Stand up for your rights

Posted on: October 29, 2015

– Not many patients know that a code of ethics binds doctors. But the problem, medical experts tell Sonia Sarkar, is that errant doctors are seldom hauled up

Autumn is not always a time for celebration. In many parts of India, the rains and their aftermath leave behind a deadly trail. Ailments are rampant — and death from diseases such as dengue is common.

Still, the tragic death last month of a seven-year-old boy made news. The boy, who was suffering from dengue, died after he was denied admission by five hospitals in Delhi. Unable to cope with the loss of the child, his parents committed suicide.

The incident highlighted the apathy shown by hospital administrations. But it also underlined another fact — that hospitals and doctors violated Medical Council of India (MCI) guidelines when they turned the boy away.

The Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002, states that no hospital can deny admission to critically ill patients. It says: “In case of emergency, a physician must treat the patient. No physician shall arbitrarily refuse treatment to a patient. A physician is free to choose whom he will serve. He should, however, respond to any request for his assistance in an emergency.”

Despite the guidelines, turning away patients is a common practice. “Doctors and hospitals have repeatedly failed to follow the code of ethics,” stresses Dr Ravindra Ghooi, a crusader of patient rights in India, and director, Scientia Clinical Services, which gives advice on clinical research and training.

According to the World Health Organization, the right of a patient is the same as the right of a human being. In the US, the right to medical records and right to privacy are considered basic rights but that’s not the case in India, where many hospitals deny patients access to their medical reports.

The code of ethics defines the obligations of physicians to their patients in India. But how does a patient know about his or her rights? The MCI rules state that every hospital should put up the list of rights at the front desk but that is not always done.

Not many patients, for instance, know that they have the right to know about a doctor’s qualifications. “If patients cannot evaluate [the qualification] by themselves, they should not hesitate to ask the doctors. Doctors are supposed to provide this information without being asked,” says another patient rights activist, Dr Shailesh R. Deshpande, who heads education and training at the Chellaram Diabetes Institute, Pune.

The MCI is supposed to take action when doctors violate the rules. There have been occasions when it has deregistered doctors for negligence. In 2013, for instance, the MCI said a Bangalore doctor had violated Indian Medical Council Regulations, especially Clause 7.16, which states that a physician should obtain written consent from a patient or kin before performing surgery. This was violated by the doctor, and the case came up after the patient died following the surgery.

But action is seldom taken against errant doctors, activists rue. And that, they say, is because the MCI itself consists of doctors.

In 2013, a report submitted by a parliamentary committee said: “All members of the MCI are medical professionals… There are reports that the medical professionals probing into allegations of medical negligence are very lenient towards their colleagues guilty of negligence and none of them is willing to testify (against) another doctor as negligent.”
Because of this, complaints of medical negligence are often taken to the Consumer Guidance Society of India (CGSI).

‘‘We step in to assist people to fight cases in consumer courts as our experience with MCI is very poor. Patients come to consumer courts for their rights because in the MCI doctors are setting laws for themselves,” says M.S. Kamath, honorary secretary, CGSI. “Patients have very many rights — but in reality, they are almost unenforceable.”

The MCI code of ethics, in any case, is not all encompassing, says Dr Ghooi. He explains that it doesn’t address the issue of what rights patients have when it comes to knowledge about their illness or medical records or about the risks and side effects of a treatment. “It just says that all physicians should give factual information to patients and their relatives. The rights mentioned in this document stem from the duties of the physician. But the guidelines issued by the CGSI are more patient-centric as they specify what all patients can ask their doctors,” he adds.

Most hospitals, he points out, are seldom keen to transfer their patients to another hospital. On the other hand, they are reluctant to take in serious or medico-legal cases and refer to them to government hospitals.

“Worse, private hospitals sometimes experiment with treatments, causing a lot of unnecessary expenditure to patients and then refer them to other hospitals, claiming inability to manage the condition,” he says.

The CGSI guidelines state that if patients are “discharged or moved to another hospital”, they have the right to be informed in advance so that they can choose their own hospital or nursing home, in consultation with their doctor.
The MCI guidelines also say that patients — or their relatives — have the right to be told in advance what an operation is for and the possible risks involved.

Often, patients are not told if there is an alternative to surgery that they can opt for. Doctors cite the case of hysterectomies — removal of the uterus — which can often be avoided. “Many hysterectomies are fraudulent, carried out by unscrupulous doctors to provide comfort to women and also as a means of family planning,” points out Dr Ghooi in a chapter in the book, Patient Rights, Ethical Perspectives, Emerging Development and Global Challenges, that he has authored with Deshpande. “The details of the line of treatment are not given to patients.”

But hospital administrations argue that there are not enough doctors to handle the burgeoning number of patients in the country. “We work under a lot of pressure as we cater to a large number of patients. It is not always possible to explain everything to every patient,” an official at a Delhi private hospital says.

A senior MCI official says that the council is now planning to induct non-doctors such as patients and social workers to resolve the issue of punishing negligent doctors. A new framework of ethical code is also being worked out, he says.
But as the situation stands today, most patients do not know about their rights. And if they do and believe that their rights are being violated there is little scope for redress. The situation will change only when — and if — the MCI wants change.


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