Rajan Gandhi
Most Indians consider doctors as next to God if not God. We still have many doctors with impeccable ethical records. But the era of Florence Nightingales has long ended, there are many others – not so ethical who without thinking twice take their patients for a ride. In a recent verdict by Supreme Court nursing homes without an intensive care unit facility can’t carry out surgeries on a patient as absence of an ICU poses danger to the patient’s life. Charging different patients at different rates for the same treatment is order of the day. A “cartelization” among diagnostic centers and pathological laboratories has resulted in patients being subjected to unnecessary tests by the doctors who are guided by the “lucre of commissions” offered by diagnostic centers and pathological laboratories. Patients have no option but to pay up for these tests. This exacerbates their physical and mental agony. The laissez faire spirit that dominates this business in India works to the disadvantage of the consumer and needs correction underlining the need to codify laws relating to clinical/ diagnostic examinations. Our state government had fixed the rate list for all the tests in the past but nobody follows it and as such association of diagnostic centres is calling the shots instead of Government. Even the consultation fee of doctors once fixed by Health Services Department is not at all followed by these doctors as otherwise what’s the explanation of variation of charges from Rs150/= to Rs 500/= . Who has fixed this exorbitant fee? But who cares as all this is happening right now without any check.
It is not beyond one’s imagination how these nursing homes and diagnostic centres have come up in all prime residential localities like Gandhi Nagar, Trikuta Nagar etc as permission from JMC/local bodies, UEED and Pollution Control Board is a must . All these clinics are without parking causing great inconvenience to the public, multiple health risks to the people of locality and main source of contamination of air and ground water. As per PCB total bio- medical waste generated daily in Jammu Division is 1014 kg as against waste treatment capacity of 349 kg only, the rest goes with daily garbage in dumping grounds spreading contagious diseases and polluting ground water. In 2016, State Pollution Control board issued notice to 758 such facilities in Jammu Division alone but what follow up action has been taken is still a puzzle to be resolved. Amazingly no such information for Kashmir division is in public domain. All government agencies like Director Health Services, JMC, UEED, PCB have either failed to check all this or just ignored their mushrooming for obvious reasons.
Health cover provided by our employers has become an instrument for nursing homes to perform unnecessary operations or tests, whether required or not and thus patients have to suffer directly or their employers indirectly by bearing the rising cost of healthcare. Since it’s the patients or their employers who are really bearing the rising cost of health care, insurance companies don’t object to rising medical malpractices unless the net claim payments exceed the premiums received. Insurance premium for unorganized individual cover seekers is 300 % -400% higher than Corporate Premium. To cut the long story short doctors, private hospitals, pharmaceutical companies and often insurance companies are having fun at the cost of individuals and corporate without any check.
Subsection 6.4.1 and 6.4.2 of the MCI Regulations stipulate that these are highly unethical practices and Section 6.8 stipulates the code of conduct for doctors in their relationship with pharmaceutical and allied health sector industry clearly stating a medical practitioner shall not receive any gift, travel facility, hospitality or cash from any pharmaceutical or allied health care industry or representatives for self and family members under any pretext. But MCI is not effective in checking malpractices and corruption in medical field. In Jammu and Kashmir even State Medical Council is defunct right now due to pending court case. Government must order mandatory recording, archiving and sharing of the recording with patients or their representative. At present, private hospitals do publish the credential of its specialist doctors like education and past experience. How about making it compulsory the information say about its gynecologist’s total deliveries in the last 3 years-normal deliveries, C-sections performed and such information will help patients take informed decisions about which doctor to go to for a treatment. If the medical system is as clean as claimed then doctors should voluntarily come forward and provide such information whether asked or not. Government should start rating and ranking of top specialist doctors in fraud prone specializations such as kidney transplant, gynecology and heart surgeries by a third party independent agency and the ratings to be made available online without any restrictions. Rating of hospitals based on basic infrastructure, charges, and indicators of ethical business practices like how many medical malpractice suits filed against should be shared publicly. These measures can check most of the malpractices but not all and for serious deviant, stringent punishments including permanent disbarment and imprisonment should be implemented.
Private practice by government doctors is another aspect to be checked. Various committees had been set up in the past for banning of private practice of doctors but their recommendations had not been implemented. Jammu and Kashmir Legislative Assembly panel also in 2012 called for imposition of ban on private practice of government doctors particularly those posted in the Government Medical College Hospitals in the state but who cares. It may be recalled that private practice by Government doctors was first banned in 1986 by the then Governor Jagmohan. Later, a writ was filed in the High Court against the ban but the same was contested by the State and accordingly dismissed by Division Bench. After the Governor rule came to end, the then Government removed the ban vide SRO No.42 in 1987.In July 1995, the State again imposed ban on the private practice by the Government doctors. However, after the return of elected Government again in 1996, the ban was again removed and doctors were allowed to continue private practice. In April 2011, the Division Bench of State High Court, in a PIL, banned the private practice which was however challenged in the Supreme Court. It seems that those in power are much interested in revoking the ban otherwise there is no explanation why respective Governor’s rule have invoked the ban and elected governments have revoked it time and again. Apart from the disservice to the citizens, the private practice has also been causing irreparable damage to the quality of medical education being imparted in the institutions. The summer timing of the OPD in medical colleges and hospitals is 8:00 AM to 2:00 PM and 10:00 AM to 4:00 PM in winters as against all weather normal timings of 9:00 AM to 5:00 PM in the rest of the country. The consultants here hardly adhere to this schedule as there is no biometric attendance system. In these limited hours of their active presence on the campus, they are supposed to conduct classes, carry out research work, do hospital ward rounds, handle emergency cases and do surgical procedures if need be.
The current status keeps the doctors in good humour, no one cares if the general public continues to suffer and as such the doctors are the last ones complaining. It is the patients and especially the trainees who are at the receiving end as they are exposed to three things which are detrimental to their ethical grooming – money, nepotism and indiscipline. Moreover, can our government allow, for example, its engineers, judges, KAS/IAS officers or police personnel to work simultaneously in private companies? Are they provided any extra allowance, obviously answer is no. The current “parallel” system of healthcare for underprivileged people – free dispensaries at local Gurudwaras or Mandirs – can’t solve the healthcare problems of everyone in need nor does it absolve private doctors from the responsibility of helping the sick and needy. Government should ensure that government doctors are spending maximum time serving the citizens rather than in private practice. Tightening noose on the doctors and diagnostic centres is the need of the hour and government cannot shirk its responsibilities. Government’s, all carrots and no stick, approach is not good for the health care sector and it cannot be mute spectator to this menace anymore. Accountability of erring officials is much required and it’s the time government starts thinking about major reforms in the health sector.
“Acting responsibly is not a matter of strengthening our reason but of deepening our feelings for the welfare of others.”
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