CONSUMER PROTECTION.ppt

PATIENT’S RIGHT
AND
CONSUMER PROTECTION ACT

PATIENTS RIGHTS
The health care rights have been the subject of much
public debate and legislative action in the later half of the
20th century. The fundamental right to quality medical care
and compensation for medical malpractice, the right to
informed consent, and the right to health care privacy, are all
protected under United States congressional law. While these
and other laws ensure many rights for medical patients, the
changing nature of medical knowledge and care also ensures
the continued need to regulate the relationships among
patients, care-givers, and care- giving institutions.
The government is concerned about the deteriorating
services in medical care both in private nursing homes and
public hospitals. Consumer organizations are also pressing
for a charter of right of consumers of medical services.

The legislative controls of nursing practice
primarily protect the rights of the patients. Until
the 1960’s patients had few rights, in fact,
patients often were denied basic human rights
during a time when were vulnerable. In 1973,
however, the American Hospital association
published its first patient’s bill of rights.
 The patient has the right to considerate and
respectful care.
 The patient has the right to and is encouraged to
obtain from physicians and their direct care givers
relevant, current, and understandable information
concerning diagnosis, treatment and prognosis.

 The patient has the right to make decisions about the
plan of care prior to and during the course of treatment
and to refuse a recommended treatment or plan of care to
the extent permitted by law and hospital policy and to be
informed of the medical consequences of this action. In
case of such refusal, the patient is entitled to other
appropriate care and notify patients of any policy that
might affect choice within the institution.
 The patient has the right to have an advance directive
(such as living will, health care proxy or durable power
of attorney for health care) concerning treatment or
designating a surrogate decision maker with the
expectation that the hospital will honor the intent of that
directive to the extent permitted by law and hospital
policy.

 The patient has the right to every consideration of
privacy. Case discussion, consultation, examination, and
treatment should be conducted so as to protect each
patients privacy.
 The patient has the right to expect that all
communications and records pertaining to his/her care
will be treated as confidential by the hospital, except in
cases such as suspected abuse and public health hazards
when reporting is permitted or required by law. The
patient has the right to expect that the hospital will
emphasize the confidentiality of this information when it
release it to any other patients entitled to review
information in these records

 The patients has the right to review the records pertaining
to his/her medical care and to have the information
explained or interpreted as necessary, except when
restricted by law.
• The patients has the right to expect that, within its
capacity and policies, a hospital will make reasonable
response to the request of a patient for appropriate and
medically indicated care and services. The hospital must
provide evaluation, service, and/or referral as indicated by
the urgency of the case. When medically appropriate and
legally permissible, or when a patient has so requested, a
patient may be transferred to another facility.

• The patient has the right to ask and to be informed
of the existence of business relationships among
the hospital, educational institutions, other health
care providers, or prayers that may influence the
patients treatment and care.
• The patients has the right to consent to or decline
to participate in proposed research studies or
human experimentation affecting care and
treatment or requiring direct patient involvement,
and to have those studies fully explained prior to
consent.

 The patient has the right to expect reasonable continuity of
care when appropriate and to be informed by physicians
and other care givers of available and realistic patient care
options when hospital care is no longer appropriate
 The patients hast the right to be informed of hospital
policies and practices that relate to patient care, treatment
and responsibilities. The patient has the right to be
informed of available resources for resolving disputes,
grievances and conflicts, such as ethics committees, patient
representatives, or other mechanisms available in the
institution. The patient has the right to be informed of the
hospitals charges for services and available payment
methods.

PATIENTS RESPONSIBILITIES
In order to receive optimal care, patient and his family
are responsible for:
 Providing accurate information about present illness and
past medical history and wishes for your medical care
 Seeking clarification when necessary to fully understand
health problems and the proposed plan of care
 Following through on agreed plan of care
 Considering and respecting the rights of others.
 Being courteous.
 Providing accurate information for insurance claims and
working with the Health System to make payment
arrangements when necessary so that others can benefit
from the services provided here.
 Following visitation policies of University Hospital.

ETHICAL RIGHTS OF
PATIENTS
The following four are the
types of patient’s ethical rights
are as:
Rights of personal Dignity:
These are the rights that
describe the personal dignity of
the patients while caring for
them, given as follow:
 Where the patients are to be
considered as human beings by
the following actions/activities:

Fig: Patients’ rights supported by ethics.

 Calling the person by name that he or she chooses to have
 Maintaining privacy
 Modesty by knocking on closed doors, pulling curtains,
providing appropriate garments etc.
 Helping a person to have the best possible appearance
through careful attention to personal hygiene and personal
care.

 The attitudes towards the patients, which can be reflected
by the manner the nurse, communicates with them through
the following ways:
 Listening to the thoughts and concerns of patient
 Explaining expectations and new situations
 Accepting the individual’s feelings as real without judging
them right or wrong.

Right to individualized care: This can be considered by the
following ways:
• Every patient has right according to his or her needs and life
style.
• Adapt a method of bathing or other nursing procedure to respect
a patient’s attitude about modesty.
• Alter if possible, visiting hours to help to maintain an important
family bond.
• Plan diet modifications to fit the patient’s cultural background.

Right to assistance towards
independence:
It is ethical right of a
patient that he or she should
be helped to be independent in
carrying out activities of daily
living of building their self
esteem and encouraging them.
Few examples are as follow:
 Allow the patient to perform
self-care wherever possible.
 Take care of interest of the
patient.
 Take extra time to give
instructions or directions
carefully to the patient.

Right to complain and obtain
changes in care: The patient
has right to complain when care
has not been of high quality and
to obtain changes that are
important to improve the quality
care.
Since the nurses have duties
towards patient care, ward
management and education of
patients, they should also have
concerned on the following
significant matters:
 The right to find dignity in self-
expression and self-
enhancement through use of our
special abilities and educational
background.

 The right to recognition for our contribution
through the provision of environment for its
practice and proper professional economic
rewards
 The right of work environment, which will
minimize physical and emotional stress and
health risks.
 The right to control what is professional practice
within the limits of the law.
 The right to set standards for excellence in
nursing.
 The right to social and political action on behalf
of nursing and health care.

In case of unknown patient
 Intimate the nursing superintendent thereby
RMO for further arrangement and body should
be sent to mortuary with proper packing and
labelling.
 In case of MLC, intimate the police through the
proper channel and sent the body to for autopsy.
If the individual desired to donate his/her
organs, information should be sent to the
concerning authority for the removal of organ.

RECORDS AND REPORTS
The medicolegal patient clinical record is a brief account
of the personal and medical history of the patient, results of
diagnostic tests, findings of medical examination, treatment
and nursing care, daily progress notes and advice on discharge.
 The records are kept under safe custody of the nurse in each
ward of department.
 No individual sheet is separated from the complete record.
 Records are kept in a place, not accessible to the patients and
visitors.
 No stranger is ever permitted to read the records.

 Records are not handed over to the legal
advisors without the written permission of the
administration.
 All hospital personnel are legally and ethically
obligated to keep in confidence all the
information’s provided in the records.
 All records to be handled since, careless
handling can destroy the records.
 All records are field according to the hospital
custom, so that they can traced easily. Records
could be arranged:
 Alphabetically

 Numerically
 With index cards
 Geographically.
 All records are identified with the bio-data of the
patient’s such as name, age, ward, bed no, Op no.,
diagnosis, etc.
 Medicolegal records are never sent out of the
hospital without the doctor’s permission.
Reference is made by writing separate sheets and
sending to the agency who requests for them, e.g.
reference letters, discharge summaries.

REPORTS
Oral report should be
accompanied by written
reports.
 Nurse is not only meant for
providing care to the patient,
she should shoulder some of the
responsibilities in respect to the
patient’s needs, and nurse
should know her limitations,
for the knowledge of laws
regarding health is essential.
 She should adapt some of the
legal aspects while discharging
her duty in every field.

LEGAL ROLE OF THE NURSE
Professional nursing practise is not
determined by a simplistic adherence to patients
rights. Rather its emerge from an interplay
between the rights of patients and the legal role
of the nurse, and her concern for quality
psychiatric nursing. There are three roles that the
psychiatric nurse moves in and out in the process
of completing her/his professional and personal
responsibilities. These are: The role of provider
of services, employer or contractor of service
and private citizen. These roles are played
simultaneously and each role has attendant rights
and responsibility.

Nurse as provider of services:
• All psychiatric professional have legally defined duties of care
and are responsible for their own work. If duties are violated
‘Malpractise’ exists.
• Malpractise involves the failure of a professional person to give
the kind of proper and competent care that is given by member
of his profession in the community resulting in harm to the
patient.
• Most malpractise claims are field under the law of negligent tort.

Under the law of negligent tort the plaintiff must prove
the following:
• A legal duty of care existed.
• The nurse performed the duty negligently.
• Damages were suffered by the plaintiff as a result.
• The damages were substantial.

It would be valuable, for the nurse to practise the
following preventive measures to avoid possible
lawsuits.
• Implement nursing care that meets the standards of
psychiatric mental health nursing practise.
• Know the laws of the state in which one practises,
including the rights and duties of the nurse as well
as the patients.
• Keep accurate and concise nursing records.
• Maintain the confidentiality of patient information.
• Consult a lawyer if any question arises.

Nurses as an employee:
As an employee, a nurse has the responsibility to
provide adequate supervision and evaluation of those
under her/his authority for the quality of care given, to
observe her /his employers rights and responsibilities to
clients and other employees, to fulfil the obligation of
the contracted service adequately, to adequately apprise
the employer of circumstances and conditions that
impair the quality of care given, and to report
observations of negligent care by others when and where
appropriate.

Nurse as a citizen:
This role is particularly significant, because all other
roles, responsibilities and privileges are awarded because
of the inherent right of citizenship. In our form of
democratic Government these rights are inherent, civil
rights, property rights, right to protection from harm, right
to a good name and right to due process. These rights
form the foundations for the extension of other legal
relationships of the nurse.

Community health nursing:
Community health nursing is the combination of
nursing practise and public health practise. The
community health nurse is subject to the law relating to
nursing practise and public health practise. The duties of
all nurses become legally binding responsibilities for
which the nurse is accountable. In addition, the
community health nurses have many responsibilities that
are unique to public health focused practise. Despite the
broad nature and varied roles of community health nursing
practise, two legal aspects apply to most practise
situations, such as:

 Professional negligence or malpractise.
 Scope of practise.
The issue of scope of practise involves
differentiating between the practises of
physician, nurses and other health care
providers. Scope of practise is assessed by:
 Examining the usual and customary practise of
profession.
 Taking into account how legislation defines the
practise of profession in a jurisdiction.

The usual and customary practise of
community health nursing can be determined
through a variety of sources which include:
 Contents of community health nursing education
profession, general and special.
 Experience of other practising nurses.
 Activities and statements, including standards of
community health nursing professional
organization.
 Policies and procedures of agencies employing
nurses.
 Literature, including books, text and journals.

All these sources can be describe and help
determine the scope of the usual practise of
community health nursing. Legal aspects of the
roles and functions of the community health
nursing, especially scope of practise and
negligence will prove to be useful information for
nurses in community health. Every community
health nurse must consider legal implication of
practise in each clinical encounter, i.e. health
education, Nutrition education, maintaining
sanitation and supply of portable water, maternal
and child health including family planing,
communicable diseases control, school, health,
occupational health, mental health and so on.

Because the community health nurse may be
agent of the government when implementing a
particular health programme, consideration must
be given to the power of the state or the
relationship of this power to individual right. In
each clinical encounter, before treating the client,
the community health nurse should know what
standards of care apply to the situation.
Standards of care can be learned from expert
nurse witness and can be found in agency
policies and procedures, nursing and health care
literature.

POINTS TO BE KEPT IN MIND BY NURSES REGARDING
LEGAL ISSUES
The hospital as an employer:
The controlling authority of a hospital is deemed
to be an employer. The employer is legally
responsible for the acts committed by all employees
in the course of their duty and must ensure:
 Employees posses the required qualification,
registration and level of competence.
 All legal requirements are met, including valid
contracts of employment.
 Safety standards are observed in relation to buildings,
equipments and standard of patient care.

The nurse’s responsibility:
The legal liability of an employer does not relieve a
nurse from individual responsibility and legal action can
be taken against hospital and a nurse or against Nurses are
less likely to fail in their responsibilities of the following:
 They remember that all patients have the rights and
privileges accorded to every citizen and it is the duty of
the nurses to protect these, whenever patients are unable
to do so for themselves.
 They require the knowledge, understanding and level of
competence to ensure safe, effective nursing care.
 They do not take tasks which are beyond their level of
competence.
 They maintain a high ethical standard in their professional
life.

The poisons Act:
This Act control the packing, sale and use of
poisonous substances in the community. All
poisons are listed on one of the eight schedules,
and for each schedule there are specific rules
regulating the use of poisons listed. The schedule
which are of particular importance to nurses are:
Schedule ‘4’ containing drugs called restricted
drugs. They can only be obtained on written
prescription and they must be kept in a locked
cupboard.

Schedule’8’ containing drugs od addiction. The
regulations relating to poisonous drugs are:
 They must be stored in a separate cupboard, away
from all other goods.
 The cupboard must be firmly fixed to a wall and
must be kept locked. The key must be in
possession of an authorized person at all times.
 A register must be maintained in which full details
are recorded of all drugs received from the
pharmacy and drugs disposed off in anyway, e.g.
administered to the patients, and returned to the
pharmacy.

Care of property:
On admission to hospital patients should be
advised to send home any personal possession
which they will not required during
hospitalization.
Consent for procedures:
Standard forms are provided on which written
consent must be obtained before an anaesthetic is
given, surgery performed or any procedure
carried out which is out of the ordinary or
involves risk for the patient.

Safety:
The maintenance of safety in a hospital
divided into two areas:
 Provision of safe environment.
 Provision of safe patient care.

Confidentiality:
Nurses have an ethical obligation not to disclose
confidential information which is required about patients
in their care, except when such disclosure occurs during
the course of their professional duties. The patient’s right
to privacy should be respected and his/her affairs should
not be discussed with other patients or with non-
professional staff or members of the general public.
Trespass:
It is a term used to describe a number of unlawful
acts, e.g. searching a person or person’s property without
authority, entering or remaining in premises without
owner’s consent opening letters or parcels addressed to
others without their consent.

 Witnessing wills: A patient wishing to make a will should
be given all the assistance required, but it is a rule in most
hospital that the nurses may not act as witnesses.
The law defines the conditions under which a license
may be revoked. These conditions include:
 Negligence is defined as harm done to a patient as a result
of neglecting duties or procedures. Negligence is the
omission of ordinary precautions expected of a responsible
person.
 Malpractice is improper treatment of a patient resulting in
illness or injury (where negligence is an error of omission
and malpractice is an error of commission).
 Assault/ Battery are the threat of physical damage and the
carrying of that threat. Assault may be violent act, either
physical or verbal. Battery is a physical striking or beating.

Some common types of situation that might cause injury to
a person and involve legal liability are the following:
 Burns from hot water bags, heating pads, contact with
steam pipe or scalding by hot water chemicals either
improper mixture or improper application.
 Sponges overlooked in surgical wound.
 Falls on slippery floors.
 Falls from an unprotected bed or rib by unconscious
patient.
 Injury from wrong blood transfusion- mismatching.
 Injury from wrong IV fluid infusions.
 Injury from wrong site of injections.
 Injury from cross infection or hospital born infection.

Therefore, the only practical way for a nurse
to prove that she rendered good nursing care to a
patient is to document the care rendered in the
patient’s record. If good care was given and
documented, the medical record is the nurses
evidence in the court room. Even if the nursing
care given was excellent, if it is not documented in
the medical record, the nurse is at a distinct
disadvantage in the law suit. Good documentation
of the care giver is vital part of good nursing care
as well as good ‘legal nursing’.

ROLES AND FUNCTIONS OF NURSE MANAGER IN
LEGAL ISSUES
The following are the leadership roles and managerial
functions of a nurse in legal and legislative issues, him
or her:
 Serves as a role model by providing nursing care that
meets or exceeds accepted standards of care.
 Is current in the field and seeks professional
certification to increase expertise in a specific field.
 Reports substandard nursing care to appropriate
authorities.
 Fosters nurse/ patient relationships that are respectful,
caring and honest, thus reducing the possibility of
future lawsuits.

 Joins and actively supports professional
organisations to strengthen the lobbying efforts of
nurses in health care legislation.
 Practises nursing within the area of individual
competence.
 Priorities patient’s rights and welfare first in
decision-making.
 Demonstrates vision, risk taking, and energy in
determining appropriate legal boundaries for
nursing practises, thus defining what nursing is
and should be in the future.

 Is knowledgeable responding sources of law and
legal doctrines that affect nursing practise.
 Delegates to subordinates wisely, looking at the
managers scope of practise and that of those they
supervise.
 Understands and adheres to institutional policies
and procedures.
 Practises nursing within the scope of the state
nurse practise act.

 Monitors subordinates to ensure that they have a
valid, current and appropriate license to practise
nursing.
 Uses foresee ability of harm in delegation and
staffing decisions.
 Increases staff awareness of intentional torts and
assists them in developing strategies to reduce
their liability in these areas.
 Provides educational and training opportunities
for staff on legal issues affecting nursing
practise.

CONSUMER PROTECTION ACT
Doctors and other health professionals are
liable under the prevailing laws such as Civil Panel code,
Indian Panel Code, Law of Contractors, Sale of Goods Act,
Law of Torts and other specific legislation. These laws are
not free from some drawbacks such as delay in justice, huge
legal fees, and limited access to courts, difficulties involved
in providing both negligence and cause. The last decade of
turning millennium saw enactment of Consumers Protection
Act (COPRA) 1986 of India, a very important legal
instruction aimed at better social justice. This Act was
passed by the Indian Parliament to safeguard and protect the
interest of consumers.

CONSUMER
Consumer means any person who hires any
services for a consideration, and includes any
beneficiary of such services other than the person who
hires the services, when such services are availed of
with the approval of the first mentioned person.
A person who avails himself of the facility of a
government hospital is not a consumer because the
facility offered in government hospitals is not service
hired for a consideration. For deficiency of service in
government hospitals, the aggrieved person will have to
file a claim in civil court.

 RIGHTS-
 Right to be informed about the quality, quantity,
potency, purity, standard and price of goods or
services so as to protect the consumer against
unfair trade practices.
 Right to be assured, wherever possible, access to a
variety of goods and services at competitive prices.
 Rights to be heard and to be assured that
consumers’ interests will receive due consideration
at appropriate forums.
 Right to seek redressal against unfair trade
practices and unscrupulous exploitation of
consumers.
 Rights to consumer education.

GRIEVANCE REDRESSAL MECHANISM UNDER CPA
An aware consumer can approach Consumers
Protection Act at three different levels.
 For complaints that involve payment compensation upto
Rs. 20 lakh, the consumer can approach District
Consumer Court.
 For complaints above Rs. 20 lakh but less than 1 crore,
consumers can approach State Consumer Commission.
 For complaints above one crore, the aggrieved person will
need to approach the National Commission for redressal
of his grievance.

A complaint can be filed within two years from the
date on which the cause of action has arisen. However a
complaint can be entertained after the period if the
complaint had sufficient cause for not filling the complaint
within such period by recording its reason for condoning
such delay.
Who can file a compliant?
A complaint can be filed by
 A consumer to whom goods are sold or delivered or
agreed to be sold or delivered or such services provided or
agreed to be provided.
 A voluntary consumer organization.
 The central Government

 The State Government, Union Territory Administration
 One or more consumers where they are of same interest
 In case of death of consumer, his/ her legal heir of
representatives.
Grounds to file a complaint
Any allegation in writing made by the complaint against
the service provider should enlist:
 Adoption of any unfair trade practice or restrictive trade
practice.
 The goods bought or agreed to be bought suffer from one
or more defects.
 Services hired/availed or agreed to be hired /availed,
suffer from any deficiency.

 The trader has charged for the goods or services a piece in
excess of the stipulated price.
 The goods or services being offered to the public are
hazardous to life and safety.
CATEGORIES OF PATIENTS AS CONSUMERS
Patients nursed in different types of hospital are
considered as consumers are:
Patients of Government Hospitals
Patients availing free medical care in general wards are
not consumers but patients availing medical care in
private wards of these hospitals are consumers as they are
hiring services for a consideration.

Patients of Charitable Hospitals
The patient of charitable hospitals is a consumer
when he pays for the medical treatment either
partially or in full, but he is not a consumer when he
does not pay at all.
Patients of Nursing Homes and Private
Practitioners
Patients of nursing homes and private
practitioners are covered under the act because they
satisfy the definition of consumer and services as
given under section 2 (1) (d) (ii) and 2 (1) (0). Hence
as a consumer the service should have been rendered
to him, the service should have been hired by him and
for hiring the service, he should have paid a
consideration.

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