‘noose’ will tighten on private clinics and Nursing Homes

In response to the newspaper article published in the Times of India, I wish we could give a rejoinder paragraph by paragraph as below.  It is not likely to get published because our thoughts won’t make Masala  for publication.

Read the news item first and then this. Readers in the IMA group may add more comments- u never know we may even decide to actually send the rejoinder.

The Health Minister did mention that the

English: St Annes Nursing Home

English: St Annes Nursing Home (Photo credit: Wikipedia)

‘noose’ will tighten on private clinics and Nursing Homes, but purposely failed to mention rather that the ‘noose’ shall also tighten on the PHCs and SADs that the Government runs with no facilities at all. Private clinics which are competitively placed with each trying to offer better facilities than the next have all the basic facilities required . But it is these govt clinics run in the hills and villages without doctors or nurses and coming under the same Clinical Establishment Act that shall face the possibilities of closing down, shutting the already meager existing facilities. It shall be interesting to see if in the future only private clinics will be targeted or even the govt clinics shall be gunned down which fall under the same required minimum standards in the Act.

The Indian Medical Association is trying not to stop Registrations and Regulations which are definitely for the betterment of health delivery system, but is pointing out the half baked rules within this Act possibly put together by some babus in the government without giving due thought. All establishments have been defined as places where diagnosis and treatment is to be done. By this definition medical health camps conducted once or twice a year by well meaning clubs, societies, charitable organizations etc sometimes providing the only medical relief in far flung areas etc shall not be allowed unless registered for a heavy fee. And no one is clear whether they shall register provisionally or permanently and how, if held for a day, shall they acquire minimum standards. By the same definition even a patient’s home shall not be a registered place obviously and legally speaking, home visits shall become illegal activity of the family physician. The IMA is trying to point out this unintended discrepancy in the Act

The IMA is persistently pointing out to the Government the muddle within the MCI too and the Government being on a back foot does not fail to mention to the press that some 2000 doctors are not registered. The truth of the matter is that doctors are supposed to register in the Indian Medical Register of the Central Medical Council only, directly or through the State Medical Council , but only once and there is no provision of re-registration. The State MC has contradictory rules. The 2000 doctors mentioned are the ones registered already with the Centre via the Uttar Pradesh Medical Council from before Uttarakhand became a separate State and hence are not supposed to register at more than one places as that is considered illegal. The High Court has also restrained the State Medical Council for the same about five years back. Several thousands of the registered 5000 doctors are also from UP Council and have been illegally forced by the Uttarakhand Council to re- register. It remains to be seen whether the onus of contempt of Court lies with the Council or the doctors who are doubly registered. What the CMO mentions as doubtful authenticity of these doctors shall become clear to them when they go from doctor to doctor for checking, and shall be able to verify that they hold the erstwhile UP Medical Council certificates, how else?

The notice to register till August was withdrawn by the DM after the Government realized it had made the rules and sent notifications when even the parent Act itself had not been passed in the Assembly. At present the IMA, quite contrary to what has been made out in the news item, is actually assisting the Government to quickly but efficiently implement the Act. The qualified doctors of the IMA do not want to get a bad name for health care and are interested in a quick implementation of the Act to wean out the quacks and so called jhola chaap doctors who shall obviously not get registered, though if the Act is allowed in the form that it exists, even they can, year after year renew provisional registration. The IMA is taking such lacunae in the Act seriously and hoping its protests shall be heard wisely.

Under previously existing norms the records of patients treated are already maintained by hospitals and are presented till date in the court of law whenever asked for. It is the divulging of private information to the District authorities that the doctors are rightfully objecting to as it breaks the age old Hippocratic Oath of secrecy of  doctor patient relationship. For example if a celebrity undergoes plastic surgery she would object if her private information is divulged.

The display of fees and routine charges is a step in the right direction and doctors are not against this. But it is the fixing of fee by the Government for private establishments that is objectionable as in a Democratic country this outrages a professionals fundamental right to free enterprise. What is not realized is that doctors charge according to their seniority, expertise, speciality, place of vocation and so many other market forces that come in play. They remain highly competitive and anyone overcharging shall soon loose business- so there are enough checks in place. The government has already realized it’s mistake on this and the Bill to regulate fees, likely to be struck down by the Supreme Court in violation of the fundamental rights provided in the Constitution, has not even been tabled in the Parliament

Dr Rakesh Kalra
+91 9760077000

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