DR SHAMBHU N GUPTAM.S.

CITY HOSPITAL,45 MODEL COLONYSRI GANGANAGAR

What Is Clinical establishment Act?This bill makes it mandatory for each

and every clinical establishment including every individual clinic, consulting chamber, laboratory or any other investigative or treatment place without indoor beds, nursing homes, hospital etc. by whatever name it may be called to register and follow minimum standards of infrastructure i.e. of space / equipment and qualified para medical staff.

It provides for mandatory registration of all clinical establishments, including diagnostic centers and

single-doctor clinics across all recognized systems of medicine both in the public and private sector

except those run by the Defense forces

As-is-where-is'

Initially, provisional registration would be granted within 10 days of application on ‘as-is-where-is basis' upon receiving the application filed with supporting documents. Once standards have been notified, permanent registration would be provided to all those conforming to the notified standards.

To stabilize the emergency patient (with its grammatical variations and cognate

expressions) means, with respect to an emergency medical condition specified in clause (f), to provide such medical treatment of the condition as may be necessary to assure, within reasonable medical probability, that no material deterioration of the condition is likely to result from or occur during the transfer of the individual from one clinical establishment to other.

 

The registering authority can impose fines for non-compliance and if a clinical establishment fails to pay the same, it would be recovered as an arrear of land revenue.

Penalties for non registrationThere are stringent and huge monitory penalties for non registration by any professional, which are more than many criminal penalties of IPC. 

For First Offence, 10,00 FOR SECOND 50,000,subsequent offenses Rs.5 Lakhs. 

Any person serving in non registered establishment 25,000/- 

Disobeying any direction or obstruction to inspection Rs. 5 Lakhs.

Rajasthan and Uttar Pradesh have already adopted the Act.

The state government is making an all out effort to crack the whip on private clinics and hospitals with an Act which would require them to declare the amount of fees they charge, the number of services they offer and get registration from the medical authorities to set up a health facility. 

clinics and private hospitals will have to mention on a display board about the services they are providing and the fees they are charging for that.

The proposed Act envisages to have district level committees, which would include district collector, chief medical health officer and superintendent of police. 

Act would also prescribe minimum quality standards of services at the private clinical establishments. 

A medical department official said under the Act, no one can open clinics and hospitals without applying for registration. For the first two years, the department would issue temporary registration and after two years, permanent registration would be provided. 

IMA view point This bill unleashes a license Raj. Draconian powers have been vested with authorities at all levels with little provision for appeal. 

Are doctors doing some illegal work to be harassed like this??

What IMA proposes- Single Doctor establishment and clinics to be considered for minimum registration only without applying strict rules, these provisions should be prospective in implementing ( old clinics, establishments should be excluded).   

IMA wants that only those establishments with indoor facilities should be included for registration under this act. Till date existing establishments should be exempted from the provisions of this act.)

What IMA proposes That every clinical establishment shall

try to provide every possible care for emergency cases so as to stabilize the condition of the patient to best of its ability and refer it to appropriate clinical establishment. This is already a part of ethical conduct.

Ethics and rules are different and should not be mixed.

There are many more such objectionable and highly detrimental provisions Govt. has included in this Clinical Establishment Act. IMA has given their suggestions in writing to everybody concerned including Union Health Minister and the Parliamentary Standing Committee.  

But nobody cared and Parliament had passed the Clinical Establishment Bill without discussion.

NATIONAL COMMISSSION FOR HUMAN RESOURCES

IN HEALTH BILL

2011 (NCHRH)        

Decentralization is a slogan of the Union Government for better organization and achievements. 

But it is unfortunate to learn that the benign Government is proposing for centralization of powers by forming National Commission and by taking away the autonomy of all the concerned Board, Councils and other wings of the Union Government for health.

    The Bill in introduction – States to supervise and regulate professional councils in various disciplines of health sector.

Page (1) However, subsequently it dissolves all the existing Councils and takes away all their duties and fund. 

    

The Medical Council of India, constituted by Indian Medical Council Act 1956, has been an autonomous body regulating medical education in the country.

As the majority of the members were elected and represented different states, they were able to give unbiased opinion regarding medical institutions and medical courses.

This new Commission is constituted by Central Government appointed members.

They will act like a department of union Ministry of health and family welfare and will not be able to give unbiased opinion.

As per the clause 105(1) & (2), the Commission, the Board, committee or the National Council will be bound by the directions of the central government.

In other words, the Commission, the Committee and the Council will execute the orders given by the central government.

9) No elected members from Professional Associations in National Commission

1) National Commission the proposed supreme body with vested powers will have no elected members and State representatives to represent their needs and demands

2) Professionals from other discipline of Management technology and law are given place in this Commission will pave way for dilution and nepotism

3) It is unfortunate in a democratic country elected representative Council is brought under appointed non democratic body

There is no provision for the representation from the professional organizations, like Indian Medical Association or Health Universities in the Commission, Board or Council, shunning the voice of the health care providers.

In the circumstances, it will not be possible for the Commission, Board, committee or Council to provide fair assessment of the medical education or health care delivery.

Sec. 100 which bars challenging of removal of name from state register should be deleted. It is unconstitutional and is against the fundamental principles of constitution.

No law can bar the citizen of India from seeking a judicial recourse for getting relief against the decision of a regulatory body. Further a single body can’t be investigating, prosecuting, judging and then final super punishing authority whose decision is un- challengeable in the court of Law.

It is against natural justice.

Is the bill is above the existing laws?

Clause 100 & 101 (Page 34) says the decisions of the Commission cannot be questioned in the court of law and the agreed persons cannot seek legal remedies.

Modern medicine is not defined properly it is defined only as medicine.

Health professionals are not properly defined to discharge their duties.

Without defining properly the objectives of the bill will not be accomplished.

Similarly the words" medical practitioner" in section 2(t), should be replaced with the words "modern medical practitioner"

Doctor doing any other occupation is misconduct?

The seventh schedule in continuation of section 68 in Part I (10) (page 50) says engage in any business (or) occupation other than health profession is a misconduct.

This prohibits all career opportunities for health professionals.

The statement of object and reason for the bill section (2) page 53 says “……. to reduce shortage, standardize quality and bridge the uneven distribution of existing work force in the health sector”.

          

With No roadmap.  How is the Government going to reduce the shortage of manpower by forming this Commission?

Use of attractive words will not solve the problem. 

-      There is no need to dissolve the existing health Councils to achieve this purpose. 

-      Health is a State subject and resources cannot be redistributed by the Central Government.

  For example - “There is acute shortage of water & electricity in various parts of the country.  Will the Central Government constitute the Commission to make even distribution?”

·       

Audit and Accounting Clause 77 says even the accounts of State

Councils will be audited only by the CAG of Central Government. State will have no role on this

The Indian Medical Association totally rejects the proposed “National Commission for Human Resources for Health Bill 2011 for the following reasons:-

BRMS / BRHC Course  The Government of India has decided to

introduce a Short 3 years course of Modern Medicine, called BRHC (Bachelor of Rural Health & Care) exclusively to serve the Rural population (villages).

Decision was taken under the pretext that doctors are not available for rural population.

It is understood that for this purpose Medical Schools will be started in District Hospitals.

The recruitment of the students will be from rural areas and on completion of the course they will be obliged to serve in their native rural area compulsorily for 5 years.  Such graduates will also be given an option to undergo bridge course so as to enable them to obtain MBBS degree. 

IMA opposes substandard, short BRHC Course.

  Hon’ble Prime Minister of India said “India needs more Family physicians and efforts will be taken to increase the importance of Family physician.

Contradicting to this the bill says 4(c) page 53 “….to ensure uniform augmentation of trained specialist and super specialist” as its priority. 

·      

        National Commission, the proposed supreme body with vested powers will not have elected members and State representatives to represent their needs and demands.

Professionals from other discipline of Management technology and law are given place in this Commission which will pave way for dilution and nepotism.

It is unfortunate that in a democratic country elected representative Council is brought under power of non democratic body.    

  Health is a State subject. -      Independent Councils is the need of Medical Professions.

-      NCHRH will do more harm to health education and health care of India. 

    In short NCHRH is of the Government by the Government and for the Government and not for health care and medical education.

  With No roadmap.  How is the Government going to reduce the shortage of manpower by forming this Commission?

Pay scales for Doctors & stipend for Junior Doctors.

Salaries of sate govt. doctors should be at par with central govt. scales. Stipend of the junior doctors should be at par with those of central govt. medical institutions.

Amend the CPA act. Medical profession should be

exempted from the present CPA act, which is crippling the medical fraternity and forcing the doctors to do defensive medical practice resulting in denying of proper medical aid to needy patients.

Mandatory rural service

Indian Medical Association – positively responds to the Govt.’s newly proposed compulsory rural service after internship for MBBS graduates, provided the ‘provisional doctors’ shall get salary and other perks as of regular service personnel along with weight age in PG  entrance exam.

IMA stresses that this mandatory rural service shall be implied to those students studying in Govt. colleges only.

IMA recommends to Govt. of India, that this ‘rural service clause’ shall be optional to those students studying in private medical colleges. IMA would also advise the Hon. Health Minister and BOG of MCI to discuss the matter with all India Junior doctors association and other stake holders in medical education, before finalizing the decision.

Likewise there are so many issues relating to health care bothering the medical practitioners at local and state level also.

Doctors not going to rural areas is the problem of governance.

Adequate allowances and facilities like rural service allowances,

proper free accommodation, education allowances for children, vehicle or vehicle allowances, appropriate reservation for education

and employment for their children, ·       

sabbatical leave for academic enhancement of Doctors, allowances for attending academic conferences for updating their knowledge, f

acility for interest free personal loans should be provided to doctors serving in rural areas. 

This will attract doctors to rural areas. 

Enhance budgetary allotment for health care from present meager 2% to at least 12% of GDP.

Pay good salaries; make sure the Government PHCs have adequate supply of medicine.

All PHCs should be fully equipped with required para - medical staff and nursing staff to help the doctors.

Mandatory rural service

Indian Medical Association – positively responds to the Govt.’s newly proposed compulsory rural service after internship for MBBS graduates, provided the ‘provisional doctors’ shall get salary and other perks as of regular service personnel along with weight age in PG  entrance exam.

IMA stresses that this mandatory rural service shall be implied to those students studying in Govt. colleges only.

IMA recommends to Govt. of India, that this ‘rural service clause’ shall be optional to those students studying in private medical colleges.

IMA would also advise the Hon. Health Minister and BOG of MCI to discuss the matter with all India Junior doctors association and other stake holders in medical education, before finalizing the decision.

Likewise there are so many issues relating to health care bothering the medical practitioners at local and state level also.