Inject accountability in health care
The Clinical Establishments Bill 2007 needs to be implemented says Dr GLADSTONE A D’COSTA
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The passage of the Clinical Establishments Registration and Regulation Bill was welcomed by the larger corporate hospitals. However, there was some consternation and apprehension among the smaller players in the industry. Their misgivings appear to be based on fears of the establishment of yet another dimension to the license raj. However, to the neutral observer, it appears ridiculous to shut down and confiscate “gaddas” selling omelette pao because they did not have a license to operate, and at the same time permit hospitals which deal with life and death to function totally unregulated and unaccountable.
The concept regulation is not new. The Bombay Nursing Homes Act dates back to 1949, though it was amended in 2006. Feeble attempts at introducing some semblance of order were made with the Bhore report 1946, Mudalier 1962, Mukherjee 1966 and ICMR 1981. However, these largely addressed the public sector. Private health care sector in India has gone from strength to strength and today accounts for 58% of the hospitals and 83% of national health care expenditure. It is one of the largest sectors in the world in sheer size and least regulated. Only about thirteen states have any form of private nursing home regulations; and those that do exist are so weak and watered down that they are reduced to bureaucratic scraps of paper.
The Bombay Nursing Homes Act 1949 had comprehensive meaningful amendments proposed only in 2006, specifying in fair detail, the precise facilities that should be available in nursing homes. Even the National Human Rights Commission had an occasion to direct the government to implement nursing home regulations in 1996.
The Goa Assembly passed the Goa Daman and Diu Private Nursing Homes (Regulation) Bill of 1986. After having made its way to the Gazette (page 378, series 1-20), it was murdered by wilful negligence because no rules were ever framed, which should have been done within six months.
The problem was that Goa with more than a hundred odd private hospitals had dreams of establishing itself as a major centre for health care tourism. To the embarrassment of all, most of these tourists were insured; and the insurance companies at the time of reimbursement quite naturally asked the establishment “What is your registration number?”
In 2001, the Central Health Ministry in a laudable attempt to sort out the mess, directed all states to enact/review legislation to regulate private hospitals. Unlike the 1986 Bill, this one did not even make it to the Assembly. Why are the authorities so bashful about introducing some degree of regulation in such a crucial aspect of community care? But then one has to understand that no progress is likely as long as we have public officials like one ex-chief minister of Goa whose stated reason for not pursuing such a Bill was “the more rules you have, the more people break them”. Functioning of these hospitals is largely dependant on local economic factors and the owner’s dedication. With the right kind of leverage one can even put up a “gadda” and call it a “nursing home” in Goa.
The Central Health Ministry once again renewed its efforts and drafted the current Bill in 2007. It has been languishing since then for various reasons. The recent decision of the insurance companies to withdraw all cashless facilities from private hospitals may have stimulated him.
As a matter of fact, the original draft of this Bill was brutally frank in its introductory Statement of Objects and Reasons. Under Article 252 (1), the Bill was introduced in parliament in response to resolutions passed in the Assemblies of Arunachal Pradesh, Himachal Pradesh, Sikkim and Mizoram. Parliament has no power to make laws relating to health and impose them on States. This Bill was introduced at the request of these four assemblies and union territories
In a reply in parliament, Union Health Minister Gulam Nabi Azad said that the legislation can be extended to other states, once their Assemblies adopt resolutions He had written to all the chief ministers, “Most of them have replied in affirmative”, he added. He further clarified that registration of clinical establishments would help the government to build a database for hospitals, which in turn, would assist in formulating the national policies on health.
The concept must be appreciated in view of the spineless attitude displayed on the subject by politicians from most states; and most pointedly from Goa, the second most ‘emancipated’ state in the country. Why should such regulation be necessary at all? Quite simple. A patient has the right to know what to expect when he makes a decision to get admitted into a particular hospital. There have to be some established minimum standards to qualify for the description “hospital” Does the nursing home employ qualified nurses as approved by the Nursing Council? Can the patient expect to be looked after by qualified RMOs?’ If an emergency arises at 2 am in the morning, will the attending doctor be a qualified allopath or a make shift homeopath/ayurved? Does the hospital have a 24 hour pharmacy with a qualified pharmacist as specified by law? Or will he be expected to go hunting for a vital drug at 3 am on the lonely unpoliced streets of Goa, where public transport is non-existent after 9 pm? The main highlights of the Bill are:-
1. A nineteen member National Council will be formed to oversee the implementation of the Bill. The various professional councils from allopathy as well as the Indian systems of medicine will have representation on this council, with the Director General of Health Services, MOHFW of the Central Government in the Chair. Elected members shall hold office for three years and nominated members, one year. The Council will have the task of determining and establishing minimum standards. A system of classification of clinical establishments will be set up. A national register will be set up with all details and statistics of the establishment. Minimum standards will be developed and reviewed periodically.
2. At State level, the DHS will act as Registrar of clinical establishments and will be responsible for compiling and updating the register. The registering authority will be designated such as the CMO or District Health Officer. No person shall carry on a clinical establishment unless it is registered, and fulfill minimum prescribed standards, with minimum qualifications for staff, and regular reporting.
3. The term ‘establishment’ covers virtually every type of health care facility, whether hospital or investigative laboratory; and whether in the public or private sector. The only exclusion is the armed forces.
4. Procedures for temporary and permanent registration will be laid out, as well as guidelines for inspection.
5. An all India register will be maintained which will be an amalgam of the State registers.
I applaud the efforts of the Union Health Minister, and hope that this Bill, does not get consigned to the dustbin of history, because the rules were not framed. Nor should it get drowned in the morass of corruption that has consumed our society today.
(The author is a Member, National Executive Committee, Voluntary Health Association of India)
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Hidden Facts
By Dr Pradeep V Kamat
Just the other day, at Thailand’s Suvarnabhumi airport, a two month old tiger cub was discovered hidden with a stuffed tiger toy in the baggage of a woman. The Thai lady who was heading to Iran was soon arrested after tiger bones were spotted by X ray staff in the overweight luggage destined for the cargo hold.
Umpteen tricky methods of illegal trafficking at airports and across the borders have come to light from time to time. Narcotics top the list although other contraband finds it way through. This may sound depressing and humans have mastered the art of covertness.
While on this specific point, a few tricks employed by flyers to outsmart custom officials and other intelligence at airports and at borders deserve special mention. Apart from becoming a ‘human mule’ who swallow or strap or plaster drugs to their body parts or stuff them in various orifices, the consignment is also transported by stuffing it sometimes into own belongings like for example dolls, cycle tyres, walking stick, in shoes (between two layers of leather), frozen fish and even live puppies. A few years back, there was a report of a submarine stuffed with cocaine intercepted by the Coast Guard off the coast of Costa Rica.
Strict vigilance by spy cameras, sniffer dogs, scanning by most sophisticated X ray machines, video surveillance, and now screening by Raman fluoroscopy and spectrography, have made detection easy with many criminals in the crime branch net. But what about those who conceal money in every quarter and at all levels? If strict vigilance and innovative checking methods were applied rigorously at all bureaucracy levels, one can imagine how many netas, babus and political bigwigs would be behind bars. We will have to build more prisons! We have so many laws which are either ineffective or not implemented.
We regularly of IT sleuths raiding and unearthing stacks of unaccounted money hidden in the house or in bank lockers. There are so many cases of corrupt politicians, party workers, chairmen of mega projects, hawala dealers, bookies, drug mafias, land sharks. The list is endless. Then there are those who amass wealth disproportionate to their known source of income or stash their moneys into secret bank accounts, but go into hiding if arrest warrants are issued against them .
In a lighter vein, we all humans have a hiding trait. Hiding certain facts are sometimes good and essential. For example, concealing grey hair by applying a hair dye, camouflage creams, cosmetics to hide wrinkles and pimples, concealed wiring for smooth interiors, and also hiding icons to prevent crowding on a computer screen is absolutely perfect.
A clandestine extra marital affair is best kept hidden for a healthy and happy marriage. which, although, isn’t correct.
In life we sometimes have to hide our weak points and for good reason. A Muslim woman has to hide her face with a ‘burqa’ in Islamic countries. Some hidden facts are in bad taste. Catchy advertisements have sometimes have a hidden meaning. Various holiday packages come not only with conditions in fine print but also hidden costs and the customer is taken for a ride, if he/she is not careful. A student who hides his exam report card and signs for his parents deserves severe punishment.
Then again our history is replete with stories of ancient hidden treasures (to protect from enemies) in caves, underground and in mountains. Thus priceless artifacts, sculptures, ancient paintings, have been lost forever to us.
Going into hiding for pursuing a good cause and to retain your position and respect in life, is commendable. The Pandavas went into ‘Adnyatwas’ (hiding) for 13 years just to respect the word of ‘Yudhistir.’ In our times, we have Salman Rushdie and Taslima Nasreen to name a few, who went into hiding after the fatwa was issued from a Islamic cleric.
But it is sad to sometimes see that hidden talent among children and youth is suppressed or not tapped in time. This is a worse scenario than the above tiger cub incident.
