How long to preserve medical records of patients?

[Guest guest]

Dear Dr Bedi:

You have raised a very pertinent question as to for how long patient records must be preserved. This becomes important in case a patient lodges a complaint against a hospital or a doctor several years after he was discharged. There are several rulings put forth by MCI, DGHS, individual States and civil law in this regard. Same are outlined as under:

A—Under MCI Regulations, 2002, applicable to doctors (not to hospitals)—

As per Regulation 1.3.1 of the Indian Medical Council (Professional conduct, Etiquette and Ethics) Regulations, 2002, “Every physician shall maintain the medical records pertaining to his / her indoor patients for a period of 3 years from the date of commencement of the treatment in a standard proforma laid down by the Medical Council of India and attached as Appendix 3â€.

B—Under the DGHS guidelines, applicable to central government hospitals—

The guidelines for the government hospitals have been published by the DGHS vide letter No. 10-3/68-MH dated 31-8-68 as follows:

For inpatient medical records (case sheets)……………….10 years

For medico-legal registers…………………………………….10 years

For outpatient records………………………………………….5 years

The above requirement can be found in the “Hospital Manual†published in 2002 by the Directorate General of Health Services, MOHFW, GOI, in chapter 12 titled “Medical Record Servicesâ€.

C—Under the state rules: As applicable in individual states. For example, as per Punjab Medical Manual (1934), the medicolegal record is to be preserved for 12 years.

D—Under general principles of law—There may be situations when it is not clear whether any specific period has been stipulated by law for preservation of medical records. I such situations, and even otherwise, the following general legal principles would apply:

a—The main purposes of preserving hospital records are as follows:

i)—For the benefit of the hospital, say for defending itself against allegations of malpractice;

ii)—For the benefit of the state, say for proper prosecution in criminal cases launched by the state against the accused;

iii)—For the benefit of the public / patients—For providing appropriate continuity of medical care of a patient.

b—Since medical records are the property of the hospital, the above purposes relate to the length of preservation as follows:

i)—As regards the self interest of the hospital, it is the hospital’s own responsibility and sweet will. Nobody has any business advising the hospital how to take care of its property. Medical negligence cases filed in consumer or civil courts have a limitation period of 2 or 3 years after completion of treatment. Courts may relax this period in case the injury claimed to be caused by the hospital came to the notice of the claimant after a long period of time. Doubling this period would mean that 6 years should be sufficient.

ii)—As regards the needs of the state for criminal prosecution purposes, there is no limitation period prescribed in the IPC / CrPC for lodging a criminal complaint or registering an FIR. An FIR can be registered even for a murder committed 50 years ago. The hospitals cannot be expected to preserve records indefinitely. Ten year period would appear to be adequate.

iii)—The problem of storage of records for a long time has been eased by the availability of electronic means of preserving records. Scanned copies can be maintained on the computer even after physical records are destroyed.

iv)—The above does not apply to cases where court cases are pending. If a particular record is the subject matter of litigation, the hospital should preserve the record even beyond the limits suggested above during the pendency of the litigation and up to a period of, say, 2 years after the last court decision 9so as to allow for the possibility of any appeal etc.)

v)—It is a sound practice to hold an annual medical records destruction board (consisting of the medical superintendent; i/c medical records section; hospital’s lawyer; and the concerned clinical departments) which should decide which records to destroy permanently. A public announcement inviting any objection to such destruction would be all the more appropriate.

Dr. Geer M. Ishaq

Sr. Assistant Professor

Dept. of Pharmaceutical Sciences

University of Kashmir

Srinagar-190006 (J & K)

Ph: 09906673100

http://www.sites.google.com/site/ishaqgeer

From: Dr. Sanjay Bedi <drsanjaybedi@...>netrum Sent: Friday, 1 July 2011 8:59 AMSubject: Re: Kind Attn Dr Arin Basu: What RTI means for patients : 01-06 July 2011

There are some MCI rules in code of ethics regarding keeping of patient records for 3 years .

Dr Sanjay Bedi

On Thu, Jun 30, 2011 at 7:56 PM, Geer M. Ishaq <ishaqgeer@...> wrote:

Dear Dr Arin Basu:

Thanks for drawing our attention to an informative and fairly inspiring website in medical activism that inter alia makes several case reports/judgements of National Consumer disputes redressal commission (NCDRC) and Supreme Court availabe for the interest of readers. It needs to be emphasized that Consumer Disputes Redressal Fora are available throughout the country at district level, state level as well as national level that can be approached in the event of an cases of medical negligence, malpractice or minor grievances.

Under RTI all govt organizations and private institutions substantially funded by the govt have been designated as "Public Authorities" that in turn have designated "Public Information Officers" who can be approved in the event of a request for seeking information. If PIO fails to provide the required information within 48 hours in health-related and within 30 days in non-health related cases, "first appellate authority" can be approached for redressal. Beyond that an appeal can be filed directly in the State information Commission for getting the needful done.

Keep informing our members about other provisions of the RTI Act and oblige.

With Regards

Dr. Geer M. Ishaq

Sr. Assistant Professor

Dept. of Pharmaceutical Sciences

University of Kashmir

Srinagar-190006 (J & K)

Ph: 09906673100

http://www.sites.google.com/site/ishaqgeer

From: Arin Basu <arin.basu@...>netrum Sent: Thursday, 30 June 2011 4:09 PMSubject: Re: New discussion: What RTI means for patients : 01-06 July 2011

Most interesting remarks, Om. On hat note, for over the last ten years, "People For Better Treatment" founded by an Indian pediatrician. Dr Kunal Saha, has brought to the public interesting debates and arguments about patient rights and issues around as they say, "better" treatment in the context of india. Here is the website http://pbtindia.com/?page_id=70Cheers,Arin"There's a crack, a crack in everything.That's how the light gets in." (Leonard Cohen)

On Thu, Jun 30, 2011 at 10:07 PM, om singh <opsingh.india@...> wrote:

Dear Members,

Dr Ishak and Dr Anupama have rightly mentioned about the rights of the patients. The worry is that this all seems to be theoratical in books only. In practice, most of the patients do not dare to ask or interrogate about the treatments and facilities availble in the hospital due to various fear factors like would not like to annoy the clinical staff, or the process may get delay, clinicians are now live savers and asking for rights may result in delay. This is mainly due to poor knowledge of patients and their relatives on the subject. What I have noticed that right to consent is being followed as it is mandatory, but again the patient or relative has no choice here, he/she has to sign the consent form as without it further clinical precedure will not proceed.

To some extent corporate hospitals have realised this and provide some of of the basic informations needed by the patient, still rights in the terms of clinical procedure or treatment followed still needs to advocated. In today's world, in clinical sector RTI needs to rejuvinated. Every hospital and clinics should display clear messages in the premises, which will allow the patients to know and demand their rights in the hospitals.

I will be pleased to read the comments of eminent netrum members on this.

Kind Regards,

O.P.Singh

Consultant Health and Pharmaceuticals

From: Geer M. Ishaq <ishaqgeer@...>Subject: Re: New discussion: What RTI means for patients : 01-06 July 2011"netrum " <netrum >Date: Thursday, 30 June, 2011, 9:47 AM

Dear NetRUMians:

Once again we are back at the vibrant platform of NetRUM, the forum that has been providing an excellent avenue in the past few years for sharing our views, experiences, ideas and scientific material on the various topics concerning rational use of medicine in our society. It is contributing significantly towards promoting RUM in the country and therefore needs to be fostered and nourished to achieve greater heights.

I am highly thankful to its dynamic moderator Prof Vijay Thawani for providing me yet another opportunity to moderate this discussion on "What does RTI mean for the patients?" which was officialy supposed to start tomorrow from July 1st and continue till July 6th but thanks to Prof Sanjay Bedi for setting the prelude and initiating the discussion one day in advance by making a very important post concerning applicability of RTI Act on Fortis Mohali. This encouraging gesture is highly appreciated and Prof Sanjay Bedi is humbly requested to be with us till the end of this discussion and enlighten us with more such valuable information.

I had thought of starting with an introduction, benefits, applications of RTI and proceed in a pre-planned, sequential manner but Prof Bedi has thankfully set the ball rolling and I deem it prudent to cite another similar case as that cited by Prof Bedi, wherein a patient of spinal injury had moved CIC, Delhi in a case again India Spinal Injury Centre which is a private hospital but had been alloted land on concessional rates by the govt on the condition that 10% of beds would be provided free of cost to patients belonging to Economically Weaker Sections but the hospital had miserably failed to provide the necessary relief in the above-mentioned case. In its fairly deterrent judgement, information commission had ordered a compensation of Rs. 50,000 in favour of the plaintiff to be paid by the delhi govt. Bottomline is all private institutions that are substantially funded by the govt come under the purview of RTI Act. Read

below for further details in the case. http://in.news./delhi-slammed-delayed-information-fined.html

All learned members of NetRUM are urged and requested to contribute their bit in enhancing awareness and applicability of RTI in medicine and healthcare and make as many posts as possible during this discussion over the next seven days. I shall be looking forward to an encouraging response from all esteemed members of the forum.

with Regards

Dr. Geer M. Ishaq

Sr. Assistant Professor

Dept. of Pharmaceutical Sciences

University of Kashmir

Srinagar-190006 (J & K)

Ph: 09906673100

http://www.sites.google.com/site/ishaqgeer

From: Dr. Sanjay Bedi <drsanjaybedi@...>netrum Sent: Thursday, 30 June 2011 8:07 AMSubject: Fwd: New discussion: What RTI means for patients : 01-06 July 2011

http://www.indianexpress.com/news/fortis-covered-under-rti-act/789868/

Fortis covered under RTI Act

This is a very welcome move for the following reasons: 1--It shows the determination of people to fight for their rights, as shown in this case by the VC. 2--It shows the validation of the principle that hospitals getting land at throw away / token rates from the government must be deemed to be funded substantially by the govt. 3--It will most likely lead to similar RTI applications to private hospitals in other plces. Just a month ago when such an application was made to my client's hospital, I had told the hospital to reply that the private hospital is not covered under the RTI. For general benefit, I am reproducing the news here--

Fortis covered under RTI Act

http://www.indianexpress.com/news/fortis-covered-under-rti-act/789868/3

Posted: Fri May 13 2011, 01:07 hrs Chandigarh:

The Fortis Hospital in Mohali

The Fortis Hospital in Mohali

[ Land given at concessional rate, it’s a public authority discharging important service to society, says info panel.]

A full Bench of the Punjab State Information Commission has ruled that Fortis Hospital, Mohali, is covered under the Right to Information (RTI) Act. The hospital will now have to appoint a public information officer (PIO) and the first appellate authority to discharge its duties as a public authority.

The bench, comprising Chief Information Commissioner R I Singh and station information commissioners Kulbir Singh, P P S Gill, Surinder Singh and Ravi Singh, said the hospital got land at concessional rate from the government, which meant that it was substantially financed by the state.

The ruling came on Thursday as the bench was deciding the case of Dr S G Damle, Vice-Chancellor of MM University in Mullana, Ambala, whose daughter Dhanashree was admitted to Fortis for a surgery in February last year. In August, he filed an application under the RTI Act, seeking information on the names of doctors who treated and operated upon her; on the make and company of “VP shunt†used in the surgery and its actual cost.

The respondent, however, denied the information saying it was not covered under the RTI Act. Aggrieved, the complainant moved the commission, where he argued that the hospital was substantially funded by an instrumentality of the state government, Punjab Urban Development and Planning Authority (PUDA), which allotted it land at a rate far below the commercial price for such sites.

Contesting this averment, the respondent claimed that 8.22 acres were allotted to it on freehold basis without any condition of providing free treatment to yellow card holders (poor patients). It submitted that no control was exercised by the government over the hospital, and the land allotment was a one-time policy decision to encourage medical infrastructure in the region.

To find out if the hospital gets any government aid, the commission summoned the deputy chief engineer of Punjab State Powercom Limited, Mohali, on the next hearing, when the latter confirmed that electricity tariff was being charged at commercial rates from Fortis. The assistant excise and taxation commissioner (Mohali) was called too, and he said no VAT rebate was allowed to the hospital.

In the meantime, Fortis, however, voluntarily provided information on the doctors and the make and company of ‘VP shunt’, but refused to furnish its cost, saying it was a trade secret.

After hearing both sides, the bench said: “A financial benefit, direct or indirect, accrued to a private organisation would mean it received monetary aid from the government. When land is given at a price less than the market price, it results in financial savings to the buyer, which otherwise would have gone to the state exchequer.â€

In government, the normal procedure for disposal of all assets was through a competitive process of auction or open bidding, so as to ensure that the state got the highest price, but it was not followed in this case, it said. The concessional rate was charged with a condition that the hospital would provide free treatment to yellow card holders, but this was later withdrawn on the advice of the advocate general, but the rate charged by PUDA (now Greater Mohali Area Development Authority) was not altered, the commission said.

“The lapse may have happened as a bureaucratic bungling or maybe the government decided to impose this condition as an afterthought,†the bench observed. It said Rs 2,100 per square yard was charged from Fortis for the land when the market rate was Rs 31,262 per sq yd, giving it a substantial financial benefit. “The respondent is a hospital. Given the nature of its business, it is discharging an important service to the society,†the bench said, adding that every institution which impinges on public life or carries out activities that impact community should be transparent in functioning. “Why should the respondent be an exception,†it said, declaring that Fortis was covered under the RTI Act.

Sanjay

---------- Forwarded message ---------- From: drvijaythawani <drvijaythawani@...> Date: Wed, Jun 29, 2011 at 8:49 PM Subject: New discussion: What RTI means for patients : 01-06 July 2011 netrum

Dear NetRUMians, NetRUM is starting with E-discussions. Thanks to Dr Geer Ishaq from Srinagar, Kashmir, India, for volunteering to come forward to moderate this from 01 to 06 July 2011. Members are reminded that during official, scheduled discussion they can only make postings relating to discussion topic and NOT on any other subject. Happy interaction friends. Welcome Geer and please take over NetRUM. Vijay

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Professor Dr Sanjay Bedi

Professor in Pathology

MM IMSR ,Mullana ,Ambala

09996038569

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Professor Dr Sanjay Bedi

Professor in Pathology

MM IMSR ,Mullana ,Ambala

09996038569