Patients’ve right to be informed

At hospitals, a primary problem is the secrecy of treatment records. It is the billing section that holds complete control over the case sheets, not even the doctor. Doctors are now under total control and command of the managements of hospitals. They have to subserve the profiteering interests of owners and meet the targets of money earned.

As the doctors have spent huge amount to secure post-graduation in a particular ‘specialisation,’ they are also interested in making quick buck either as a subserving employee of a corporate business house running the commerce in treatment of diseases or as an owner of another such business house. Doctors earlier used to explain the problem, and treatment process so that the patient is in the full know of things that happen to him in hospital, during or after the treatment.

But the patient or his relatives will not get the records even after they ask. Regulations say that they can secure records on request within 72 hours of treatment, but none implement it. The doctors are terribly ignorant of this right of patients. The regulation also suffers from inherent defect. The patients should get records automatically, why should they request?

A patient totally depends upon the mercy of treating doctor and the hospital staff for information. All those interested in patient, like family & friends, are kept under the grip of fear or tension. They should have abundant black money or wonderful influence or political power.

First, they do not give any access to complete record of treatment to either patient or his relatives. They claim that it is their property. They refuse to understand that medical records are generated because of patient acceptance of offer of services sold. Like the diagnostic reports and scanning sheets to be handed over to the patients, the hospital also has to give the medical records from time to time.

Patient, a consumer
A patient is a consumer as per the definition in the Consumer Protection Act, 1986 Section 2(1). A consumer means any person who (i) (omitted), (ii) 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 deferred payment and includes any beneficiary of such services other than the person who hires (or avails of) the service 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”

Similarly ‘service ‘ is defined under Section 2(1)(o) as: "service of any description which is made available to the potential users and includes the provision of facilities in connection with banking, financing, insurance, transport, processing, supply of electrical or other energy, board or lodging or both, (housing construction), entertainment, amusement or the purveying of news or other information, but does not include rendering of any service free of charge or under a contract of personal service."

Liability of Doctors
In a landmark judgment in Indian Medical Association Vs. VP Shantha, the Supreme Court of India has stated that "Service" rendered by a medical practitioner is covered under the Consumer Protection Act. One of the important rights of the consumers is right to be informed about the service.

Section 6 of Consumer Protection Act says:
The objects of the Central Council shall be to promote and protect the rights of the consumers such as­ (a) the right to be protected against the marketing of goods and services, which are hazardous to life and property; (b) the right to be informed about the quality, quantity, potency, purity, standard and price of goods or services, as the case may be, so as to protect the consumer against unfair trade practices ;

One of the main problems is that the right to be informed is not guaranteed as a statutory right but included as one of the objects of the Central Council. This remains a weak point.

Section 2 (f) of the CP Act says;
"defect" means any fault, imperfection or shortcoming in the quality, quantity, potency, purity or standard which is required to be maintained by or under any law for the time being in force or under any contract, express or implied, or as is claimed by the trader in any manner whatsoever in relation to any goods;

Similarly 2 (g) defines: "deficiency" 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;

Refusal to provide record might amount to deficiency in service or negligence. On the point of negligence AP State Consumer Sommission said in the case of Force v. M Ganeswara Rao that there was negligence as the case sheet did not contain a proper history, history of prior treatment and investigations, and even the consent papers were missing. In V P Shanta v. Cosmopolitan Hospitals (P) Ltd the State Commission held that failure to deliver X­ray films is deficient service.

The patient and his attendants were deprived of their right to be informed of the nature of injury sustained. In Devendra Kantilal Nayak v Dr. Kalyaniben Dhruv Shah, the State Commission disbelieved the evidence of the surgeon because only photocopies were produced to substantiate the evidence without any plausible explanation regarding the absence of the original.

Unfair Trade Practices
Section 2 (r) defines unfair trade practice. Relevant aspects of it are: "unfair trade practice" means a trade practice which, for the purpose of promoting the sale, use or supply of any goods or for the provision of any service, adopts any unfair method or unfair or deceptive practice including any of the following practices, namely,­ (1) the practice of making any statement, whether orally or in writing or by visible representation which,­

(i) falsely represents that the goods are of a particular standard, quality, quantity, grade, composition, style or model;
(ii) falsely represents that the services are of a particular standard, quality or grade;
(v) represents that the seller or the supplier has a sponsorship or approval or affiliation which such seller or supplier does not have;
(vi) makes a false or misleading representation concerning the need for, or the usefulness of, any goods or services;…
(viii) makes to the public a representation in a form that purports to be:..(ii) ….. if such purported warranty or guarantee or promise is materially misleading or if there is no reasonable prospect that such warranty, guarantee or promise will be carried out;
(ix) materially misleads the public concerning the price at which a product or like products or goods or services, have been or are, ordinarily sold or provided, and, for this purpose, …..;
(x) gives false or misleading facts disparaging the goods, services or trade of another person.

All cases of overbilling, non-display of prices, breach of MRPs are unfair trade practices. The commercial hospitals resort to these unfair practices every day and night, but that go unquestioned as the patients can’t afford a prolonged litigation. The state has to come to rescue of the vulnerable victims.

There should be specific prescription of right to information about medical treatment to the patients accompanied by the practical mechanism of achieving it.

If the hospitals do not share the medical records with patients within 24 hours of each day’s treatment, they should be imposed with heavy penalties, doctors also should be made liable for that. Not giving medical records itself would amount to corruption.