On Gandhi Jayanti, nearly 100 people gathered at the Rajghat to conduct a “Patients’ Satyagraha”. Mobilised by the Jan Swasthya Abhiyan and other patients’ rights groups, many of the protestors were from families of patients who had been subjected to malpractice and negligence in private hospitals.
Some of them had attempted to seek redressal from bodies like Delhi Medical Council, without much luck. They reported harassment, biased behaviour and knocking, in vain at the doors of appellate authorities. As a method of protest, “satyagraha” insists on the truth; the demonstration by the patients was therefore apt.
They were able to share their stories — often shocking ones — with the media and in the process, highlighted a less-recognised infringement of human rights.
The commercialisation of India’s health sector in the last two decades has exacerbated the traditional power asymmetry between healthcare providers and patients. Health activists and doctors have pointed out that the existing codes of medical ethics are insufficient to protect patients from excessive misuse of medical power.
Although the Centre has recently drafted a bill to protect healthcare professionals and hospitals against violence — a laudable objective — progress on similar legal protection for patients against violations in hospitals has been much tardier.
In April last year, the National Human Rights Commission (NHRC) formulated a comprehensive Patients’ Rights Charter, delineating 17 rights which should be honoured by all public and private healthcare establishments. These pertain to the rights of patients over information about their illness, treatment and costs; their right to access records and reports; the right to seek second opinion; the right to emergency medical care irrespective of paying capacity; the right to transparency in rates; right to choose a pharmacy or pathology laboratory; the right to discharge a patient or receive a dead body, without detention by the hospital; the right to grievance redressal.
This document also includes certain patient responsibilities, including the obligation to share required information with healthcare providers, and not to indulge in violence in healthcare institutions.
In June, the secretary, Union Ministry of Health and Family Welfare (MoHFW), issued a letter to all state governments outlining a smaller set of rights and some additional responsibilities for patients. Some key patients’ rights enunciated in the NHRC charter were dropped in this communication. Nevertheless, this set of do’s and don’ts must be publicised and implemented by all state governments.
To begin with, all public hospitals, charitable hospitals with public obligations, and private hospitals involved in health insurance schemes (like Ayushman Bharat-PMJAY) must display the charter in their premises. This will set the stage for all private hospitals to implement this charter.
The MoHFW should include the entire set of 17 patients’ rights in the standards related to Central Clinical Establishments Act (CEA); this would ensure that all healthcare facilities in 11 states, which have adopted this Act, will observe patients’ rights. Citizens groups, consumer organisations and health rights networks across India should demand the implementation of the Patients’ Rights Charter in all hospitals.
Gross overcharging on medicines and consumables — on which some private hospitals are known to make whopping profits — must be restricted by capping margins at reasonable levels, say 35 per cent of the cost price.
Given the failure of most medical councils to provide timely justice to aggrieved patients, an independent and unbiased grievance redressal system must be operationalised. Such bodies should have representation from members of civil society and patients and consumer groups. Rates of medical procedures and treatments must be available to users of services in all private hospitals, and attempts should be made to standardise such rates — as recommended in the Central CEA Rules. All state governments must either adopt the central CEA, or enact their own CEA.
The current asymmetry of power in the healthcare sector should be corrected urgently. The implementation of the NHRC Patients’ Rights Charter and the MoHFW’s circular on patients’ rights are good starting points for such a purpose.
This article first appeared in the print edition on October 23, 2019 under the title ‘A legal remedy for patients’ The writer is national co-convenor, Jan Swasthya Abhiyan, and member of the NHRC Core group on Health and Mental Health