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Monday, 20 March 2017

Title- “West Bengal clinical establishment ( Registration, Regulation, and transparency ) bill-2017- Rest of India can take lesions from West Bengal for such a regulatory body in every state as a part of health care reform

 Professor Dr Pranab kumarBhattacharya MD( Calcutta Univ) FIC path  Professor of Pathology Murshidabad Medical college Behrampore Murshidabad  West Bengal;  Runa Mitra MA ( university of Calcutta) social worker   Barrackpore ; Sagorika Dutta choudhury Correspondent Ajka; news Paper

 In India health care system is mixed type i.e. both the public & private medicare health system runs parallel and side by side. In public health care system governed by the state or central government is almost at free of costs in majority of provinces in India with some kinds of national program on vaccination and eradication of some infectious diseases like malaria, Chickengunia ,dengue, leprosy, kala-azar, tuberculosis, NRHM but these tropical diseases even in this 21 century claims a good numbers of life . Preventive health care in chronic diseases like, diabetes, COPD, cardiovascular , Stroke hypertension ,cancer psychiatric illness etc that costs too much financial burden for any family is over looked usually till date. Health is a state government affair mostly. Private health care system consist of private practitioners , private nursing homes and private health care institutions, private diagnostic centres and these private hospitals , nursing homes and diagnostics are big profitable health industries in health economics mainly targeting for business without any regulatory bodies or commissions from end of government and vigilance laws and acts to regulate their functions so long through licenses for doing such trades or business from the government level with trade licenses issued & permission to them to carry on business with ailments . The lands are usually provided by the government for establishment i.e. for hotel like buildings or Air conditioned rooms and for many infrastructures human resources ( Doctors and nurses) are also recruited by them either from government medical colleges having post graduate/post doctoral degrees or retired faculties and specialists from public hospitals with huge percentage of incentives or with persons having foreign diplomas like MRCP FRCS MRCS most of which are not recognized by the highest councils ( So far it was regulatory bodies in India) like Medical councils of India with its state branch offices like in West Bengal state West Bengal Medical councils So in India out of pocket expenditure in health was/is huge in relation to any other welfare countries, unprotected by nationalized health insurances and about roughly 60 millions of 129 millions populations are pushed towards poverty almost every years because of mushrooming private Medicare health industries and house holds are unable to afford such treatment for illness typically for cardiovascular causes diabetes mellitus with or without complications septicemia End stage renal disease liver diseases cancer septicemia , organ failure and transplants of either stem cells or biologic molecules and people had to sell house lands valuables every things for hospital treatment at least in West Bengal state . However this authors never say that all private hospitals doctors and nurses are corrupted or bad but many private care industries misuses the health system and causes harassment to people for so long years together. So there needed some sort of reform in health system which are pro-poor and has universal access to health care in this country
 The present Indian government (2017) health department in march 2017 for the first time since independence in 1947 declared its political intention to set up its intention in health care system spending to provide free supply of medicine free diagnosis and free emergency essential services to reduce house hold out of pocket expenditure that present government health department of west Bengal provinces did in 2014 July for the public hospitals run by government But it needs policies, strategy and priority selections and increase of expenditure of GDP for health (which is in 2017-18 budget is 1.3%) to at least 3.5 to 5% and must be in time bound manner and to support universal accesses to health services be it in public and private care like Obama health care in USA or NHS care in UK The policy according to me * offering Free medicines of quality and good bio availability ** offering free diagnostic including radiology digital x ray CT scan , Serological pathological bacteriological tests*** New comprehensive primary health care packages for cardiovascular diseases , Diabetes, dialysis, cancer if it is in private health care industries done under a fixed government rate and capping of fees , billing system by making new laws and acts( besides 1985 clinical establishment acts) through some regulatory bodies with power of judiciary system In India there are almost 30,000 primary health centres and 500 community health centres where facilities infrastructure and human resources are rudimentary particularly in relation to free supply of medicine, diagnostic, palliative care, and mental health care. In addition to existing national level health care allocation of funds should be directed so towards 1) Free screening for Diabetes mellitus through FBS HBA1C and free supply of medicine /insulin /drugs 2) Screening of hypertension at free of cost with treatment to reduce stroke Acute Myocardial infarction and death 3) Screening for breast cancer at free of cost with proper treatment if and when detected 4) Screening for pre cancerous lesions for oral cancer (OSMF) and oral cancer 5) Screening for Lung cancer at free of cost and treatment 6) Target for elimination of Leprosy Kalaazar and tuberculosis by 2025 Target for elimination of malaria and dengue by 2025 by vaccine 8) To reduce pre mature death from diabetes mellitus type 2, cancer COPD by 25% at least by 2025 Problem is political will in our country India to increase GDP in health care system at public hospitals and with human resources- as most post graduates post doctoral specialists being trained in public medical colleges and hospitals joining in private health care institutions for lucrative salaries incentives lavish life styles The problems in health care system in west Bengal I author do identify • Huge load of patients – almost 70% - 73% patients rushes to medical colleges from districts rural sub divisional hospitals • Overcrowding – due to faulty referral system or not working • High bed occupancy rate and non availability of beds – one bed is often shared by 2-3 patients due to non referral system in public hospitals by order of supreme court when admissions is through emergency • Waiting time for any investigations it is variable in different public hospitals. But in medical colleges often one to three months due to lack of human resources non availability of sufficient technicians and reagents to tests. However waiting time is much less in west Bengal then waiting time in UK USA with high GDP expenditures in health and that resulted health tourism • Non availability of free bed side care by nurses and Group D staffs – they are in adequate in numbers. Nurses are microscopic and GDA Sweepers and other Group D staffs are not available and as such most patient party have little choices to hire private attendants or ayah at cost of approx 150/= INR per shift(12 hours) and thus costs RS 300/= INR per day in most medical colleges- though system of paid attendants in west Bengal state discontinued by previous left front government a decade ago • Most importance is cleanliness

 The health care system of west Bengal provinces as well rest of India has been struggling for decades( since 1990s) There had been numerous complaints against private health care institutes for long years together . They used to charge exorbitant rates without providing proper treatment and in many cases quarries regarding ailments and estimated costs of treatment are not properly addressed with clarity and consent There had been accesories when the body of the diseased had not released by private hospitals on account of non clearance of dues , The violence  that were witnessed recently in West Bengal in private hospitals of metro cities in kolkata is the result of accumulated anger we do consider . The state government of West Bengal has shown the courage to stop the unethical practice indulged in by the hospital authorities by a new bill In west Bengal Provinces in march 2017 a new bill has been signed by the Governor of West Bengal named as “West Bengal clinical establishment ( Registration, Regulation, and transparency bill-2017) and through this bill a commission has been formed which will tabs on approximately 2000 private hospitals and nursing homes in the state of West Bengal
 • The commission will hear complains of negligence against private health care institutions managerial staffs health technicians nurses doctors working there and this panel may order cancellation of licenses closer of that particular establishment Seizer of the property of managerial staffs doctors nurses who are at fault or found guilty of causing grievous injury or death . This panel can file FIR if it finds a clinical establishment is guilty in violating registration or license norms and if charges are proved the persons including / hospital CEOs/ Managerial staffs/ doctors/nurses/ technicians can be jailed up to 3 years . This commission will also cap charges for indoor & outdoor services doctors fees structure and investigation charges and needs 
• This kind of steps I consider is a very good step for access of all in health care system and also for the rest of India can take a lesion from government of West Bengal for such a regulatory body in every state

• West Bengal new Regulatory laws on private hospitals however set off central versus state battle amongst leadership of Indian medical Association(IMA) – the country’s largest Private association of doctors when the IMA of West Bengal chapter uniamously decided to support the new bill and laws IMA national president objected to certain clauses in “West Bengal clinical establishment ( Registration, Regulation, and transparency bill-2017”relating to prosecution for 3 years and compensation in grievous injury or death (up to 50 Lakhs INR ) without any valid reasons as this bill will not affect an honest doctor and when private health care intuitions mostly are den of malpractices and were without accountability for so long years together
• The National president of IMA  Dr KK Aggarwal told there were alternative forums like consumer forum. He told there should be consumer court or a regulatory commission. There should be single windows accountability.  But how much CPA laws were effective for so many long years? Status of CPA was not enough clear whether one aggrieved person on same ground can file two separate cases on one incidence with both the court of laws and consumer forum? And more over regarding power of consumer forum/ court verdicts can be challenged to high court and supreme court and private hospitals are more powerful players for money He also  told for omission of  criminal charges  against doctors  unless there is intention to harm the patients. But the new act  suggest that any one causing death  or injury of any types to a  patient  through negligence  should be  liable to  punishment  in under Indian penal code(IPC)  and any person violating  the conditions of registration
  or license  under act should be  liable to imprisonments up to three years

So my personal view that the bill is not against the honest doctors private practioners whose numbers are more and maximum

 • However before the bill come to as acts or rules I shall request the commission to consider following points if I am not wrong 
1) Post mortem examination should be must if and when charge of negligence on death
 2) when and if negligence cannot be proved the doctor/nurses/ technician should be paid by the order of the commission for the legal expenditure , spoiling reputation , and mental pressure he/she bears 
3) Mal handling of doctors on duty must be arrested immediately
 4) Banning of all quacks in west Bengal 
5) Case compensation and jail should be also for the managerial staff CEO who is policy makers for private hospitals and not doctors 
6) Fixing guide lines for Ethical medical practices in private health care institutions 
7) Fixing Guide line to improve bonding in individual doctors encouraging more communications and inform consent with patient’s party 
8) Encouraging audit system in practice of private health care clinical establishments in regard to investigations prescriptions of drugs in generic and doctor patients relationship after the bill is implemented 
9) Monthly if possible weekly death review committee report should be sent to health department 
10) Educating doctors on sociological issues 
11) Protection of Doctors be it private and public against civic legislative and social mal-handling & Exploitation by private hospital managements 
12) Empowering doctors to take steps legally against frivolous complains malicious defamatory press statements and unlawful harassment

 This article Title-  “West Bengal clinical  establishment ( Registration, Regulation,  and Transparency ) bill-2017-  Rest of India can  take lesions  from West Bengal for such a regulatory body  in every state  as a part of health care reform  " published in this Blog  is Strictly Copy Righted material to Prof.(Dr.) Pranab Kumar Bhattacharya under his Intellectual Property Right(IPR)  Copy Right Acts  under sections-/301 / 306/3D/107/1012( a,) (b ) / RDF and Protect Intellectual Property Right ACT of USA-2012. Please do not ever try to infringe to avoid huge  amount  damage suit charge  in several cores INR / or civil suit / or  even criminal proceedings in IPR Courts of India or in any other courts of India Professor Bhattacharya  will deem fit it so . Please do not try or take any sort of  attempts to infringe any thing [ besides reading  or liking or commenting or E mailing  if any if you have ]   or engaging yourself in  kinds  of plagiarism for yours own safety purpose from Plagiarism suit or infringement of Copy Right act suit .  You are not  ever permitted to reproduce any things  from his/ their postings/ published articles/comments/blogs/posts or sharing in his Face book etc or even use for your's fair uses also or dissemination for others knowledge or teaching or public or published  reproduce  as per IPR acts and laws for ever.These terms are however will not  be applicable for Professor Dr Pranab Kumar Bhattacharya's  only daughter miss Upasana Bhattacharya , other authors and to  all his family members who can use these articles and postings in this Blog  or his face book  for their beneficiary acts in future or ever in manner they desire to use.

This article has been published 1]  as a comment at British Medical journal The BMJ opinion to the blog article   by  Avinash Supe: Violence against doctors cannot be tolerated March 29, 2017               

2]  This article has been published also as comments  at British Medical journal  The BMJ opinion  

Tessa Richards: Patients combat corruption in healthcare December 20, 2016

BMJ 2014348 doi: (Published 08 May 2014)Cite this as: BMJ 2014;348:g3169
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