BY
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
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