CONSUMER CONSUMER PROTECTION ACT PROTECTION ACT (CPA / COPRA) (CPA / COPRA)

dr shabeelpndr shabeelpn

INTRODUCTIONINTRODUCTION

CHARAKA’S OATHCHARAKA’S OATH:: ““Thou shalt be free from envy, not cause Thou shalt be free from envy, not cause

anothers death, and pray for the welfare of anothers death, and pray for the welfare of all creatures.Day and night thou shalt not all creatures.Day and night thou shalt not desert a patient,nor commit adultery, be desert a patient,nor commit adultery, be modest in thy attire and appearance,not to modest in thy attire and appearance,not to be drunkard or sinful,while entering a be drunkard or sinful,while entering a patients house , be accompanied by a patients house , be accompanied by a person known to the patient.The peculiar person known to the patient.The peculiar customs of the patients household shall not customs of the patients household shall not be made public”be made public”

An act to provide better protection of An act to provide better protection of the interests of the consumers and for the interests of the consumers and for that purpose to make provisions for that purpose to make provisions for establishment of consumer councils and establishment of consumer councils and other authorities for the settlement of other authorities for the settlement of consumers dispute and for matters consumers dispute and for matters connected therewith.connected therewith.

The act was passed in 1986.The act was passed in 1986. The CPA(amendment)1993.The CPA(amendment)1993.

THE ACTTHE ACTSection 2(1)(d)(ii) of the actSection 2(1)(d)(ii) of the act

“ “Consumer” means any person who Consumer” means any person who hires or avails of any services for a hires or avails of any services for a consideration which has been paid consideration which has been paid or promised or partly paid and or promised or partly paid and partly promised or under any partly promised or under any system of deferred payment.system of deferred payment.

Section 2(1)(o)of the actSection 2(1)(o)of the act “ “Service” means service of any Service” means service of any

description which is made available description which is made available to potential users .Health care to potential users .Health care services will be service, if they are services will be service, if they are obtained for consideration.obtained for consideration.

Section 2(1)(o) of the actSection 2(1)(o) of the act … …and that in the event of any and that in the event of any

deficiency in the performance of deficiency in the performance of such services , the aggrieved party such services , the aggrieved party can invoke the remedies provided can invoke the remedies provided under the act by filing a complaint under the act by filing a complaint before the consumer forum having before the consumer forum having jurisdiction.jurisdiction.

ADVANTAGES OF CPA OVER ADVANTAGES OF CPA OVER CIVIL COURTCIVIL COURT

1.1. Limited time is needed for decision Limited time is needed for decision and action (period of 3 months).and action (period of 3 months).

2.2. No court fee is payableNo court fee is payable

COMPLAINT & COMPLAINANTCOMPLAINT & COMPLAINANT

Complaint: means any allegations Complaint: means any allegations in writing made by a complainant . in writing made by a complainant . Complainant: means Complainant: means (a) a consumer (a) a consumer

(b) any voluntary consumer (b) any voluntary consumer association registered under a association registered under a company’s act or under any other company’s act or under any other law for time being in force. law for time being in force.

Who can file a complaintWho can file a complaint

i.i. The patient who hires the services The patient who hires the services of a medical practitioner can file a of a medical practitioner can file a complaint.complaint.

ii.ii. It should be in writing .It should be in writing .

iii.iii. No oral complains can be filed .No oral complains can be filed .

NEGLIGENCENEGLIGENCE

Negligence consists in the omission Negligence consists in the omission to do something which a reasonable to do something which a reasonable man guided upon those man guided upon those considerations which ordinarily considerations which ordinarily regulate human affairs , would do, or regulate human affairs , would do, or doing something which a prudent & doing something which a prudent & reasonable man would not do.reasonable man would not do.

What constitutes deficiency in service What constitutes deficiency in service or negligenceor negligence

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

WhatWhat constitutes deficiency in service or constitutes deficiency in service or negligencenegligence

Reaction of injectionReaction of injection Patient left unattended while there were Patient left unattended while there were

complications.complications. Leaving patient in care of unqualified Leaving patient in care of unqualified

compounder.compounder. Foreign material left inside during operation of Foreign material left inside during operation of

leg.leg. Foreign material left in abdomenForeign material left in abdomen Death during operation.Death during operation. Post operative care.Post operative care. Refusal to admit the patient.Refusal to admit the patient.

What does not constitute deficiency in What does not constitute deficiency in service or negligenceservice or negligence

Performance of duty to the best of ability.Performance of duty to the best of ability. Adopting one out of two recognized Adopting one out of two recognized

schools of medicine.schools of medicine. Complainant failed to establish deficiency Complainant failed to establish deficiency

in service.in service. Patient having some medical history.Patient having some medical history. Bypass surgery.Bypass surgery. Patient of heart attack.Patient of heart attack. Decompression of spinal cord .Decompression of spinal cord .

Death during glucose drip.Death during glucose drip. Chronic ectopic pregnancy.Chronic ectopic pregnancy. Acute myeloblastic leukaemia.Acute myeloblastic leukaemia. Incision hernia.Incision hernia. Case of deviated nasal septum.Case of deviated nasal septum. Cyanotic congenital heart disease with Cyanotic congenital heart disease with

respiratory distress. respiratory distress.

Hospital and its negligenceHospital and its negligence

It is not only the medical practitioner It is not only the medical practitioner who may be found negligent the hospitals who may be found negligent the hospitals are also bound by the law and in certain are also bound by the law and in certain circumstances the hospitals are also circumstances the hospitals are also found negligent or deficient in services.found negligent or deficient in services.

WHO IS LIABLE TO CPAWHO IS LIABLE TO CPA

I.I. Doctors with independent practice Doctors with independent practice rendering only free services.rendering only free services.

II.II. Private hospital charging all.Private hospital charging all.III.III. All hospital having free as well as paying All hospital having free as well as paying

patients , they are liable to both.patients , they are liable to both.IV.IV. Doctors or hospitals paid by an insurance Doctors or hospitals paid by an insurance

firm for treatment of a client or an firm for treatment of a client or an employer for the treatment of an employee.employer for the treatment of an employee.

WHO IS NOT LIABLE TO CPAWHO IS NOT LIABLE TO CPA

Doctors in hospitals , which do not charge Doctors in hospitals , which do not charge their patients.their patients.

Hospitals offering free services to all patients.Hospitals offering free services to all patients.

PROCEDURES FOR LODGING PROCEDURES FOR LODGING A COMPLAINTA COMPLAINT

The redressal agency have a three-tier The redressal agency have a three-tier structure.structure.

1) District level : at this forum person 1) District level : at this forum person can claim for compensation towards damage can claim for compensation towards damage upto a maximum limit of Rs : 5 lakh .A upto a maximum limit of Rs : 5 lakh .A district judge and 2 other members chair this district judge and 2 other members chair this of which one of whom shall be a women.of which one of whom shall be a women.

(2) State level: At this level the claim for (2) State level: At this level the claim for compensation is enhanced to Rs: 5 – 20 lakhs compensation is enhanced to Rs: 5 – 20 lakhs & high court judge & 2 other members chair & high court judge & 2 other members chair it.it.

(3) National level: Here the (3) National level: Here the compensation claimed is more than 20 compensation claimed is more than 20 lakhs .This forum constitutes of a supreme lakhs .This forum constitutes of a supreme court judge ,4 other members.court judge ,4 other members.

PROVISION FOR APPEALPROVISION FOR APPEAL

Within 30 days from the date of Within 30 days from the date of decision ,appeal can be filed in the higher decision ,appeal can be filed in the higher commision commision

1. Appeal against district forum 1. Appeal against district forum before state commision .before state commision .

2.Appeal against state commision 2.Appeal against state commision before national commision.before national commision.

3.Against national commision 3.Against national commision before supreme court.before supreme court.

PREVENTIVE STEPS PREVENTIVE STEPS AGAINST LITIGATIONAGAINST LITIGATION

Precautions may be summarized as “Do’s & Dont’s”Precautions may be summarized as “Do’s & Dont’s” SOME DO’SSOME DO’S

-Mention your qualifications on the prescription.-Mention your qualifications on the prescription.

-Mention date & timing of consultation.-Mention date & timing of consultation.

-Mention age, sex, weight (child).-Mention age, sex, weight (child).

-In complicated cases-In complicated cases record history of illness & record history of illness & physical findings about the patient.physical findings about the patient.

-Avoid vague or nonspecific -Avoid vague or nonspecific terminology.terminology.

-Record history of drug allergy.-Record history of drug allergy. -Mention additional precautions eg; -Mention additional precautions eg;

food, rest.food, rest. -In case of any deviation from standard -In case of any deviation from standard

care , mention reason .care , mention reason .

SOME DONT’SSOME DONT’S

-Do not hesitate to discuss the case with your -Do not hesitate to discuss the case with your colleagues.colleagues.

-Do not hesitate to discuss the case with patients -Do not hesitate to discuss the case with patients or attendants.or attendants.

-Do not write ayurvedic formulations.-Do not write ayurvedic formulations. -Do not allow substitutions.-Do not allow substitutions. -Do not examine a patient if you are sick, -Do not examine a patient if you are sick,

exhausted or under effect of alcohol.exhausted or under effect of alcohol. -Do not adopt experimental method in treatment-Do not adopt experimental method in treatment

Another major & important thing to Another major & important thing to do for a doctor is to obtain proper do for a doctor is to obtain proper consent of a patient or attendant or consent of a patient or attendant or relative.relative.

The term consent is defined as “when The term consent is defined as “when two or more person agree upon the two or more person agree upon the same thing in the same sense they are same thing in the same sense they are said to consent” (as per section 13 of said to consent” (as per section 13 of Indian contract act ,1872)Indian contract act ,1872)

CONSENTCONSENT

TYPES OF CONSENTTYPES OF CONSENT

Implied consent or tacit.Implied consent or tacit.Express consent.Express consent.Informed consentInformed consentProxy consent / substitute consent.Proxy consent / substitute consent.

Implied consentImplied consent

• Most common variety of consent in both Most common variety of consent in both general practice & hospital practice.general practice & hospital practice.

• Patient comes to doctor for an ailment Patient comes to doctor for an ailment implies that he is agreeable to medical implies that he is agreeable to medical examination in general sense.examination in general sense.

• Egs: inspection , Egs: inspection , palpitation,percussion,auscultation.palpitation,percussion,auscultation.

Express ConsentExpress Consent

• Anything other than implied consent is Anything other than implied consent is expressed consent.expressed consent.

• May be either oral or written.May be either oral or written.

• Is obtained for relative minor Is obtained for relative minor examinations or therapeutic procedures , examinations or therapeutic procedures , in the presence of a disinterested third in the presence of a disinterested third party.party.

• All major diagnostic procedure, general All major diagnostic procedure, general anesthesia, for surgical operation.anesthesia, for surgical operation.

Informed consentInformed consent

• The concept of informed consent has come to The concept of informed consent has come to the fore in recent years.the fore in recent years.

• All information must be explained in All information must be explained in comprehensible non medical terms comprehensible non medical terms preferably in local languages about the preferably in local languages about the

a)a) DiagnosisDiagnosisb)b) Nature of treatmentNature of treatmentc)c) Risks involvedRisks involvedd)d) Prospects of success.Prospects of success.e)e) Prognosis Prognosis f)f) Alternative methods of treatment. Alternative methods of treatment.

Proxy Consent / Substitute Proxy Consent / Substitute ConsentConsent

• All the above types of consent can All the above types of consent can take the shape of proxy consent.take the shape of proxy consent.

• Parent for child, close relatives for Parent for child, close relatives for mentally unsound or unconscious mentally unsound or unconscious patients etc.patients etc.

• When child suffer damage due to When child suffer damage due to negligence of the hospital, nurse & negligence of the hospital, nurse & doctor ,it was held that child & parent doctor ,it was held that child & parent could claim compensation under CPA.could claim compensation under CPA.

How consent should be How consent should be obtainedobtained

• The person obtaining the consent should The person obtaining the consent should see thatsee that

• The patient understands in simple The patient understands in simple language what the medical treatment is, its language what the medical treatment is, its purpose & why it is being proposed.purpose & why it is being proposed.

• The patient should understand its The patient should understand its principal benefits , risks & alternatives.principal benefits , risks & alternatives.

• The patient should understand ,in The patient should understand ,in broad terms, what the consequences would broad terms, what the consequences would be of not receiving the proposed treatment.be of not receiving the proposed treatment.

• Retain the information long Retain the information long enough to make an effective enough to make an effective decision.decision.

• Make a free choice.Make a free choice.

Who can give consentWho can give consent

• For the purpose of clinical examination , For the purpose of clinical examination , diagnosis & treatment consent can be diagnosis & treatment consent can be given by any person who is conscious, given by any person who is conscious, mentally sound & is of & above 12 yrs of mentally sound & is of & above 12 yrs of age( section 88 & 90 of the IPC 1860). age( section 88 & 90 of the IPC 1860).

• However under section 11, those person However under section 11, those person who are & above 18 years of age are who are & above 18 years of age are competent to enter into a contract.competent to enter into a contract.

Right to refuse consentRight to refuse consent

• A competent adult has a right to A competent adult has a right to refuse treatment even if others, refuse treatment even if others, including medical practitioners, including medical practitioners, believe that the refusal is neither in believe that the refusal is neither in his best interest nor reasonable.his best interest nor reasonable.

When consent is not validWhen consent is not valid

• Consent given under fear, fraud or Consent given under fear, fraud or misrepresentation of facts, or by a misrepresentation of facts, or by a person who is ignorant of the person who is ignorant of the implications of the consent or who is implications of the consent or who is under 12 years of age is invalid. under 12 years of age is invalid. (section 90 IPC)(section 90 IPC)

Situations where consent may Situations where consent may not be obtainednot be obtained

1.1. Medical emergenciesMedical emergencies2.2. In case of person suffering from a notifiable In case of person suffering from a notifiable

disease , eg: AIDS .disease , eg: AIDS .3.3. Immigrants.Immigrants.4.4. Members of armed forces.Members of armed forces.5.5. Handlers of food and diary men.Handlers of food and diary men.6.6. New admission to prisons.New admission to prisons.7.7. In case of a person where a court may In case of a person where a court may

order for psychiatric examination or order for psychiatric examination or treatment.treatment.

After a medical mishap the After a medical mishap the following things should be following things should be donedone1.1. Complete patients record & recheck Complete patients record & recheck

the written notes.the written notes.

2.2. Be frank enough & inform clearly of Be frank enough & inform clearly of the mishap.the mishap.

3.3. After these initial responses the After these initial responses the doctor should contact some other doctor should contact some other doctor or protection organization to doctor or protection organization to seek advice.seek advice.

Model Form Of ConsentModel Form Of Consent

I……..son of………aged………resident I……..son of………aged………resident of…….. being under the treatment of………of…….. being under the treatment of………(state here name of doctor/hospital/nursing (state here name of doctor/hospital/nursing home) do hereby give consent to the home) do hereby give consent to the performance of medical / surgical performance of medical / surgical /anesthesia/diagnostic procedure of ………./anesthesia/diagnostic procedure of ……….(mention nature of procedure /treatment to (mention nature of procedure /treatment to be performed etc) upon myself or upon be performed etc) upon myself or upon ………aged……….who is related to me as ………aged……….who is related to me as ………(mention here relationship ………(mention here relationship eg :son ,mother ,daughter).eg :son ,mother ,daughter).

I declare that I am more than 18 yrs of age .I I declare that I am more than 18 yrs of age .I have been informed that there are inherent have been informed that there are inherent risks involved in the treatment or procedure .i risks involved in the treatment or procedure .i have signed this consent voluntarily out of my have signed this consent voluntarily out of my free will without any pressure & in my fell free will without any pressure & in my fell senses. senses.

Date PlaceDate Place

Signature TimeSignature Time

(To be signed by parent/guardian in case of (To be signed by parent/guardian in case of minor)minor)

Protection against false or Protection against false or frivolous complaintsfrivolous complaints

Where a complaint instituted before the Where a complaint instituted before the district forum ,sate commission ,the district forum ,sate commission ,the national commission, is found to be national commission, is found to be frevolous or vexatious , it shall, for frevolous or vexatious , it shall, for reasons to be recorded in reasons to be recorded in writing ,dismiss the complaint & make writing ,dismiss the complaint & make an order that the complaint shall pay to an order that the complaint shall pay to the opposite party such cost, not the opposite party such cost, not exceeding 10,000 Rs , as may be exceeding 10,000 Rs , as may be specified in the order.specified in the order.

LIMITATIONLIMITATION

Limitation period : the district Limitation period : the district forum ,the state commission or the forum ,the state commission or the national commission shall not admit national commission shall not admit a complaint unless it is filed within a complaint unless it is filed within 2 years from the date on which the 2 years from the date on which the cause of action has arisen.cause of action has arisen.

INTERNATIONAL CODE FOR INTERNATIONAL CODE FOR MEDICAL ETHICSMEDICAL ETHICS

Duties of Doctors in GeneralDuties of Doctors in General A Doctor must always maintain the A Doctor must always maintain the

highest standards of professional highest standards of professional conduct. conduct.

A Doctor must practice his A Doctor must practice his profession uninfluenced by motives of profession uninfluenced by motives of profit .profit .

The following practices are deemed The following practices are deemed unethicalunethical

Any self advertisement except such as Any self advertisement except such as is expressly authorized by the national is expressly authorized by the national code of medical ethics.code of medical ethics.

Collaboration in any firm of medical Collaboration in any firm of medical service in which he or she does not have service in which he or she does not have professional independence.professional independence.

Receiving any money in connection Receiving any money in connection with services rendered to a patient other with services rendered to a patient other than a proper professional care ,even with than a proper professional care ,even with the knowledge of the patient.the knowledge of the patient.

Any act or advice that could weaken Any act or advice that could weaken physical or mental resistance of a physical or mental resistance of a human being may be used only in his human being may be used only in his interest.interest.

A doctor is advised to use great caution A doctor is advised to use great caution in divulging discoveries or new in divulging discoveries or new techniques of treatment.techniques of treatment.

A Doctor should certify or testify only to A Doctor should certify or testify only to that which he has personally verified .that which he has personally verified .

Duties of doctor to the sickDuties of doctor to the sick A Doctor must always bear in mind the A Doctor must always bear in mind the

obligation of preserving human life.obligation of preserving human life. A Doctor owes to his patient complete A Doctor owes to his patient complete

loyalty & all resources of his science.loyalty & all resources of his science. Doctors shall preserve absolute secrecy Doctors shall preserve absolute secrecy

on all he knows about his patient on all he knows about his patient because of the confidence entrusted in because of the confidence entrusted in him. him.

A Doctor must give emergency care A Doctor must give emergency care as a humanitarian duty unless he is as a humanitarian duty unless he is assured that others are willing & able assured that others are willing & able to give such care.to give such care.

Duties of Doctor to each other Duties of Doctor to each other A Doctor ought to behave to his A Doctor ought to behave to his

colleagues , as he would have them colleagues , as he would have them behave to him.behave to him.

A Doctor must not entices patients A Doctor must not entices patients from his colleagues .from his colleagues .

A Doctor must observe the principles A Doctor must observe the principles of “Declaration of Geneva”. of “Declaration of Geneva”.

DECLARATION OF DECLARATION OF GENEVAGENEVA

I will solemnly pledge myself to I will solemnly pledge myself to consecrate my life to the service of consecrate my life to the service of humanity.humanity.

I will give to my teachers the respect I will give to my teachers the respect & gratitude which is their due.& gratitude which is their due.

I will practice my profession with I will practice my profession with conscience & dignity.conscience & dignity.

The health of my patient will be my The health of my patient will be my first consideration.first consideration.

I will respect the secret which are I will respect the secret which are confided in me ,even after the confided in me ,even after the patient has died.patient has died.

I will maintain by all the means in my I will maintain by all the means in my power the honor & the noble power the honor & the noble traditions of the medical profession.traditions of the medical profession.

My colleagues will be my brothers .My colleagues will be my brothers .I will not permit considerations of religion, I will not permit considerations of religion,

nationality, race, party politics, or social nationality, race, party politics, or social standing to intervene between my duty & standing to intervene between my duty & my patient.my patient.

I will maintain the utmost respect for human I will maintain the utmost respect for human life from the time of conception , even life from the time of conception , even under threat .I will not use my medical under threat .I will not use my medical knowledge contrary to the laws of humanity.knowledge contrary to the laws of humanity.

I make these promises solemnly ,freely & I make these promises solemnly ,freely & upon my honor.upon my honor.

CONCLUSIONCONCLUSION

Consumer Protection Act Consumer Protection Act provide for better protection of the provide for better protection of the interests of consumer & for that interests of consumer & for that purpose to make provision for the purpose to make provision for the establishment of consumer councils establishment of consumer councils & other authorities for settlement on & other authorities for settlement on consumers disputes & for matters consumers disputes & for matters connected therewith.connected therewith.

REFERENCEREFERENCE

Consumer Protection Act & Medical Consumer Protection Act & Medical Practitioners – J V N JaiswalPractitioners – J V N Jaiswal

Essentials Of Preventive And Essentials Of Preventive And Community Dentistry – Soben PeterCommunity Dentistry – Soben Peter

THANK YOU!!!