OFFICIAL CHARTERS FROM
GOVERNMENT OF INDIA
 MODEL
CITIZEN'S CHARTER |
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EMERGENCY SERVICES
IN HOSPITALS |
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POSTSCRIPT |
1. Preamble:
Government hospitals exist to provide every citizen of India with health care within resources and facilities available. Such care is to be made available without discrimination by age, sex, religion, caste, political affiliation, economic and social status. This Charter seeks to provide a framework which enables citizens to know what services are available, the quality of services they are entitled to and to inform them about the means through which complaints regarding denial or poor quality of service will be addressed.
2. Objectives:
2.1 To make available medical treatment and related facilities, for citizens who seek treatment at the hospital,
2.2 To provide the appropriate advice, treatment and support that would help cure the ailment to the extent medically possible,
2.3 To ensure that treatment is based on well considered judgement, is timely and comprehensive and with the consent of the citizen being treated,
2.4 To ensure users awareness of the nature of ailment, progress of treatment, duration of treatment and impact on their health and lives, and
2.5 To redress any grievance in this regard.
3. Components of service at hospitals:
3.1 Access to hospitals and professional medical care to all,
3.2 Making provision for emergency care after main treatment hours, whenever needed,
3.3 Informing users about available facilities, costs involved, and requirements expected of their with regard to treatment as well as use of hospital facilities, in clear and simple terms,
3.4 Informing users of equipments out of order,
3.5 Ensuring that users can seek clarifications on and assistance in making use of medical treatment and hospital facilities,
3.6 Collecting fees and charges that are reasonable and well known to public, and
3.7 Informing users about steps to be carried out in case of most of the common deficiencies in service.
4. Commitments of the Charter:
4.1 To provide access to available facilities without discrimination,
4.2 To provide emergency care, if needed, on reaching the hospital,
4.3 To provide adequate number (to be defined) of notice boards detailing location of all facilities,
4.4 To provide written information on diagnosis, treatment being administered, and costs that will be recovered, each day in case of in-patients,
4.5 To provide a receipt of all payments made for medical care,
4.6 To record complaints round the clock, and designate Medical Officers who will respond at an appointed time the same day in case of in-patients and the next day in case of out-patients.
5. Grievance redressal:
5.1 Grievances that citizens have will be recorded round the clock.
5.2 There will be a designated medical officer to respond to requests deemed urgent by the person recording the grievances.
5.3 Aggrieved users would, after having their complaint recorded, be allowed to seek a second opinion from within the hospital.
5.4 Have a Public Grievances Committee outside the hospital to deal with grievances that are not resolved within the hospital.
6. Steps that will be taken:
6.1 Hospital staff, Department of Health and citizens representatives will discuss the utility and content of the Charter before it is formulated.
6.2 The areas on which standards are prescribed will be selected on the basis of feedback from users of problems and deficiencies, collected by an independent body.
6.3 Systematic efforts will be made to create wide awareness that a Charter exists, among the users of the hospital, and
6.4 Performance in areas where standards have been specified in the Charter will be compiled and displayed publicly.
7. Responsibilities of the users:
7.1 Users of hospitals would attempt to understand the commitments made in the Charter and demand adherence,
7.2 Users would not insist on service above the standards set in the Charter, particularly because it could negatively affect the provision of the minimum acceptable level of service to another user,
7.3 Instructions of the hospital personnel would be followed sincerely, and
7.4 In case of grievances, the redressal machinery would be addressed by users without delay.
8. Feedback from the users:
8.1 The perceptions of users on the quality of service of hospitals would be systematically collected and analysed by an independent agency, and
8.2 The feedback would cover areas where standards have been specified as well as other areas where standards are proposed to be set up.
9. Performance audit and Review of the Charter:
9.1 Performance audit may be conducted through a peer review every year or every two years.
9.2 The audit would look at user feedback, records on adherence to committed standards, the performance on parameters where standards have not yet been set, and other indicators of successful goal realisation.
9.3 Identify areas where standards can be introduced, tightened, etc., opportunities for cost reduction, and areas where capacity building is required, and
9.4 Through re-assessment of the contents of the Charter every five years.
1. The Honourable Supreme Court in their judgement dt 6-5-96 in SLP (C) No.796/92 - Paschim Banga Khet Mazdoor Samity and others Vs State of West Bengal and another suggested remedial measures to ensure immediate medical attention and treatment to persons in real need. The State Government of West Bengal alone was a Party in the proceedings of the case. The Hon. Court has given directions that other States though not parties should also take necessary steps in the light of recommendations made by the Enquiry Committee which was set up by the State Government of West Bengal and further directions as given by the Court.
2. The following guidelines may also be kept in view while dealing with emergency cases in addition to the existing guidelines:-
i) In the hospital, the Medical Officer in the emergency/Casualty services should admit a patient whose condition is morbid/serious in consultation with the specialist concerned on duty in the emergency department.
ii) In case the vacant beds are not available in the concerned Department to accommodate such patient, the patient has to be given all necessary attention.
iii) Subsequently, the Medical Officer will make necessary arrangement to get the patient transferred to another hospital in the Ambulance. The position as to whether there is vacant bed in the concerned department has to be ascertained before transferring the patient. The patient will be accompanied by the resident Medical Officer in the Ambulance.
iv) In no case the patient will be left unattended for want of vacant beds in the emergency/Casualty Department.
v) The services of CATS should be utilised to the extent possible in Delhi.
vi) The efforts may be made to monitor the functioning of the emergency department periodically by the Heads of the institution.
vii) The Medical record of patient attending the emergency services should be preserved in the medical record department.
viii) The Medical Superintendent may coordinate with each other for providing better emergency services.
3. With regard to maintenance of admission register of patient, following may be kept in view:-
a) Clear recording of the name, age, sex, address and disease of the patient by the attending Medical Officer;
b) Clear recording of the date and time of attendance, examination/admission of the patient;
c) Clear indication whether and where the patient has been admitted, transferred, referred;
d) Safe custody of the Registers;
e) Periodical inspection of the arrangement by the Superintendent;
f) Fixing of responsibility of maintenance and safe custody of the Registers.
4. With regard to identifying the individual medical officer attending to the individual patient approaching OPD/emergency department of a hospital on the basis of consulting the hospital records, it has been directed by the Court that the following procedure should be followed in future:-
a) A copy of the Duty Roster of Medical Officers should be preserved in the Office of the Superintendent incorporating the modifications done for unavoidable circumstances;
b) Each Department shall maintain a register for recording the signature of attending medical officers denoting their arrival and departure time;
c) The attending medical officer shall write his full name clearly and put his signature in the treatment document;
d) The Superintendents of the hospital shall keep all such records in safe custody.
e) A copy of the ticket issued to the patient should be maintained or the relevant date in this regard should be noted in an appropriate record for future guidance.
It is appreciated that Hospital Superintendent/Medical Officers-in-charge may have difficulty in implementing these guidelines due to various constraints at the ground level and as such, feedback is vital to enable Government to refine and modify the order as it will ensure a valid working plant to regulate admission on a just basis. Detailed comments are, therefore, requested with constructive suggestions.
Pushed by the Judiciary to act, the Central Government of India has done its job of making a fairly good and citizen-friendly healthcare policy for implementation.
How far has it been implemented by the Government Hospitals all over the country?
Who is monitoring? And Who will bell the cat(s)?