Even as the first amendment to the Right to Information Act, 2005 awaits parliamentary approval to keep political parties outside the ambit of law, psychiatrists in the public health system are fighting a legal battle to protect patients’ confidentiality, which the Act appears to violate occasionally.
The Institute of Human Behaviour and Allied Sciences (IHBAS), earlier notoriously known as Shahdara Mental Hospital, in Delhi has been getting requests from patients, their family and relatives for access to records under the RTI Act. Generally, the medical file of a patient contains confidential information. The institute had been adopting a very cautious approach as sensitive information, if divulged, could be misused.
“Our stand is that information obtained from various sources is taken under fiduciary relationship and hence cannot be divulged under the Act,’’ Director of IHBAS Dr. Nimesh G. Desai said. “In most cases, our stand is upheld by the Central Information Commissioner (CIC). Even when patients had sought their medical records, we have extended the same ground of fiduciary relationship, to the information provided by other informants,’’ Dr. Desai said.
However, in one case, where medical records were demanded by the patient and not provided by the institute on the same ground, the patient went in an appeal to the CIC, which issued directions to provide the records to the patient. As of now, the Delhi High Court had given the institute a stay order against disclosing information.
RTI activist Subhash C. Aggarwal appeared to back Dr. Desai's stand about maintaining the confidentiality of patients.
He said instances like this should be “decided on a case-to-case basis by the CIC.” According to Dr. Desai, unlike others, records of psychiatric illness were made not only on the basis of physical conditions, but also based on inputs provided by relatives, who functioned as informants for mental health assessment.
The December 2011 CIC order by Information Commissioner Shailesh Gandhi stated that while the hospital was exempted from disclosing treatment records to anyone other than the patient, “these precedents are not relevant when information is being sought by the patient herself.”
Arguing against this, petition before the High Court said disclosure of information contained in psychiatry case records would discourage patients and their relatives to furnish sensitive information, which would largely affect treatment.”
“We were hoping that the new Mental Health Care Bill, 2013, tabled in Parliament earlier this week, would address the issue of patient confidentiality but the proposed law is silent,’’ Dr. Desai told The Hindu. “I have often argued for ‘compartmentalised confidentiality,’ wherein a patient can have access to partial information, which would ensure confidentiality of the informants. Information is extremely sensitive and intimate and often forms the basis of the line of treatment,” he said.
Dr. Desai called for a wider discourse on the issue. He pointed out that while public mental health care facilities were under the purview of the RTI Act, private hospitals were not and hence not obliged to share any information on their patients. “All 14 publicly-funded mental healthcare institutions in the country are facing a similar dilemma about disclosing information on psychiatric patients,” he claimed.
