National Survey of Patients’ Bill of Rights Statutes
Despite vigorous national debate between 1999–2001 the federal patients’ bill of rights (PBOR) was not enacted. However, states have enacted legislation and the Joint Commission defined an accreditation standard to present patients with their rights. Because such initiatives can be undermined by overly complex language, we surveyed the readability of hospital PBOR documents as well as texts mandated by state law.
State Web sites and codes were searched to identify PBOR statutes for general patient populations. The rights addressed were compared with the 12 themes presented in the American Hospital Association’s (AHA) PBOR text of 2002. In addition, we obtained PBOR texts from a sample of hospitals in each state. Readability was evaluated using Prose, a software program which reports an average of eight readability formulas.
Of 23 states with a PBOR statute for the general public, all establish a grievance policy, four protect a private right of action, and one stipulates fines for violations. These laws address an average of 7.4 of the 12 AHA themes. Nine states’ statutes specify PBOR text for distribution to patients. These documents have an average readability of 15th grade (range, 11.6, New York, to 17.0, Minnesota). PBOR documents from 240 US hospitals have an average readability of 14th grade (range, 8.2 to 17.0).
While the average U.S. adult reads at an 8th grade reading level, an advanced college reading level is routinely required to read PBOR documents. Patients are not likely to learn about their rights from documents they cannot read.
- Mariner WK. What recourse? Liability for managed-care decisions and the Employee Retirement Income Security Act. N Engl J Med. 2000;343(8):592–96. CrossRef
- Binette MJ. Patients’ bill of rights: legislative cure-all or prescription for disaster? North Carol Law Rev. 2003;81:653–96.
- Blaes P. Promotion and enforcement of patients’ rights. Med Law. 2004;23(2):289–97.
- Annas GJ. A national bill of patients’ rights. N Engl J Med. 1998;338(10):695–9. CrossRef
- Monaghan JC. Whatever happened to the patient’s bill of rights? Med Econ. 1975;52(16):109–10.
- Annas GJ. A.H.A. Bill of Rights. Trial. 1973;9(6):59–61.
- Paasche-Orlow MK, Jacob DM. Powell JN. Notices of Privacy Practices: a survey of the Health Insurance Portability and Accountability Act of 1996 documents presented to patients at US hospitals. Med Care. 2005;43(6):558–64. CrossRef
- Paasche-Orlow MK, Taylor HA, Brancati FL. Readability standards for informed-consent forms as compared with actual readability. N Engl J Med. 2003;348(8):721–6. CrossRef
- MicroBrothers Software. Prose: The readability analyst. Reference Manual. 1988. Boulder Colorado.
- Patient Rights. Tx Stat. title 25, §133.42.(2007).
- Florida Patient’s Bill of Rights and Responsibilities. Fla. Stat. title 29, § 381.026 (2007).
- Annas GJ. The Rights of Hospital Patients: The Basic ACLU Guide to a Hospital Patient’s Rights. New York: Discus Books; 1975.
- Veatch RM. Bioethics discovers the Bill of Rights. Natl Forum. 1989;69(4):11–3.
- Rosenbaum S. Managed care and patients’ rights. JAMA. 2003;289(7):906–7. CrossRef
- "The Patient Care Partnership," (Accessed December, 23, 2008, at http://www.aha.org/aha/issues/Communicating-With-Patients/pt-carepartnership.html).
- Gunning R. The Technique of Clear Writing. New York: McGraw Hill; 1952:29.
- Hochhauser M. Some overlooked aspects of consent form readability. IRB. 1997;19(5):5–9. CrossRef
- Hochhauser M. Informed consent and patient’s rights documents: a right, a rite, or a rewrite? Ethics Behav. 1999;9(1):1–20. CrossRef
- Coleman N. “A bill to ensure that all Americans have basic health literacy skills to function effectively as patients and health care consumers.” S.2424 (Accessed December, 23, 2008, at http://www.govtrack.us/congress/bill.xpd?bill=s110-2424).
- Zaremski MJ. Patients rights and accountability: can there exist rights without remedies in an American legal and legislative framework? Med Law. 2003;22(3):429–50.
- Coyle SL. Physician-industry relations. Part 1: individual physicians. Ann Intern Med. 2002;136(5):396–402.
- National Survey of Patients’ Bill of Rights Statutes
- Open Access
- Available under Open Access This content is freely available online to anyone, anywhere at any time.
Journal of General Internal Medicine
Volume 24, Issue 4 , pp 489-494
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- patient rights
- Industry Sectors
- Author Affiliations
- 1. Department of Medicine, Boston, University School of Medicine, Boston, MA, USA
- 5. Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, 801 Massachusetts Avenue, 2nd Floor, Boston, MA, 02118, USA
- 2. Healthcare Analytics, LLC, New York, NY, USA
- 3. Readability Consultant, Golden Valley, MN, USA
- 4. Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA