Clinical Establishments Act can lead to corporatization of healthcare

Clinical Establishments Act can lead to corporatization of healthcare system in India: MLAG
Our Bureau, Chennai
Friday, April 25, 2014, 08:00 Hrs [IST]  by PHARMABIZ.COM

The Chandigarh based ‘Medicos Legal Action Group’ (MLAG), a registered trust of allopathic doctors, has alleged that the Clinical Establishment (Registration and Regulation) Act, 2010 and the Clinical Establishments (Central Government) Rules, 2012 notified by the government of India are sponsored by corporate lobbies to promote corporatisation of the entire healthcare management system in the country.

The very impact of these corporate friendly laws will be forcible closure of all small hospitals that provide reasonable and low cost treatment and surgery to the common people, said Dr Neeraj Nagpal, convener of MLAG.

While speaking to Pharmabiz over telephone from Chandigarh, he said the ministry of health and family welfare has invited comments from healthcare institutions and public on the minimum standards required for the establishments before April 30. MLAG will demand the removal of hospitals with less than 25 beds from the purview of CEA. According to him, 70 per cent of the total healthcare managements in India are carried out by small hospitals/clinics owned by single doctor or doctor couples and most of the centres are with less than 25 beds.

Dr Neeraj said the government should bring in laws to help the small and medium clinical establishments in the country rather than helping and promoting corporate establishments. Likewise, the government should encourage small healthcare institutions for getting NABH certification and give incentives in the form of tax exemptions, soft loans etc.

Requirement of stringent enforcement of safety regulations and quality control is acknowledged to be needed in large hospitals dealing with large number of patients. But if it is enforced on small scale medical establishments which are not financially viable, they will be forced to close down. In the small establishments the doctor himself is the administrator, quality control officer, fire safety officer, pharmacist and sometimes driver of the ambulance, he commented.

The Dr.Neeraj says that the act is totally confusing, it should segregate Ayush institutions from allopathic establishments and stringent punishment should be imposed on those Ayush doctors who practice allopathy. In the minimum standards, the definition of level 1 and level 2 hospitals says that Ayush doctors can work in these hospitals. It has not been mentioned later in human resources requirement and it is against several judgments of the national consumer disputes redressal commission (NCDRC) and the Supreme Court.

“Unani, ayurvedic and other Ayush doctors cannot use allopathic drugs as per law. For Unani hospitals the list of emergency drugs includes adrenaline, dobutamine, nitroglycerine, amiodarone, magnesium sulphate, mannitol etc. What is not clear is, are the Unani doctors supposed to use these allopathic drugs in emergency? There is no post for allopathic doctors in these hospitals. If Unani doctors use these drugs, they are contravening the Supreme Court verdicts of Poonam Verma vs Ashwin Patel as well as Mukhtiar Chand vs State of Punjab judgments”, he said.

DMMS course in place of BRMS

Govt should revive erstwhile DMMS course in place of BRMS: Dr MC Gupta
Peethaambaran Kunnathoor, Chennai
Monday, April 21, 2014, 08:00 Hrs [IST]  (phamabiz.com)

In place of the controversial Bachelor of Rural Medicine and Surgery (BRMS), a short-term rural medical course being introduced by the government to tide over the shortage of doctors in the rural areas, the government should revive the erstwhile short term medical course, Diploma in Modern Medicine and Surgery (DMMS) which was started by government of Orissa and recognised by Medical Council of India (MCI) in the past, opined Dr M C Gupta, medico-legal consultant and a member of the Delhi Bar Council.

It can be a supplement to the proposed health agenda of the Indian Medical Association (IMA), he said and added that in the recent past the union health ministry had also proposed the same course in lieu of the BRMS.

Similarly, a cadre of nurse practitioners should be started in place of the B Sc (community health). A new pattern of training for nurse practitioners must be designed in association with medical colleges and nursing schools. He said admission to all the health related para-medical courses including B Pharm should be made through a common entrance examination.

Dr Gupta, who will submit his proposals to the new health minister in the next government, said that on the lines of IAS, IPS and IFS, a provision should be made for creation of Indian Medical Services (IMS) for the administration of health services in the country. He said a civil service cadre of that kind had existed in India at the time of British rule when the Indian medical services were heavily manned by the British.

Disagreeing with the demand of IMA that the country needs more medical colleges in urban areas, Dr Gupta suggested that each district must have one medical college and no need of more number medical colleges in urban areas. The district medical college, along with other colleges or schools of para-medical sciences, should involve in the training of professionals in the respective areas.

His health agenda suggests that government should increase the health budget to five per cent of the GDP. India’s health budget is one of the lowest. The country falls under countries that spend the lowest on healthcare in the world. In 2011, the government spent a paltry one per cent of its GDP on healthcare. Primary health care should be declared as a fundamental right, and necessary legal and budgetary provisions should be made for the same.

Dr Gupta further suggests that the Clinical Establishments Act, 2010 should be amended in order to provide in section 12(2) that the state would reimburse private clinical establishments for providing emergency services as per the mechanism suggested in Law Commission’s report number 201. A cap should be provided for compensation payable for medical negligence under Consumer Protection Act (CPA) 1986. Special medico-legal benches with necessary expertise should be established in the consumer courts to deal with medical negligence cases.

He remarked that PNDT act should be radically amended or replaced by another act with the basic concept that rather than criminalise pre-natal sex identification, there should be a mechanism that once the sex so determined must be immediately reported to the appropriate authority. Thereafter, it should be the responsibility of the authority to track the continuance and safe delivery of the female baby and to punish those who perform abortion of the female fetus.

Dr Gupta also proposes that the D&C Act should be strictly enforced with special reference to enforcing the ban on sale of drugs without prescription and also ban on sale of allopathic drugs against prescription issued by Ayush doctors.

Clinics under Clinical Establishment Act

Minimum standards drafted for clinics under Clinical Establishment Act
Joseph Alexander, New Delhi (pharmabiz)
Wednesday, April 16, 2014, 08:00 Hrs [IST]

In a bid to effectively implement the Clinical Establishments (Registration and Regulation) Act 2010, the Union health ministry has announced draft minimum standards for various categories of clinical establishments, both in the allopathic and Indian streams of medicine.

Once approved, the registered establishments in the States where the Act is at present applicable should follow the minimum standards laid down separately for different kinds of clinics. The National Council for Clinical Establishments, the apex body under the chairmanship of Director General of Health Services, has held a series of consultations with the stakeholders including the Quality Council of India and Indian Medical Council to prepare the draft standards.

At present, States like Himachal Pradesh and Jharkhand, apart from the Union Territories of Andaman, Diu and Daman and Chandigarh have implemented the Act and over 4600 establishments had been registered. States like Uttar Pradesh, Mizoram, Sikkim, Rajasthan and Arunachal Pradesh have also adopted the Act, but yet to implement them in the absence of rules, while the Centre is still trying to impress upon other States to adopt the same.

“The comments, suggestions, objections, including deletions/additions if required in the draft documents are invited from public at large, including the stakeholders like hospitals and other clinical establishments, consumer groups etc,” according to a notification by the Council.

The Indian Public Health Standards (IPHS) for sub-centre, PHC, CHC, sub-district/sub-divisional hospital and district hospitals have already approved documents. The draft is hence only for those in the private sector.

Separate standards have been prepared for allied health executive, behavioural health integrated counseling centres, dental centres, dental hospitals, dietetics, hospitals in primary, secondary and tertiary levels, labs, collection centres, mobile clinics, dialysis centres, physiotherapy centres, polyclinics with diagnostic support, polyclinic with dispensary, polyclinic with observation, radiology and imaging centres and stem cell laboratories, in the allopathy sector.

Likewise, the detailed standard parameters have also been prepared in consultation with the Ayush department for establishments of Ayurveda, Naturopathy, Siddha, Sowa-rigpa, Unani and Yoga.

Ayush dept terminates 134 Ayurveda

Kerala Ayush dept terminates 134 Ayurveda therapists; absorbs 51 doctors in NRHM
Peethaambaran Kunnathoor, Chennai, Wednesday, April 09, 2014, 08:00 Hrs [IST]

The Ayush department in Kerala has given termination orders to 134 contractual therapists working in 104 Ayurveda hospitals in the state due to discontinuation of funding from central Ayush department. The health workers have been working in various hospitals for the last five years under a scheme of central Ayush department.
Meanwhile, 51 Ayurveda doctors and 22 homoeopaths who were appointed along with these therapists have been absorbed by NRHM and posted in various hospitals and dispensaries under it.
According to M Mithun Krishna, a terminated therapist from government Ayurveda hospital at Paravoor in Kollam, the hospital management committees (HMCs) functioning in the hospitals have recruited 203 qualified therapists on the advice of state NRHM (National Rural Health Mission) and appointed them for a period of five years in all the 119 Ayurveda hospitals in Kerala. They were appointed on a monthly salary of Rs.9140, but the payment was halted in the middle due to lack of fund from Ayush department. All the persons appointed were qualified the course of Ayurveda therapy (AT) from leading Ayurveda colleges.
The staff including doctors and therapists were selected in 2009 when the project was started. The list included 102 doctors and 203 therapists who were given jobs in the 104 hospitals. According to sources, though there are 119 Ayurveda hospitals in Kerala, therapists are posted only in 15 hospitals. Remaining 104 hospitals have no therapists whose services are an indispensable part of the punchakarma therapy. The terminated health workers have contacted the health minister and submitted a memorandum.
When contacted, state programme manager of NRHM Dr P Haridas said NRHM has not sanctioned a post of Therapist in ISM hospitals and these people were appointed by the respective HMCs. The amount for salaries to the employees were allotted by central Ayush department, and not by NRHM. He said the therapists were employed on contractual services under a five year scheme funded by Ayush department for the purpose of upgradation of hospitals and dispensaries.
“Now the funding has been stopped, so we had to inform the Ayush department that the term of contract would be expired on March 31. The therapists were appointed by hospital management committees”, he added.
Regarding absorption of doctors, he said they were selected after written test and interview by NRHM and for fulfilling the project of Ayush, they were deputed to state Ayush hospitals for five years. The doctors were posted from the rank list prepared by NRHM. But, he said, NRHM has no sanctioned post of therapist, so it cannot absorb the contract-expired people.
Meanwhile, Ayurveda Medical Association of India (AMAI) has come down heavily on the state government for not furnishing the utilisation certificate of the project and held that it was the reason for the stoppage of funds from the centre. Dr Rejith Anand, secretary of AMAI said he would write a letter to the centre seeking government intervention into the matter.