CONSUMER PROTECTION ACT (CPA / COPRA)

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CONSUMER PROTECTION ACT (CPA / COPRA)

dr shabeel pn
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INTRODUCTION

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

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• An act to provide better protection of the
  interests of the consumers and for that purpose
  to make provisions for establishment of consumer
  councils and other authorities for the settlement
  of consumers dispute and for matters connected
  therewith.
• The act was passed in 1986.
• The CPA(amendment)1993.

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THE ACT

• Section 2(1)(d)(ii) of the act
• Consumer means any person who hires or
  avails of any services for a consideration which
  has been paid or promised or partly paid and
  partly promised or under any system of deferred
  payment.

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• Section 2(1)(o)of the act
• Service means service of any description
  which is made available to potential users
  .Health care services will be service, if they
  are obtained for consideration.

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• Section 2(1)(o) of the act
• and that in the event of any deficiency in
  the performance of such services , the aggrieved
  party can invoke the remedies provided under the
  act by filing a complaint before the consumer
  forum having jurisdiction.

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ADVANTAGES OF CPA OVER CIVIL COURT

1. Limited time is needed for decision and action
   (period of 3 months).
2. No court fee is payable

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COMPLAINT COMPLAINANT

• Complaint means any allegations in writing made
  by a complainant . Complainant means
  (a) a consumer
• (b) any voluntary consumer association registered
  under a companys act or under any other law for
  time being in force.
  

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Who can file a complaint

1. The patient who hires the services of a medical
   practitioner can file a complaint.
2. It should be in writing .
3. No oral complains can be filed .

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NEGLIGENCE

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

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What constitutes deficiency in service or
negligence

• Deficiency of service means 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 or otherwise in relation
  to any service .

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What constitutes deficiency in service or
negligence

• Reaction of injection
• Patient left unattended while there were
  complications.
• Leaving patient in care of unqualified
  compounder.
• Foreign material left inside during operation of
  leg.
• Foreign material left in abdomen
• Death during operation.
• Post operative care.
• Refusal to admit the patient.

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What does not constitute deficiency in service or
negligence

• Performance of duty to the best of ability.
• Adopting one out of two recognized schools of
  medicine.
• Complainant failed to establish deficiency in
  service.
• Patient having some medical history.
• Bypass surgery.
• Patient of heart attack.
• Decompression of spinal cord .

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

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Hospital and its negligence

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

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WHO IS LIABLE TO CPA

1. Doctors with independent practice rendering only
   free services.
2. Private hospital charging all.
3. All hospital having free as well as paying
   patients , they are liable to both.
4. Doctors or hospitals paid by an insurance firm
   for treatment of a client or an employer for the
   treatment of an employee.

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WHO IS NOT LIABLE TO CPA

• Doctors in hospitals , which do not charge their
  patients.
• Hospitals offering free services to all patients.

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PROCEDURES FOR LODGING A COMPLAINT

• The redressal agency have a three-tier structure.
• 1) District level at this forum
  person can claim for compensation towards damage
  upto a maximum limit of Rs 5 lakh .A district
  judge and 2 other members chair this of which one
  of whom shall be a women.

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• (2) State level At this level the
  claim for compensation is enhanced to Rs 5 20
  lakhs high court judge 2 other members chair
  it.
• (3) National level Here the
  compensation claimed is more than 20 lakhs .This
  forum constitutes of a supreme court judge ,4
  other members.

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PROVISION FOR APPEAL

• Within 30 days from the date of decision ,appeal
  can be filed in the higher commision
• 1. Appeal against district forum ?before
  state commision .
• 2.Appeal against state commision ?before
  national commision.
• 3.Against national commision ?before
  supreme court.

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PREVENTIVE STEPS AGAINST LITIGATION

• Precautions may be summarized as Dos Donts
• SOME DOS
• -Mention your qualifications on the
  prescription.
• -Mention date timing of consultation.
• -Mention age, sex, weight (child).
• -In complicated cases? record history of
  illness physical findings about the patient.

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• -Avoid vague or nonspecific
  terminology.
• -Record history of drug allergy.
• -Mention additional precautions eg
  food, rest.
• -In case of any deviation from
  standard care , mention reason .

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SOME DONTS

• -Do not hesitate to discuss the case
  with your colleagues.
• -Do not hesitate to discuss the case
  with patients or attendants.
• -Do not write ayurvedic formulations.
• -Do not allow substitutions.
• -Do not examine a patient if you are
  sick, exhausted or under effect of alcohol.
• -Do not adopt experimental method in
  treatment

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CONSENT

• Another major important thing to do for
  a doctor is to obtain proper consent of a patient
  or attendant or relative.
• The term consent is defined as when two or
  more person agree upon the same thing in the same
  sense they are said to consent (as per section
  13 of Indian contract act ,1872)

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TYPES OF CONSENT

• Implied consent or tacit.
• Express consent.
• Informed consent
• Proxy consent / substitute consent.

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Implied consent

• Most common variety of consent in both general
  practice hospital practice.
• Patient comes to doctor for an ailment implies
  that he is agreeable to medical examination in
  general sense.
• Egs inspection , palpitation,percussion,auscultat
  ion.

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Express Consent

• Anything other than implied consent is expressed
  consent.
• May be either oral or written.
• Is obtained for relative minor examinations or
  therapeutic procedures , in the presence of a
  disinterested third party.
• All major diagnostic procedure, general
  anesthesia, for surgical operation.

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Informed consent

• The concept of informed consent has come to the
  fore in recent years.
• All information must be explained in
  comprehensible non medical terms preferably in
  local languages about the
• Diagnosis
• Nature of treatment
• Risks involved
• Prospects of success.
• Prognosis
• Alternative methods of treatment.

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Proxy Consent / Substitute Consent

• All the above types of consent can take the
  shape of proxy consent.
• Parent for child, close relatives for mentally
  unsound or unconscious patients etc.
• When child suffer damage due to negligence of the
  hospital, nurse doctor ,it was held that child
  parent could claim compensation under CPA.

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How consent should be obtained

• The person obtaining the consent should see that
• ?The patient understands in simple language
  what the medical treatment is, its purpose why
  it is being proposed.
• ?The patient should understand its principal
  benefits , risks alternatives.
• ?The patient should understand ,in broad
  terms, what the consequences would be of not
  receiving the proposed treatment.

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• ? Retain the information long enough to make
  an effective decision.
• ? Make a free choice.

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Who can give consent

• For the purpose of clinical examination ,
  diagnosis treatment consent can be given by any
  person who is conscious, mentally sound is of
  above 12 yrs of age( section 88 90 of the IPC
  1860).
• However under section 11, those person who are
  above 18 years of age are competent to enter into
  a contract.

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Right to refuse consent

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

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When consent is not valid

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

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Situations where consent may not be obtained

1. Medical emergencies
2. In case of person suffering from a notifiable
   disease , eg AIDS .
3. Immigrants.
4. Members of armed forces.
5. Handlers of food and diary men.
6. New admission to prisons.
7. In case of a person where a court may order for
   psychiatric examination or treatment.

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After a medical mishap the following things
should be done

1. Complete patients record recheck the written
   notes.
2. Be frank enough inform clearly of the mishap.
3. After these initial responses the doctor should
   contact some other doctor or protection
   organization to seek advice.

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Model Form Of Consent

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

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• I declare that I am more than 18 yrs of age .I
  have been informed that there are inherent risks
  involved in the treatment or procedure .i have
  signed this consent voluntarily out of my free
  will without any pressure in my fell senses.
• Date Place
• Signature Time
• (To be signed by parent/guardian in case of minor)

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Protection against false or frivolous complaints

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

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LIMITATION

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

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INTERNATIONAL CODE FOR MEDICAL ETHICS

• ?Duties of Doctors in General
• A Doctor must always maintain the highest
  standards of professional conduct.
• A Doctor must practice his profession
  uninfluenced by motives of profit .

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• The following practices are deemed unethical
• ? Any self advertisement except such as is
  expressly authorized by the national code of
  medical ethics.
• ? Collaboration in any firm of medical
  service in which he or she does not have
  professional independence.
• ?Receiving any money in connection with
  services rendered to a patient other than a
  proper professional care ,even with the knowledge
  of the patient.

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• Any act or advice that could weaken physical or
  mental resistance of a human being may be used
  only in his interest.
• A doctor is advised to use great caution in
  divulging discoveries or new techniques of
  treatment.
• A Doctor should certify or testify only to that
  which he has personally verified .

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• Duties of doctor to the sick
• A Doctor must always bear in mind the obligation
  of preserving human life.
• A Doctor owes to his patient complete loyalty
  all resources of his science.
• Doctors shall preserve absolute secrecy on all he
  knows about his patient because of the confidence
  entrusted in him.

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

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• ? Duties of Doctor to each other
• A Doctor ought to behave to his colleagues , as
  he would have them behave to him.
• A Doctor must not entices patients from his
  colleagues .
• A Doctor must observe the principles of
  Declaration of Geneva.

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DECLARATION OF GENEVA

• ?I will solemnly pledge myself to consecrate my
  life to the service of humanity.
• ?I will give to my teachers the respect
  gratitude which is their due.
• ?I will practice my profession with conscience
  dignity.

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• ?The health of my patient will be my first
  consideration.
• ?I will respect the secret which are confided in
  me ,even after the patient has died.
• ?I will maintain by all the means in my power the
  honor the noble traditions of the medical
  profession.

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• ?My colleagues will be my brothers .
• ?I will not permit considerations of religion,
  nationality, race, party politics, or social
  standing to intervene between my duty my
  patient.
• ?I will maintain the utmost respect for human
  life from the time of conception , even under
  threat .I will not use my medical knowledge
  contrary to the laws of humanity.
• I make these promises solemnly ,freely upon my
  honor.

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CONCLUSION

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

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REFERENCE

• Consumer Protection Act Medical Practitioners
  J V N Jaiswal
• Essentials Of Preventive And Community Dentistry
  Soben Peter

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THANK YOU!!!