Jan Swsathya responds to the National Council for Clinical Establishments , which has uploaded draft standards for Clinical and is now collecting suggestions from people. Below is s response to the call for comments and suggestions on the minimum standards documents as displayed on the MOHFW website- http://clinicalestablishments.
Jan Swasthya Abhiyan- Maharashtra
1st May 2014
Dr. Anil Kumar,
CMO (AK), Room No.506 ‘D’ Wing,
5th Floor, Nirman Bhawan, New Delhi-110018
Subject- Suggestions for clearer, more definitive inclusion of various Patient’s Rights in Minimum Standards in CEA-2010
Dear Dr. Anil Kumar,
Greetings from Jan Swasthya Abhiyan!
We are glad that the National Council for Clinical Establishments has uploaded draft standards for Clinical and is now collecting suggestions from people. This is response to the call for comments and suggestions on the minimum standards documents as displayed on the MOHFW website- http://clinicalestablishments.
Jan Swasthya Abhiyan and its constituent organisations have been consistently advocating for inclusion of Standard Charter of Patients’ Rights as a part of process standards for hospitals. In this context, we welcome the fact that the draft standards for hospitals do mention that patient’s rights and responsibilities are to be displayed in hospitals. In this connection, we have the following concrete suggestions –
- Without specifying the Standard Charter of Patient’s Rights, the Draft Minimum Standards make a generic mention of need to display patient’s rights. Point number 10.2 in the section“Basic Processes” says – “Patient shall be guided and informed regarding Patients’ rights & responsibilities, cost estimates, third party services (e.g. Insurance) etc.”
However it has not been clarified, specified what these Patient’s Rights are. Without specifying a detailed Standard Charter of Patient’s Rights, generic mention of need to display patient’s rights and responsibilities is quite inadequate. Further, some important entitlements for patients are not mentioned in the existing standards, which we feel should be included:
- second opinion from a relevant clinician of patient’s choice
- non-discrimination regarding behavior and treatment on the basis of HIV status
- choose the registered pharmacy or diagnostic centre/laboratory from which to avail services, while being treated at an establishment
- claim body of deceased patient by the concerned relative / attendant without preconditions
- protection ensured by ICMR ethics guidelines and other legally enabled provisions, for all persons participating in clinical research
- choose alternative treatment at their own risk if option is available
- seek redressal in case of grievance
Absence of mention of these patients’ rights in the draft minimum standards appears to be in contrast to the level of detail with which physical standards have been specified, which are mentioned in considerable detail (e.g. detailed list of various items of furniture). It is necessary to add an annexure which specifies Standard Charter of Patient’s Rights. A draft of this Standard Charter of Patient’s Rights has been attached herewith and it is requested that it be added (with due modifications if any) as Annexure 10 in the Minimum Standards. It should be mentioned that this Standard Charter of Patient’s Rights should be displayed in a central and prominent place of the establishment, and would be in local language of the state.
- Secondly where relevant, the content of the various Patient’s Rights need to be integrated into the minimum standards in an appropriate manner. For example, in point number 10.2, the following point needs to be included –
“Patients shall have the right and easy access to all details of their care, including a copy of their case records and investigation reports. Patients would be informed of costs of care and options as relevant, including what would be entitlements under insurance programmes or government schemes.”
In the attached file, we have inserted a few such additions/modifications. It is requested that these additions be considered (with due modifications if any) during finalization of these Draft Minimum Standards.
- In the rules of CEA-2010 published in May 2012, the following provision has been included under para 9 ii of the rules –
“The clinical establishment shall charge rates for each type of procedure and services within the range of rates determined by and issued by the Central government from time to time, in consultation with the State Governments”.
However in the section ‘informative signage’, there is only a vague, generic mention of ‘fee structure’. We would like to suggest specific mention that “Key indicative rates of the clinical establishment would be displayed prominently, along with a notice that all rates are available at the reception counter.”
We would also like to inform that certain networks associated with Jan Swasthya Abhiyan – Public Health Resource Network and Christian Coalition for Health are separately giving detailed comments and suggestions about specific standards, which may be taken into consideration while finalizing the standards. Here we would like to emphasise the need to ensure that the final standards should not constrain the functioning of smaller, not-for-profit clinical establishments, especially those working in rural and tribal areas where unduly demanding physical and humanpower requirements may be difficult to fulfill.
We would be glad to provide any clarifications and explanations. Do provide us an opportunity to share our rationale to the national council and appropriate officials.
We hope that these changes would definitely be incorporated (with due modifications if any) while finalizing the standards for clinical establishments.
(Jan Swasthya Abhiyan- Maharashtra)
जन आरोग्य अभियान- महाराष्ट्र राज्य
(जन आरोग्य अभियानचे सर्व कार्यकर्ते; कष्टकरी संघटना, लोकसंघर्ष मोर्चा, रेशनिंग कृती समिती, महाराष्ट्र नर्सेस फेडरेशन, जन आरोग्य मंच, महिला राजसत्ता आंदोलन, जन आंदोलनांचा राष्ट्रीय सम्नवय, भारतीय महिला फेडरेशन, अखिल भारतीय जनवादी महिला संघटना, आशा वर्कर्स युनियन, मासूम, संग्राम, कागद–काच-पत्रा कष्टकरी पंचायत, श्रमिक मुक्ती दल(लोकशाहीवादी), मूव्हमेंट फॉर पीस ऍन्ड जस्टीस, मुंबई- जन स्वास्थ्य अभियान, वादा-न-तोडो अभियान, घर कामगार संघटना )
संपर्क – डॉ अनंत फडके- ( ९४२३५३१४७८), लेनी चौधरी(९८२०६३९७६२),
डॉ. सुहास कोल्हेकर (९४२२९८६७७१), डॉ सतीश गोगुलवार (९४२२१२३०१६),
श्रीपाद कोंडे-(९४२१८१३८०९) आणि बंडू साने (७२२३२०२७१५)