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Patient Rights : all you need to know

May 30, 2022

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This article has been written by Gauri Saxena, an LLM student from Dr. DY Patil College of Law, Navi Mumbai. This article covers exhaustive research on the current situation, awareness, solutions, and everything you need to know about patient rights in India.

This article has been published by Sneha Mahawar.

Table of Contents

Introduction

India is a country where most of us go to a doctor or a hospital only when there is an emergency. In such cases, the doctor’s word is considered final and whatever he explains is considered to be the paramount truth. In the current paternalistic framework, patients have little say in their treatment as all the important decisions are taken by the doctor. Furthermore, there are instances of over-hospitalization, excess medications that patients are getting without their acknowledgment or proper knowledge, unjustifiable laboratory tests, and the list goes on. As a healthcare consumer, it is a patient and his relative’s right to know everything related to their treatment.

Patient Rights in India

The Code of Ethics Regulations, 2002, has a duty-centric approach as it mainly deals with the duties of physicians in general, to their patients, during the consultation, to the public and paramedical profession, and the responsibilities of physicians to each other, in addition to a few rights of the patients. The Consumer Guidance Society of India states nowhere about the right to refuse treatment, which means once a doctor has begun with treatment, the patient cannot refuse to get treated and the only escape he has is to ask for a second opinion.

Patients and their relatives are not informed about the diagnosis, illness, and line of treatment. Even if they are informed, they do not fully comprehend the situation due to the difficulty of understanding medical terminology, which is not simplified by doctors when explaining to patients. There is a varied medical system in India in which the private medical system dominates, giving rise to an intense mistrust between both the private and public healthcare systems, which impedes the standardization of treatment outcomes and affects patients’ rights in general.

The Indian medical system is disproportionately divided between private and public sectors. As per a report, in the financial year 2020, 70% of the hospital market share was controlled by the private sector, which has grown significantly over the years across a multitude of sectors such as the pharmaceutical industry, blood banks, hospitals, etc. The main area of concern for the private sector is providing secondary, tertiary, and quaternary care institutions in tier-I and tier-II cities. While the government, i.e., the public sector’s main area of concern is providing basic healthcare facilities in secondary and tertiary care institutions.

In contrast to massive growth in the private sector across all regions and rising usage, there is no effective system for regulation or mandatory assistance of benchmarks for standard care. This is a difference from the public health sector, which has standards for all amenities, from hospitals to dispensaries. Both sectors lack institutional and regulatory mechanisms. According to some studies conducted over the last two decades, over-prescription of drugs, lack of standardization of fee structure, excessive use of technology in diagnosis, and poor record-keeping are widely observed, and the money spent by patients does not guarantee them quality services and care.

Patients and their relatives must understand that healthcare providers are responsible for the facilities they provide.

Levels of healthcare

Patients often hear doctors mentioning the following healthcare levels, which not many of us understand:

primary,
secondary,
tertiary, and
quaternary

Doctors have used these classifications for decades to differentiate between the intricacies of illness and the amount of care required. Knowing about these various types of healthcare levels can make a patient understand the severity of their disease or lack thereof. In simple terms, if your doctor tells you that you require a particular level of healthcare, you will immediately know how severe your illness is and the kind of treatment you will require.

Primary care

It is a type of general medical care in which a patient is usually examined by a physician or a general practitioner because the severity of the problem in such cases is not too intense. It is the first level of care provided to patients when they have health complications or needs.

Secondary care

The secondary care level begins when a patient is referred to a specialist by his or her physician. A specialist is a doctor who looks into a particular organ system to treat the disease related to it.

For example, a nephrologist is a kidney specialist who can look into all kinds of health issues related to the kidneys.

Tertiary care

It comes into the picture when a patient is admitted to the hospital and requires a higher standard of care and monitoring as it is not related to a particular part of the body. The patient’s bodily functions are constantly monitored by medical equipment, and he is provided with advanced medical treatment.

Quaternary

Quaternary care is the final type of care provided to a patient. It is an extended version of tertiary care, which is not available in all hospitals as it requires sophisticated equipment and extremely advanced procedures. It is provided only when traditional treatments have been unsuccessful in improving a patient’s condition. At times, the patient also undergoes clinical trials and experimental medications.

Throughout their lives, most people only go through primary and secondary medical care, but in the event of an accident or severe injury, patients are provided with tertiary care.

Legislative provisions for patient rights in India

The pandemic has revealed some significant shortcomings in India’s healthcare system. Much of this is attributed to India’s low public health spending, which is lower than in most other countries. Another important reason for India’s poor public health is the lack of a legal framework that guarantees the fundamental right to health.

The Indian Constitution has no explicit mention of a fundamental right to health. However, the Constitution does make references to public health and the role that the states are required to play in providing healthcare to citizens under some of the Fundamental Rights and the Directive Principles of State Policy under Part IV of the Indian Constitution that serve as a foundation for the right to health with the help of the following Article:

Article 21	Guarantees protection of life and personal liberty.
Article 39 (e)	The state is required to ensure workers’ health.
Article 42	The state is required to provide just and benevolent working conditions and maternity leave.
Article 47	The state is required to enhance nutrition, and the standard of living, and to improve public health.
Article 243G	Equips panchayats and municipalities to strengthen public health.

Laws governing patient rights in India

The following legislation deals with the protection of patient rights:

NOTE: The term “patient” is not defined anywhere in Indian law. However, the term includes all those who obtain medical care from doctors and medical professionals. The Union, as well as every state, must be providing healthcare services to enhance public health.

Landmark judgements around patient rights

In the case of Rakesh Chandra Narayan v. State of Bihar (1988), the issue before the Supreme Court was based on the appalling conditions in a Ranchi mental hospital, and a petition was filed under Article 32 of the Indian Constitution. The Court held that the government has to ensure medical attention is provided to every citizen.

In the case of State of Punjab & Ors v. Mohinder Singh Chawla (1983), the respondent’s hospital bill reimbursement of ₹1,29,000 was rejected by the petitioners, who themselves had referred the respondent to get treated at AIIMS, New Delhi, due to the unavailability of valve replacement in Punjab State Hospitals. The Supreme Court upheld that the right to health is an integral part of the right to life under Article 21 of the Indian Constitution, so the government has a constitutional mandate to provide health care.

In the case of Ms.Nisha Priya Bhatia v. the Institute of HB & AS, GNCTD (2014), the question before the Commission was whether the appellant had a right to information and a right to access her medical record that was with the respondent institute. It was held that it is a patient’s right to procure his or her medical record under the following:

Right to Information Act, 2005
Indian Medical Council (Professional Conduct, Etiquette, and Ethics) Regulations 2002
Consumer Protection Act, 1986

It is a doctor’s responsibility to establish a framework where the patient is provided with the medical reports by default (i.e., without his asking).

The Charter of Patient Rights

Hospitals can be centers of hope and restoration, but they can also be sources of great distress and financial hardship for many people. When a loved one is critically ill or injured, we tend to have complete faith in a hospital and its doctors. It is not always true that anyone takes advantage of this situation, but everyone must be aware of their rights at all times.

The laws that we already have help medical professionals maintain a higher quality of care and treatment for their patients to a certain extent. As there is no specific legislation in India governing patient rights, the National Human Rights Commission and the Ministry of Health and Family Welfare initiated the Patient Rights Charter.

This Patient’s Rights Charter draws on all pertinent provisions, captivated by international charters and supervised by national level provisions, to consolidate these into a single document and make them publicly known coherently.

Objectives

Uniform regulations throughout India

Till now, India does not have specific laws related to patient rights in all the states. Some states have adopted some different acts to meet the need, while some are in the process of adopting such regulations.

For example, a few states have the Natio nal Clinical Establishments Act 2010 to meet the requirement of patient rights, while some others have adopted the Nursing Homes Act, 1949.

Create awareness

The Patient Rights Charter wants to create awareness among Indian citizens in consideration of their rights as citizens, the kind of treatment, healthcare, and prescription they deserve, and the role of the government and healthcare systems in providing them so.

List of patient rights

Right to information

Every patient has the right to know about his or her illness, its cause, diagnosis, and further explanation in the language known to him or her by the healthcare provider in simple terms and language.

The patient has the right to know the cost of his treatment in writing, and he should be given the bill at the end of his treatment with a reasonable explanation.

The patient and his caregivers (or relatives) can freely know about the identity, qualifications, and professional status of the healthcare providers they have around them and the doctors or experts treating him for their knowledge and convenience, in writing with acknowledgment.

Right to records and reports

Every patient or his caregiver has the right to obtain originals or copies of case reports, indoor patient reports, and investigation reports within 24 hours at the time of admission and within 72 hours post-discharge once the payment of photocopies for such reports is made by the patient or his caregiver.

The hospital management is responsible for providing the patient’s caregiver (or relative) with a discharge summary or death summary in the event of the patient’s demise.

Right to emergency medical care

Every patient has the right to receive basic emergency medical care in both public and private hospitals. All hospitals are bound to provide such care without compromising safety and quality. Such emergency medical care should be initiated without asking for payment or advance.

Hospital management has to ensure that the said care is being provided to patients.

Right to informed consent

Every patient has the right to give consent before the initiation of any critical or complicated treatment or test. Doctors and healthcare providers must not proceed unless such consent has been obtained, for which a proper policy should be drafted along with a consent form mentioning the risk involved in the given treatment or test.

It is the responsibility of doctors to explain to the patient or his caregiver in simple language the risk and everything else related to the procedure involved, and only then give consent in writing.

Right to confidentiality, human dignity, and privacy

A doctor has to uphold the privacy of his patient’s illness, treatment, and other related issues. Under no circumstances should the data related to a patient be leaked and hence kept in safe custody. Patients’ information can be disclosed only if it is necessary to do so.

Female patients have the right to get diagnosed by a male doctor in the presence of another female person. The hospital management has to make sure that the female patient is paired with another female person at the time of her diagnosis.

Right to a second opinion

Every patient or his caregiver has the right to get a second opinion, for which the current doctor or hospital should provide the patient with all the necessary test reports at no extra charge that would be required during the second opinion.

There should not be any drop in the quality of services provided by the hospital and doctors solely because the patient took a second opinion. Any biased activity will be considered a violation of human rights.

Right to transparency in rates, and care according to prescribed rates wherever relevant

Every patient and his caregiver have the right to know the cost of all the services and facilities that will be provided by the hospital on an obvious display board and in a brochure. Every hospital and clinic must display the key rates on a board, which is easily spotted by everybody in English and the local language. The patient and his caregiver are authorized to receive a detailed bill while making the payment.

Every hospital has to make sure that the implants, essential medicines under the National List of Essential Medicines (NLEM) as per the Government of India (GoI) and World Health Organization (WHO), and devices are not charged more than the price mentioned in the packaging.

Every patient has the right to obtain medicines as per India Pharmocepia and the National Pharmaceutical Pricing Authority (NPPA) and within the range prescribed by the Central and state governments from time to time.

Right to non-discrimination

In the hospital, no patient shall face discrimination based on HIV, cancer, other medical conditions, gender, caste, community, region, religion, ethnicity, sexual orientation, linguistic or geographical origin, or age.

Hospital management must make sure no such bigotry takes place and routinely instruct their doctors and medical staff about the same.

Right to safety and quality care according to standards

Every hospital is bound to provide safety, security, quality treatment, and care to its patients, along with clean drinking water and a healthy environment that is infection-free according to the current standards of the National Accreditation Board for Hospitals (NABH).

Every patient has to be attended to with consideration and professionalism without compromising medical principles. Patients or guardians can seek redress in case of any negligence from the hospital’s side.

Right to choose an alternative treatment option if available

Every hospital must brief the patient and his guardian about an alternative treatment option whenever one is available and respect the patient’s choice. It is up to the patient to choose the line of treatment he wants for himself after looking into all the available options and their pros and cons, and his decision has to be respected.

Hospital management is not responsible for the condition of a patient if he or she decides to leave the premises and the care that was being provided.

Right to choose the source for obtaining medicines and tests

Patients and their caregivers are free to choose the pharmacy and diagnostic laboratory of their choice, provided the lab has qualified personnel and is accredited by the National Accreditation Board for Laboratories (NABL). This will not affect the quality of treatment provided by the hospital and healthcare staff.

Right to proper referral and transfer, which is free from perverse commercial influences

When a patient is being transferred from one healthcare facility to another, the patient and his caregiver must be updated with all the grounds for doing so, and the receiving hospital must give assurance that the said patient is being admitted with care and quality. There can not be any negligence on the part of either hospital involved.

Such referrals must be made in the best interests of the patient and must be free of commercial considerations such as kickbacks, commissions, incentives, or other unscrupulous business practices.

Right to protection for patients involved in clinical trials

Every person who wishes to undergo clinical trials has a right to protection. All clinical trials must take place in conformity with the following:

Good Clinical Practice Guidelines (CGP), regulated by the Central Drugs Standard Control Organization (CDSCO), Directorate General of Health Services, and GoI.
Amended Drugs and Cosmetics Act, 1940

The rights of patients in clinical trials are as follows:

The patient should always be informed of all pertinent trial information, and he should be given the original or copy of his signed consent form, which will serve as a document and proof of his participation in the clinical trial.
The patient’s participation is solely dependent on his approval, and if he declines to participate in the trial, it should not affect his regular healthcare or checkups.
He has to be informed about the name of the drug he will be taking, its dose, and administration.
The right to confidentiality is paramount here. Details of the participant along with the information he or she gives must be kept private and disclosed.
In the event of any health issue or adverse effect on the trial participant during the trial, he or she should be provided free medical care, irrespective of whether the fact it was due to the clinical trial or not, or till it is established that it was not due to the trial.

In the event of the participant’s demise, the dependents can claim compensation.

A trial participant has the right to receive additional care for a health problem that is not directly related to the trial but occurs during the trial period. He might be referred to some other doctor or healthcare facility if required.
Insurance schemes must cover illnesses related to or not related to the trial but taking place while the clinical trial is going on.
Trial patients or participants must be assured of getting the best healthcare facilities that may have been proven by the study.
Right to protection of participants involved in biomedical and health research

Patients involved in biomedical and health research are supposed to give written consent. In the case of vulnerable populations, more safeguards should be taken. The following rights of patients and communities should be protected:

Right to dignity
Right to privacy
Right to confidentiality.

Any research involving such participants should follow the National Ethical Guidelines for Biomedical and Health Research Involving Human Participants, 2017 laid down by the Indian Council for Medical Research and should be carried out with prior approval of the Ethics Committee.

In the event of any temporary or permanent impairment after the research, and the patient suffers physical, physiological, legal, or economic harm, he or she is entitled to financial or other respective assistance to restore himself.

Whatever benefits the hospitals obtain from the research should be made available to all the participants, communities, and population (whenever necessary).

Right to discharge a patient or to receive the body of a deceased patient from a hospital

The hospital management is responsible for ensuring that the patient is comfortably discharged from the hospital. The same goes in the case of the deceased, whose corpse can be taken by the caregiver even in the event of a payment that is yet to be paid.

Right to patient education

Patients need to be educated by the hospital or doctor about the following intricacies:

Facts that are essential to know about their condition
Healthy living practices
Right and responsibilities
Health insurance schemes related to them
Privilege in the case of charitable hospitals
Seeking redressal in the case of grievance.

Right to be heard and seek redressal

Every patient and their caregiver has the right to:

give feedback;
make comments;
lodge complaints.

The complaint has to be filed with the commissioned officer by the hospital and further with an official mechanism constituted by the government, such as the Patients’ Rights Tribunal Forum or Clinical Establishments Regulatory Authority, as the case may be.

A registered number must be provided at the time of filing the complaint. Robust tracking is one of the key features. The patient and the caretaker are entitled to receive the outcome of their complaint within 15 days in writing. There has to be an internal redressal mechanism in every hospital and clinic.

Rajasthan’s Right to Health Bill

Rajasthan is the first state in India to come up with an exhaustive Bill to protect the rights of patients, their health, and good governance in the medical sector.

As per the Bill, there will be free consultation, medication, emergency treatment and care, and diagnosis at all public (government) hospitals for the 8 crore population of Rajasthan.

Salient features of the Bill

Rights of the residents

Informed consent and confidentiality.
Safe and quality treatment is to be available at all government and private hospitals.
Free of cost medical consultation, drugs, emergency treatment, care, and transport as per prescribed standards.
Free or reasonable care for surgeries at all government hospitals.
Free assistance from private hospitals that were established through a land allocation at concessional rates according to the condition of the land allotment.
To collect information to make themselves healthy.

Obligations of the government

To develop and institutionalize a human resource policy for health for equitable distribution of healthcare staff across hospitals within six months of the enactment of the bill.
Social audit and grievance redressal mechanism.
Guaranteeing quality and safety at all levels of hospitals within one year.
To ensure that there is no direct or indirect denial of assistance to anybody for any government-funded healthcare service.
The appropriate state budget for health.
Constitute adequate measures to prevent, treat, and control epidemics and other public emergencies.
Setting up state and district level health authorities.

Government health insurance schemes

Before we proceed further to learn about the various schemes, we should first know what we mean by government health insurance schemes. These are central or state-sponsored systems that provide health coverage at an affordable rate.

Ayushman Bharat

Also known as Pradhan Mantri Jan Aarogya Yojna (PMJAY)

Ayushman Bharat is one of the biggest healthcare schemes funded by the Government of India. It marks a move from a selective approach to a broader approach. It covers complicated treatments such as knee replacement, prostate cancer, double valve replacement, and skull surgery, to reach more than 50 crore Indians. It covers up to 15-days of post-hospitalization expenses. It comprises 1393 medical treatments.

Aam Aadmi Bima Yojana (AABY)

AABY covers all citizens who fall under the low-income range and provides coverage to either one earning member or the head of the family. ₹75,000 is entitled by the beneficiary or family member in case the policyholder losses an eye, or limbs. It provides the beneficiaries under the following circumstances:

Death due to natural causes or accidents, permanent or partial disability.

The Universal Health Insurance Scheme (UHIS)

This scheme was implemented to shield the neediest families in the country. It provides up to ₹30,000 if a family member is admitted. In the case of an earning member, the amount is ₹50 per day for a maximum of 15 days. UHIS is available to both individuals and groups.

NGOs working towards healthcare in India

Our government is not alone when upgrading the healthcare system. Various NGOs across India are working day and night to help the citizens. Here is a list, to name a few:

Rural Health Care Foundation

They are working towards bridging the gap between the availability of low-cost medical care in rural and urban areas of underprivileged classes.

CanKids KidsCan

It is a nationwide NGO working towards childhood cancer. They provide all the aid right from detection to treatment and post-treatment. They have partnered with 113 cancer centers across India.

DoctorsForSeva Aarogya Foundation

It is a micro-volunteering organization determined to work through various segments of society. They provide a platform for pharmaceutical corporations, hospitals, etc., to benefit patients in marginalized parts of society.

Countries with the best healthcare facilities

The following countries have the best of everything: from patients’ rights to the hospital or doctor’s obligations, fee structure, insurance, etc. Some of them are listed below:

France

France has one of the best healthcare facilities in the world. The government is said to reimburse most of the amount a citizen pays to the doctor. The mortality rate in France from cardiovascular diseases has reached its lowest among OECD countries after Japan.

The French National Authority for Health has described the patient rights as follows:

Freedom from discrimination
Informed consent
Cost of care information
Litigation and settlement in the event of disputes

Germany

Germany is said to have the most advanced medical system due to a large number of medical technology universities. It keeps costs and waiting times low due to its collaborative system of public and private institutions.

They have the German Patient’s Right Act, 2013 (PRA). Some of its rights are as follows:

Doctors are bound to store and keep all the files of their patients.
Free choice of hospital, even after the doctor has recommended a few to the patients.
Workplace sickness benefits.
Every patient can choose their rehabilitation facility.

Singapore

Singapore has the highest status in the healthcare department outside Europe. It is renowned for its efficient system with great public insurance plans that cover a great amount during large procedures.

Patient rights in this country are covered under the Singapore Medical Council’s (SMC) Ethical Code and Ethical Guidelines (ECEG). Some of them are listed below:

Right to informed consent.
Right to refuse visitors.
Right to know the names of the healthcare staff.
Right to know the approximate cost of the treatment.

United Kingdom

The UK is famous for its universal government-run system, which is one of the best in the world. However, it is slightly behind the other European countries.

The National Health Service (NHS) is a publicly funded healthcare system that covers the patient rights of its people. To name a few:

Right to receive free NHS services.
Right to have a complaint acknowledged and action taken within three days.
Right to expect the NHS to constantly improve the quality of services.
Right to be given detailed information about the treatment and reports.

Japan

The lifespan of the Japanese is the highest in the world. One of the reasons could be the excellent and efficient healthcare system that is dedicated to serving its people.

Its Statutory Health Insurance System (SHIS) covers 98.3% of the population, while the remaining 1.7% is covered by another public social awareness program. SHIS covers treatments like mental health, dental care, and various other problematic areas that are not usually covered. Some of the patient rights are:

Right to have the medical reports stored discretely.
Right to be thoroughly informed of the treatment in simple language.
Right to receive quality care irrespective of the condition he or she is going through.
Right to a healthy and smoke-free environment.

Issues with the existing system

Prevalent discrimination

When it comes to seeking care, prejudice based on caste, creed, gender, or even physical issues is well known. Discrimination in the past has included not just incidents where medical care was inadequate or nonexistent, but also cases where patients were exploited to obtain basic checkups. The severity, timing, and even dimensions of incidents vary.

Lack of consent

When patients are admitted to various government hospitals, they are required to give consent, authorizing the doctor to do any procedure he considers appropriate. However, the legitimacy of this action is in doubt.

Indian courts currently use the approach of “true consent,” which favors doctors. Western courts, on the other hand, take a “reasonable patient” approach.

No transparency

Patients are not only overpaid for services; they are also unaware of what they are paying for at times.

Doctor-patient ratio

This ratio is 1:834 as of 2022. However, there is no system to find out how many doctors are really practicing in India. There is no mechanism to track them.

Poor infrastructure

According to a report, some internationally famous institutions in India have a substandard infrastructure. However, it is not a problem that only India faces. Geographic diversity, medical errors, and other factors affect both developing and developed nations’ quality.

While infrastructure restrictions have traditionally been linked to quality care, the issue is more than just the accessibility of clinical facilities. Although they may assume they are offering The health system’s sub-party quality is due to their lack of ability or understanding of the actual concept of quality infrastructure.

Recommendations

Digitalization

Health sector providers require pressure to adopt digital health. This should follow the same pattern of meaningful usage of telemedicine, hospital information systems (HIS), and electronic medical records (EMRs) in countries with advanced medical systems.

Infrastructure

By encouraging and supporting essential procedures and employing systems that enable flexible delivery, the objective of providing better, faster, more advanced, and less expensive healthcare can be achieved.

Reducing the doctor-patient ratio

The government has planned to bring the doctor-patient ratio to 1:1000 by 2024 (according to the WHO standards). The budget for the health and family welfare department has been increased by 50.5 percent.

Focusing on patients

A crucial determinant of quality is the extent to which patients’ desires and expectations are realized. Customized services that meet the needs and wants of patients encompass:

the well-being of patients.
synchronization of treatment with various elements of healthcare services.
patient-centered healthcare and cultural sensitivity.
language-friendly communication and treatment.

Conclusion

Dealing with prejudice and ill-treatment is not only the responsibility of practitioners but also of hospitals and healthcare staff. The Patient Rights Bill is a comprehensive solution to the existing lacunae in our system. Waiting for every state to draft and enact patient rights bills is a long journey. What is more important here is to learn from the other countries’ policies and make India an affordable yet quality center of healthcare for the world. Hospitals should draft their policies keeping innocent patients in mind and treat them as their people, as a doctor has to serve the people, and serving is best done to make a change in the other person’s life.

Frequently asked questions (FAQs)

Who is responsible for implementing the Charter of Patient Rights in India?

“Health” is a state subject in India. Therefore, states and union territory governments have to implement the Charter of Patient Rights.

Who is eligible for government health insurance schemes?

It is available to people in the low-income range only.

Are health checkups covered under AB-PMJAY?

No, health checkups are not included in AB-PMJAY

Can I use my Aadhaar Card while applying for any of the government health schemes?

Yes, you can either use your Aadhaar card or any other identity card while enrolling yourself.

References

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