care and this right is essential for the
Charter to be meaningful.

2. The Australian government commits to international agreements about human rights that
recognise everyone's right to have the highest possible standard of physical and mental
health.

3. Australia is a society made up of people with different cultures and ways of life, and the
Charter acknowledges and respects these differences.

Under COPRA all the procedures of civil procedure code are applicable. The burden of proof
is on the complainant (patient). The doctor can produce his expert wit- nesses as well as
cross-examine complainant's witnesses. All over the world, even in the developed countries
like the US and UK, medical negligence cases are decided by judges who have no medical
expertise. These decisions are- taken as per the evidence produced. Even before the COPRA
was enacted, cases of medical negligence were decided in civil and criminal course where
judges have no medical expertise.

The American Hospital Association has devised a Patients' Bill of Rights which is accepted
in many hospitals in America. However, in India there are no standards enforced by the
Indian Medical Council and it makes the judgements in favour of the hospitals.
CONCLUSION

With the advent of the Consumer Protection Act there is better protection for those who pay
for their medical services. Since their number is on the increase the coverage will also
increase. But two categories remain excluded, those who are denied service and those who
cannot pay for the service. There were attempts to bring the last category, which constitute
the vast majority within the jurisdiction of the agencies, and it was rejected as contrary to the
scheme of the Act. In fact, that category of patients is catered for by philanthropic institutions
and Government hospitals. Steps have to be taken in both the cases for a better supervision
and a therapeutic audit in order to avoid mishaps. As far as doctors are concerned whatever
may be their reasons against the Act. There is no denying the fact that medical service is
rendered more and more on commercial line and the treatment is becoming more and more
costly. The adjudicating agencies offer sufficient guarantee of justice to them on account of'
appeals and revisions provided for. They may also take some preventive steps. The first one
is to be careful. They may also refrain from dealing with cases beyond their competence and
equipment. Of course they will not sent away a person in need of an urgent medical
treatment. When in spite of all precautions, a case is filed before a C.D.R.A. the best defence
of the doctor is the case sheet, which has to be kept genuinely with entries now and then of
the observations and treatment.

But doctors may still have a legitimate grudge. When a complaint is taken on file, it may
receive publicity tarnishing the reputation of the doctor concerned even if ultimately the
complain fails. This may perhaps be obviated by making conciliation mandatory in the
agency before taking the complaint on file. Secondly medicine may be included as one of the
qualifications prescribed for being a member of the C.D.R.As. When given an opportunity to
sit in judgement over the acts of other professionals, doctors will reconcile themselves with
others probing their performance.

The Consumer Protection Act (CPA) is a comprehensive legislation implemented in the year
1986 in India to promote and safeguard the concerns of consumers. Under the act, six
different consumer rights, namely right to choose, right to be heard, right to education of
customer, right to seek redress, right to be informed, and right to safety, have been included
to protect the customers. For the smooth execution, consumer councils and consumer courts
have been established in the district, state and central level to settle the consumers’ disputes.
The CPA was enforced in India as people were reluctant to avail the services of the civil
courts owing to the excessive court fee and a long delay to get a final verdict. CPA has been

formulated to be customer‑friendly, as there is no court fee payment, the person can plead

their own case, and the decision is taken within 3‑6 months. The doctor‑patient relationship

relies on the mutual trust and conviction. However, over the years owing to the
commercialization of the health care and the medical profession, the profession has run out of
faith. The law is not enforced to penalize all health care professionals that cause injury to the
patients; but is concerned only with negligent acts. The CPA provides a forum to safeguard
the rights of the customers and establishes guidelines for the speedy redress of their
grievances against unethical medical practices. All service rendered to a patient by a medical
practitioner is covered under the CPA except when the service is provided free of cost,
especially in charitable or governmental dispensaries and hospitals, and primary health
centers. If a patient or the relations of a patient feel that the suffering or death of a patient is
because of either negligence by the concerned doctor or the health facility, they can complain
to the Medical Council of India or to the Consumer Court. The Act covers all the medical
practitioners and does not limit itself to the allopathic system in order to ensure accountability

and keep a check on quackery by non‑allopathic practitioners. Similar sorts of acts has even

been implemented across the world and has shown encouraging results in the field of medical
care. Despite the rise in the number of cases that are filed against medical practitioners since
enforcement of the Act, a study

has revealed poor awareness among the medical and dental professionals. Further, it has been
observed that the quality of medical services offered to the ordinary man has also improved
significantly since implementation of the act. Thus, there is an immense need to update the
understanding about the Act among all the stakeholders - patient, doctors, and hospital

management. To conclude, medical professionals should internalize quality‑assured health

standards in their routine professional duties, to ensure protection of customer rights. The
enforcement of the consumer protection act is a crucial step in ensuring reforms in

doctor‑patient relationship and to benefit the patient, doctor, and society in general in years

to come.
Bibliography

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1363(TNSCDRC)
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