Rights of Patients in COVID-19
On 11th March 2020, WHO declared COVID-19 as a pandemic. Despite huge steps taken by the Indian government, we currently have more than 4,25,000 known cases and an average of 15,000 new finding every day because of which India has become the 4th most-affected country. With a continuously rising number of COVID cases, India is facing huge challenges such as – Migration of labor throughout the country, which brings back the memories of 1947s partition, continuous land disputes on the Indian border, restriction of religious gathering, huge economic losses, and many more. With these issues being under the limelight. Nobody is talking about the issues that are being faced by the most vulnerable part of our society. Yes, I am talking about patients. With 80% of the country’s health care been privately owned and run. Because of which it becomes even more important to understand and safeguard the rights of these patients.
The Doctor-Patient relationship is based on a Latin phrase Uberrima fides meaning "utmost good faith".This relationship in our country has undergone some serious change in the last two decades and a half. The fortunate doctors of the past were treated like God and earned respect. This has somehow changed to a certain extent after the economic reforms of 1991. Back in the time, various laws, which are the Law of Torts, IPC, etc., covered doctors but since the passing of the Consumer Protection Act in 1986 and subsequent amendment in 1993 include medical services in the meaning of services, litigation against doctors is on the increase. Doctors practicing ethically and honestly should not have any reason for fear. Law whether civil, criminal, or consumer law, can only set the outer limits of acceptable conduct i.e. minimum standards of professional care and skill, leaving the question of an ideal to the profession itself.
With time this law was developed such that in Hyderabad, an Infosys employee received compensation of ₹1 crore for medical negligence by SC in the case of Nizam Institute of Medical Sciences vs. Prasanth S. Dhananka and Ors. [i]. Further in 2013 SC provided a husband RS 11.41 crore for his NRI wife’s death in the case of Dr. Balram Prasad vs. Dr. Kunal Saha & Ors. [ii]. These laws were formed mainly to safeguard the interest of patients but forced the doctors to use defensive diagnosis techniques, like proscribing CT scan for headache and prescribing more and more tests, which further made health care more expensive and time taking.
The Consumer Protection Bill, 2018, had included “healthcare” in the list of services. The Bill was passed in the Lok Sabha but lapsed in the Rajya Sabha due to continuous demands from various medical organizations to remove “healthcare”, among other issues. The new Bill in 2019 excluded “Healthcare” from the list. However, the Bill also says “but not limited to” before listing out the categories of services, which leaves it open to judicial interpretation. In the past, consumer courts have penalized government doctors who didn’t come under the purview of the relevant Act.
RIGHTS OF PATIENTS AND ISSUES FACED
The Ministry of Health and Family Welfare, Government of India has proposed a 'Charter of Patient Rights' to be implemented by state governments in 2018 which provides a total of 17 rights which are –
1. Right to Information
Here the adequate amount of information has to be given to the patient about the nature, cause of illness, provisional/confirmed diagnosis, proposed investigations and management, and possible complications to be explained at their level of understanding in a language known to them.
2. Right to record and report
Patients or their respective caretakers have the right to access the originals or copies of case papers, indoor patient records, and investigation reports. Investigation reports have to be made available to them within 24 hours of admission or 72 hours of discharge. A hospital in Mumbai's Kurla suburb passed the death certificate of a COVID-19 parent as death by a heart attack.[i] Families of non-corona patients finding it deficit get a Death certificate.[ii]
3. Right to Emergency Medical Care
As per the 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 the right to get emergency medical care. Racial discrimination with Muslims during pandemic by various hospitals in many parts of the country like the Valentis Hospital in Meerut.[iii] Some parents were denied hospitalization before the COVID test results come out what takes the day. A similar incident took place in Mumbai where a 62-year-old diabetic patient died after being rejected from 5 hospitals.[iv]
4. Right to Informed Consent
Every patient has a right that informed consent must be sought before any potentially hazardous test/treatment (e.g. invasive investigation/ surgery/ chemotherapy) which carries certain risks. The doctor may proceed only if consent has been given in writing by the patient/ caregiver or in the manner explained under the Drugs and Cosmetic Act Rules 2016 on informed consent.
5. Right to Confidentiality, Human dignity and Privacy
Many of the government agencies brought phone numbers, passport numbers, addresses, and other private information of patients in the public domain.[v] Many quarantine centers had poor quality of food and sanitation facilities[vi]or had no facilities at all.[vii]
6. Right to Second Opinion
Every patient has the right to seek the second opinion from an appropriate clinician of patients' or caregivers' choice. The hospital management has to respect the patient's right to second opinion and should provide to the patient's caregivers all necessary records and information required for seeking such opinion without any extra cost or delay. Any kind of 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 as Per Prescribed Rates
Every patient and their caregivers have the right to information on the rates to be charged by the hospital for each type of service provided and facilities available on a prominent display board and a brochure. They have the right to receive an itemized detailed bill at the time of payment. It would be the duty of the to display key rates at a conspicuous place in local as well as the English language and to make available the detailed schedule of rates in a booklet form to all patients/caregivers.
8. Right to Non-Discrimination
Every patient has the right to receive treatment without any discrimination based on his or her illnesses or conditions, including HIV status or other health conditions, religion, caste, ethnicity, gender, age, sexual orientation, linguistic or geographical/social origins. Discrimination can be seen throughout the country based on religion as talked about earlier and also in many hospitals are not admitting patients without Corona test reports.
9. Right to Safety and Quality Care according to Standards
Patients have a right to safety and security in the hospital premises. They have the right to be provided with care in an environment having requisite cleanliness, infection control measures, and safe drinking water as per BIS/FSSAI Standards and sanitation facilities. Bad sanitation facilities and bad quality of care have been reported throughout the country. As a hospital in West Bengal was reported not to have the water supply in toilets.[viii]
10. Right to Choose Alternative Treatment Options if available
Patients and their caregivers have the right to choose between alternative treatment and 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.
11. Right to Choose Source for Obtaining Medicines or Tests
When any medicine is prescribed by a doctor or a hospital, the patients and their caregivers have the right to choose any registered pharmacy of their choice to purchase them. Similarly, when a particular investigation is advised by a doctor or a hospital, the patient and his caregiver have the right to obtain this investigation from any registered diagnostic center/laboratory having qualified personnel and accredited by National Accreditation Board for Laboratories (NABL).
12. Right to Proper Referral and Transfer, which is free from perverse commercial influences
A patient has the right to continuity of care, and the right to be duly registered at the first healthcare facility where treatment has been sought, as well as at any subsequent facilities where care is sought.
13. Right to protection for patients involved in clinical trials
Every person/patient who is approached to participate in a clinical trial has the right to due protection. All clinical trials must be conducted in compliance with the protocols and good clinical practice guidelines issued by the Central Drugs Standard Control Organisation and other applicable provisions.
14. Right to Protection of Participants Involved in Biomedical and Health Research
Every patient who is taking part in biomedical research shall be referred to as a research participant and every research participant has a right to due protection. Any research involving such participants should follow the National Ethical Guidelines for Biomedical and Health Research involving human participants.
15. Right to Take Discharge of Patient, or Receive Body of Deceased from Hospital
Caretakers have the right to the dead body of a patient who had been treated in a hospital and the dead body cannot be detailed on procedural grounds, including non-payment/dispute, regarding payment of hospital charges against wishes of the caretakers.
16. Right to Patient Education
Patients have the right to receive education about 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 in the language the patients understand or seek the education.
17. Right to be heard and seek redressal
Every patient and their caregivers have the right to give feedback, make comments, or lodge complaints about the health care they are receiving or had received from a doctor or hospital. This includes the right to be given information and advice on how to give feedback, make comments, or make a complaint in a simple and user-friendly manner.
In these critical times of pandemic it very important for patients to know there rights and duties. Patients are one of the most venerable parts of our society, safeguarding their rights become even more important. With the development of strong “health care” laws in the country. India still has to form a healthy balance between the rights of patients and the liability of doctors. In the end, doctors are also humans and their career must not be on stake every time they make mistake. Pandemic has affected each and every sector throughout the world. When most of the country was under lockdown our medical staff was on duty fighting the pandemic every day. I will end with a small quote:
“Doctors are men who prescribe medicines of which they know little, to cure diseases of which they know less, in human beings of whom they know nothing.”
[i] 2009 (3) AWC 2154 (SC)
ABOUT THE AUTHOR
This blog has been authored by Gourav Sharma who is a 2nd Year B.B.A., LL.B.(Hons.) student at United World School of Law (Karnavati University), Gandhinagar.