Implications of Refusal to Hand Over Patient Records
Hospitals and doctors even today do not hand over the patient records when demanded. This clearly amounts to contempt of the High Court and is actionable
Hospital and doctors always, until recently, believed that the indoor case records were the exclusive property of the hospital. What the patients had a right to was a ‘treatment summary’, which was handed over to them at the time of discharge. Hospitals and doctors invariably went to the extent of even depriving the patients of this when the patient discontinued treatment and took ‘discharge against medical advice’.
Hospitals and doctors had sound reasons for following this practice, for they believed that whatever came to their knowledge in the course of their professional practice could not be disclosed to any person.
Hippocratic Oath by which every freshly graduated medical student swears by states: “All that may come to my knowledge in the exercise of my profession or outside of my profession or in daily commerce with men, which ought not be spread abroad, I will keep secret and will never reveal.” The code of ‘Medical Ethics’ as formulated by the Medical Council of India also directs: “Confidences concerning individual or domestic life entrusted by patients to a physician and defects in the disposition or character of patients observed during medical attendance should never be revealed unless their revelation is required by the laws of the State.” To add to this, the textbook of Forensic Medicine reiterates this fact. Parikh’s Textbook of Medical Jurisprudence and Toxicology emphasises: A professional secret is one, which a doctor comes to know in his professional capacity. It should be said that he should that not divulge anything which he has thus learnt in confidence from his patients, of found on examination or noticed in the ordinary privacies of domestic lives. This is not only a moral obligation but also a legal one and a practitioner is liable to damages for its neglect. The above facts reaffirmed the views of the medical professionals that they were duty bound not to disclose the information they came across while they were treating their patients. This practice pursued by the medical profession came under judicial scrutiny in Poona Medical Foundation Ruby Hall Clinic vs. Marutirao L. Titkare and another.
The Hon’ble National Commission after hearing the parties on 11th January 1995, decided that when the in-door records were not supplied to the patient on demand there was no element of negligence or deficiency in the services rendered by the Hospital. The Hon’ble National Commission said:
“We find there is merit in the challenge raised by the appellant against the award of Rs 10,000 as compensation on the ground that failure on the part of the applicant to supply the complainant copies of the hospital records pertaining to the surgical operation performed on the complainant constitutes “negligence”. There can be no question of negligence by reasons of such failure to supply the papers unless there was a legal duty cast on the hospital to furnish such documents to a patient. The appellant hospital had duly given to the complainant at the time of his discharge, the discharge card and slip and also a case sheet wherein the particulars of the diagnosis and treatment administered to him has been mentioned. No material has been placed before us to show that either by law or convention or by practice there was any obligation on the part of the hospital to furnish to the patient full particulars of the surgical operation performed on him. It has also to be stated in this context that there was no arrangement of hiring of the services of the hospital by the complainant for consideration, with respect to the demand made by the complainant on the hospital, for being furnished such particulars and papers relating to the operation. Hence, we do not find it possible to uphold the views of the State Commission that the failure on the part of the appellant hospital to accede to the request of the complainant for being furnished all papers relating to the surgical operation and treatment constituted “negligence” and “deficiency in services” within the meaning of those expressions as defined in the Consumer Protection Act.” The order of the State Commission, which ruled otherwise, was thus set aside.
The patients and the consumer activists were not very happy with this ruling. Their views on this issue were very clear. They believed, and rightly so, that the patients had a right to know about everything that took place with respect to their healthcare management in the hospital. They further felt that under the garb of secrecy the doctors hid from them the true facts regarding the treatment. They vociferously further argued that the information the doctors gathered in the course of their professional practice was not a ‘privileged communication’ and therefore there were no reasons to withhold it from others.
Thus this issue once again stood the test of judicial scrutiny but this time it was the Hon’ble High Court of Bombay that applied its mind on this subject. In Raghunath G. Raheja vs. The Maharashtra Medical Council and others, the petitioner’s wife expired whilst under treatment and he demanded to be a privy to the indoor case records. The same, as usual, was denied to him. He also had other complaints against the Maharashtra Medical Council. Being thus aggrieved he filed a writ petition in the High Court of Bombay. Their Lordships were pleased to pronounce an order, which was not only a landmark judgement but also a trend setting one. Their Lordships said: “We have already referred to the scheme of the provisions of the Maharashtra Medical Council Act 1965 and the 1967 Rules framed thereunder. We are of the view that when the patient or his near relative demands from the hospital or the doctor the copies of the case papers, it is necessary for the hospital authorities and the doctors concerned to furnish copies of such case papers to the patient or his near relative. In our view it would be necessary for the Medical Council to ensure that necessary directions are given to all hospitals and doctors calling upon them to furnish the copies of the case papers and all relevant documents pertaining to the patient concerned. The hospital and the doctors may be justified in demanding necessary charges for supplying the copies of such documents to the patient or the near relative. We, therefore, direct the first respondent Maharashtra Medical Council to issue necessary circular in this behalf to all the hospitals and doctors in the State of Maharashtra. We do not think that the hospitals or the doctors can claim any secrecy or any confidentiality in the matter of copies of the case papers relating to the patients. These must be made available to him on demand subject to payment of usual charges.” The hospitals and the doctors were now saddled with two divergent judgements on the same issue. But the fact remains that the Bombay High Court judgement has an over-riding effect and becomes an enforceable law on this subject. So as things stand today, this precedent is binding on all Consumer Forums and Commissions including the National Commission – New Delhi. It therefore necessarily means that when an application is made for the patient records, a hospital or a doctor is duty bound to hand over a certified copy of the same. Does this mean that a copy is to be handed to anybody and everybody who demands for the same? As per the directions of the High Court only the patient or the patient’s near relatives (when the patient is no more) are entitled to it.
Hospitals and doctors even today do not hand over the patient records when demanded. This clearly amounts to contempt of the High Court and is actionable.
