Muller Journal of Medical Sciences and Research

REVIEW ARTICLE
Year
: 2013  |  Volume : 4  |  Issue : 1  |  Page : 18--22

Significance and prospective of "Consumer Protection Act" deliberations for the dentist


Puneet Kumar1, Prince Kumar2, Roshni Dupare3, Vineet Gupta4, Ashish Khattar5,  
1 Department of Public Health Dentistry, Shree Bankey Bihari Dental College and Research Centre, Ghaziabad, Uttar Pradesh, India
2 Department of Prosthodontics, Shree Bankey Bihari Dental College and Research Centre, Ghaziabad, Uttar Pradesh, India
3 Department of Public Health Dentistry, YC Dental College, Ahmednagar, Maharashtra, India
4 Department of Oral Pathology, DJ Dental College, Modinagar, Ghaziabad, Uttar Pradesh, India
5 Private Practitioner, Pitampura, New Delhi, India

Correspondence Address:
Puneet Kumar
Department of Public Health Dentistry, Shree Bankey Bihari Dental College and Research Centre, Masuri, Ghaziabad
India

Abstract

Practicing medicine in India has revolutionized during the last five decades affecting the health-care delivery in both positive and negative directions. This actually let the establishment of norm that would legally govern the medical treatment and make it answerable everyway; therefore, doctors were covered by various laws. Moreover, the doctor-patient relationship has undergone a transition throughout the ages. This liaison was primarily between a patient in quest of help and a doctor whose decisions were silently compiled with by the patient. Medical negligence arises from an act or omission by a medical/dental practitioner, which no reasonably-competent and careful practitioner would have committed. Here, authors have sought the Consumer Protection Act and related legal-issues that may assist dental professionals to be on a legally safer side.



How to cite this article:
Kumar P, Kumar P, Dupare R, Gupta V, Khattar A. Significance and prospective of "Consumer Protection Act" deliberations for the dentist.Muller J Med Sci Res 2013;4:18-22


How to cite this URL:
Kumar P, Kumar P, Dupare R, Gupta V, Khattar A. Significance and prospective of "Consumer Protection Act" deliberations for the dentist. Muller J Med Sci Res [serial online] 2013 [cited 2020 Apr 8 ];4:18-22
Available from: http://www.mjmsr.net/text.asp?2013/4/1/18/112267


Full Text

 Introduction



The dental profession is a vocation in which knowledge and skill is used for the service of others. Being a health-care provider it carries with it a responsibility to individual patients and society. The special status that society confers on the professionals requires them to behave in an ethical manner. This responsibility should be at the core of the professional's ethical behavior. In India, the Consumer Protection Act (CPA) of 1986 was enacted for better protection of the interests of consumer grievances. Consumers can file their complaints, which will be entertained by the judicial bodies referred to as consumer forums, which have been empowered to award compensation to aggrieved consumers for the hardships they have endured. [1] Finally, it was on 13 th November 1995 that the honorable Supreme Court of India delivered judgment on application of CPA, 1986 to the medical/dental profession, hospitals, dispensaries, nursing homes, and other related services. This act empowers the patient to file law-suits (in case of perceived negligence) in consumer courts. [2] It is concerned only with negligent acts. Medical negligence arises from an act or omission by a medical/dental practitioner, which no reasonably competent and careful practitioner would have committed. The relationship between doctor and patient is based on trust and confidence. However, patients are sometimes dissatisfied with the treatment they receive from their dentists and the patient turns to a legally competent body, which can judge whether the complaint is reasonable or not. Earlier, the remedy for medical negligence was available only under the law of Tort. Now, it is possible to get speedy redressal under CPA for such negligence. [2],[3] Thus, this study was performed to assess the awareness of CPA among dental and medical practitioners.

 Consumer Dispute Redressal Agencies



Consumer disputes redressal agencies (popularly known as Consumer Forums or Consumer Courts) are set-up under the Act at district, state, and national level to provide simple and inexpensive quick redressal against consumer complaints. In India, the CPA 1986 envisages three-tier grievance redressal mechanisms: [4],[5],[6]

District Consumer Disputes Redressal Commission was established by State Government for each district headed by President and two members. President must be qualified to be a District Judge. Presently 569 district forums are functioning. Pecuniary where compensation claimed is not exceeding Rs. 20 lakhs.State Consumers Dispute Redressal Commission was established by State Government and Headed by President and two members. President must be a person who is or has been a Judge of a High Court. Presently 32 State Commissions are functioning in the country. It hears original complaint, which includes pecuniary jurisdiction where compensation claimed exceeds Rs. 20 lakhs up to rupees one crore.National Consumers Dispute Redressal Commission was established by Central Government and located in New Delhi and headed by President and five members. President must be a person who is or has been a Judge of the Supreme Court. It entertains complaints where compensation claimed for value of goods or services exceeds rupees one crore. Within 30 days from the date of decision, appeal can be filed in the higher commission. Appeal against the decision of the district forum can be filed before the state commission. Appeal against the decision of the State commission can be filed before the National commission. Appeal against the decision of the National commission can be filed before the Supreme Court. The authority that may sue the doctor includes, patient himself, registered consumer organizations, State or Central Government, the legal heir or legal representative. Apart from the above, official complained may be filed against, all medical practitioners (medical, dental, others), all private or trust hospitals, polyclinics, Government hospitals and doctors, laboratories, X-ray clinic, the nurses, and paramedical staff, medical stores, pharmaceutical companies and quacks.

If you receive a summon from a court of law or consumer forum, immediately inform your insurance company at the earliest and keep a photocopy of the papers and envelope received, and send the originals to the insurance company. Write a summary of the treatment using treatment record to refresh your memory and include all that you can remember. Make a photocopy of the complete records and keep the originals at a safe place. Tell your staff about the suit and instruct them not to talk to anyone about the case without your permission. The permissible time limit to file a complaint is 2 years from the date of injury. If the patient is aware of certain facts regarding treatment then time starts from that point. The time starts from the date of injury and not from the date of disability certificate. However, if the injury is continuous then the time starts from the date of last treatment given.

 Doctor Patient Relationship



The nature of the doctor/patient relationship essentially forms a simple contract. In essence, patients seek professional services from a practitioner, with the expectation that their professional needs will be addressed, resulting in a "cure" of some type. The doctor, on the other hand, consensually agrees to treat the patient, with the expectations of affecting such a "cure" and receiving compensation for the professional services rendered. It has been stated that "talk is the main ingredient in medical-care and it is the fundamental instrument by which the doctor-patient relationship is crafted and by which therapeutic goals are achieved." There have been four patterns of doctor/patient relationship have been described. [7]

The paternalistic approach is typified by a doctor centred style. It relies on closed questions designed to elicit "yes" or "no" answers. The doctor will tend to use a disease centred model and be focused on reaching a diagnosis, rather than the patient's unique experience of illness. In consumeristic relationship, the patient knows exactly what they want and forces the doctor into a patient centred approach whereas in default relationship the patient centred style fails. The doctor is trying to relinquish control but the patient is unwilling to accept it. The result is an impasse. Additionally, in mutuality the doctor uses open questions to encourage the patient to talk about his complaint. This approach relies on taking time to listen and trying to understand the patient's point of view. [8]

 Consent



The term "consent" is defined as "When two or more persons agree upon the same thing in the same sense they are said to consent" as per the definition of "consent" given in section 13 of Indian Contract Act, 1872. It is the legal issue that protects every patient's right not to be touched or in any way treated without the patient's authorization. In implied consent, the fact that a patient comes to a doctor for an ailment implies that he is agreeable to medical examination in the general sense. This, however, does not imply consent to procedures more complex than that inspection, palpation, percussion, auscultation, and routine sonography. [9],[10]

Anything other than the implied consent is express consent. This may be either oral or written. Express oral consent is obtained for relatively minor examinations or therapeutic procedures, preferably in the presence of a disinterested third party. A written signed consent to the treatment is the most substantial consent for protecting a dental surgeon from litigation. Express written consent is to be obtained for all major diagnostic procedures, general anesthesia, for surgical operations, and intimate examinations. [11],[12]

Informed Consent

Informed consent is the process of obtaining the permission of a subject to participate in studies and to give an opportunity to decide about his or her health-care. Informed consent means understanding of the patients of:

The nature of his/her conditionThe nature of the proposed treatment or procedureThe alternative to such a course or actionThe risks involved in both the proposed and alternative procedureThe relative chances of success or failure of both procedures, so that the patient may accept or reject the procedureIf it is experimental, it should be stressed.

Who Can Give Consent?

Any person who is conscious, mentally sound can provide consent. Under Section 11 that only those persons who are of and above 18 years of age are competent to enter into a contract. Consent should be obtained, specially written consent, from parents/guardian of a patient who is below 18 years so that validity of the contract is not challengeable. Consent would not be valid when given by a person under 18 years of age or a person of unsound mind, given under fear, fraud, or mis-representation of facts, given by a person who is ignorant of the implications of the consent. [13],[14],[15] However, there are certain situations where consent may not be obtained like medical emergencies or in case of person suffering from a notifiable disease i.e., AIDS/HIV positive patients or in case of a person where a court may order for psychiatric examination or treatment.

 Common Elements for Litigation Crown and Bridgework

Poor fit of denturesDisturbance of function including temporomandibular joint painCost/value issuesUnexpected complications (e.g., irreversible pulpitis).

 Endodontics

Fractured or retained instrumentsPain following endodontic treatmentRecurrent pathologyDamage to adjacent teeth structuresCost/value concernsForeign body left after treatment.

 Restorative Dentistry



Failure of multiple fillingsComposite fillings, particularly posterior composites.

 Oral Surgery

Paraesthesia to lingual and inferior dental nerve including taste disturbanceUnexpected sequel (e.g., involvement of the antrum)Removal of wrong teethRetained rootsDamage to adjacent structures.

 Periodontal Care

Failure to monitor periodontal diseaseFailed surgery.

 Orthodontics

Unexpected relapseDamage to teeth and adjacent structures (e.g., loss of vitality and resorption)Specialist versus non-specialist treatmentsInappropriate treatment plans.

 Failure to Diagnose



Neglect in diagnosis of periodontal disease or cariesOral carcinomaRisk of bacterial endocarditis.

 Preventive Steps against Litigation



When the doctors feel that the patient is suffering from some major illness in which complications are pre-existing or are likely to occur, the precautions desired to be taken may be summarized as Do's and Dont's which are: [16],[17]

Some Do'sMention your qualifications on the prescriptionAlways mention date and timing of the consultationMention age, gender, weight (if child)In complicated cases, always record precisely history of illness and substantial physical findings about the patient on the prescriptionIf the patients/attendants are erring on any count (history not reliable, refusing investigations, refusing admission) make a note of it or seek written refusal preferably in local language with proper witnessMention the condition of patient in specific/objective terms. Avoid vague/non-specific terminologyWrite name of drug clearly. Use correct dosagesMention additional precautions, e.g., food, rest, avoidance of certain drugs, allergens, alcohol, and smoking etc., if indicatedMention whether prognosis explained. If necessary take a signature of patient/attendant, after explaining the prognosis in written local languageIn case of any deviation from standard care, mention reasonsSpecifically, mention review, follow-up scheduleMention if patient/attendant is/are under the effect of alcohol/drugsIn case a particular drug/equipment is not available, make a noteMention where the patient should contact in case of non-availability/emergency of doctor.Some Dont's

Do not hesitate to discuss the case with your colleaguesDo not hesitate to discuss the case with patients/attendantsDo not write ayurvedic formulationsDo not allow substitutionsDo not examine the patient if you are sick, exhausted, under effect of alcoholNever talk loose of your colleagues, despite intense professional rivalryDo not adopt experimental method in treatment.Protection Against Outcome of Litigation

A tertiary level of protection against outcome of litigation would be to go for insurance cover. Professional indemnity insurance cover became available for doctors and medical establishments only recently, i.e., from December 1991. These insurances are designed to provide the insured person protection against the financial consequences of legal liability.

 International Code of Medical Ethics Duties of Doctors in General



A doctor must always maintain the highest standards of professional conductA doctor must practice his profession uninfluenced by motives of profitAny act or advice that could weaken physical or mental resistance of a human being may be used only in his/her interest.

 Duties of Doctors to the Sick



A doctor must always bear in mind the obligation of preserving human lifeA doctor owes to his patient complete loyalty and all the resources of his science. Whenever an examination or treatment is beyond his capacity, he should summon another doctor who has the necessary abilityA doctor shall preserve absolute secrecy on all he knows about his patientsA doctor must give emergency cares as a humanitarian duty unless he is assured that others are willing and able to give such care.

 Conclusion



Law should not be a source of fear or an obstruction in the delivery of professional services. The profession should take an inward look and correct malpractices and distortions, which have given a negative image to a noble profession. Professionals should inculcate in their behavior and minds that the professions are for the service of the people and not professionals. Answer to all the problems lies in the strict self-control and standardization of professional care. Dental and medical councils should exercise their powers more vigilantly and strictly so that it will help in structuring the law and legal processes, primarily for the service of the society and secondarily to the advantage of the professionals.

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