A family doctor in South Mumbai will find it impossible to have a 500 square-feet-area clinic, given the prohibitive real-estate costs in the city.
The doctor’s medical skill notwithstanding, he or she could still end up on the wrong side of the law, say doctors protesting the recently notified Clinical Establishment Act (2010).
The Act sets out to standardise practices in the patients’ interest, say Health Ministry officials. But doctors say the Act was passed without discussion, and as a result, is not in touch with ground realities.
In fact, it puts the responsibility of a patient entirely at the doctor’s door-step, even when it should be shouldered by the Government, they say.
As a result, a well-intended law stands caught in the cross-fire, as doctors protest this and two other Government initiatives, affecting the medical fraternity.
Emergency and penalties
The Clinical Establishments Act sets out to regulate private hospitals and clinics, ensuring that no centre is run without registration etc. A key achievement of this Act was that no person be refused emergency treatment.
A doctor has to stabilise the patient and send him or her across to the nearest referral hospital - failing which, a non-bailable warrant could be issued against the doctor, points out the Indian Medical Association’s immediate past-President, Dr Vinay Aggarwal, adding that the penalties are “draconian”.
The problem is the lack of emergency services in the country, but the Government wants to put this responsibility on a practising doctor, Dr Aggarwal told Business Line .
There is no clarity on the definition of “stabilise” and who bears the cost of such emergency services. A ventilator costs about Rs 15 lakh-20 lakh, he says. Even the Government-run smaller centres lack such facilities, he adds.
Similarly, if size-related minimum standards are not adhered to, a district authority can impose a fine up to Rs 5 lakh and even close the clinic, he said. This could lead to abuse of power, he points out.
Health being a State subject, he said, there are existing norms and stringent procedures for issuing and renewing licences.
The IMA has approached the Delhi High Court for a stay on the implementation of the Act.
Doctors’ concerns
The IMA is also protesting the Government’s National Council for Human Resources in Health Bill (2011) that seeks to supersede the Medical Council of India (MCI).
The MCI has been mired in controversy and corruption charges in the past. And yet, it is a more democratic institution with 160 members from across States and universities, doctors say.
Compared to this, the proposed body will have only Government nominees, Dr Aggarwal points out.
Urging the Government to discuss these initiatives, doctors caution against another proposal to have short-term modern medicine courses to address rural needs.
They suggest other programmes, including a one-year compulsory rural service for MBBS graduates that would generate 30,000 doctors.