Private pressure: Health ministry says, patients must 'obligatorily' pay hospital fees

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The civil rights network Jan Swasthya Abhiyan (JSA) has demanded from the Union health ministry that it should ensure there is “no dilution” in patients’ rights, insisting, the ministry should adopt the charter on patients’ rights based on the recommendation to the ministry by the National Human Rights Commission (NHRC) last year.
The demand comes close on the heels of Preeti Sudan, secretary, Union health ministry, sending a fresh instruction to all state chief secretaries, which JSA says is a diluted version of the NHRC charter. In a letter to Sudan, JSA has said, “Only around half of the original patients’ rights are contained in this letter”, and “ten important rights have been dropped, apparently due to resistance from the private medical lobby.”
Sent on July 26, the letter to Sudan says, earlier, in September 2018, the Union Health Ministry displayed a charter of patients’ rights containing 17 rights on its website, based on NHRC recommendations.
JSA says, “Since no progress was made for several months regarding this charter, on February 26, Jan Swasthya Abhiyan, Mahila Pragati Manch, People for Better Treatment, Delhi Network of Positive People, All India Patients’ Rights Group collectively organised a major protest at Jantar Mantar, New Delhi, and subsequently had discussion with concerned officials at Union Ministry of Health and Family Welfare (MoHFW), asking for speedy implementation of the NHRC-based charter.”

Text of the letter:

We the undersigned are health professionals, health activists and social workers from across various states of India, who are associated with Jan Swasthya Abhiyan and various other networks working on health rights and patients’ rights.
We are writing with reference to the letter issued by your office to Chief Secretaries of all states regarding adoption of the Charter of Patients’ rights, dated 2 June 2019. We have compared the list of patients’ rights outlined in your letter, with the Charter of Patients’ Rights which had been originally proposed by NHRC and was displayed on Health Ministry’s website from September 2018 onwards. This issue was discussed in a national workshop on patients’ rights (July 23, 2019) and Jan Swasthya Abhiyan national coordination committee (July 24, 2019) held at Delhi.
Based on this analysis and deliberations, while we welcome the initiative by MoHFW in circulating a letter on Patients’ rights to states, we are also deeply concerned to note that although the NHRC charter contained a comprehensive set of 17 patients’ rights, your letter has significantly diluted and reduced this list, effectively dropping 10 important patients’ rights which were contained in the NHRC charter, these rights deleted by MoHFW are as follows:

Right to emergency medical care
Right to care according to prescribed rates wherever relevant
Right to safety and quality care according to standards
Right to choose source for obtaining medicines or tests
Right to proper referral and transfer, which is free from perverse commercial influences
Right to protection for patients involved in clinical trials
Right to protection of participants involved in biomedical and health research
Right to take discharge of patient and not be detained in hospital
Right to patient education
Right to be heard and seek redressal

Each of these rights is not only non-negotiable and absolutely essential for the protection of patients, they are also backed by various legal provisions, judgements and official documents. Given this context, it is surprising that almost half of the rights contained in the original charter displayed on your Ministry’s website have been summarily dropped by your Ministry without any explanation.
Further there is addition of certain patient responsibilities, such as obligation to pay hospital agreed fees on time, which have been added in your letter, which we find problematic due to potential for misuse of this provision by private hospitals.

Given this situation we strongly propose the following:

MoHFW, Govt of India should issue a modified letter to Chief Secretaries of all states, which must include mention of all 17 patients’ rights which were outlined in the NHRC patients’ rights charter without dilution; this should be done as soon as possible.
Recently, a set of draft minimum standards for clinical establishments has been released for comments by MoHFW. We regard this as a positive though extremely delayed step. However, we note that these standards mention a charter for patients’ rights (containing nine rights) as annexures, this charter is an even further truncated version of the 12 patients’ rights mentioned in your own letter dated June 2, 2019.
This situation should be rectified, and besides mentioning all 12 rights of your letter,the entire set of rights contained in NHRC charter (mentioned above) should be included in the patients’ rights charter which would be part of the Central minimum standards for clinical establishments.

Union health ministry has sent fresh instruction to all state chief secretaries, which is a diluted version of the NHRC patients' rights charter

We are aware of the private medical lobby which tends to oppose or demand dilution of such regulations in public interest; your letter dated June 2, 2019 has appropriately mentioned about this lobby.
Further, in case any of the patients’ rights mentioned in the NHRC charter is being contested by certain sections of the private medical sector, then the Health Ministry should overrule such vested commercial interests, holding the interests of the general public as paramount. Nevertheless, if considered necessary MoHFW may organize a multi-stakeholder consultation at the earliest to discuss any such contentious issues so that an appropriate resolution may be found.
JSA and patients’ rights groups would be happy to participate and contribute to such a consultative process in the interests of patients and ordinary people, who are today suffering a wide range of rights violations in commercialized private hospitals, and look upon the Union Health Ministry as their ally and protector of public health in the country.
---
Click HERE for the list of signatories

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