CONSUMER PROTECTION ACT & Its RELEVANCE IN INDIA- Dr.Anzil K S Ali

1. CONSUMER PROTECTION ACT
AND ITS RELEVANCE IN
DENTISTRY.

2. Contents
Introduction
Consumer protection act
Legal vulnerability in Dental Practice
Negligence
Consent
Cases involving allegations of Negligence
Conclusion
Bibliography

3. Relation b/n doctor & patient – trust &
confidence
In past – doctors have enjoyed the trust of people
With growing awareness and commercialization –
doctors often blamed

4. Necessity of Consumer Protection act, and
its application to the Medical Profession ?
foremost question
existing laws in cases of medical negligence under the
Law of Tort and Indian Penal Code, have problems
(i) Delay
(ii) the cost of bringing an action
(iii) limited access to the courts
(iv) success depends on proof of both negligence and causation

5. an alternate system – easily accessible, speed and
cheap, gave birth to the Consumer Protection Act
This was made applicable to doctors because there are
no provisions in the Indian Medical Council Act, 1956
(i) to entertain any complaint from the patient ;
(ii) to take action against the Medical Practitioner in case any
negligence has been committed ;
(iii) to award any compensation, etc. in case the negligence is
proved.

6. The Consumer Protection Act,
1986
came into force on 15th April,1987
It is a welfare legislation mainly titling towards the
consumer
the Act has been amended by the Consumer Protection
(Amendment) Act, 1993, w.e.f. 18.6.1993

7. The Act envisages a three-tier quasi-judicial
machinery
District Consumer Disputes Redressal Forum at the
district level
State Consumer Disputes Redressal Commission at
the state level
National Consumer Disputes Redressal Commission
at the National level

8. DEFINITIONS
Complainant means -
(i) a consumer ; or
(ii) any voluntary consumer association registered under
the Companies Act, 1956 or under any other law for
the time being in force; or
(iii) the Central Government or any State Government ;
(iv) one or more consumers, where there are numerous
consumers having the same interests ;
who or which makes a complaint

9. Complaint means -
Any allegation, in writing made by a complainant
that the services hired or availed of or agreed to
be hired or availed of by him suffer from
deficiency in any respect.

10. Consumer means -
Any "person" who hires or avails of any services
- For a consideration which has been paid or promised or partly
paid and partly promised and includes any beneficiary of such
services other than the person who hires or avails of the
services for consideration paid or promised,or partly paid and
partly promised, Or
- under any system of deferred payment,
when such services are availed of with the approval of the first
mentioned person.

11. A person who receives medical treatment in
Government hospital or charitable hospital free of
cost is not a consumer under the Act.
In case of death of patient who is a consumer, legal
heirs (representatives) of the deceased will be
considered as "consumer".
If the payment has been made by any person who is
not a legal heir of the deceased he too will be
considered as "consumer."

12. Deficiency means -
Any fault, imperfection, shortcoming or inadequacy
- in the quality, nature, and manner of the performance which is
required to be maintained by or under any law for the time
being in force or
- has been undertaken to be performed by a person in pursuance
of a contract or otherwise in relation to any service.

13. Service means –
Service of any description which is made available to
potential users and includes the provision of facilities
in connection with banking, financing, insurance,
transport, etc., but does not include the rendering of
any service free of charge or under a contract of
personal service.

14. Salient features of consumer protection act
A complaint should be decided with in 3-6 months
There is no court fee to file a case
The consumer himself can plead his case
There is opportunity for the person who is not
happy with the decisions of the lower court to file
a appeal in the higher court

15. Consumer protection Forum
Redressal Forums have been established at three different
levels :-
"District Forum" by State Government. At least one in
each district or in certain cases one District Forum may
cover 2 or more districts.
"State Commission" by State Government.
"National Commission" (National Consumer Disputes
Redressal Commission ) by Central Government.

16. DISTRICT FORUM
shall consist of :
a.President :a person who is, or has been, or is
qualified to be a District Judge,
b.two other members : who have adequate knowledge or
experience or have shown capacity, in dealing with
problems relating to economics, law, commerce,
accountancy, industry, public affairs or
administration,one of whom shall be a woman.

17. Jurisdiction of District forum
where the value of services and compensation claimed
does not exceed Rupees Five Lakhs

18. Manner in which complaint shall be made
Complaint may be filed with a District Forum by -
a.the consumer to whom such service is provided or is
agreed to be provided;
b.any recognized consumer association, whether the
consumer to whom the service is provided or is agreed
to be provided is a member of such association or not
c.one or more consumers, where there are numerous
consumers having the same interest, with the
permission of the district forum, on behalf of or for the
benefit of all consumers so interested ;
d.The Central or the State Government.

19. The District Forum shall -
a.refer a copy of complaint to the opposite party
directing him to give his version of the case within a
period of 30 days or such extended period not
exceeding 15 days as may be granted by the District
Forum ;
b.Where the opposite party, on receipt of a copy of the
complaint, denies or disputes the allegations
contained in the complaint, or if omits or fails to
take any action to represent his case within the time
given by the District Forum, then the District Forum
shall proceed to settle the consumer dispute,
Procedure on receipt of Complaint

20. i) On the basis of evidence brought to his notice by the
complainant and the opposite party, where the
opposite party denies or disputes the allegations
contained in the complaint ; or
ii) On the basis of evidence brought to its notice by the
complainant where the opposite party omits or fails to
take any action to represent his case within the time
given by the Forum ;

21. (iii) Where the complainant or his authorised agent fails to
appear before the District Forum on such day, the
District Forum may in its discretion either dismiss
the complaint in default or if a substantial portion of
the evidence of the complainant has already been
recorded, decide it on merits.
Where the opposite party or its authorised agent fails to
appear on the day of hearing, the District Forum may
decide the complaint ex-parte.

22. iv) Where any party, to whom time has been granted
fails to produce his evidence or to cause the attendance
of his witnesses or to perform any other act necessary to
the further progress of the complaint, for which time has
been allowed, the District Forum may notwithstanding
such default :-
a. If the parties are present, proceed to decide the complaint
forthwith ; or
b. if the parties or any of them is absent, proceed as mentioned
before

23. v) The District Forum may, on such terms as it may think
fit at any stage, adjourn the hearing of the complaint but
not more than one adjournment
the complaint should be decided
within 90 days from the date of notice received by the opposite
party where complaint does not require analysis or testing of
the goods and
within 150 days if it requires analysis or testing of the goods.

24. Findings of the District Forum
If, after the proceedings, the District Forum is satisfied &
the allegations are proved, it shall issue an order to the
opposite party directing him to do one or more of the
following things :
a. To return to the complainant the charges paid.
b. Pay such amount as may be awarded by it as compensation to
the consumer for any loss or injury suffered by the consumer
due to the negligence of the opposite party.
c. To remove the deficiency in the services in question.
d. To provide for adequate costs to parties.

25. Appeal against orders of the Dist. Forum
Any person aggrieved by an order made by the District
Forum may appeal against such order to the State
Commission
within a period of 30 days from the date of the order.
The State Commission may entertain an appeal after 30 days if
it is satisfied that there was sufficient cause for not filing it
within that period.

26. STATE COMMISSION
It shall consist of -
a. President : person who is or has been a Judge of a High
Court ,
b. two other members ( as for District Forum).

27. Jurisdiction of the State Commission
The State Commission entertain -
a. Complaints where the value of services and compensation
claimed exceeds rupees 5 lakhs but does not exceed rupees 20
lakhs;
b. appeals against the orders of any District Forum within the
state ;
c. revision petitions against the District Forum.

28. Appeals against orders of State Commission
Any person aggrieved by an order made by the State
Commission may appeal against such order to the
National Commission
within a period of 30 days.
The National Commission may entertain an appeal after 30
days if it is satisfied that there was sufficient cause for not filing
it within that period

29. NATIONAL COMMISSION
This shall consist of -
a. President : person who is or has been a Judge of the
Supreme Court,. (No appointment under this clause shall
be made except after consultation with the Chief Justice
of India) .
b. 4 other members ( qualifications : As for District Forum
/State Commission ).

30. Jurisdiction of the National Commission
The National Commission shall have jurisdiction –
(a) to entertain
(i) complaints where the value of services and
compensation claimed exceeds rupees 20 lakhs ; and
(ii) appeals against the orders of any State
Commission.
(b) to entertain revision petition against the State
Commission.

31. shall be presented by complainant in person or by his
agent to the National Commission or be sent by
registered post, addressed to National Commission :-
a. the name, description and the address of the complainant;
b. the name, description and address of the opposite party or
parties, as the case may be, so far as they can be ascertained ;
c. the facts relating to the complaint and when and where it
arose ;
d. documents in support of the allegations contained in the
complaint ;
e. the relief which the complainant claims.
Complaint at National Commission

32. Appeal against orders of the National
Commission
Any person, aggrieved by an order made by the National
Commission, may appeal against such order to the
Supreme Court within a period of 30 days from the date
of the order.
The Supreme Court may entertain an appeal after 30
days if it is satisfied that there was sufficient cause for
not filing it within that period.

33. Limitation Period
The District Forum , the State Commission or the
National Commission shall not admit a complaint unless
it is filed within 2 years from the date on which the cause
of action has arisen.
In case there are sufficient grounds for not filing the
complaint within such period, extension may be granted.

34. Dismissal of frivolous or vexatious complaints
Where a complaint instituted is found to be
frivolous or vexatious, it shall,
dismiss the complaint and make an order that the
complainant shall pay to the opposite party such cost,
not exceeding 10,000 rupees, as may be specified in
the order

35. Penalties
Where a person fails or omits to comply with any
order made by the District Forum, the State
Commission or the National Commission, such
person shall be punishable with
imprisonment for a term which shall not be less than
one month but which may extend to three years, or
with fine which shall not be less than 2,000 rupees but
which may extend to 10,000 rupees or with both.
In exceptional circumstances the penalties may be
reduced further.

36. CONSUMER PROTECTION COUNCILS
The Act provides for the establishment of –
(1) The central consumer protection council ( The
Central Council).
(2) The State Consumer Protection Council ( The State
Council).
Objectives of the Council shall be
To promote and protect the rights of the consumers

37. The Central Council shall consist of
150 members.
Chairman – The Minister In Charge of the Consumer Affairs in
the Central Government.
The State Council shall be
Chairman – Minister Incharge of Consumer Affairs in the State
Government.
The resolution passed by these Councils shall be
recommendatory in nature.

38. Rights of Patients
The eight rights as defined by the International
Organization of Consumers’ Union ( IOCU)
1. The Right to Safety
2. The Right to be Informed
3. The Right to Choose
4. The Right to be Heard
5. The Right to Redress
6. The Right to Consumer Education
7. The Right to a Healthy Environment
8. The Right to Basic Needs
The Consumer Rights No. 1 to 6 are included in our
Consumer Protection Act, 1986.

39. 15th March is celebrated as World Consumer Rights Day.
In 1962, President J.F. Kennedy declared four consumer
rights ( No.1 to 4 ) in the special message to the
American Congress.
Consumer rights number 5 to 8 were subsequently added by
IOCU.

40. Legal vulnerability in dental practice
Criminal
(Quasi-criminal)
Civil
Tort Contract
Unintentional Intentional
Negligence
(Professional Negligence
or Malpractice)
Assault
and
Battery
Misrepresentation
(Deceit)
Defamation
(Libel and
Slander)
Breach of
Confidentiality

41. Duties of the dentist
By accepting a patient for care it implies that the dentist
warrants that he/she will-
Use reasonable care in providing service as measured
against acceptable standards set by other practitioners with
the similar training in a similar community under similar
circumstances
Be registered and meet all other legal requirements
Maintain good level of knowledge in keeping with current
advances in the profession

42. Obtain informed consent from the patient before
starting an examination or treatment
Use techniques, procedures and methods which are
acceptable
Not leave the treatment halfway
Ensure that care is available in emergency
Charge a reasonable fee for the services based on the
community standards
Not exceed the scope of the practice authorized by
registration / not undertake any treatment for which
he is not qualified

43. Keep patient informed of the progress
Maintain complete records of the treatment rendered
Maintain confidentiality of the information
Inform any undesirable occurrence during the course
of the treatment
Make appropriate referrals and second opinions as
and when required

44. Duties of the patient
In accepting dentist and his treatment patient warrants –
Home care instructions will be followed
Appointment will be kept
Bills of the treatment will be paid as agreed, if no agreement,
then with in reasonable time
Will cooperate in the treatment
Will inform the dentist about the changes in health status

45. What to do if sued
Step taken immediately
Inform your insurance company at the earliest
Keep a photocopy of the papers & envelope received and send
the originals to the insurance company
Write the summary of treatment using treatment records –
refresh memory
Make a photocopy of complete records & lock the originals at a
safe place
Tell your staff about suit and instruct them not to talk about
case to anyone with out permission
Cooperate with your insurance company

46. Do not
Get upset
Tell patient that you are insured
Agree to or offer a settlement with out consulting
insurance company
Agree to or offer specialist treatment with out
consulting insurance company
Alter your patient records
Give the original treatment records to the patient or
anyone except court if required
Discuss about the patients treatment with anyone
Admit fault or guilt to anyone
Contact any other practitioner about the case

47. Relevant supreme court
decisions on COPRA
All services – are included in the act, except where the
dentist is offering services free of charge & is not
benefited in any manner directly or indirectly
Employee under contract of employment – outside the
purview
Non-governmental hospitals/nursing homes where
charges have to paid by the person – with in the purview

48. In non – governmental hospitals/nursing homes, if the
person is not able to pay – in the purview of the act
In governmental health centre (no charges) – out side the
purview
If the person availing service for medical care and the
charges are borne by the insurance company – in the
purview of service

49. NEGLIGENCE
Negligence – failure to exercise due care
Three essential elements –
A) Duty – the defendant owes a duty of care to the
plaintiff
B) Breach – the defendant has breached this duty of
care
C) Injury – the plaintiff has suffered an injury due to
defendents breach of duty

50. LIABILITY
Not when the patient has suffered injury, but when the
injury has resulted due to the conduct of the doctor,
which has fallen below that of reasonable care (breach
of his/her duty)
Law does not expect the doctor to to cure all cases, but
expects to make a reasonable attempt & take reasonable
care under the circumstances

51. REASONABLE CARE
The degree of care and competence which an
“ordinary competent member of the profession
who passes to have those skills would exercise in
the same circumstances in question”

52. CONSENT
Is a process which involves a treatment
relationship with effective agreement and
communication

53. Requirements of a valid consent
Patient must be legally competent to consent his or her
treatment
The patient must possess the mental capacity to authorize
care
The patient must receive a proper disclosure of
information from the care-giver
The authorization should be specific to the treatment and
the procedure to be performed

54. The patient should have an opportunity to ask questions
and receive understandable answers and be satisfied
The consent obtained should be free of undue influence
and forcible compulsion
The consent obtained should be free of misrepresentation
of material information to the patient or his guardian

55. Disclosure of information by doctor to patient ?
Nature, extent and purpose of proposed intervention
The probable risks and its severity and benefits of
proposed intervention
Reasonable alternative to treatment if any, and their
advantages and disadvantages
Impact of treatment on patient lifestyle if any
Economic considerations in all alternative plans

56. Consequences of refusing diagnostic tests or treatment if
any
Who is to perform the procedure and when
The doctor can with held the information when disclosure
poses a threat to the patients life, but not because
divulgence may prompt the patient to forego the therapy

57. Nature of the consent
Written
Oral
Partly written
Partly oral
Apparently implied by law
Implied by the action of the patient

58. In emergency –
The condition encountered after starting surgery could not be
diagnosed prior even after reasonable efforts
Sound medical practice dictates such an extension
No one of patient side is available to give necessary consent
Waiting for consent will be risky for the patient
In accidents –
Immediate action is necessary to protect the life
A reasonable person would give consent under such
circumstances
Implied Consent-

59. Consent Of Minors
The emancipated minor
The “mature minor rule”
In dental emergency
Minors away from home
Child of separated parents

60. Indian penal code
Section 90 – consent by below 12 yrs age – not a real
consent unless contrary appears from the context
Sections 88,89 and 92 – provide consents as a defence
only if an act is done by doctor for the patient benefit
Section 87 – provides consents as a defence to the act
which are not intended to cause death or grievous hurt
and which are not known by the person who does the act
to be likely to cause death
Below 18 yrs – not valid

61. Confidentiality
Most fundamental ethical obligations owed by the doctor
EXCEPTIONS -
Required by court or court has ordered for it
The patient or his legal advisor gives a written consent
On medical grounds – given in confidence to close relatives

62. When in doctor’s opinion disclosure to some third party other
than relatives would be in the best interest of the patient
To comply with a statutory requirement eg – notification of an
infectious disease
In public interest eg investigation by police of a serious crime
For medical research project approved by ethical committee, in
this the identity of patient is not disclosed

63. Cases involving allegation of
negligence
The duty to exercise “reasonable care & skill” begins
from the moment patient is accepted
Failure to examine correctly
Case report
A child – having fallen down in playground
Complained pain in front teeth pointing 21
Patient was uncooperative
Dentist felt the tooth & said – the tooth has loosened but it will
tighten up in few days & pain will gradually disappear

64. After few days the dentist gets a telephone that the
child was taken to other dentist and he diagnosed
fracture below the gum line in a radiograph and he
extracted the tooth
A solicitor’s letter – alleging negligence that led to
loss of tooth & pain experiences by the child, was
received by the dentist asking for compensation

65. The positioning & maintenance of the equipments
Case report
A girl aged 8 yrs – required extraction of a deciduous tooth
Dentist after reassuring her , raised the chair and her finger
got trapped b/n arm rest & spittoon. The chair was immediately
lowered but the finger was severely damaged

66. Many times in power actuated chairs – buttons being
pushed by auxiliaries or by child for fun – lead for
complication
The working area of the clinic should be spacious
Case report
A patient attended her dentist in an evening
Examination & oral prophylaxis was done
On the following day dentist noticed that the bur left in the
airotor handpiece was fractured

67. Later the same day the patient consulted a surgeon on
getting pain & swelling in the arm. The radiograph
showed a piece of bur , which had entered her arm
when she stretched her arm while sitting
Negligence in positioning of dental equipments

68. BURNS
Due to instruments – eg overheated handpieces
Due to chemicals
Use of excessive quantity of chemicals causing spreading to
areas other than that requiring the application
Inadvertent use of stronger solution
Accidental dripping or spilling of acidic solutions on exposed
areas of skin

69. HAZARDS OF LOCAL ANAESTHESIA
The fracture of a needle in situ
Hematoma
Syncope
Trismus
Injection of an incorrect fluid
Anaphylactic shock

70. INCORRECT TREATMENT
Extraction in wrong patient
Extraction of wrong tooth
Leaving roots behind during extraction
Wrong filling etc ,.

71. INHALATION OF FOREIGN BODIES
Root canal instruments; burs; calculus; fillings;
crowns; plaster impression material etc,.
Prev – use of rubber-dam

72. PRECAUTIONS WHILE EXTRACTING TEETH
Obtain Consent and use only agreed form of Anesthesia
Give preoperative instructions & medications as and when
required
Ensure correct teeth is being extracted
Check extracted teeth whether extraction is complete .if not the
patient should be informed and a decision taken on whether or
not to operate further

73. Check that the number of teeth extracted corresponds
to treatment plan. If the number doesn’t correspond &
teeth is not present in mouth, then a proper search
should be instituted
Give proper post operative instructions

74. RECORD KEEPING
Chief complaint, all treatments provided, pre & post operative
instructions, unusual sequelae, drugs prescribed (with dosage),
and any treatment advice given to which patient is not willing .
Every visit with date & time should be recorded
If two or more doctors are providing treatment then entries
should be initialed accordingly

75. OWNERSHIP OF RECORDS
Property of practitioners
Patient moving to another city – records will be made
available to their subsequent dentist on request
PRESERVATION OF RECORDS
Minimum of 7 yrs from the date of last entry
Children – atleast 7 yrs after the child has reached the
age of maturity (18 yrs)

77. the Supreme Court has ruled that – if a patient dies due
to an error of judgement committed by the doctor, then
he is not criminally liable though could have to pay
damages.
Bench comprising – Justice YK Sabharwal and Justice
DM Dharmadhikari while quashing criminal
proceedings against a plastic surgeon who faced trial for
criminal charges for causing death of a person who had
wanted to remove a minor deformity in his nose.
For fixing criminal liability – negligence required to be
proved should be so high as could be described as "gross
negligence" or "reckless".
Doctor not criminally liable if patient dies of error
SC Press Trust of India New Delhi, August 5

78. "It is not merely lack of necessary care, attention and
skill," the Bench said and added "when a patient agrees
to go for medical treatment or surgical operation, every
careless act of the medical man cannot be termed as
'criminal'."
"Mere inadvertence or some degree of want of adequate
care and caution might create civil liability but would not
suffice to hold him criminally liable,".

79. Conclusions
Medical profession is a noble profession, the burden to
maintain its dignity lies on the members of the profession
Law should not be a source of fear or an obstruction in
the delivery of professional services
The fact should not be ignored that in our country there
are more quacks than qualified doctors, yet complaints
against quacks are occasional
Answers to all the problems lies in the strict self control
and standardization of professional care

80. Bibliography
Essentials of preventive & community dentistry
– Soben Petre
Community Dental Health – Jong
Text book of Community Dentistry - Satish chandra
Consumer Protection & the Medical Profession
– RK Chaube
Professional accountability & patients rights – module 4,
- the Institute of Law & Ethics in Medicine
The Week – Magazine – August 22, 2004
Various web sites on Consumer Protection Act in India