Editorial

Charter of Patients’ Rights

The cabinet decision has put the spotlight on the Charter of Patient Rights recommended by the National Human Rights Commission (NHRC).

Sentinel Digital Desk

The Assam Cabinet's approval of regulatory measures aimed at curbing the alleged practice of a section of private nursing homes/hospitals withholding bodies over pending bills is an admirable policy move. The cabinet decision has put the spotlight on the Charter of Patient Rights recommended by the National Human Rights Commission (NHRC). The draft Standard Operating Procedure (SOP) and Regulatory Guidelines to prevent coercive practices by private nursing homes and hospitals in the state approved by the State Cabinet mandate that hospitals must hand over bodies within two hours post death certification. The SOP warns that delays beyond this timeframe may attract penal action, and such incidents are to be mandatorily reported to the police authority and the district administration concerned within four hours. It allows family members of the deceased to call the helpline number 104 to report coercion of any form and mandates the designated authority to visit the hospital to release the body, if wrongfully held, and initiate legal proceedings. Punitive measures against violations, including suspension of license for a period that may range from three months to six months, a penalty up to Rs 25 lakh, and blacklisting or permanent deregistration on repeat offences, are expected to have a deterrent effect. Chief Minister Dr. Himanta Biswa Sarma, while announcing the cabinet decision, spelt out his government's logically coherent stance on the issue thus: "We can't hold a body as hostage. It's against human dignity." While all private business is driven by profit maximisation, a clear line of distinction must be drawn between healthcare business and other business, as healthcare must be subjected to ethical practices and quality standards, as it involves patients's well-being, safety, and dignity. With health being a state subject, the onus to protect the patients from exploitation by nursing homes/hospitals primarily lies with the state government. The Central government shared the Charter of Patients recommended by NHRC with the States and Union Territories for adoption and implementation so that the grievances and concerns of patients are addressed while delivering healthcare. Lack of transparency in treatment cost and procedure in nursing homes/private hospitals often leads to pendency of medical bills, often landing patients and his or her family members in trouble. They are unable to anticipate the final bill amount due to the opaque billing process and the hospital not providing them prior and detailed information about the treatment cost. Lack of an efficient grievance redressal mechanism exacerbates the situation and compels the patients and family members to somehow manage to clear the pending bills and take the patients discharged to home and sometimes face the traumatic situation of not being handed over the body of the deceased when they are unable to manage the required amount to clear the pending bills. The NHRC Charter insists that every patient has a right to adequate relevant information about the nature and 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. The treating physician has a duty to ensure that this information is provided in simple and intelligible language to the patient to be communicated either personally by the physician or by means of his/her qualified assistants to the patient or line of treatment in writing. On completion of treatment, the patient has the right to receive an itemised bill, to receive an explanation for the bill(s) regardless of the source of payment or the mode of payment, and to receive payment receipt(s) for any payment made. Patients and their caretakers also have a right to know the identity and professional status of various care providers who are providing service to him/her and to know which doctor/consultant is primarily responsible for his/her care. The hospital management has a duty to provide this information routinely to all patients and their caregivers in writing with an acknowledgement; it states the patient's right to information. The NHRC also recommended that a patient has the right to take discharge and cannot be detained in a hospital on procedural grounds such as a dispute in the payment of hospital charges. Similarly, caretakers have the right to the body of a patient who had been treated in a hospital, and the body cannot be detained on procedural grounds, including non-payment/dispute regarding payment of hospital charges against the wishes of the caretakers. The Assam Cabinet's decision on curbing the practice of withholding bodies by hospitals has provided an opportunity for raising awareness on the rights of patients and extending cooperation to the State Government for the adoption and implementation of a comprehensive charter of patients' rights in sync with NHRC recommendations so that healthcare services in nursing homes and private hospitals become transparent. Private hospitals play a critical role in bridging the gap in healthcare services, which must not be allowed to be overshadowed by opaqueness.