Original Article

Journal of General Internal Medicine

, Volume 24, Issue 4, pp 489-494

First online:

Open Access This content is freely available online to anyone, anywhere at any time.

National Survey of Patients’ Bill of Rights Statutes

  • Michael K. Paasche-OrlowAffiliated withDepartment of Medicine, Boston, University School of MedicineSection of General Internal Medicine, Department of Medicine, Boston University School of Medicine Email author 
  • , Dan M. JacobAffiliated withHealthcare Analytics, LLC
  • , Mark HochhauserAffiliated withReadability Consultant
  • , Ruth M. ParkerAffiliated withDepartment of Medicine, Emory University School of Medicine



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.


patient rights readability policy literacy