Patient right

PATIENTS’ RIGHTS’ BY MOHFW
INTRODUCTION:
Ministry of Health and Family Welfare (MoHFW) plans to implement 'Charter of Patients Rights'. In this
regard a draft document has been developed by National Human Rights Commission (NHRC). The draft
has been put up on website (https://mohfw.gov.in/newshighlights/draft-patient-charter-prepared-national-
human-rights-commission) on 30th August, 2018 and public opinion has been solicited on the same.
1. Right to Information:
The first paragraph of the description given for the right to information states that ‘Every patient has a
right to adequate relevant information 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 language known to them’. Following clarification is required in this regard
 Is the right applicable for patients who are not capable or not in a situation of receiving or
understanding the information? For eg. Child patient, mentally unstable patient or patient with
altered sensorium.
 If it is applicable then how to fulfil the same?
 If in these cases the care-taker of the patient to be informed, then how to address those situations
in which patient with above condition is without any designated care-taker. For eg. An accident
victim getting treated in a hospital without any care-taker.
 The last paragraph of the description under this right, states that caretakers of the patient also
have a right to know the identity and professional status of doctors and other healthcare
providers. However, I think some more description shall be provided to clarify following points
 Who shall be considered as a rightful care-taker of the patient?
 In case of multiple care-takers (family, relatives etc.) of a patient, should the information be
shared with everyone who asks for it, or should they be asked to designate some-one as a primary
care-taker?
 Should an explicit/implicit permission be taken from the patient that information related to his/her
healthcare will be shared with the care-taker?
2. Right to records and reports:
This right states that ‘Every patient or his caregiver has the right to access originals / copies of case
papers, indoor patient records, investigation reports (during period of admission, preferably within 24
hours and after discharge, within 72 hours). Following points must be incorporated and improved in this
description,
 The first statement shall be made gender neutral by stating ‘his/her’.
 24 hours limit for making records available during period of admission, should be there only if
the patient needs a photocopy of his/her records. In case the patient just wants to see the original
file, it should be made readily available without any need of giving 24 hours’ time-frame.
 In case hospital is planning to discard old records of patient, should the patient be informed
before that?
 Reasonable restrictions on care-takers accessing patient’s file shall be stated. If patient refuses the
care-taker cannot access the patient’s file.

 In the second paragraph the description states that ‘The relatives / caregivers of the patient have a
right to get discharge summary or in case of death, death summary along with original copies of
investigations.’ It is suggested that following points be incorporated/clarified in this description
 Time frame for issuance of death summary must be stated
 Who should be a rightful care-taker to whom these documents can be given shall be explained.
 Whether or not hospital/doctor can withhold death/discharge summary, if the full payment is not
done?
3. Right to Emergency Medical Care
This right mandates provision of basic care without demanding payment/advance.
Some suggestions on this are as follows,
 I think, it is extremely important to define and describe what should be considered as basic care. In
absence, of clear understanding on basic care, I fear that many hospitals may provide sub-optimal
emergency care to those whom they think may not pay for the emergency care services.
 It should also be made clear that life saving measures, if required on an emergency basis shall be
provided, irrespective of payment, even if such measures incorporates performance of a cost intensive
measure such as life-saving surgery or providing ventilator support.
 A clarification is also required on ‘who determines the emergency’? Is it the patient’s right to
determine their condition as emergency and seek emergency care or is it the doctor’s right to assess
the patient and decide whether or not the patient be considered as an emergency patient?
4. Right to Informed Consent –
This right states that ‘Every patient has a right that informed consent must be sought prior to any
potentially hazardous test/treatment (e.g. invasive investigation / surgery / chemotherapy) which carries
certain risks’.
The description must clarify how this rights shall be fulfilled in following situations
 Patient unconscious/mentally unstable/children or not in a situation to give consent
 A potentially hazardous clinical intervention is required on an urgent basis and there is no time to
obtain informed consent
5. Right to confidentiality, human dignity and privacy
As per my understanding ‘confidentiality’ and ‘privacy’ are two very different things and should be stated
as two separate rights. While confidentiality deals with the secrecy of data and information, ‘privacy and
human dignity’ is related to behavioural and physical aspects.
I also think that many elaborations are required in the description of this right, such as
 Which data and information shall be kept confidential?
 Situations where exceptions will be made to the right of confidentiality (such as legal matters,
research requirements etc.)
 Within healthcare organization, who all can have access to patient’s data?
 Privacy and human dignity needs to be explained (for example, will the act of not informing the
patient before touching him/her for assessment be considered as violation of privacy? An OBG
doctor performing PV examination without explicit consent of patient, should it be considered as a
privacy and dignity issue?
6. Right to non-discrimination
The first paragraph of the description of this right states that ‘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 condition, religion, caste, ethnicity, gender, age, sexual orientation, linguistic or geographical
/social origins’.
I suggest following basis shall be added in addition to those that are already written
 Economic status of the patient
 Category of accommodation in which patient is admitted
 Affiliations of the patient (For example other patients shall not be neglected when a VIP patient gets
admitted in a hospital)
7. Right to safety and quality care according to standards
One of the statement in first paragraph of the description states that ‘Patients have a right to receive
quality health care according to currently accepted standards, norms and standard guidelines as per
National Accreditation Board for Hospitals (NABH) or similar’. I think this should be removed, as
majority of NABH standards are not prescriptive in nature. Also, as of today, NABH is being adopted
voluntarily and a very small proportion of hospitals in India are NABH accredited. By stating that patient
has a right to expect NABH standard level of service from hospital, it may not be realistic.
8. Right to choose source for obtaining medicine or test
I suggest a re-thinking on this right. I believe hospitals should be given flexibility to make a policy that a
patient in their hospital should take medicine or test from their own pharmacy or laboratory. Otherwise
how can a hospital be made accountable for a treatment outcome, if patient is taking medicine or test from
another place on which the hospital has no control on.
9. Right to take discharge of patient, or receive body of deceased from hospital
I think some more clarity is required in the description. As of now it is stated that a patient cannot be
detained in a hospital, on procedural grounds such as dispute in payment of hospital charges. But what in
case patient has not paid at all.
Moreover, stating that patient has a right to get discharge irrespective of whether or not he/she settles
payment, gives a very different message. In-fact it shall be stated as a responsibility of the patient to settle
bills before getting discharged from the hospital.
10. Other points to be added
Besides the points stated for each rights there are few more things that needs to be modified in the charter
 As Advance Directive for Passive Euthanasia has been made legal in India, this should also be
incorporated in the patient rights charter
 The charter must specify the scope such as ‘Who shall be considered as patient’, ‘Which kind of
healthcare professionals/providers’ does it applies to’ and ‘What could be some exceptions to the
various rights described’
FULFILLING PATIENTS’ RIGHTS IN HOSPITAL
Patients and their family has certain defined rights which hospitals and medical practitioners need to
fulfill. Some of these rights are legally enforceable and a patient can approach consumer court or higher
court, if those rights are infringed. Other rights are derived on ethical ground and can affect the image of
healthcare provider and its relationship with patient community. Besides legalities, almost all healthcare
accreditation programmes gives a lot of importance to protection of patients’ rights and not fulfilling the
same may lead to denial of accreditation. While it is important for healthcare providers to fulfill the rights
of patients, some of these rights are complex to understand because of the unique and complex scenarios
that occurs in healthcare frequently.

This post attempts at simplifying those rights with respects to its scope and intent and guide the healthcare
providers on what needs to be done to fulfill them. The rights discussed here have been referred from
charter of patients’ rights by consumer guidance society of India, code of ethics regulation by MCI and
NABH accreditation standards.
1. Right to be explained about his/her health problems and treatments
This is one very important right which also has high significance in legal matters. It requires that a
patient is informed and explained about all such thing which will enable him/her to take an informed
decision about his/her healthcare. This could be further divided in following
 Patient shall be explained about his/her disease or health condition in detail. This means
that patient is made aware of his/her diagnosis, whether provisional or final, with an
explanation of the diagnosis in a simplified language that the patient can understand. This
also includes informing patient about reason why a specific diagnostic test is being
ordered for him/her.
 Patient shall be explained about the proposed treatment for his/her condition, including
the side-effects and expected benefit from it.
 Patient shall also be explained about the alternatives to the proposed treatment (if any),
including its risks and expected benefits
 Patient shall be informed about the progress in his/her health condition and change, if
any, in the proposed plan of care
How to fulfill this right?
 The most important part of fulfilling this right is to have a strong policy and procedure of
obtaining a written consent from patients. The consenttaking process should be specified to
ensure that patient receives all required information.
 A general consent should also be taken from patient in written
 Importance of fulfilling this right must be emphasized and its legal implications must be
explained to all doctors
Special situations pertaining to this right
 In situations where the patient is not competent to make decisions, such as patient is unconscious,
mentally unstable or of minor age, this right should be fulfilled by informing the patients’ family
member (next of the kin) or guardian or custodian (like jailer in case of prison inmate, custodian of
the orphanage etc.) who would be taking decision on patient’s behalf.
 If the patient is not competent to make decision and is also not accompanied by a family or custodian
(for eg. In case of unidentified patient brought in an unconscious stage and needs a surgery for which
a consent is required), two doctors can jointly give consent in good faith of the patient. This consent
also must be documented.
2. Right to be involved in decision making process about his/her own care
This right flows from the earlier right of being explained about illness and treatment. This requires that
after explaining all relevant details about illness and treatment, patient’s views and preferences should be
taken into consideration and treatment plan should be modified accordingly. For example, if a patient
with knee joint problem who has been proposed knee replacement surgery, wants to avoid it for as long as
possible, the treatment plan should be modified to provide relief from symptoms for as long as possible
before actual knee replacement is carried out. This also gives following additional rights to the patients
 Right to take a second opinion (and even multiple opinions)
 Right to refuse treatment at any point of time
 Right to get discharged against medical advice (DAMA)
 This being a part of the earlier right, incorporating this requirement in the informed consent
policy will be required to fulfil it.
 Besides this, informing patients that they have these right is also an effective way to honour
this right

 A policy and process on handling DAMA should be there in place
3. Right to know his/her doctor’s credentials
If asked by the patient, it would be obligatory on part of the hospital or the doctor to provide the
full credentials of the doctor who would be treating the patient. The details of doctors that could be
asked include, qualifications, institute from where obtained, specialization, years of experience and any
other professional details. However, the information that are irrelevant to doctor’s professional credibility
or are private information about the doctor may be denied. For example, details of past patients treated by
the doctor, HIV status of the doctor, his/her family or residential details are irrelevant and may be denied
to the patient.
 Have a credentialing system through which updated credentials of each doctor empanelled
with the hospital is maintained.
 A brief profile of all the doctor highlighting important credentials should be maintained on
website, brochure or pamphlets which can be handed over to the patient who request for it.
4. Right to know an estimate of the cost of the treatment
Cost of treatment is an important information for patient to decide whether or not they would like to get
that treatment done. It is obligatory on the part of healthcare provider to provide as best estimate of the
cost of proposed care, as possible and at right time. If there is any change of care plan which can affect
the cost, patient should be again informed about the cost implications.
 Written estimate must be given to all patient at the time of admission. The hospital must fix
responsibility to someone for working out estimate and communicating the same to patient
 Have a standardized form in which estimate can be given with important details.
 Have a system in place to ensure that change of estimate is communicated to the patient on
time
 Have a system in place to communicate daily or interim bill with the patient
 Evaluate the estimates being given by comparing the same with the final bill amount and
make improvements in the process
5. Right to confidentiality of personal and health related details
All data and information collected from patient, whether personal or related to his/her healthcare should
be kept confidential and used only for the purpose of providing healthcare. There could be numerous
situations which could lead to breach in confidentiality. Such as, keeping medical records in open where
any one can easily access it, displaying identity of the patient outside the room or by providing
information about patient on phone to anyone without confirming his/her relation with patients etc.
 Having a detailed policy on confidentiality specifying all precautions that must be taken to
ensure confidentiality
 Restricting access of medical records only to the healthcare providers and to the patient.
Access to others should be given only with patients’ explicit consent
 Policy of not disclosing patients details over phone or to any-one else other than those
identified as the patients’ family members or guardian
 Control and safeguards on accessing information on HIS
 Use of patients’ information for publicity, promotion of hospital etc. should be done only
with explicit consent of the patient
 Staff should be oriented that patients’ details should not be discussed in public areas or with
people who are not related to the patients’ treatment
 Ensuring that patients’ details are not displayed or kept in areas where it could be seen or
accessed by unauthorized personnel. Examples include displaying patients full name in
waiting areas or discarding filled registration forms in general waste bins etc.

 Maintaining medical and other records of patients in a secured area and destroying these
records in a manner that prevents its unauthorized retrieval of information from it. For
example medical records should be shredded after its retention period and not sold off as
scrap papers.
6. Right to be respected for special preferences, spiritual and cultural needs
Patients may have certain personal preference based on his/her belief system or living habits. Some
examples include, eating only vegetarian or Jain food, wearing certain ornaments that they might consider
lucky to them or listening to a specific chants every day.
Similarly, patients may have spiritual and cultural needs. For example, praying and worshipping
requirement as per the patient’s religion, following of rituals specially on occasions of birth or deaths, or
observing some religious practices on occasion of festivals etc.
The hospital must respect these individual preferences, habits, spiritual and cultural needs and should try
to accommodate or allow as many of them as possible. However,restrictions can be put on those practices
which has a reasonable risk to the health and safety or if it can cause inconvenience to other patients in
the hospital or if it can affect the functioning of the hospital.
 Sensitise your staff through regular sensitization programme, on respecting patients’
preferences, spiritual and cultural needs
 Have clear policy on what kind of needs could be honoured. For example, can patient be
allowed to have non-vegetarian food in hospital? What kind of rituals will be allowed to be
performed in case of births and deaths? Etc.
 Have a guideline for staff on how to respond in case of patients’ expressing their spiritual,
cultural or preferential needs.
 Unique situations arising, should be brought to a multidisciplinary committee, who should
then discuss and issue directives. (Refer list of committees required in a hospital)
 Identify what needs are frequently expressed by your patients and have arrangements for
fulfilling them. Some examples could be designating a prayer room, availability of a Pundit,
Chaplain or Moulvi to attend to dying patients, provision for preparing Jain food in kitchen
etc.
7. Right to privacy and dignity during medical procedures
While performing healthcare functions, such as examination, investigations and treatment, there could be
situations where patients’ privacy and dignity could get compromised. For example, undressing whole or
a part of body for physical examination, conduction of PV examination, provision of certain therapies etc.
Similarly, situations such as patient discussing his/her disease with doctor or being counselled for family
planning etc. requires privacy.
Hospitals must ensure that adequate privacy is provided in needed situation and patients’ dignity is
maintained throughout his/her care.
 Having adequate infrastructure arrangement for privacy, such as bed side curtains in multi-bed
ward doors and windows that can be closed when privacy has to be provided, providing adequate
change rooms where needed and restricted entries in areas of privacy such as labour room,
procedure room etc.
 Clear policy on situations where visual and hearing privacy must be rendered to patients
 Guidelines to doctors, nurses and technicians on how to provide adequate privacy including
hearing privacy
 Privacy and dignity shall also be maintained during restraint of a patient
8. Right to protection from neglect or abuse:
There are instances of patients being abused or neglected in healthcare settings. For example, delay in
attending the patient despite being urgently called by patient/relative, talking rudely to patient if he/she
frequently calls for help or harassing the patient for procedural matters. This right requires that healthcare
organizations put into place measures to prevent and to deal with such happenings. This right also entails

that patients are not discriminated on the basis of their background or setting in which they are receiving
care and are provide medical care as per their clinical condition
 Having a clear policy documented and communicated to staff conveying the message of ‘No
tolerance to abuse or neglect of patients’. The policy must explain what constitute
abuse/neglect with examples
 Having a mechanism for capturing such events. Patient feedback,anonymous feedback from
staff, monitoring rounds etc. can be some of them
 Having a disciplinary policy and procedure in place to investigate and decide repercussions,
when an occurrence of any abuse/neglect comes to notice.
Making a policy on provision of uniform care to all patients and specifying elements that
must be the part of uniform care.
9. Right to complain and receive the response on their complaints
Patients can voice there complain to an appropriate authority and can expect a response on their complaint
How to fulfil this right?
 Have an adequate mechanism in place for patients to loge complaint without any
apprehension. Some of the mechanisms include, having complaint drop boxes at various
locations, displaying a phone number and/or email id on which complaints can be sent,
capturing complaint through feedback mechanism etc.
 There should be a designated authority who should receive all complaints for review and
further processing
 Each complaint must be processed through relevant department/authority or committee.
 A response must be sent to the patient about the action taken or not taken with reasons,
within a defined timeframe
10. Right to die with dignity
The right to die with dignity is the latest addition in rights of a patient (and for all citizens). This has come
in effect with legal approval of Passive Euthanasia and Advance directives.Please refer the linked post
for getting details of scope and conditions related with this right.
DR.ANJALATCHI
M.SC(N),MD(AM),MBA(HA)
VICE –PRINCIPAL
ERAS COLLEGE OF NURSING

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