PCPNDT ACT ASSIGNMENT

Group A

Introduction

The Pre-conception & Pre-natal Diagnostics Techniques (PC & PNDT) Act, 1994, was enacted in response to the decline in Sex ratio in India, which deteriorated from 972 in 1901 to 927 in 1991.

Female infanticide had been prohibited through legislation in pre-independence period and certain provisions were included in the Indian Penal Code, 1860, for punishing causing miscarriages and other such offences .

But with the advent of diagnostic technology to detect the sex of the foetus very early on in pregnancy, a need was felt for a specific law to prevent the misuse of the technology ,which could lead to female foeticide.

Following is an effort to look at the process of implementation and execution of the act from the

viewpoint of a hospital administrator.

Introduction

A 100-bedded hospital.

Proprietary concern.

The hospital is actively involved in carrying out deliveries.

The hospital has an IVF Center as a specialty focus.

The hospital also has a separate Executive Health Check Department.

Facility Infrastructure

The hospital has in total 4 USG machines which are distributed as follows:

1. One stand-alone machine operated by a radiologist, housed in a 20-sq-m area.

2. One portable machine, operated by a radiologist used anywhere in the hospital in case of emergencies.

3. One 2-D echo machine in EHC department operated by the cardiologist.

4. One USG machine used exclusively by the IVF center, operated by the gynecologist, housed in a 20-sq-m area.

Understanding the Legal Framework

The PC PNDT act deals with two stages :

1) Preconceptional stage – when sex selection can be done (PGD, preimplantation genetic diagnosis.)

2) Prenatal stage– after conception and before delivery . At this stage, sex determination can be done by two techniques,

Non invasive– USG Invasive--- Amniocentesis, CVS ( chorion villous

sampling ). The act prohibits sex selection as well as sex

determination.

Administrative Issues/Problems

1) Contravention is considered a Criminal Offence with imprisonment upto 3-5 years .

Punishment till now has been awarded only to those who are convicted for performing sex selection/determination. However, the current cases indicate two things:

A) Possibility of getting punished even for a technical error/ minor irregularities (not maintaining the records, irregularities in relation to F forms, etc.).

B ) Possibility of extension of the period of imprisonment upto 10 years.

Administrative Issues/ Problems contd..

2) Doctors / Hospitals reputation which is earned over period of many years gets tarnished

3) Loss of income—The USG machine can be sealed if the doctor is found guilty and the machine can be seized. The machines may not be released for a period of5-6 months (Dr. Sujeet Dange Vs state of Maharashtra ).

4) Variations in the protocols laid down by local appropriate authorities.

Thus from a hospital administrator’s perspective, it’s a huge monetary and nonmonetary loss. (Huge cost of Poor Quality).

As an administrator, my role would be to ensure

“Complete co-operation and legal compliance”

Objective of Implementation

1. To spread education and awareness amongst patients, relatives, and hospital staff about the act and its purpose.

2. To ensure that nobody promotes or carries out sex selection, determination, or disclosure in the hospital premises.

3. Not to get into legal tangles.

4. To ensure that everyone understands the importance of the law and its repercussions.

5. To develop an effective system for monitoring and evaluation

Process

Patient Arrives for a Scan.

Patient is explained about

sex selection and

determination not being

carried out in the facility, in the language

understood by the patient.

Patient understands and signs the consent form.

Signature of the doctor

performing the scan is taken

before commencing

the scan.

Form F is completed,

checked and uploaded.

Structure of Implementation

All the machines used for USG are registered .

All the doctors operating the USG machines have to register themselves, and their names have to be on the PNDT certificates.

The certificate of registration is displayed at a conspicuous location in the waiting room as well as in the examination room, which houses the USG machine. The location should be such that it can be easily seen from where the patient/ relatives are sitting . The certificates are not laminated to facilitate any future inclusions in the same.

The signages are displayed declaring that sex declaration tests are not carried out in the premises and it is a criminal offence. By the recent notifications of MCGM , the patients / relatives also can be punished if they pressurize the doctors to carry out the sex determination tests. Such conversations need to be recorded and data forwarded to local ward office/ helpline toll free numbers. The banners stating this information can act as a strong deterrent for those who keep on pressurizing doctors to disclose the gender under various pretexts.

Process of Implementation

The signage and banners indicating that fetal sex is not selected or determined is displayed in English and Devnagari ( Marathi/ Hindi ) in the reception area. It can be displayed in any other local language, if the need be.

USG register has to be maintained listing the names of all obs. USGS done apart from the general register .

F forms have to be maintained as per the PNDT guidelines.

Form D has to be maintained for prenatal invasive test (e.g. amniocentesis).

Act book has to be kept handy , in case any patient/ AA would like to refer.

All records should be made readily available to AA . Records should be maintained for two years. A dedicated cupboard should be assigned to keep the records as AA can come at any time to inspect records .

Procedures and policies to check the completeness of F forms, at the end of a session, before doctors leave for lunch/ visits.

Process of Implementation contd…

.The requisition forms need to be maintained and preferably attached to the F forms . These may be the pre printed forms by the hospital on which the doctors may refer or the doctor’s own letterheads. These would mention patient’s name, name of USG —obstetric, indication and the referring doctor’s address and registration nos. In case the patient does not have any of these, a self-referral form needs to be filled and attached to the F form. The department should have a list of addresses and registration nos of the doctors who routinely refer patients for obstetric scans.

Process of Implementation contd…

A monthly report is submitted to the Appropriate Authority regularly before the 3rd of every month. Of late, the data of patients need to be uploaded on a government website ( www.pcpndtmumbai.org).

A copy of the same monthly report with the signature of the AA acknowledging receipt is obtained and preserved.

Silent Observer in pipeline ???

Snapshots

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Measures for Evaluation and Control

1. It is ensured that the notice board always displays the signage about sex selection and determination not being performed in the facility conspicuously at all times.

2. The PC&PNDT act book is always kept handy.

3. It is ensured that nobody performs a scan without the relevant registration under PNDT act.

4. Scans not being performed until the patient fills the form F.

5. Dedicated person is employed to ensure that the forms are completed, checked, and uploaded on a daily basis.

Measures for Evaluation and Control contd..

6. Reminders are built into the IT system of the hospital to ensure that the expiry of the registration period is notified in advance (2-3 months before the expiry) .Pop-ups and alerts if F forms are incomplete / not uploaded on website.

7. Second-trimester MTP’s are scrutinized to ensure that they are not happening with the intention of female feticide.

8. Regular feedback is taken from the patients. This will ensure that patients are explained about the hospital policy about sex determination in the language they understand, before taking their signatures.

Measures for Evaluation and Control contd..

9. No terminologies, which will send/ indicate a wrong message to the patient, will be used by the doctors.

Example– avoiding the term baby and use the word fetus instead, while discussing with the patients. Avoiding getting into discussion and formulate answers for likely questions on gender determination , which will be polite but firm.

10. Continued education programs for staff, doctors and public giving them the scientific update about the act and its implications because

“ No matter what we and mindsets

change.

“ No matter what we do , the real change will come only when our mind and mindsets change.