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PM asks Health Ministry and Planning Commission to sort out their differences

December 2, 2012 Leave a comment

Prime Minister Manmohan Singh asked health minister Ghulam Nabi Azad and Planning Commission Deputy Chairman Montek Singh Ahluwalia to sort out their differences over the planning and formulation of the health policy under the 12th Five Year Plan.

The health ministry is up in arms against the Planning Commission’s suggestion to ‘corporatize healthcare’ which they feel will create a competitive scenario between public and private healthcare institutions. The commission’s decision to regulate hospitals based on number of patients is another sore point. The planning commission on the other hand is opposed to setting up two separate health missions for the rural and urban centres which perhaps explains why the much touted National Urban Health Mission hasn’t been launched yet.
Ahluwalia said that there were several concerns that needed to be sorted out and he will meet Mr Azad to sort out the differences before the 12th Plan goes to the cabinet. The Planning Commission had tried to push for a healthcare model where the public sector would be a mere regulator in the delivery of healthcare services with greater impetus from the private sector.

The commission’s suggestion to have a single National Health Mission instead of a separate national rural and urban health missions also ran into rough weather. Ahluwalia said, “The ministry is of the opinion that NRHM should not be touched and be allowed to run separately.” He was firm against having two separate missions in the country — one catering to urban and the other to rural populations.

ghulam-nabi-azad vs montek-singh-ahluwalia

Categories: Public Health

57% reduction in new HIV infections in last decade

December 1, 2012 Leave a comment

Overall decline in adult new-HIV infections, annual AIDS-related deaths, says NACO report

India has registered an overall decline in the number of adult new-HIV infections and annual AIDS-related deaths across the country, while Odisha, Gujarat, Tamil Nadu and Chandigarh have shown estimated adult HIV prevalence greater than the national prevalence, according to the latest round of HIV sentinel surveillance and estimations conducted by the National AIDS Control Organisation (NACO), which was released by Union Health Minister Ghulam Nabi Azad here on Friday.

The report notes that India has registered 57 per cent reduction in new HIV infections during last decade and 1.5 lakh lives have been saved due to scale up of free antiretroviral therapy (ART) services since 2004. NACO conducts HIV surveillance and estimations at regular intervals and the latest round was completed in 2011. The data generated is then used for estimation of HIV burden and projection of HIV epidemic trends in the country.

“The HIV estimations 2012 indicate an overall continuing reduction in adult HIV prevalence, new HIV infections and AIDS related deaths in India. The adult HIV prevalence declined from an estimated level of 0.41 per cent in 2001 through 0.35 per cent in 2006 to 0.27 per cent in 2011. The decline was registered in high prevalence areas including Andhra Pradesh, Tamil Nadu, Manipur, Karnataka and Nagaland. Also of the 1.6 lakh estimated new infections in 2001 among adults, the six high-prevalence States account for 31 per cent of the new infections,” noted the report.

There has also been a considerable decline in HIV prevalence among female sex workers at the national level and decline has also been achieved among men with same-sex partners(7.41 per cent in 2007 to 4.43 per cent in 2011). Stable trends have been recorded among injecting drug users at the national level (7.23 per cent in 2007 to 7.14 per cent in 2011). Besides, North-East States where declines have been achieved, newer pockets of high HIV prevalence among drug users have emerged over the past few years, in States including Punjab, Chandigarh, Delhi, Mumbai and Bihar. In certain northern States, evidence indicates the possible role of migration in fuelling HIV epidemics. Besides high-risk migrants, long distance truckers also show high levels of vulnerability and form an important part of bridge population, says the report.

The data released also notes that the total number of people living in India with HIV/AIDS is estimated at 21 lakh in 2011, children less than 15-year-old account for seven per cent of all infections, while 86 per cent are in the age group of 15-49 years. Of all HIV infections 39 per cent are among women.

Stating that the evidence shows that India is on track to achieve the global target of ‘zero new infections, zero AIDS-related deaths and zero discrimination,’ NACO in its report states that major challenge for the programme will be to ensure that the treatment requirements are fully met without sacrificing the needs of prevention.

Categories: Public Health

After success at home, Indian docs take battle against polio abroad

December 1, 2012 Leave a comment

As India celebrates the success of having no new polio case over the past 19 months, Indian doctors are now taking their fight against the scourge to its strongest bastion.

A team of 25 Indian doctors and volunteers — a first-of-its kind single specialty unit — will fly to Nigeria’s capital Abuja on Saturday night to conduct 400 polio corrective surgeries.

Nigeria is currently the global capital of polio. It reported as many as 110 cases this year and is, according to the Global Polio Eradication Initiative, one of the world’s three polio-endemic countries. Pakistan reported 56 cases in 2012, and Afghanistan 31.

The incidence of polio globally declined 99.8 per cent from 3,50,000 cases in over 125 endemic countries in 1988 to only 650 reported cases in 2011. India, which reported 741 cases in 2009 — more than any other country — is now no longer on the World Health Organisation’s list of polio-endemic countries. No case of wild poliovirus has been reported in India since January 13, 2011.

“Health authorities worldwide are worried about the setback to immunisation efforts in polio-endemic countries. WHO has raised an alarm over deteriorating health indices in Nigeria, and called for urgent efforts to reverse the trend. In our small way we decided to respond to the challenge by sending a team of our doctors to help correct deformities related to polio, and create awareness of vaccination,” Panvel-based orthopaedic surgeon Dr Girish Gune, a key Rotarian involved in the Indo-Nigerian Medical Mission programme, told The Indian Express.

Rotary International, which has around 1.2 million members in over 200 countries, has funded the Rs 50 lakh project. Indian doctors are carrying their own equipment to conduct 400 surgeries at two public hospitals inAbuja.

Dr A K Pandey from Ranchi, who is in the team of 19 doctors and six volunteers, said an effort would be made also to reach out to parents of polio-afflicted children.

Panipat anaesthetist Dr Sunil Mehta said the message the fortnight-long surgical workshop hoped to convey was about the need to save future generations from polio.

Doctors from Pune, Mumbai and Chandigarh too are part of the medical mission. Health Minister Ghulam Nabi Azad has applauded the initiative and told the doctors that people and community participation was critical to the success of international and domestic efforts to eradicate polio.

Categories: Public Health

60 new medical colleges to be set-up across India during 2012-17

November 30, 2012 Leave a comment

The union government, in partnership with the state governments, is planning to open over 60 medical colleges across the country during the 12th five-year plan period (2012-17).

The union government will fund 75 per cent of the cost while the respective states will bear the rest 25 per cent.

The union government has responded favourably to a proposal of the Odisha government to open four medical colleges in the state. The medical colleges would have 100 MBBS seats each to begin with.

“We have proposed to convert four district headquarters hospitals into medical colleges under the new plan. We are hopeful the plan will materialize,” said the state health secretary Pradipta Kumar Mahapatra.

Categories: Public Health

Revised proposal for new Pune military hospital cleared

November 30, 2012 Leave a comment

The union cabinet on Thursday approved a revised proposal for the construction of a new multi-storeyed Command Hospital Complex in Pune.

The project includes accommodation for essential category staff and Command Medical Dental Centre at Pune at a revised estimated cost of Rs 382.37 crore.

The Command Hospital (Southern Command) at Pune is a 1,047-bedded referral hospital, which provides tertiary level medical care in various specialities and super-specialities to serving personnel of the armed forces, ex-servicemen, their families and civilians.

The hospital is affiliated to the Armed Forces Medical College, Pune, for teaching and training of both undergraduate and postgraduate students.

The project, which was originally approved by the cabinet in October 2008 at an estimated cost of Rs 270.77 crore, will be completed by November 2016.

Categories: Public Health

Regulatory requirements for private clinics

November 6, 2012 Leave a comment

A clinic may be defined as a place of professional practice with facilities for outdoor consultation and treatment during scheduled hours by one or more physicians and staff and equipment essential for the services provided. It may or may not have the facilities for limited investigations specific to the scope of services provided.

A large percentage of the population, in rural as well as urban areas, is dependent on private clinics and, therefore, the quality of healthcare services provided by them is very important. At present there is no system of registration of private clinics by health authorities in India. The Clinical Establishments (Registration and Regulation) Bill, 2007 is still pending in the parliament.

Presently, the operation of private clinics is being governed by the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations 2002 and certain other legislations as outlined below.

1. Registration/Requirement of Licenses

•          Registration with health authorities is not mandatory for private clinics but the clinic will be subject to inspections in case of any complaints. If and whenever the Clinical Establishments (Registration and Regulation) Bill, 2007 is passed by the parliament and implemented by the states, registration of all clinics (Private/Public) of all systems of medicine will become mandatory;

•          Registration with the municipal authorities (Delhi Shops and Establishments Act, 1954);

•          Recognition for usage of narcotic drugs (Delhi Narcotic Drugs (Amendment) Rules, 2002;

•          Authorisation for generation of Bio-Medical Waste, if treating 1,000 or more patients per month;

•          Permit for procurement/usage of spirit;

•          Registration under the Medical Termination of Pregnancy (MTP) Act 1971, the Pre-Natal Diagnostic Techniques (PNDT) Act, 1994, as applicable.

2. Regulations Related to Employment of Staff

•          Employment of staff (Doctors, Nurses, Pharmacists) only after proper credentialing;

•          Prevention of sexual harassment of women at work place (Judgment of the Supreme Court of India (SCI) in Sakshi Vs the Union of India and Others);

•          Responsibility of employer for safety of employees (Delhi High Court Judgment in Ms XYZ Vs Shanti Mukund Hospital, Delhi and Punjab & Haryana High Court Judgment in Jasbir Kaur Vs the state of Punjab);

•          Rules governing the employment of staff (Delhi Shops and Establishments Act, 1954);

•          Immunisation / other measures for protection of staff from Occupational Health hazards.

3. Sign Boards

 

•          Rules for the size, contents and correct place for sign boards (IMC Regulations 2002).

 

4. Information to be displayed at the Clinic

•          Certificate of registration of clinic with the municipal authorities;

•          IMC/SMC registration certificate (IMC Regulations, 2002);

•          Charges for consultation and other procedures/services (IMC Regulations 2002);

•          Clinic timings, closed days (Delhi Shops and Establishments Act, 1954).

5. Documents to be maintained by the Clinic

•          Registration of the clinic with the municipal authorities (Delhi Shops and Establishments Act, 1954);

•          Record of employment of adults, letters of employment issued and hours of work;

•          Maintenance of record of patients treated (IMC Regulations 2002) and a register of medico-legal cases (MLCs);

•          Maintenance of a register of medical certificates issued;

•          Copies of medical certificates issued;

•          Registration certificates of doctors/nurses/pharmacists with the State Medical Councils (SMCs);

•          Professional qualifications (degrees/diplomas) of the staff;

•          Record of consumption of Morphine (if applicable) (Delhi Narcotic Drugs Rules, 2002);

•          Account of money receipts and expenses (Income Tax Act, 1961);

•          Authorisation for generation of Bio-Medical Waste and record of category wise waste generated (BMW Management Rules, 1998);

6. Issue of any medical certificate, notification, document or report, which is untrue, misleading or improper is a misconduct and punishable offence (IMC Regulations 2002, Section 197 of Indian Penal Code);

7. Regulations Related to Treatment of Patients

•          Valid consent for examination/investigation/treatment/research procedure (or informed refusal of consent), as applicable (IMC Regulations, 2002);

•          Confidentiality of privileged communication, as far as permitted under the law;

•          Life saving treatment of emergency cases (SCI Judgment in Parmanand Katara Vs Union of India, and The Delhi State CDRC (Consumer Disputes Redressal Commission) Judgment in the case of death of NB Sub K L Guliani);

•          PNDT Act 1994, Conduct of Euthanasia (SCI Judgment in Aruna R Shanbaug Vs Union of India & Others, March 2011), MTP Act 1971 and IPC sections 312-315, 318;

•          Rules for issue of prescriptions (IMC Regulations, 2002);

•          Maintenance of Medical Records of the patients treated for a period of three years and as per the format vide Appendix 3 to the IMC Regulations, 2002;

•          Reporting of Medico-Legal cases to the police;

•          Reporting of occurrence of occupational diseases;

•          Responsibility for ensuring safety of patients (Judgment of Punjab High Court in Jasbir Kaur Vs the State of Punjab);

•          Rights of patients;

•          Privacy of patients during consultation, examination and treatment;

•          Professional indemnity insurance cover of an appropriate amount (Insurance Regulatory and Development Authority Act, 1999);

•          Laws applicable to medical negligence — Vicarious Liability, Respondeat Superior, Indian Contract Law, Tort law, Consumer Protection Act, 1986, Indian Penal Code sections (52, 80, 88, 89, 92, 93, 274-276, 284, 304-A, 336, 337, 338 and 376-D).

8.  Drug and Cosmetics Act 1940, Drugs (Control) Act 1950, Narcotic Drugs and Psychotropic Substances Act 1985, Drugs and Magic remedies (Objectionable Advertisements) Act, 1954, Pharmacy Act, 1948.

9. Submission of Reports/Returns to Health Authorities

•          Cases of notifiable diseases as applicable in the state (Section 371, Delhi Municipal Corporation Act);

•          Report of cases of food poisoning, if required by Municipal Health Authorities (Prevention of Food Adulteration Act, 1954);

•          Incidence of needle stick injuries;

•          Annual report under BM Waste Management Rules, 1998 (if applicable);

•          Reports on the MTPs carried out;

•          Reports on the USG abdomen (abdominal ultrasonography) done on the pregnant women.

10. Safe disposal of infectious/hazardous waste generated at the clinic (BMW Management Rules, Environment Protection Act 1986, IPC Section 269, 270).

11. Prohibition of unethical activities, such as soliciting patients directly or indirectly, by a physician, a group of physicians, or by institutions or organisations by advertising, self-promotion or self-aggrandizement; use of touts for procuring patients; giving/offering or receiving rebates, gifts, commissions, cutbacks or kickbacks in return for referral or procurement of patients etc (IMC Regulations, 2002).

12. Prohibition of Smoking in Public Places Rules, 2008, Fire Safety Regulations, Financial Regulations: Income Tax Act, Value Added Tax (VAT) Act, Central Sales Tax Act, etc.

13. State laws for prevention of vandalism/violence against medical service staff and institutions.

Note: 1. All of these regulations may not be applicable to every clinic.

2. Delhi Laws quoted above may be substituted by the relevant state laws.

Categories: Public Health

Junior doctors admitting patients under their senior’s name — Whom to blame in case of some mishap?

November 6, 2012 Leave a comment

It was December 1987, almost 25 years back, when Dr Prafulla B Desai (a renowned cancer surgeon) was charged for negligence and disowning his own patient. The case has been in news for all these years and has surprised people from each and every walk of life.

Here is a flashback, in case you are not aware about the whole hullabaloo around it. In December 1987, Leela Singhi, a cancer patient, was admitted to Bombay Hospital by Dr A K Mukherjee who was Dr P B Desai’s junior. The patient was set up for a surgery on the advice of Dr Desai who was in an adjoining operation theatre. But, when Dr Mukherjee realized that he couldn’t carry on with the operation because of some complications, he closed it on his senior’s advice. Leela Singhi’s health deteriorated and she died after 14 months. Lately, the Bombay High Court held the 78-year-old Dr Desai guilty of negligence.

Padma Vibhushan awardee Dr P B Desai has always highlighted that Leela Singhi was never his patient and it was a practice to admit patients under a senior doctor’s name, which is why he had to bear the brunt for all these years. All he did was just gave some advice, which acted against him. This has tarnished his otherwise brilliant career for which he has been fighting for a good 25 years.

Dr Rakesh Kumar Singh

Talking about the case, Dr Rakesh Kumar Singh, a general surgeon based in Surat, told AalaTimes, “The unfortunate patient died of advanced breast cancer for god’s sake, not by any of Dr Desai’s doing. Opening an abdomen and closing it without doing anything is perfectly alright, when circumstances are not favourable for surgery inside abdomen. She was doomed to die because of her advanced cancer and I do not think justice is being done with Dr Desai.”

He further said, “Suppose, just suppose, Dr Desai had admitted her and Dr Mukherjee had operated upon her, and then closed the abdomen without doing anything else after consulting Dr Desai, still he had done nothing wrong because that is how things are being done since ages in hospitals everywhere and one has to delegate work. There is something grossly wrong in the presentation or understanding of the case.”

The question arises why is such a practice being followed where a junior doctor is allowed to admit patients under his senior’s name and what’s the logic behind it?

Dr Tarun Mittal

Dr Tarun Mittal, a general surgeon at Sir Ganga Ram Hospital, New Delhi, told AalaTimes, “Such a practice is not prevalent, now. In this technology driven world, everyone is under scanner all the time, so the whole question of shifting blames and taking responsibility has taken an all new meaning.”

Dr Sanjay Chaurasia, assistant professor, surgery, Patliputra Medical College, Dhanbad, also felt that it is not a usual practice and a senior doctor is always aware when a patient is admitted under his/her name. “In any case a senior doctor directs his juniors and operating upon by a junior is a very rare thing. The duty of a junior is to assist a senior and not perform activities without being guided by his/her senior,” he told AalaTimes.

Dr Sanjay Chaurasia

Doctors work on a shift basis and many in the healthcare profession felt that it is not possible for a doctor to work for the whole day. Dr Chaurasia said that a junior practising under the name of his senior is completely wrong and very objectionable. “Even if a junior admits a patient, it is his duty to call his superior, inform and explain him about the case, and take directions which have to be followed at any cost. And, if the junior fails to follow the instructions and carries on the duties on his own, it will be nothing less than objectionable,” he added.

If one goes by media reports of the case, it would appear that the junior doctor might not have informed the patient that the senior doctor’s name was being used for the sake of it and that the actual surgery would be performed by the junior doctor. But, why is it that a patient or patient’s family is always unaware of what goes inside a hospital?

A doctor, who agreed to speak on the condition of anonymity, said that Dr Desai’s case comes wrapped in many mixed situations. She said, “There are many consultants who have made a very good name for themselves, which is why patients or their families want to get treatment from them. But they need to clearly understand that a doctor can’t be there all the time and every doctor has a team to fill in for him. In countries like US and UK, doctors are very open about the fact that they are not available round the clock. But, sadly, such a straight approach and transparency is missing in India.”

The doctor clearly stated that reputations get cases to doctors/hospitals as patients feel that one doctor is more competent than the other. She told AalaTimes, “It is unethical to use someone else’s name and a strict stand ought to be taken, but our system has failed big time to give doctors the respect they deserve. Our medical norms are not very strong and no regulatory body wants to keep ethics going. The only thing that is keeping the medical profession going in India is doctors’ own conscience and their sincerity towards the profession they have opted.”

The medical profession, according to healthcare professionals, has a lot more good than bad and highest level of care is delivered in India. Doctors are very particular, sincere and responsible. Many felt that juniors often outdo seniors many a times because of a sense of sincerity and zeal to learn. However, the question still arises that in the light of this case do hospitals plan to stop this practice where a senior doctor gets dragged for something he has not done in the first place?

The anonymous doctor said, “Comprehensive care is multi-layered and requires a very strong team work. The challenge to deliver great service is a coordinated team work in which one leads and a lot of others are involved in care. So, working without a team is just not possible. There is a strong network that informs a senior doctor about everything happening and it’s a complete lie if a doctor says he is unaware of some certain situation at the hospital. If you are a senior everyone listens to you and working against a senior’s direction is totally breaking the rule. How can a Prime Minister or a Chief Minister not take responsibility of adversities even if they were not involved or aware of it? Being a leader you are in command and should be ready to bear the brunt.”

If in future a senior’s name is used without his knowledge, who should be blamed in case some complications surface? Dr Chaurasia said, “Complete responsibility will lie on the doctor who handles the case. There was a possibility in the past that the senior could have been framed because of the lack of evidence, but now everything is tracked. From mobile phones to computers everything carries complete information, which makes it difficult to fool the existing system.”

Categories: Public Health
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