By: Vijay Kumar Verma ( Editor-ICN Group )
SHIMLA: The medical profession which is considered as second to none is, today, being looked at with suspicion. Doctors, hospitals, the health sector, patients, media, and politicians all are unhappy. In view of the prevailing circumstances the Indian Medical Association has proposed the following self imposed regulations:
All IMA members shall practice with compassion and follow IMA ALERT policy (Acknowledge, Listen Listen and Listen, Explain, Review and Thank you).
IMA Medical Redressal Commission
There shall be IMA Medical Redressal Commission in each state to engage in social, financial, and quality audits of health care (Suo moto or on demand). The commission will have a public man, an IMA office bearer, one former state medical council representative, and two subject experts.
· The commission shall consider every grievance in a time bound manner.
· An appeal to the state commission will be heard by the head-quarters which will have the powers to take Suo moto cases also.
· Apart within the medical establishment all patient complaints should be addressed in a timely manner through an internal redressal mechanism with a chairman from outside the hospital.
IMA Policy for affordable Drugs and Devises
· Doctors are often blamed for prescribing costly drugs. All IMA members shall choose affordable drugs.
· Government is requested to come out with an urgent ordinance for one drug-one company-one price policy to check gross prize variations.
· All IMA members should prescribe preferably NLEM drugs.
· All IMA members shall promote Janaushidhi Kendras where all NLEM drugs should be avialbel
· The government should classify all disposables under both NLEM and non-NLEM categories and cap the price of essential ones.
· Most hospitals compel patients/attendants to procure drugs from in-house pharmacy for in-door/out-door treatment. As per Delhi Government order (23/290/1647/NH/DHS/HQ/14 / 9088-95 Dated: 05/02/17 the hospital authorities should refrain from above restrictive practice and patients/attendants may be allowed to source the requisite drugs for their treatment as per their choice.
IMA Policy on MRP
· No establishment can sell any item priced higher than the MRP.
· No service charges should be added on MRP to procure drugs and devices from outside.
· MRP shall not be dictated by the purchaser.
· All medical establishments should sell the disposables at procurement prize after adding a predefined fixed margin.
IMA policy on over charging and over investigations
· Hospitals and doctors are often blamed of over charging and over investigations. Billing should be transparent, and all special investigations should be well informed.
· Every medical prescription must include counseling on the cost of drugs and investigations.
· Choice of drugs and devices rests with the doctors based on the affordability of the patient and not on the profitability.
· Clause 15 of the Schedule appended with Rule 14 of Delhi Nursing Homes Registration (Amendment) Rules, 2011 states that the keeper of the nursing home shall ensure that the charges levied by the nursing home for all services available in the nursing home are prominently displayed.
IMA Admission Policy
Every IMA member should ensure that it becomes mandatory on the part of the hospital administrator to give options at the time of admission to choose cost-effective treatment room and treatment (single room, sharing room, and general-ward) and explain the difference in total bill estimates. The hospital estimates at the time of admission should be near to actual.
The treating doctor must explain the chances of death and unexpected complications and resultant financial implications.
Once doctors take charge of a patient, the patient should not be neglected. They should look after the patient till discharge.
Emergency care
Emergency care is the responsibility of the state government and the costs of all emergencies in private sector should be subsidized by the government.
Cause 14.2 of the Schedule appended with Rule 14 of Delhi Nursing Homes Registration (Amendment) Rules, 2071 states that the nursing home shall not refuse
Treatment to the injured/serious patients brought to them due to any reason whatsoever. Medical establishments must provide immediate medical care, without any. delay, due to any reason whatsoever, to persons requiring emergency medical care, especially victims of crimes, road accidents, acid attack, sexual assault or critical patients brought to them.
Section 357 C of the Code of Criminal Procedure provides that all medical establishments private or government shall provide first-aid or medical treatment free of cost, to the victims of any offence covered under section 326A, 376, 376 A, B. C, D, E of the Indian Penal Code and shall immediately inform the police. (rape or acid attack or child sexual abuse). They will also get free ambulance service.
IMA Discharge Policy
· IMA LAMA policy: being a grey area is being made.
· Every dead body needs to be treated with respect and dignity.
· IMA policy: With no National Guidelines viability of fetus issue is being looked upon by IMA, FOGSI, IAP and NNF.
· No premature baby should be declared dead in presence of hypothermia
· A hospital has no right to stop life-saving investigations or treatment for non-payment of bills if the patient is still admitted in the hospital.
· All medical establishments should maintain due dignity of dead persons under all circumstances. Dead bodies need to be handled with due respect and seriousness. Hospitals, especially those having mortuaries attached to them, should be actively involved in sensitizing their staff and should lay down protocols in this regard. Further, such hospitals should reinforce and upgrade their mortuary infrastructure so as to ensure safe and proper handling of dead bodies. It may be noted that showing disrespect and inflicting indignity to the dead body is an offence punishable under section 297 of the Indian Penal Code.
· Dead bodies of deceased persons should be promptly handed over to the next of kin and should not be unduly held back by the hospital authorities under any circumstances or pretext whatsoever.
Unethical Acts
· All medical establishments must ensure that their ethics comply with the MCI ETHICS (Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002)
· IMA has zero tolerance to doctors indulging in female feticide.
· IMA also has zero tolerance to cuts and commissions.
· Medical establishment should revisit their referral fee system. Billing paid to all doctors should be transparent and reflected in the bill.
· No doctors should issue false certificates
IMA Hospital Consultant policy
· No hospital can force their consultants to work on targets.
· Contractual agreements should be in such way in which interested of both parties that is consultant and the hospital is equally protected.
· All hospitals should consider not charging service charges from the consultants.
Commitments to the poor
· All hospitals must comply to the commitment towards EWS, BPL, and poor patients without any discrimination.
· Ensure for us all are equal. BPL, APL, EWS, rich, or poor all should get the same attention and treatment.
· All charitable hospitals should do their free work as assigned.
· All needy patients must be routed through the social worker of the establishment and guided and directed to the appropriate place.
· Clause 3.3 of the Schedule appended with Rule 14 of Delhi Nursing Homes Registration (Amendment) Rules, 2011 states that besides the main areas in the intensive care units, the ancillary area shall include space for communication, clerical space and public space adjacent to unit and prayer area. As per a Delhi Government order 23/290/1647/NH/DHS/HQ/14 / 9088-95 Dated : 05/02/17 the hospitals authorities must ensure that the amenities in the public space for relatives/attendants in the hospitals conform to the above and are comfortable, hygienic, user friendly and adequate. .
IMA LSCS Policy
At least one more equally experienced gynae surgeon should preferably be involved in the consent form during elective LSCS. Proper counseling and record keeping should be done in every case.
Medical Records
The patient has a right to get medical records within 72 hours of request. Acknowledge their request.
Second opinion
The patient has the right to go for a second opinion from an appropriately qualified medical doctor. The primary doctors have no right to get offended.
Transgender Policy
We must ensure that our establishment has a transgender policy.
Government Hospitals
All government hospitals should be upgraded and have facilities like those in the private hospitals. All public, private or charitable hospitals should have quality accreditation
Single window Registration?
We are not against any regulations and accountability, but we should all ask for a single window accountability at the state level. The state medical council should be proactive and take timely decisions. We should also ensure a single window registration.
IMA is not against Clinical Establishment act?
IMA supports CEA cleared by Inter Ministerial Committee (IMA with four ministries MOH, Consumer affairs, Law and Justice
