Haryana orders doctors to write prescriptions in capital letters to prevent medication errors

The Director General of Health Services (DGHS), Haryana, has written to all civil surgeons that "all diagnoses/prescriptions shall be written in capital/bold letters."

He added, “The instructions shall be applicable only in case of handwritten diagnosis/prescription and shall cease to apply once computerised typed prescriptions are adopted. Furthermore, you are directed to inform all private hospitals through the IMA (Indian Medical Association) of your respective district.”

Similar instructions were issued first on May 27 and then again reiterated on September 18, following a judgment pronounced by the Punjab and Haryana High Court on August 27.

The High Court was dealing with a matter of anticipatory bail in a rape and forgery case. After looking at the Medico-Legal Report (MLR) filed by Haryana, Justice Jasgurpreet Singh Puri said, “…it shook the conscious of this Court as not even a word or a letter was legible.” He added that in another case, the prescription, like clinical notes, was totally illegible. “Both of them have been written by the doctors working in the government hospitals while treating their patients.”

Haryana counsel, however, told the High Court that efforts would be made to get the handwritten notes deciphered by the same doctor.

The concerned doctor who wrote the MLR later filed her affidavit after deciphering the language. She told the court that the woman was medically examined on February 19, 2024, but her last sexual contact was made two-and-a-half months ago on December 3, 2023, so the sample could not be collected.

The accused finally got anticipatory bail.

Taking judicial cognizance of illegibility of notes on medical history and prescriptions, the Court said, “…it is very surprising and shocking to note that in this era of technology and accessibility of computers, the notes on the medical history and on the prescriptions by the government doctors are still written by hand which cannot be read by anybody except perhaps some doctors…”

Haryana, Punjab, and Chandigarh told the High Court that instructions had been issued that all medical prescriptions/diagnosis should be written in capital letters by all doctors till the time computerised/typed prescriptions were adopted.

Amicus Curiae Tanu Bedi submitted that “illegible or incomplete prescriptions are a leading cause of medication errors.” She added, “Pharmacists may misinterpret drug names, dosages, routes of administration, frequencies and other medical related opinions, leading to patients receiving wrong medication, incorrect doses or improper instructions prejudicially affecting treatment plan. Such errors can also result in adverse drug reactions, therapeutic failures, prolonged hospital stays, increased healthcare costs and in severe cases even death.”

She further submitted that when “prescriptions are clear, patients can better understand their treatment regimen, including how and when to take their medications.”

After hearing the arguments, the High Court held that 'Legible medical prescription and diagnosis' is an integral part of 'Right to Health' and ‘is thus a Fundamental Right under Article 21 of the Constitution of India.’

It directed Punjab, Haryana and Chandigarh shall in coordination with the State Medical Commission, if any, make endeavours “to inform and sensitise all the doctors” on legible prescriptions by “holding periodic meetings at the district level under the supervision of the Civil Surgeon.”

As PGIMER, Chandigarh, said that it was already in the process of implementing a medical software wherein medical e-prescription was a part of the Doctor Desk Module, the High Court directed that it should “ensure its implementation as expeditiously as possible and preferably within two years.”

It further directed Punjab, Haryana and Chandigarh to achieve the objective of computerisation/typed prescriptions, “sincere efforts be made for framing a comprehensive policy in this regard, with due emphasis on providing financial assistance…”