|Year : 2016 | Volume
| Issue : 1 | Page : 27-33
Awareness of Consumer Protection Act among the dental fraternity in India
Lingam Amara Swapna1, Pradeep Koppolu2, Tarakji Basil1, Deepak Koppolu3, Kusai Baroudi2
1 Department of Oral Medicine and Diagnostic Sciences, Al-Farabi Colleges, Riyadh, Kingdom of Saudi Arabia
2 Department of Preventive Dental Sciences, Al-Farabi Colleges, Riyadh, Kingdom of Saudi Arabia
3 Department of Clinical Research, George Clinical, Bangalore, Karnataka, India
|Date of Web Publication||6-May-2016|
Dr. Lingam Amara Swapna
Department of Oral Medicine and Diagnostic Sciences, Al-Farabi Colleges, Riyadh
Kingdom of Saudi Arabia
Source of Support: None, Conflict of Interest: None
Background: The medical and dental professionals have been included in the Consumer Protection Act (CPA) to shield the patients in case of any unethical treatment given by the doctor. Though there is ample literature regarding the CPA and its importance, insufficient data is available from the Indian subcontinent regarding the awareness of dentists in India and the problems faced by them in clinical practice. Thus, there is a need to know the awareness of the dental fraternity in India and their knowledge about CPA. Objective: To evaluate the knowledge, awareness, and practices regarding the CPA among dental professionals in India. Materials and Methods: In a cross-sectional study, a total of 467 dental professionals (198 males, 269 females) comprising (117) Bachelor of Dental Surgery (BDS) practitioners, (114) Master of Dental Surgery (MDS) practitioners, (104) interns, and (79) postgraduate (PG) students were surveyed using a self-administered structured electronic questionnaire. The questionnaire comprised 20 questions about the awareness of CPA and whether these professionals were following the recommendations of CPA. Chi-square test was used to know the significance. Results: The CPA awareness scores were significantly higher among MDS practitioners when compared with those of BDS practitioners, interns, and postgraduates. Almost 66% of the participants found the taking of written consent to be time-consuming. Nearly 70% and 69.3% of the BDS and MDS practitioners, respectively, were updating the medical ethics. Conclusion: Considering the present scenario, a better understanding of CPA is necessary for dentists in order to be on the safer side and an educational program would be helpful to increase the knowledge and confidence of dentists in any medical legal jurisprudence to avoid any litigation.
Keywords: Bachelor of Dental Surgery (BDS), Consumer Protection Act (CPA), Dental Council of India (DCI), Master of Dental Surgery (MDS), postgraduate (PG) students
|How to cite this article:|
Swapna LA, Koppolu P, Basil T, Koppolu D, Baroudi K. Awareness of Consumer Protection Act among the dental fraternity in India. J Orofac Sci 2016;8:27-33
|How to cite this URL:|
Swapna LA, Koppolu P, Basil T, Koppolu D, Baroudi K. Awareness of Consumer Protection Act among the dental fraternity in India. J Orofac Sci [serial online] 2016 [cited 2019 Nov 20];8:27-33. Available from: http://www.jofs.in/text.asp?2016/8/1/27/181924
| Introduction|| |
The association between the doctor and patient is based on faith and confidence. Fortunate are the doctors of the past who were treated like God and were respected by the people. Today, we observe a rapid pace of commercialization and globalization in all the spheres of life and the medical profession is no exemption to this actuality.  It is estimated that 98,000 people die every year in the United States because of mistakes committed by medical professionals;  we can as well imagine the figures in India. The treatment of patients by doctors in India has undergone a significant change during the last 50 years.  It was increasingly felt that medical treatment should also be made answerable; therefore, doctors were covered by various laws. A dentist is a health care expert providing care for the patient, as does a physician. Obviously there is a duty imposed upon the dentist to practice dentistry with the certain standard of care. A breach of this duty that results in injury to the patient is called negligence. Such negligence can result in a lawsuit against the dentist. Dental practitioners must be aware of the legal fundamentals, as there are greater possibilities of the dentist encountering such cases, particularly in the context of patient empowerment and increased desire for improved personal appearance. The treatment of a patient without his or her consent has been viewed as a string and can calls upon legal action. Litigation involving consent issues has often alarmed the nature and extent of information that is provided to a patient in the course of obtaining authorization for treatment.  However, the law does not aim to punish all acts of a doctor that caused injury to a patient. It is concerned only with negligent acts. Medical negligence arises from an act or omission by a medical practitioner, which no reasonably competent and careful practitioner would have committed. What is expected of a medical practitioner is "reasonably skillful behavior" adopting the "ordinary skills" and practices of the profession with "ordinary care."  The word ethics is derived from the Greek word "ethos" meaning custom or character. Moral conduct and judgment are dealt with in the philosophy of ethics. There are several principles that dental professionals must be aware of in their clinical practice. The major principles are:
- To do no harm,
- To do good,
- Respect for patients,
- Veracity or truthfulness, and
- Confidentiality. 
The Consumer Protection Act (CPA) 1986 is a generous social legislation that lays down the rights of the consumers and sees to the promotion and protection of the rights of consumers. The first and the only Act of its kind in India, it has enabled ordinary consumers to secure less expensive and often speedy redressal of their grievances. As per CPA, there are six rights of a consumer:
- Right to safety,
- Right to choose,
- Right to information,
- Right of education,
- Right to be heard, and
- Right to seek redressal. ,,
This Act applies to all goods and services, excluding goods for resale or for commercial purpose and services rendered free of charge and under a contract for personal service. The provisions of the Act are compensatory in nature. It covers public, private, joint, and cooperate sectors. Dental negligence falls under section 2 (0) of CPA because the Indian Dentist Act (IDA) had no provision to entertain any complaint from the patient, take any action against the dentist in case of negligence, or award compensation to the patients. In India, the Dental Council of India (DCI) is concerned with maintaining ethics among dental professionals. The code of ethics for dentists specifies certain duties and rights of a dental practitioner including those that concern the welfare of patients;  various steps have been taken to educate dentists on ethics. A notification of DCI published in the Indian Gazette contains a separate section on forensic odontology, which comprises jurisprudence and ethics in dentistry. Reference is made to a 30-h syllabus with didactic lectures and practical exams. , However, such steps do not guarantee that dental practitioners will practice dentistry in an ethical manner. Though there is ample literature regarding the CPA and its importance, insufficient data is available from the Indian subcontinent regarding the awareness of dentists in India and the problems faced by them in clinical practice. Thus, there is a need to know the awareness of the dental fraternity in India and their knowledge about CPA.
| Materials and Methods|| |
A cross-sectional online survey was conducted using a self-designed electronic questionnaire among the dental fraternity in South India from October 2012 to November 2012. The questionnaire was designed in www.freeonlinesurveys.com. The participants received a full explanation on how to fill and send the questionnaire, and answering all the questions was compulsory. Prior to the data collection, the questions were pretested among a group of 15 professionals in order to ensure the level of validity and degree of repeatability sample size was calculated based on this. The assessment of content validity in the questionnaire was related to the opinions expressed by a group of five academicians working in different institutions in addition to their experiences in their own dental clinic setups. The participants comprising Bachelor of Dental Surgery (BDS), Master of Dental Surgery (MDS) practitioners, postgraduate (PG) students, and house surgeons (interns) from various dental colleges were selected randomly from South India. A total of 6,000 contact mail IDs were obtained by the checking the different specialty dental associations in India where the dentists and students were registered. We have randomly selected about 1,000 mail IDs (10% of the collected ID's) to send the electronic survey, among which almost for 400 mail IDs there was permanent mail delivery failure, either because of expired mail IDs or unused IDs. Out of 600 participants who received our mail, only 467 responded within the stipulated time period of 2 months. The participants were asked to respond to each item according to the response format provided in the questionnaire. They were further grouped according to their gender (198 males and 269 females), level of Educational qualification (170 BDS practitioners, 114 MDS practitioners, 104 interns, 79 PGs). The data were analyzed using Statistical Package for the Social Sciences version 15.0 software (SPSS Inc., Chicago, Illinois, USA). Descriptive statistics were obtained and frequency distribution was calculated for awareness among practices regarding CPA. The chi-square was used as a test of significance for statistical evaluation. P < 0.05 was considered as statistically significant.
| Results|| |
The frequency distribution analysis showed that there were 278 participants with a clinical experience of 0-5 years, 53 participants with a clinical experience of 6-10 years, 27 participants with a clinical experience of 11-20 years, and 109 participants with clinical experience of greater than 20 years [[Table 1] and Graph 1].
Taking informed consent
[Table 2] shows that nearly 38.11% of the participants stated that it was necessary to take consent for every treatment provided for the patient. Around 51 (71.8%) BDS practitioners, 29 (47.5%) MDS practitioners, 41 (75.9%) interns, and 24 (77.4%) PGs took written consent from the patient; the statistical significance with respect to taking written consent was seen in all the groups except with MDS practitioners. Among the participants who took written consent, only 27.83% of them took treatment-specific consent; the rest of the practitioners took general consent. The results revealed that 86.5% of BDS practitioners, 76.3% of MDS practitioners, 71.2% of interns, and 69.6% PGs obtained written consent in the local language. About 66% of the participants felt that taking written consent was time-consuming and it was found to be statistically significant in all the groups. Just about 27% of the participants were aware that one copy of the informed consent form should be given to the patient if asked for. Almost 39% of BDS practitioners, 50% of MDS practitioners, 56% of interns, and 43% of PGs asked for a reason to give the consent form to the patient [Graph 2].
When taking consent from illiterate patients
Fifty (29.4%) BDS practitioners, 62 (54.4%) MDS practitioners, 61 (58.7%) interns, and 48 (60.8%) PGs reported taking the patient's thumbprint, whereas 31.8% BDS practitioners, 24.6% MDS practitioners, 13.5% int
erns, and 19% PGs stated that they obtained only verbal consent before starting a procedure on the patient [Graph 3].
Awareness on informed consent and Consumer Protection Act
[Table 2] shows that virtually 52.4% of the BDS clinicians, 87% of the MDS practitioners, 14.4% of the interns, and 85% of the PGs confirmed that they were aware of the CPA; the significance on awareness was seen in BDS clinicians and MDS practitioners only. At least 41.5% of the dental practitioners were aware of consumer courts for redressal of grievances by the consumer. Almost 119 (70%) BDS practitioners, 79 (69.3%) MDS practitioners, 73 (70.2%) interns, and 51 (67%) PGs stated that they were updating themselves about medical ethics. Nearly 32 (19%), 20 (18%), 18 (17.3%), and 13 (17%) BDS practitioners, MDS practitioners, interns, and PG clinicians, respectively, stated that CPA affected their professional freedom. Approximately 69% of the dental clinicians were aware that delay in treatment or negligence caused by dentists was liable for punishment.
General clinical practices followed by dentists
Nearly 76.4% of the participants stated that they discussed the various treatment modalities available at their clinic with their patients before starting treatment; with respect to advising on the various treatment modalities available in the clinic, it was statistical significant in all the groups [Table 3].
Information given on risks and discomforts of procedures [Table 3]: One hundred and twenty nine (75.9%) BDS practitioners, 86 (75.4%) MDS practitioners, 85 (81.7%) interns, and 57 (72.2%) PGs declared that they gave a detailed explanation of any procedure to be performed and the complications associated with local anesthesia. About 126 (74.1%) BDS practitioners, 87 (76.3%) MDS practitioners, 78 (75.0%) interns, and 54 (68.4%) PGs affirmed that they gave the success and failure rates of any dental treatment before starting the procedure. Almost 82% of all the participants acknowledged that they explained to their patients in detail about the procedures, duration, and costs associated with the dental treatments. About 81% of the dental clinicians in this survey declared that they maintained information secrecy and privacy of their patients. And 81% of the dentists in this study collected the past history of drug allergy and reactions of their patients.
| Discussion|| |
The CPA was passed by the Indian Parliament in the year 1986 to safeguard and protect the interest of consumers. Prior to enforcement of this Act, cases against dentists were decided by civil courts and even under the Indian Contract Act. But the disadvantage of the latter was high cost and the fact that it was more time-consuming.  Advantages of CPA:
- Court fee is less.
- Speedy justice.
- Procedural simplicity.
- A nonintimidating atmosphere and encouragement to settle the case without too many formalities and lengthy procedures.
The Supreme Court of India has given the subsequent guidelines on informed consent; a doctor must ask for and secure the consent of the patient before starting treatment. The consent obtained should comprise the nature and method of the treatment and its rationale, benefits and outcome, any alternative treatment if available, an outline of the considerable risks, and the unfavorable consequences of refusing treatment. The Supreme Court judgment accentuates the need for specificity of consent. Consent taken for a specific method will not be valid for conducting another procedure. However, there can be a general consent for diagnostic and operative procedures where they are considered. Consent can also be sought for a particular surgical procedure that also overtly covers additional procedures that may become necessary during the course of surgery. ,,,,,, For legal suits, preservation of judicial records is necessary for a minimum of 2 years in consumer cases (The CPA, 1986) and 3 years in civil cases with no time limit in criminal cases. ,
The process of taking consent builds a good rapport with the patient as we communicate with the patient regarding the particulars of the treatment, thus allowing the patient to express his/her opinion and apprehension. Vijayalakshmi S. Kotrashetti et al. conducted a study in India that showed nearly 25% of the dental practitioners believed that a consent form was necessary for every treatment.  In our study, nearly 38.11% of the participants considered that a consent form was necessary for every treatment provided for their patient. A study conducted by K. Sigh et al. in Udaipur, Rajasthan, India showed that the mean scores of awareness about CPA were higher among medical professionals compared to dental professionals.  In our study, we could see moderate significant difference between the MDS and BDS practitioners regarding the awareness of CPA. For that reason, there were no earlier data with which to compare with the findings of this study. Singh et al. found that the awareness on CPA among the private practitioners was higher in their study when compared to the academic or private clinicians.  The reason attributed to this was that patients of a higher socioeconomic level got their treatment done from the private sector. With the increasing knowledge, it was found that the PGs in our study were significantly more aware compared to the interns. This might be due to the reason that with increase in knowledge, awareness also increases. Only 9% of the dentists in previous study took consent in the local language,  whereas nearly 78% of the dentists in our study were aware of the need to obtain written consent in the local language. Sikka et al. also documented similar results where the private practitioners took the patients' consent on a daily basis when compared to the dentist working in a teaching institute. 
The DCI preserves the Indian Dentists Register, which encloses the information of all the dentists registered in the state. State dental councils are empowered to punish persons who claim to be registered and/or practice dentistry without registration with a fine or imprisonment or both.  With the increase in patients who are more educated and well aware of their rights, there is an increase in the approach to the consumer forum to register their grievances and complaints. However, different clinical dental treatments are involved in such claims. The major percentage of claims are involve oral surgery and fixed prosthodontics. ,
Discussing treatment options
Almost 82% of all the participants in our study acknowledged that they explained to their patients in detail about the procedures and duration and costs associated with the dental treatments. On the contrary, the previous study showed that 93.1% of the dentists discussed the various treatment modalities available at their clinic.  Doyal and Cannell in their article on informed consent and the practice of good dentistry have concluded that a written note of treatment options explained to patients and countersigned by patients was mandatory. ,,,,,,,,,
The reason behind us opting for an electronic survey is that recent literature testifies the use of the Internet to perform survey research.  In addition, the Internet allows questionnaires and surveys to reach a worldwide population with minimum cost and time. Researchers can contact rare and unknown participants who are frequently geographically dispersed. , Most of the studies suggest that the majority of the subjects in all the studies were mindful of the existence of CPA. Conversely, the basic awareness regarding the rules and regulations were found to be low and showed conflicting results in different studies. This could be ascribed to dissimilar study settings and a disparity in the sample size. 
| Conclusion|| |
Considering the present situation, a better understanding of CPA is essential for dentists in India to be on the safer side and an educational program would be useful to increase the understanding and confidence of dentists in any medical legal jurisprudence to avoid any lawsuit. Dentists are often ignorant about the laws governing their profession. This article is an attempt to give uncomplicated explanations of different laws and legal issues affecting dentists. There is the need for maintaining the records legitimately and competently to guard against any commercial, legal, and medicolegal litigations. Records are the most vital factors needed to prevail in a lawsuit. Written records, including medical and dental history, chart notes, radiographs, photographs, and models are the only existing guiding principles, which are important in a negligent lawsuit and must be carefully kept. All records must be contemporaneous and must be signed and dated. Legally, dentist written records carry more weight than the patient's recollections. The legal process is difficult and distressing to navigate; so it is best to avoid this when possible. Once a negligent lawsuit is filed against the dentist, a complex legal maze is opened up. A dental practitioner needs the help of a competent attorney who specializes in such litigations. The best defense is avoiding the grievance in the first place. Hence, dental health professionals need to update their understanding on CPA and its amendments to be legally circumspect.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3]