(CPA / COPRA)
“Thou shalt be free from envy, not cause
anothers death, and pray for the welfare of all
creatures.Day and night thou shalt not desert a
patient,nor commit adultery, be modest in thy
attire and appearance,not to be drunkard or
sinful,while entering a patients house , be
accompanied by a person known to the
patient.The peculiar customs of the patients
household shall not be made public”
An act to provide better protection of the
interests of the consumers and for that
purpose to make provisions for
establishment of consumer councils and
other authorities for the settlement of
consumers dispute and for matters
The act was passed in 1986.
Section 2(1)(d)(ii) of the act
“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 or under any system of
Section 2(1)(o)of the act
“Service” means service of any
description which is made available to
potential users .Health care services will
be service, if they are obtained for
Section 2(1)(o) of the act
…and that in the event of any
deficiency in the performance of such
services , the aggrieved party can invoke
the remedies provided under the act by
filing a complaint before the consumer
forum having jurisdiction.
ADVANTAGES OF CPA OVER CIVIL
1. Limited time is needed for decision and
action (period of 3 months).
2. No court fee is payable
COMPLAINT & COMPLAINANT
Complaint: means any allegations in
writing made by a complainant .
(a) a consumer
(b) any voluntary consumer association
registered under a company’s act or
under any other law for time being in
Who can file a complaint
i. The patient who hires the services of a
medical practitioner can file a
ii. It should be in writing .
iii. No oral complains can be filed .
Negligence consists in the omission to do
something which a reasonable man guided upon
those considerations which ordinarily regulate
human affairs , would do, or doing something
which a prudent & reasonable man would not
What constitutes deficiency in service
Deficiency of service means any fault,
imperfection ,shortcoming or inadequacy in the
quality ,nature and manner of 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 .
What constitutes deficiency in service or
Reaction of injection
Patient left unattended while there were complications.
Leaving patient in care of unqualified compounder.
Foreign material left inside during operation of leg.
Foreign material left in abdomen
Death during operation.
Post operative care.
Refusal to admit the patient.
What does not constitute deficiency in
service or negligence
Performance of duty to the best of ability.
Adopting one out of two recognized schools of
Complainant failed to establish deficiency in service.
Patient having some medical history.
Patient of heart attack.
Decompression of spinal cord .
Death during glucose drip.
Chronic ectopic pregnancy.
Acute myeloblastic leukaemia.
Case of deviated nasal septum.
Cyanotic congenital heart disease with respiratory
Hospital and its negligence
It is not only the medical practitioner who may be
found negligent the hospitals are also bound by the law
and in certain circumstances the hospitals are also
found negligent or deficient in services.
WHO IS LIABLE TO CPA
I. Doctors with independent practice
rendering only free services.
II. Private hospital charging all.
III. All hospital having free as well as paying
patients , they are liable to both.
IV. Doctors or hospitals paid by an insurance
firm for treatment of a client or an
employer for the treatment of an employee.
WHO IS NOT LIABLE TO CPA
Doctors in hospitals , which do not charge
Hospitals offering free services to all patients.
PROCEDURES FOR LODGING A
The redressal agency have a three-tier
1) District level : at this forum person
can claim for compensation towards damage
upto a maximum limit of Rs : 5 lakh .A
district judge and 2 other members chair this
of which one of whom shall be a women.
(2) State level: At this level the claim for
compensation is enhanced to Rs: 5 – 20 lakhs
& high court judge & 2 other members chair it.
(3) National level: Here the
compensation claimed is more than 20 lakhs
.This forum constitutes of a supreme court
judge ,4 other members.
PROVISION FOR APPEAL
Within 30 days from the date of
decision ,appeal can be filed in the higher
1. Appeal against district forum
before state commision .
2.Appeal against state commision
before national commision.
3.Against national commision
before supreme court.
PREVENTIVE STEPS AGAINST
Precautions may be summarized as “Do’s & Dont’s”
-Mention your qualifications on the prescription.
-Mention date & timing of consultation.
-Mention age, sex, weight (child).
-In complicated cases record history of illness &
physical findings about the patient.
-Avoid vague or nonspecific
-Record history of drug allergy.
-Mention additional precautions eg;
-In case of any deviation from standard
care , mention reason .
-Do not hesitate to discuss the case with your
-Do not hesitate to discuss the case with patients
-Do not write ayurvedic formulations.
-Do not allow substitutions.
-Do not examine a patient if you are sick,
exhausted or under effect of alcohol.
-Do not adopt experimental method in treatment
Another major & important thing to do
for a doctor is to obtain proper consent of
a patient or attendant or relative.
The term consent is defined as “when
two or more person agree upon the same
thing in the same sense they are said to
consent” (as per section 13 of Indian
contract act ,1872)
TYPES OF CONSENT
Implied consent or tacit.
Proxy consent / substitute consent.
• Most common variety of consent in both
general practice & hospital practice.
• Patient comes to doctor for an ailment
implies that he is agreeable to medical
examination in general sense.
• Egs: inspection ,
• Anything other than implied consent is
• May be either oral or written.
• Is obtained for relative minor
examinations or therapeutic procedures ,
in the presence of a disinterested third
• All major diagnostic procedure, general
anesthesia, for surgical operation.
• The concept of informed consent has
come to the fore in recent years.
• All information must be explained in
comprehensible non medical terms
preferably in local languages about the
d) Nature of treatment
e) Risks involved
f) Prospects of success.
Proxy Consent / Substitute Consent
• All the above types of consent can take
the shape of proxy consent.
• Parent for child, close relatives for
mentally unsound or unconscious patients
• When child suffer damage due to
negligence of the hospital, nurse &
doctor ,it was held that child & parent
could claim compensation under CPA.
How consent should be obtained
• The person obtaining the consent should see
• The patient understands in simple
language what the medical treatment is, its
purpose & why it is being proposed.
• The patient should understand its principal
benefits , risks & alternatives.
• The patient should understand ,in broad
terms, what the consequences would be of not
receiving the proposed treatment.
• Retain the information long enough
to make an effective decision.
• Make a free choice.
Who can give consent
• For the purpose of clinical examination ,
diagnosis & treatment consent can be
given by any person who is conscious,
mentally sound & is of & above 12 yrs of
age( section 88 & 90 of the IPC 1860).
• However under section 11, those person
who are & above 18 years of age are
competent to enter into a contract.
Right to refuse consent
• A competent adult has a right to refuse
treatment even if others, including medical
practitioners, believe that the refusal is
neither in his best interest nor reasonable.
When consent is not valid
• Consent given under fear, fraud or
misrepresentation of facts, or by a person
who is ignorant of the implications of the
consent or who is under 12 years of age
is invalid. (section 90 IPC)
Situations where consent may not
1. Medical emergencies
2. In case of person suffering from a notifiable
disease , eg: AIDS .
4. Members of armed forces.
5. Handlers of food and diary men.
6. New admission to prisons.
7. In case of a person where a court may order
for psychiatric examination or treatment.
After a medical mishap the
following things should be done
1. Complete patients record & recheck the
2. Be frank enough & inform clearly of the
3. After these initial responses the doctor
should contact some other doctor or
protection organization to seek advice.
Model Form Of Consent
I……..son of………aged………resident of……..
being under the treatment of………(state here
name of doctor/hospital/nursing home) do
hereby give consent to the performance of
medical / surgical /anesthesia/diagnostic
procedure of ……….(mention nature of
procedure /treatment to be performed etc)
upon myself or upon ………aged……….who is
related to me as ………(mention here relationship
eg :son ,mother ,daughter).
I declare that I am more than 18 yrs of age .I
have been informed that there are inherent risks
involved in the treatment or procedure .i have
signed this consent voluntarily out of my free
will without any pressure & in my fell senses.
(To be signed by parent/guardian in case of minor)
Protection against false or frivolous
Where a complaint instituted before the
district forum ,sate commission ,the
national commission, is found to be
frevolous or vexatious , it shall, for
reasons to be recorded in writing ,dismiss
the complaint & make an order that the
complaint shall pay to the opposite party
such cost, not exceeding 10,000 Rs , as
may be specified in the order.
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
INTERNATIONAL CODE FOR
Duties of Doctors in General
A Doctor must always maintain the
highest standards of professional conduct.
A Doctor must practice his profession
uninfluenced by motives of profit .
The following practices are deemed unethical
Any self advertisement except such as is
expressly authorized by the national code of
Collaboration in any firm of medical service
in which he or she does not have professional
Receiving any money in connection with
services rendered to a patient other than a
proper professional care ,even with the
knowledge of the patient.
Any act or advice that could weaken
physical or mental resistance of a human
being may be used only in his interest.
A doctor is advised to use great caution in
divulging discoveries or new techniques of
A Doctor should certify or testify only to
that which he has personally verified .
Duties of doctor to the sick
A Doctor must always bear in mind the
obligation of preserving human life.
A Doctor owes to his patient complete
loyalty & all resources of his science.
Doctors shall preserve absolute secrecy on
all he knows about his patient because of
the confidence entrusted in him.
A Doctor must give emergency care as a
humanitarian duty unless he is assured
that others are willing & able to give such
Duties of Doctor to each other
A Doctor ought to behave to his
colleagues , as he would have them
behave to him.
A Doctor must not entices patients from
his colleagues .
A Doctor must observe the principles of
“Declaration of Geneva”.
I will solemnly pledge myself to
consecrate my life to the service of
I will give to my teachers the respect &
gratitude which is their due.
I will practice my profession with
conscience & dignity.
The health of my patient will be my first
I will respect the secret which are
confided in me ,even after the patient has
I will maintain by all the means in my
power the honor & the noble traditions of
the medical profession.
My colleagues will be my brothers .
I will not permit considerations of religion,
nationality, race, party politics, or social standing
to intervene between my duty & my patient.
I will maintain the utmost respect for human life
from the time of conception , even under
threat .I will not use my medical knowledge
contrary to the laws of humanity.
I make these promises solemnly ,freely & upon my
Consumer Protection Act provide for
better protection of the interests of
consumer & for that purpose to make
provision for the establishment of
consumer councils & other authorities for
settlement on consumers disputes & for
matters connected therewith.
Consumer Protection Act & Medical
Practitioners – J V N Jaiswal
Essentials Of Preventive And Community
Dentistry – Soben Peter