CPA for health care professionals

3. Consumer Protection
Act, 1986

4. Aims Of CPA, 1986
 This Act aims to provide better protection
to the interests of the consumers
 To make provisions for the establishment
of consumer councils and other authorities
to provide speedy and cheap remedy to
the consumers.
 It safeguards the rights of consumers.

7. TERMS AND TERMINOLOGY
USED IN CPA, 1986
 Complaint: An allegation shall constitute a
complaint where the goods or services
mentioned in the complaint suffer from
deficiency in any regard.
 Complainant: Any consumer or voluntary
consumer association registered under the
Companies act, 1956; or under any other law
for the time being in force; the central or state
government

8.  Consumer: Any person who buys any
goods or avails of any service, for a
consideration which has been paid or
promised to be paid; either fully or partially
or in some form of deferred payment.
 Consideration: Refers to fees or payment
paid to the doctor/hospital. This may be
paid; either by the patient or guardian any
other person on behalf of patient; and in
case of death of a patient; his legal heir

9. becomes the consumer.
 Service: “ means service of any description
such as banking, financing, insurance,
transport, processing, supply of electrical or
other energy board or lodging,
entertainment, Amusement or purveying of
news or other information; but does not
include the rendering of any service free of
charge or under contract of perosnal
service.”

10.  Consumer Dispute: A dispute where a person
against whom a complaint has been made
denies the allegation.
 Medical negligence: Medical is falling short of
reasonable medical care.
 Defect: any fault, imperfection or shortcoming
in the quality, quantity, potency, purity or
standard which is required to be maintained by
or under any law for the time being in force.

11.  Deficiency: Any fault, imperfection,
shortcoming, or inadequacy in the quality,
nature and manner of performance which
is required to be maintained by or under
any law for the time being in force; or has
been undertaken to be performed by a
person in pursuance of a contract.

12. Consumer Protection Councils
 Under the Act, consumer protection
councils have been established at central
and state level.
 Central consumer protection councils
consists of 150 members, is chaired by the
minister incharge of food and civil supplies
in centre and must meet at least thrice in
a year: at such place and time as the
chairman may think fit.

13.  State Consumer protection council is
chaired by Minister incharge of Consumer
Affairs or Food and civil supplies. The
numbers of members in the state council
varies from state to state and it meets at
least twice in a year.

14. Consumer Dispute
Redressal Agencies

15. Under the Act envisages setting up
a three tier quasi judicial redressal
mechanism:
 District forum: This is established by State
Government with at least one forum in each
district. Each forum consist of 3 members:
(b)A person who has been, or is qualified to be a
District Judge as the President.
(c) A person of eminence in field of education,
trade or commerce.
(d)A lady social worker, each of whom hold office

16. for a term of five years or upto 65 years of
age .
 The pecuniary jurisdiction of this is up to
Rs. 5 lakhs. Its territorial jurisdiction
extends throughout the local limits of the
district.
 Any person aggrieved by an order passed
by district forum may appeal to State
Commissions within 30 days from date of
issue of order.

17. State Commission:
 It is at the level of state and compromise of
following members:
(a) A person who is or has been a judge of a
High court shall be the president.
(b) Two others members who shall be persons of
ability, integrity and standing and have
adequate knowledge, or experience of, or have
shown capacity in dealing with problems
relating to economics, law, commerce,
accountancy, industry, public affairs or
administration; one of whom has to be a
woman.

18.  State Commissions has jurisdiction to entertain
complaints where value of goods/services
exceeds 5 lakhs rupees but is less than Rs. 20
lakhs.
 Appeals against the orders of any District
Forum in the state.
 To call for case records of district forum and
pass appropriate orders in any consumer
dispute pending before or decided by district
forum.
 Any person aggrieved by an order made by
state commission may appeal to National
commission within 30 days.

19. National Commission
 It is situated at New Delhi and consists of 5
members as follows:
(b)A person who is or has been a judge of
supreme court shall be the president.
(c) Four other members who shall be persons of
ability, Integrity and standing and have
knowledge or experience of, or have shown
capacity in dealing with problems relating to
economics, law, commerce, accountancy,
industry, public affairs or administration, of
which has to be a woman.

20.  Jurisdiction is to entertain complaints where the
value of goods/services and the compensation
claimed is more than 20 lakhs. Appeals against
the orders of any state commissions; to call for
the case records and pass appropriate orders in
any consumer dispute which is pending/has
been decided by any state commissions.
 Any persons aggrieved by any order made by
National Commission may appeal to supreme
court within 30 days of date of order.

21. Other salient features
 Limitation period: The various redressal
agencies shall not admit a complaint , unless it
is filed within 2 years from the date on which
the cause of action has arisen. It can be
entertained even after 2 years provided there is
sufficient cause for the same.
 Appeals: Appeals will be entertained by both
State and National and also supreme courts
even after the expiry date of thirty days, if it is
satisfied that there was sufficient cause for not
filling within that period.

22.  Dismissal of frivolous or vexatious complaints:
where a complaint before any of the fora/
commissions is found to be frivolous; it shall
dismiss the complaint (reason to be recorded
in writing) and pass an order that complainant
should shall pay to opposite party such as cost,
not exceeding an amount of Rs. 10,000.
 Penalties: a party or person failing to comply
with any order made by District Forum, state or
National commissions, shall be punishable :
(a) With imprisonment for a term more than
month up to three years.

23. (b) With fine not less than Rs. 2,000 to Rs.
10,000.
 Enforcement of orders: every order made by
these three agencies may be enforced by these
as the case may be, in the same manner as if it
were a decree by the corresponding civil court.
In the event of its inability to execute its own
orders, it should send such orders to the
corresponding court within the local limits of
jurisdiction. Thereafter, the civil courts shall
execute the order, as if it was a decree or order
sent for execution.

24. Implications in hospital

25. Application of Consumer
Protection Act In Hospitals
 As far as hospitals are concerned, the
private hospitals or nursing homes or
polyclinics which charge for the services
provided, have been included under the
ambit of the Act.
 However government run or aided
hospital have been exempted as they do
not charge the patients for services
provided.

26. Recent judgement of supreme
court
 A landmark judgement was delivered by the
Hon’ble supreme court in 1996,wherein the
following decisions were taken:
(a) Service rendered to a patient by a medical
practitioner (except where the doctor gives
service, free of charge to every patient) by way
of consultation, diagnosis or treatment (both
medical and surgical) will fall within the ambit
of service.

27.  The fact that medical practitioners belong to a
profession and are regulated by Medical Council
Of India, does not exclude them from this act.
 Service rendered at a non government hospital/
nursing home where no charges are taken from
any person availing the same and all patients
(both rich and poor) are treated free, will be
outside the purview of service. Payment of a
“token” amount for registration purpose only
will not alter the position.

28.  Service rendered at a non goverenment
hospital/nursing home where the charges are
paid by those persons who are availing the
facilities and are able to pay and other poor
patients are treated free of cost shall also
treated as ‘service’. Recipient of “free” service
would also be a consumer.
 As regards government hospitals: those
hospitals where no charge whatsoever is taken
from any patient; rich or poor falls outside the
purview of Act. Charging of a “token” amount
for registration purposes only will not alter the
position. However, services rendered at

29. government hospitals/dispensaries where some
payment is taken from patients who can pay
and poor patients are treated free will also fall
within the purview of the Act.
 Service rendered by a medical practitioner or
hospital or nursing home cannot be regarded
as free of charge, if the person availing service
has taken an insurance policy for medical care,
where the charges for consultation, diagnosis
and treatment are borne by insurance
company.

30.  In those cases where as a part of the
condition of service, the employer bears
the expenses of medical treatment of an
employee and his/her dependent
members, this would constitute “service”
as per the act and could not be considered
as being free of charge.

31. Implications For Health
Professionals
 The doctor patient relationship is a “contract”
under which the doctor must continue to
provide “reasonable” care as long as the
patient is being treated by him/her. There are
some high risk which need caution:
(b)Failure to attend to patients: Especially
children with acute conditions.
(c) Retention of objects in operation sites: Swabs,
packs, instruments can be left behind if proper
counting and retrieval is not done.

32. (c) Amputation of wrong limb or digit,
extraction of wrong eye or tooth: The
reasons are carelessness in hospital notes,
errors in pre-operative skin marking and
failure to check the name of patient in OT.
(d) Therapeutic Hazards: These can be
avoided by administration of the right drug
in the right dose via the right route and
informing patient/attendants of potential
risk of treatment.

33. (e)Medical Case Records: It is extremely
important to fill up the case sheets carefully
and properly; as these can be produced in
courts as evidence. In complicated cases,
negative findings should be mentioned.
(f) Consultations And referrals: These should be
done in writing wherever required.
(g) Channels of communications: it has often
been found that lack or improper
communication regarding patient health/illness,
leads to litigations. Hence, it is important that
patient or attendants should be informed about
the diagnosis, treatment and prognosis in

34. Simple and understandable language.
(h) Prescription of non specific/Ayurvedic
preparation: It is advisable not to
prescribe non specific or Ayurvedic
preparation; as the knowledge regarding
constituents is not known.

35. Preventive Measures
How to avoid litigation?

36. PREVENTION AT PERSONAL
LEVEL
 1. True and M.C.I. approved qualification,
training & experience of recognized centers are
the primary safeguards against any litigation.
The prescription heads, signboards and
advertisements should mention the actual
facilities available. We should refrain from
claims of guarantee of results.
2. Communication: This is the key to doctor-
patient relationship. Increasing crowds of
patients and improper communication to

37. patient about diagnostics and treatment
procedures, complications and claims of
guarantee success are main reasons for patient
dissatisfaction.
 Interpersonal behaviour: The human face of
medical care decides the patient's /attendant's
reaction towards on medical mishap/untoward
reaction. The whole system of medical
establishment should made courteous, and
polite. The special training should be imported
to staffs from HRD experts about dealing with
patients/relatives under grievous mental stress
due to some loss/injury.

38.  Academic & technical up gradation: To keep
pace with fast changing scenario of technical
advancement, one should regularly attend
CMEs, workshops and other academic sessions
should also be organized to upgrade our junior
staff and nursing team.
 Medical ethics laws: A through knowledge of
medical ethics and laws is essential for all
medical professionals. Unless we know about
something we can't improve/correct our
practice standards so We should always try to
get feedback from our patients about our
setup, our staff, charges etc.

39. PREVENTION AT PRACTICE
The reasonable skill & care: There are 3
aspects of reasonable skill and care
1. Medical Aspect: First and foremost it is
imperative for every doctor/hospital/nursing
home to exercise reasonable skill and care
expected of an average person with equivalent
qualification and experience in similar
circumstances.
2. Social Aspect: We should always exhibit our
reasonable skill and care to the patient/
attendants/relatives, through expressions, body

40. language, actions and discussions. These must
be visibly palpable. We may be very sincere but
failure to exhibit these gestures may lead to
doubts in the mind of patients and their
relatives.
(3) Legal Aspects: This includes documentation
about exercising reasonable skill and care in
consultation, diagnosis and treatment.
This can be done by making good clinical notes
of findings on examination and treatment
given.
(4) Proper Documentation: Please make sure
that handwriting is legible.

41. PREVENTION BY
PROFESSIONAL INDEMNITY
 Insurance cover: Profession indemnity
insurance is a tool which not only meets the
claim of compensation awarded against doctor/
hospital but also gives a sense of mental
security that even if same negligence is proved
the insurance company will take care of it.
• Please clarify in detail about different individual
premium rates of insurance in case of
insurance, Doctor/nursing home/hospital with
qualified staff and unqualified but trained staff
because at time of paying compensation there

42. are many such enquiries are made by
insurance company.
 The insurance companies not only pay the
compensation to other party but also arrange
for the legal help from advocates because they
some time join hand with other party for
monetary gains with an excuse that it’s the
insurance not the doctor who is to pay the
compensation.

43. GENERAL GUIDELINES FOR
LEGAL DEFENSE
 Not defending yourself and hospital is
negligence. We should always make all possible
points in defense in first instance of making a
reply to the complainant. Subsequent points
during hearing of the case are liable to be
rejected.
(a) TECHNICAL DEFENSES:
 The medical service rendered was free of
charge (now, this is applicable in certain
situations only).

44. The complaints frivolous and vexatious
and liable to be dismissed under section 26
of the Act.
Inform your insurance company in writing
with a copy of the complaint.
Complaint is time-barred.

45. FACTUAL DEFENSES
 Mention your qualifications, training,
experience, expertise etc. Support with relevant
documents.
 Mention hospitals infrastructure facilities,
special facilities, back-up support, it with
documents.
 Complainant has not come to the court with
clean hands i.e. he has suppressed material
facts, e.g. previous illness, treatment etc.
 Inconsistence between notices sent directly or
through consumer groups and the complaint

46.  Written evidence of consent of the
patient/relative/attendant to assumption of
inherent and special risks in the treatment.
 Circumstances of the case; viz. There was emergency,
lack of facilities (e.g. rural area) no one to give history
of patient’s illness etc.
 Consolation/treatment by patient from other
doctor/other systems of medicine simultaneously.
 Reasonable knowledge, skill and care
exercised (Rely/quote standard text books with