Book Review

Demystifying Healthcare Legalese

Book: Healthcare Case Law in India— A Reader Editors: Adv Mihir Desai, Adv Kamayani Bali Mahabal Publishers: Centre for Enquiry into Health and Allied Themes, India Centre for Human Rights & Law Pages: 200

When it comes to awareness about healthcare rights, there are two kinds of groups. First one prefers to live blissfully in ignorance, while the second group comprises highly motivated individuals who are as unaware as their counterparts simply because the legal 'jargon' drives them away. It is precisely keeping the latter in mind, that Centre for Enquiry into Healthcare and Allied Themes Research (CEHAT), a not-for-profit organisation working on healthcare rights, has presented 'Health care Case Law in India—A Reader.'

The book is a simple yet comprehensive and useful read on healthcare case laws in India. The series of topics divided in 15 chapters provide a synopsis of the landmark cases in judiciary that altered the healthcare services paradigm in India forever. It succeeds in systematically providing an overview of the status of medical jurisprudence in key areas of Indian health system.

This reader mainly looks at the constitutional recognition and judicial pronouncements. These case laws form the foundation of the right to healthcare and can support any further Public Interest Litigations (PILs) on various other areas of public health. An attempt has been made to demystify the laws and make the information accessible to common people, so that the judgments can be used as an effective tool for demanding the right to healthcare.

The first chapter written by Ravi Duggal takes you through the concept of 'Right to Health' in the context of constitutional rights. This chapter discusses in detail about the evolution of healthcare system and critically analyses the role of private sector and stresses on the need of making healthcare a fundamental right.

The chapter 'Right to Emergency Healthcare' attempts to answer basic questions like 'Are doctors bound to attend to emergency patients? Is the obligation same for Government and private hospitals? If it is a police case, should the formalities be first completed before attending to a patient? What if the patient or her relatives do not have money to bear expenses for treatment? It unleashes the legalities and rights about all these questions in length. The article cites that there is no law that deals specifically with the duties of health facilities and personnel to provide medical treatment in emergency cases. The authors Adv Mihir Desai and Adv Dipti Chand, highlight that emergency healthcare falls in the shadow of Article 21. Hence, when there is a refusal to treat an emergency case, the patient may approach the court to claim compensation for violation of his/her right to life. It further focuses on the fact that the Supreme Court has held that the failure to provide timely medical care amounts to violation of fundamental right to life.

When it comes to 'Issues in Medical Practice Care', the authors throw light on as to what is actually medical practice and whether cross practice is permitted under the law. The authors emphasise that not every person who has studied medicine has a right to practice medicine. In case of cross practice, it cites the case of Poonam Verma Vs Ashwin Patel (1996 SCC 332). The contention was whether a homeopath can prescribe allopathic drugs or not. The Court held that the doctor's conduct amounted to an actionable negligence as he was registered only to practice homeopathy. The other themes discussed include a brief on quacks and unlicensed practitioners.

There is a dedicated section on environmental impact on healthcare. The focal point is that the right to healthy, clean and pollution-free environment has its origin in the human right to health, as in order to have a healthy body one needs a clean environment. The article addresses whether issue of right to healthy surrounding vis-à-vis health has been recognised in India and the role of judiciary and legislature in augmenting the right to healthy environment. The article concludes that the judiciary needs to play a proactive role in safeguarding the environment and also looks at the health aspects of the people in this country.

The chapter devoted on right of workers to occupational health and safety, addresses the issues that impinge on the health and safety of the worker under Indian laws. This informative article takes the reader through the provisions available in the law for workers’ healthcare rights and to what extent are the employers liable for the health problems of employees. The writers opine on the fact that working conditions and the nature of employment do tend to have major repercussions on the health of workers. They give an insight as to what determines 'occupational health' and how it not only means work-related disorders but also encompasses all factors that affect community health. Though there is no case law cited with exclusively healthcare in context, there are certain cases which deal with the working conditions and rules pertaining to them. For example in Rajangam, Secretary, District Beedi Workers’ Union Vs State of Tamil Nadu (AIR 1993 SC 410), the issue concerned the conditions of work employees in 'beedi' manufacturing and allied industries, especially keeping in mind that a large number of children are employed in this work. The article concludes that in India occupational health is not integrated with primary healthcare and it is the mandate of the Ministry of Labour, not the Ministry of Health. The authors also express concern over the fact that the numbers or agencies responsible to enforce healthy working conditions are grossly inadequate. Also, these agencies operate mostly in the organised sector. The article pleads on the urgent need for confidence building for these agencies.

The book has a dedicated section on mental healthcare which is certainly an important yet ignored issue. It answers two broad aspects— the different laws that deal with mental health and mental healthcare and the significant issues dealt by the courts concerning mental healthcare. The article goes on to inform that the mental health sector is governed by Mental Health Act, 1987 and not a national policy. This law leans heavily on institutionalised care, where ill persons can enter the institution of their own will, but cannot exit on their own choice. The authors highlight some of the specific challenges faced by the mental healthcare sector in India that includes hard facts like—with approximately 10 million persons requiring care, we have just 0.2 psychiatrists per 10,00,000 people. The article successfully convinces that even today mental illness is seen as a uniform medical problem without adequate recognition of the various kinds and degrees of mental illnesses. Thus, authors demand that the law needs to deal with these disabilities by understanding the distinctive nature of each of them.

In all, this book provides information in a lucid and yet exhaustive manner and offers key solutions to various problems. Clarity is the essence of this book. The writers have condensed without sacrificing essential features and individual case and principles discernible from vast canvas of controversial topics. The problems of healthcare have been methodically arranged topic wise. The judicial pronouncements dealing with the said problems have been carefully and logically analysed by the writers. It is a much-needed contribution in the field of health and human rights and is a useful resource to social organsiations, activists, lawyers and judges.

An awareness of these judgments does not mean that they will be implemented easily, but it is certainly important for further action and the evolving of future strategies, legal or otherwise, towards realising the right to health. CEHAT has been working towards realisation of right to health and healthcare, through research and advocacy, for more than a decade and this is just an extension of another appreciable effort to create awareness about the most basic need of the human society.

EH News Bureau