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Criminal Medical Negligence in times of Covid-19
  • By: admin
  • Date: 19 May 2020
  • Medical Negligence
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In India, the medical profession is considered one of the noblest and respectable in comparison to other such professions. Even in times of Covid-19, when everyone is locked inside their houses, it is the doctors who have taken charge and are providing the people with the right treatment and medicines. The people are sympathetic towards the doctors, as they are effortlessly and tirelessly working for the country at these trying times. To encourage the doctors, the government, as well as the general public, is arranging activities and gestures that help to motivate the doctors so that they can perform at their best.

The Prevailing situation

People equate doctors with the image of God. However, as every coin has two sides, these positive aspects have a profound negative impact as well. Similarly, due to the rising cases of Covid-19 in the country, the cases of Medical Negligence have also increased simultaneously, and this, in turn, is increasing the liabilities of the doctor in such difficult situations. Due to the outbreak of the virus, medical interaction has increased in the country, which is the root cause of the rise of medical negligence cases. The jurisprudence around criminal medical negligence is credited to the Supreme Court through three primary cases- Suresh Gupta, Jacob Mathew, and Dr. Praful Desai.

There are different types of negligent activities under IPC which a doctor may conduct. Under tortious negligence, a doctor may be asked to pay compensation and damages according to the loss of the patient, while under criminal negligence which is mentioned under section 304 of Indian Penal Code he may be awarded imprisonment or fine. There are three primary ingredients constituting negligence which are: (i) duty of care, (ii) breach of duty, (iii) subsequent injury. For a case to qualify as criminal negligence, there has to be either gross negligence or rashness endangering life. Culpable rashness is acting with the consciousness that mischievous and illegal consequences will follow, but with hope against it and the trust that the one doing the act has taken sufficient and enough precautions to prevent it. On the other hand, culpable negligence is acting without any consciousness that illegal and mischievous consequences may follow.

What is Criminal Negligence?

Every act done by a doctor cannot constitute to criminal liability. When a death occurs due to a simple misplaced judgment or because of an accident, then there is no criminal liability attached to it. Inadvertence to a degree of caution and care, which is not gross, only attracts civil liability. When the law talks about the standard care of a doctor, it means, the standard and expected care by the competent doctor according to his/her qualifications. A doctor cannot be held responsible for any negligence, until and unless he has followed the practise acceptable to the medical profession of that day. The doctor cannot be held liable if he had a better alternative or if a more skilled doctor would have chosen another part. The standard care refers to the sense of an ordinary man. This standard of care is as per the knowledge at the time of the incident and not when the trial is initiated. If a doctor has some special skill or competence, negligence is not measured as per the man, but as per the standard of an ordinarily skilled professional. Honest differences in opinions do not infer negligence. It is essential to differentiate between medical accidents, diffusion of responsibility and culpable conducts.

In times of Covid-19

Due to the increasing cases of Covid-19 in the country every day, the cases of criminal medical negligence cases are also on the rise. This is highly due to the lack of sufficient medical equipment, doctors per patient ratio, insufficient medical beds and also lack of availability of hospital staff due to the spread of Covid-19.

Another major reason for the rise in medical negligence cases is the treatment of Covide-19. As there is not a proper treatment protocol issued in treating covid-19 patients and bodies, there is an ambiguity in the treatment procedure. At times, while treating the patient to the best of his ability, the doctor may commit a mistake, this may be blamed as an instance of alleged medical negligence.

When a doctor, refuses a patient of a ventilator, or any other medical equipment which is necessary for the survival of the patient, he/she directly contributes to “Criminal Medical Negligence”. Apart from this, after the virus has taken a toll on the whole country, many doctors have stopped reporting to duty, in fear of the spread of the infection. There have also been cases reported, where the doctors or the hospital staff have deliberately refused to admit the patients even in critical situations which has to lead to many medical negligent cases and FIRs against such doctors for the same. Due to these negligent cases, many doctors have been suspended, and many doctors have also received notices from the Indian Medical Association. All these things, amidst the coronavirus and the lockdown, has contributed to more petitions by the patients in the supreme court against the doctors. The Supreme Court of India is only hearing urgent cases through video conferencing and other online modes, no judgments have been announced for such matters.

However, a negligent act is not just about being negligent to the patients; there have been various reported cases wherein the hospitals have issued notices to doctors for not showing up for treating patients. Hence, the doctors, amid this pandemic, need tobe careful in safeguarding their career.

Conclusion

It is important to note that, section 304 of the Indian Penal Code, does not talk about the word “gross”. The judiciary, with the development of jurisprudence on medical negligence, has attempted to balance wrong done to the patient against the autonomy of doctors. From the cases that have been heard by the courts, it has been established that, if doctors are held criminally for everything they do, then situations may arise where the doctor would be concerned about himself more than the patient. To avoid such circumstances, the courts believe in the evidence produced by the plaintiff. Covid-19 being a novel disease to the country at large, can be only controlled by the doctors, through their intellect, judgment and experience. Therefore, the way, these negligent cases would be handled at the courts would be different as this whole situation revolves around this pandemic. Cases which involve negligence by the hospital staff in providing with the ventilators, oxygen machines, may be easily solved. However, cases, involving not direct medical negligence would be a task for the Indian courts.

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Legal issues in the practice of Telemedicine

By: admin Medical Negligence 09 May 2020

Telemedicine means the remote diagnosis and treatment of the patients by the means of telecommunications technology. Multiple technologies can be used for delivering telemedicine consultation. There are three primary modes. They are Audio, Video and Text (chat, messaging, email, fax etc.). Telemedicine is also referred as e-health or telehealth. It is a perfect combination of modern-day information technology and medicine. Telemedicine reduces the costs on time, expenditure and cuts travel of long distances for consultation and treatment in cases where there is no necessity for physical access, follow-up consultations, etc.Only the registered medical practitioners are entitled to practice telemedicine. A Registered Medical Practitioner is a person who is enrolled in the State Medical Register or the Indian Medical Register under the Indian Medical Council Act 1956. Earlier, there was no statutory framework on the practice of telemedicine, through video, phone or any other Internet-based platforms.

Digital technologies also referred as the telemedicine in Indian healthcare are certainly witnessing huge adoption due to the lockdown imposed to reduce the spread of the coronavirus disease Covid-19. Therefore, it has become need of the hour to know the legal rights and obligations of the doctor, when they provide their services through online means.

Legal Issues

There are legal risks which are associated with the new developments of Telemedicine. Following are some of the legal issues which might arise in Telemedicine practice:

  • Litigation for medical negligence

There is a high risk of litigation for medical negligence which could take place in future due to the Telemedicine practice. In the cases of medical negligence, there are two basic requirements which must be fulfilled. The doctor-patient relationship must exist, and the doctor must have breached his professional duty of care towards his patient.

  • Doctor-patient relationship

There must be a contract either express or implied between the doctor and the patient in order to establish that there was adoctor-patient relationship between them. However, in telemedicine, it is not clear for determining whether the doctor-patient relationship exists online or through an email.In case if the interaction takes place between the doctor and patient at the time of emergency situation where the doctor was forced to treat the patient, then it will be considered that there was no doctor-patient relationship existed.

Hence, there are certain provisions mentioned under the Information Technology (IT) Act 2000 which will apply to the Telemedicine practice. For Instance, Section 4 & 5 of the said IT Act has given legal recognition to the electronic record and digital signatures. The IT Act has also amended the Indian Evidence Act 1872 in order to make the electronic record admissible in the Court as evidence.

  • No standard degree of care

In the traditional medical profession method, the standards required for a reasonable degree of care and skill by the doctors was laid down by the Supreme Court under the case of Poonam Verma V/s Ashwin Patel. However, telemedicine being a new concept, does not have the same standards of care as laid down.The standards of a reasonable degree of care and skill are not mentioned/determined for the doctors practicingtelemedicine as there has been no case of medical negligence brought against such a doctor.

  • Liability of Doctors

In case if a doctor practicingtelemedicine fails to respond to the patient’s request for medical attention and the patient suffers injury then it is possible that a doctor-patient relationship would be deemed to exist and the doctor would be held liable. Yet in another scenario, if a doctor is on vacation and the patient believes that he will receive a timely response and suffers an injury because the doctor fails to respond. In the above circumstances, it is not clear that whether the doctor has any responsibility to respond in regard to the patient’s treatment or to notify the patient that he cannot assist them for any reason.  In case of errors which takes place due to a breakdown in communication or organization during the telemedicine application, then the primary principles of organizational responsibility will possibly apply.

  • An issue relating to Security

There is another legal issue relating to the security of the patient’s information in telemedicine practice. The legislation for telemedicine practice must protect the privacy of the patient, authenticate the information, authorize, and maintain integrity. Hence, the security policy would help in making the telemedicine practice more efficient, risk-free and reliable.

Case law

Deepa Sanjeev Pawaskar and Another V/s State of Maharashtra

Bombay High Court - 2018 judgment on Telemedicine Practice Guidelines

Criminal Anticipatory Bail Application No - 513/2018

In this case, the patient was suffering from fever and severe vomiting. She was admitted to the nursing home of the doctors (who were accused) by the hospital staff without examination as the doctors were out of town. One of the doctors started treatment of the patient telephonically, by instructing on-duty nurse. The Bombay High Court held that the patient died because she was prescribed treatment over the telephone without an appropriate diagnosis. The Court also found that such an act amounts to criminal negligence.The Court rejected the bail application of the doctors. The doctors were not arrested as they were successful in receiving the bail-in appeal. Hence, many doctors interpreting the judgment deeming telemedicine illegal. However, the High Court was only concerned with the fact that there was a failure on the part of the doctor to diagnose the patient, and it does not interfere with the Telemedicine guidelines. The fact that the treatment of the patient was done through the telephone is only incidental to the conclusion of the judgement.

Conclusion

Earlier, as there was no appropriate framework that existed for the telemedicine practice, the Bombay High Court had created uncertainty about the place and legitimacy of telemedicine in its 2018 judgment.Hence, there has been a legal concern on the practice of telemedicine as there is a lack of clear guidelines which has created significant ambiguity for registered medical professionals in India.The existing Indian Law does not adequately address concerns relating to Health Information. It isessential to first understand the specific problems of the Indian patients and Healthcare provider with regards to the telemedicine practice before framing legislation that addresses their legal issues relating to it.Telemedicine practice will change the medical industry in India. However, a lot depends on how telemedicine practice is regulated in India and how a doctorpracticingtelemedicine incurs liability in the cases of medical negligence.

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Dos and Donts for doctors for practicing Telemedicine

By: admin Medical Negligence 09 May 2020

A virtual consultation is a process in which the person can seek a medical opinion without visiting the specialist in person.It is the only difference which makes virtual consultation different from a traditional medical consultation. The virtual consultations also allow a physician to start a chat session with the patient. The primary purpose of the virtual consultation is to provide quality healthcare services all over India. It includes facilitating access to healthcare to all the people in India. It will provide faster, cheaper and better communication for treatment, follow-up by experts, and to store medical records. There are some cons of virtual consultation as well. For instance, the virtual consultation will reduce direct interaction of patients with doctors because online interactions are impersonal, and also there is a need for a physical examination to be doneto make a complete diagnosis. Also, there is a lack of a standardized format to the interaction.A consent form is absent for either opting for or refusing the service of virtual consultation.

The doctors should begin the virtual consultation by informing the patient about his name and qualifications.Following are the Do’s and Dont’s for the doctors for video consulting:

No.

Do's

Dont's

1

The doctors can exercise his professional judgment to decide whether a virtual consultation is appropriate in a given situation, or there is a requirement of an in-person consultation. The doctor must gather sufficient medical information about the patient’s condition beforemaking any professional judgment.

The doctors cannot insist on the patient for virtual consultations if patientis willing to travel to a hospital or clinic orrequests an in-person consultation.

2

The doctorsshould verify and confirm the patient’s identity at the time of 1st consultation by name, age, address, email ID, phone number, registered ID or any other identification.

The doctors cannot misuse the patient images and data which are obtained at the time of virtual consultation.

3

Every doctor should display the registration number on prescriptions, website, electronic communication (i.e. through WhatsApp/ emailand receipts, etc.)that are given to his patients at the time of virtual consultation.

The doctors cannot use virtual consultations to prescribe medicines that are mentioned in a restricted list of Telemedicine guideline 2020.

4

The doctors must ascertain the identity of an adult, in the case where the minor is involved in a virtual consultation along with an adult.

The caregiver’s identity and authorization should be checked by the doctor before starting with the virtual consultation.

The doctors should not solicit patients for virtual consultationsthrough any advertisements.

5

The doctors must get the patient’s consent for any virtual consultation.

The doctor must record the explicit consentof the patient’s in his patient records.

The doctors should not do any acts which contravene the provisions that are mentioned under the telemedicine guidelines 2020.

6

The doctorsshould maintain all patient records, including case history, investigation reports, images, etc.

The doctors should not contravene the provisions that are mentioned under the Drugs and Cosmetics Act and Rules.

7

The doctors mustprescribe medicines via virtual consultation at his professional discretion only when he is satisfied that he has gathered all adequate and relevant information relating to the patient’s medical condition and prescribed medicines that are inthe best interest of the patient.

The doctors cannot prescribe the drugs mentioned under the prohibited list of telemedicine guidelines 2020 to a patient via virtual consultations.

8

The doctors must issue a prescription as per the Indian Medical Council Regulations.

The doctors should not continue with virtual consultations if he is not satisfied with the information given by the patient to provide specific treatment.

9

The doctors must retain the Patient records, reports, documents, images, diagnostics, data, etc. (Digital or non-Digital) that are utilized in the virtual consultation.

The doctors should not deny virtual emergencyconsultation. However, it should be limitedto first aid, life-saving measures, counselling and advice on referral.

Note - In case of every virtual emergency consultation, the doctors must advise the patient for in-person interaction with a doctor at the earliest.

10

The doctors are required to maintain the prescription records in the same way as it was required for the in-person consultations.

11

The doctors can charge an appropriate fee for providing the virtual consultation. From a fee perspective, the virtual consultations are treated in thesame way as in-person consultations.

12

The doctors must give a receipt or invoice for the fee that has been charged by him while providing virtual consultation.

13

The doctors must ensure that there is no breach of the patient’s privacy and confidentiality. The personal data of the patients should not be disclosed or transferred without the written consent of the patient.

14

The doctors must uphold and practice all the principles of medical ethics, including the professional norms such as protecting patient privacy and confidentiality as per the Indian Medical Council Regulations 2002 Act.

15

The doctors are required to fully abide by the IT Act, Data protection and privacy laws or any applicable rules that are notified from time to time to protect patient privacy and confidentiality and regarding the handling and transfer of such personal information of the patient.

16

The doctors can prescribe the drugs mentioned under the list O, A and B of telemedicine guidelines 2020 to a patient via virtual consultations.

Note - The List A contains those medications which can be prescribed during the first consult through video consultation and are being re-prescribed for re-fill, in case of follow-up consult.

The List B contains a list of medication which the doctors can prescribe to a patient who is undergoing follow-up consultation in addition to those which have been prescribed during an in-person consult for the same medical condition.

The List O contains those medicines which are safe to be prescribed through any mode of virtual consultation.


Conclusion

The video consultations will reduce the exposure of doctors, patients and medical staff to potential infections through remote screening and consultation. It also reduces the costs on time, expenditure and cuts travel of long distances for consultation and treatment in cases where there is no necessity for physical access, follow-up consultations, etc. With the beginning of the COVID-19 outbreak in India, there is a massive rise in virtual consultations. Hence, one can notice that the virtual consultation has started to grow in India.

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Medical Adherence to Environmental Laws

By: admin Medical Negligence 16 Mar 2020

Environmental law is the collection of regulations, ordinances, common law and agreements that govern how individuals interact with their environment. The main objective of environmental law is to protect the environment and generate rules for how an individual can use natural resources. The environmental law not only protects the environment but also determines who can use the natural resources.  Law also regulates forest protection, pollution, the use of natural resources, mineral harvesting and fish populations and animals.

Environmental issues in India

In India, there are many environmental issues such as Air pollution, water pollution, pollution of the natural environment and garbage are all challenges for India. The condition was worse between 1947 through 1995. India has a long way to go to arrive at an environmental standard same to those enjoyed in countries with evolved economics. The growing pollution remains a primary challenge for India. Several have cited economic development as the reason concerning the environment problems. The medical fraternity is one of the most significant contributors to this challenge.

Hospitals are responsible for the environmental issues arising due to the waste they generate and due to the number of resources they use. The healthcare sector has just begun to understand the impact that environmental problems such as climate change will have on the healthcare industry.

“A green and healthy hospital” is one that encourages public health by continuously minimizing its environmental impact and indirectly evicting its assistance to the burden of disease. A green and healthy hospital overseas the link between human health and the environment and determines the understanding through its strategies, operations and governance. It joins local needs with environmental action and practices primary prevention by engaging in efforts to foster health equity, community ecological health and a green economy.     

Environment Impact Assessment

Environment Impact Assessment (EIA)are procedures which make sure that all environmental issues are taken into account during the preparation process itself. In 1994, it was made obligatory under the Environmental Protection Act of 1986. The Ministry of Environment and Forests (MoEF) uses EIA as a leading tool for reducing the adverse impact of rapid industrialization on the environment and for reversing those trends which may lead to climate change in the long run. EIA is an essential tool in assuring that plans and projects will not provide an adverse impact on the environment. The EIA procedure thus could not merely prevent expenditures owing to environmental aspects but also prevent possible public views and protests against a plant.

When in hospitals, the wastes like used bottles or pieces of cotton is discharged, the EIA tool makes sure that the waste dumped is not harming the environment. The assessment is done in such a way that it checks all the ways through which a particular hospital is dumping or discharging its waste to regulate the environmental conditions near the hospital. Further EIA also helps when a hospital demands to construct a special place for dumping such material, as it overviews the impacts and all the pro’s and con’s related to it.

Sustainable Development

Sustainable development means an event that meets the needs of the present without compromising the ability of future generations to meet their own needs. The sustainable development includes Solar energy, Wind energy etc. Sustainable development has three pillars such as Economic growth, Environment protection and Social development. 

India is one of the extremely bio-diverse countries of the world. Its main aim is to bring together development and environment into a single set of targets. The concept of sustainable development can be interpreted in many different manners, but at its core is an approach to development that looks to balance dissimilar and often completing, requires against a consciousness of the social, economic and environmental limitations we face as a society.

Care systems and the hospitals slowly are looking for ways to reduce overall costs and improve efficiency while also improving the patient’s overall experience. Aggressively pursuing goals and making an active commitment to sustainability provides various strategic benefits that can help the hospitals and care systems thrive. They can accomplish sustainable initiatives reap benefits in multiple areas. Efforts of hospitals and care systems contribute to a healthier environment, can help the local communities, and improve the organization’s public perception. One of the ways through which sustainability can improve population health is by contributing to healthier communities, minimizing the use of community resources such as water and energy and also by reducing pollution.

Environmental Laws Regulations

The requirements for the protection and conservation of the environment and sustainable use of natural resources are reflected in the constitutional framework of India. Legislation has passed many acts for environmental protection.

Following are the laws passed by the legislation for environmental protection.

1. The Air (Prevention and Control of Pollution) Act, 1981

The Air (Prevention and Control of Pollution) Act, 1981 is an act to give for prevention, abatement and control of air pollution and the organization of Boards at the Central and state levels with a view performing the aforesaid reasons. To confer the boards, the authorities to execute the provision of the act and assign to the Boards functions connecting to pollution.

One of the major reasons through which air pollution is caused is by the emittance of smoke from the hospitals. This harmful smoke is a result of the pharma industries where the medicines are manufactured for the hospitals. Toxic smoke into the environment leads to air pollution.

2. The Water (Prevention and Control of Pollution) Act, 1974

The water act has been enacted to provide for Prevention and Control of Pollution and also to carry on or reinstate wholesomeness of water in the country. Further, it is provided for the organization of Boards for prevention and control of water pollution to perform the aforesaid purposes. This act forbids the discharge of pollutants into water bodies beyond the provided standard and lays down punishments for non-compliance.

Apart from the chemical industries, even the hospitals are responsible for water pollution. The waste which is generated by the hospitals is sometimes dumped inappropriately in nearby lakes and rivers, giving rise to water pollution, which is a major shortcoming for the environment. Water pollution further harms aquatic life. Hence, this vicious circle never ends, and therefore, hospitals must be responsible enough to dump the waste appropriately.

3. The Environment Protection Act, 1986

The Environment Act provides for the improvement and protection of the environment. This act establishes the framework for studying, planning, and implementing long-term needs of environment safety and laying down a system of speedy and sufficient reply to situations menacing the environment.

Talking about the health industry, it is essential that hospitals take care of the environment. There are duties and responsibilities of every citizen to take care of the environment. A hospital can ensure environment safety by providing a peaceful environment to its patients and as well as to the general public.

4. Hazardous Waste Management Regulations

Hazardous waste includes any waste which, by cause of any of its reactive, physical, explosive or corrosive, characteristics, chemical, toxic, flammable, cause hazard or is likely to cause a danger to health or environment, whether alone or when in contact with other wastes.

Mostly, the waste discharged by the healthcare sector is hazardous as it contains chemicals and toxic items. This substance, when released into the environment, causes adverse effects on the environment. Therefore, it is necessary and important for the healthcare sector to dump all its waste in adherence to the Hazardous Waste Management Regulations so that in future, no such cases arise.

5. The National Green Tribunal Act, 2010

The National Green Tribunal act has been enacted with the purposes to provide for the establishment of an NGT for the effective and expeditious disposal of matters relating to environment protection and other natural resources such as the enforcement of any legal right relating to environment and compensation for injures to persons and property and for cases connected therewith or incidental thereto.

The NGT comes into picture when any legal case arises. This type of situation may occur when a hospital fails to dispose of its waste or commits any activity which harms or hinders the environment. A case against the hospital may be brought by the NGT and not an individual. In such circumstances, the hospital is answerable to the National Green Tribunal, which might impose fines or penalties on the hospital.

Conclusion

Environmental pollution is the main problem in different parts of the world, which needs policymakers to employ several mitigation strategies. Many reasons affect the environment; increasing population, economic development, urbanization and industrialization etc. In India, economic development and population growth are contributing to too many grave environmental calamities.

Sustainable development is about finding better ways of doing things for the present and future. We might require changing the way we work and live now, but this doesn’t mean our standard of life will reduce. With all of these, India is witnessing a high amount of environmental pollution due to the healthcare sector.  As per reports, 5 per cent of the country’s GDP is spent on the Healthcare sector. It is the responsibility of the healthcare sector that this spending is used most appropriately. The hospitals can construct areas where the waste can be dumped off easily. A hospital can also utilize its resources and production in such a way that waste is minimized with effective and low-cost production.

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Hygiene maintenance in Hospitals and Clinics

By: admin Medical Negligence 09 Mar 2020

One of the prime measurements of the standard of care is the cleanliness of the healthcare facilities. The key indicator of patient’s satisfaction is connected to his/her perception of cleanliness in health care facilities. Maintenance of hygiene and cleanliness of health facilities is not only related to aesthetics and patient contentment, but it also decreases the incidents of Hospital Acquired Infections (HAI).  Keeping a hospital clean needs participation from the hospital staff, along with the patients and their relatives.

Introduction

In the health care facility, maintaining cleanliness varies from conventional cleaning. Health facilities are necessary to continue utmost cleanliness for reducing the growth of infective organisms, which can grow between patients, guests and hospital staff. Generally, public health facilities are discerned to be disagreeable and unhygienic with poorly maintained buildings, over-flowing drains, presence of dogs/cats/rodents inside the hospital, grazing cattle within the campus and patient care areas & often dirty /non-functional toilets.

There are some key factors which contribute to unhygienic conditions in health care facilities such as inappropriate facility design, obsolete equipment, consumables and erratic supplies, the gap in human resources intended to maintain cleanliness that relates to numbers as well attitudes and motivation level, deficiency of community ownership of the facility for the upkeep and maintenance, power infrastructure, non-availability of 24 X 7 water & power supply.

Importance of Hygiene

Good hygiene or cleanliness is a necessary factor for the promotion of good health. The significance becomes much more in a hospital setting, where ill patients come to restore their health. Hospitals provide cure to the patients. But, they also become possible sources of spread of infection if patient concerned are not vigilant sufficient. If a patient is hospitalized for several other issues, say cardiac failure, he/she has a high chance of acquiring several infections in the hospital.

The infection may spread from one patient to another patient, and it may also spread from a patient to a nurse or a doctor. A medical practitioner or healthcare personnel can also infect another patient. The microbes in charge of hospital obtained infections usually cause more intense sickness and are resistant to the more conventional antibiotics being used. The most common diseases and spread in a hospital are pneumonia, urinary tract infections, diarrhoea diseases and still chronic infections such as HIV/AIDS and tuberculosis.

There can be various ways through which the prevention of spreading the infection from one patient to another patient can be prevented

  • The hospitals can make sure that the beds of each patient are separated by an appropriate distance.
  • Every ward should get the right amount of sunlight as most of the disease generating bacterias are killed by strong sunlight.

Ways to Keep Patients and Staff safe

Keeping the facility safe for visitors of the patient and the health care staffs should be a priority for each and every hospital. The following can also be adopted:

  1. Focus on High-Touch Areas

Every hospital administrator should direct hospital staff to focus on the most-touched surfaces such as doorknobs, remote controls in patient’s rooms, bed rails and phones. As many people have touched these areas, there is a higher likelihood of hazardous bacterias presents there.

  1. Less use of Chemical Content

Abrasive chemicals can annoy patients’nasal passages and damage the skin of cleaning employees and hospital staff. This means that the most effectual cleaning scheme is also safer.

  1. Avoid Cross-Contamination

Almost certainly the main challenge for health care cleaning crew is detaching and disposing of contaminants right away they are in the hospital. Rags and mops are approximately guaranteed to bring bacteria to other parts of the hospital.

  1. Wear Gloves Properly

The inappropriate use of gloves spreads hazardous bacteria. The cleaning crew must wash their hands after removing gloves. Gloves must always be changed between patients, should never be well-worn in hallways, and should be changed when in motion from a residential district to a shared restroom.

 

Role of Stakeholders

A health care has various stakeholders such as community, patient, hospital staff, district administration and health department. Their sensitization would be vital for ameliorating the cleanliness of the health facilities. The detail that the facility is signifying“for the people” must be appreciated by and hold-ups “by the people”.

The patients and the visitors can contribute too:

Do’s

  1. More and more water bins should be set up by the hospitals
  2. It is the duty of every person who is visiting the hospital to follow the guidelines of the hospital.
  3. The visiting facility should be instructed to wash hands before and after a visit.
  4. Use of public convenience.

Don’ts

  1. A person should not smoke, especially in public or the prohibited areas.
  2. A person should not spit around.
  3. The person is not allowed to litter.

The Healthcare staff plays a crucial role in the implementation of these Guidelines.

  1. Keep the hospital property clean
  2. Use prevention measures to control Infectious Diseases
  3. Spread awareness about the advantages of cleanliness
  4. Follow waste disposal methods.

Sanitation Department

All the health care organizations and hospitals must devote sufficient resources to sanitation services, such as:

  1. A person should be assigned with the overall responsibility for the sanitation services of the hospital.
  2. Written processes for cleaning and disinfection of patient care areas and other areas.
  • Defined responsibility for a particular matter and regions.
  • Procedures for every day and discharge/ shift cleaning and disinfection.
  • Cleaning and disinfection standards and occurrence.
  • Procedures for cleaning in construction areas.
  1. Continuing education and education of sanitation workers.
  2. Ongoing review of procedures.
  3. Supervision of the employees who are indulged in cleaning by those who are trained and knowledgeable in cleaning practices and standards.

Case Law

S.K. Garg vs the State of U.P.

In Allahabad, the conditions of the government hospitals are terrible. The complainant had registered a complaint against the hospital. In his complaint, he mentioned about the conditions of the hospitals which included the pitiable nature of services available in government hospitals and inadequacy of blood banks, unavailability of medicines’, worn down X-ray equipment and unhygienic circumstances. The Allahabad High Court stated that the public hospitals in Allahabad are appalling and distressing sanitary and hygienic conditions. The public hospital needs some improvement. There are many complaints which had been registered against the Government Hospital staff. They are often in collusion with the medical practitioner who runs a private clinic.

Further, the court ordered that every individual has a right to get proper medical treatment. Also, the right to health is a part of the right to life which is guaranteed by Article 21 of the constitution of India.

Conclusion

The movement of micro-organisms between patients via the hands of healthcare employees is a primary contributing factor through which infections in a hospital increases. There are many products have been initiated into hospitals to assist improve patient hygienic conditions.  The hospital staff has to use lighter cleaning techniques before trying more forceful methods. The cleaning should be carefully intended to make efficient use of time. In many government hospitals, there is poor sanitation and lack of primary medical facilities such as stretcher, wheelchair and ambulance. Every hospital’s necessary function is to make sure that the hygienic facilities provided are abundant so that the patients, as well as the hospital staff and patients, are prevented from infections and other dangerous bacterias.

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Consequences of using a Fake Degree/Certificate

By: admin Medical Negligence 09 Mar 2020

In India, the problem of fake degree is not unknown. The problem of counterfeit degrees is not limited to only one field. There are many areas in which an individual uses his/her fake degree, especially in the medical field. A negligent act by a doctor who possesses a fake degree of certificate in treating a patient (by someone who is not a doctor) will have a gruesome effect on the public at large.

Introduction

The fraudulent imitation of certificates is orchestrated by fake universities, diploma mills, etc.  Many a time, it is observed that the degrees of the existing reputed doctor or medical colleges are forged. The World Health Organization had stated that around 57.3% of the doctors are operating without a medical degree by using a fake medical degree. Many people lose their lives as they are operated by a doctor who is not genuine and uses a fake degree in order to run the clinic. There are many FIRs that have been registered by the Medical Council of India against these fake medical degrees.

Statistics

The Maharashtra Medical Council stated that there were57 medical practitioners who submitted their fake Post Graduation degrees in order to get registered in the State Medical Register. All the degrees were in the name of a medical college (College of Physicians and Surgeons) in Mumbai. During the investigation, it was revealed that there were many students who had been registered with the Maharashtra Medical Council and were allowed to practice medicine on the basis of their forged degrees. After an inquiry, the Maharashtra Medical Council found out that the fake doctors were treating the patients since four years in Mumbai. An FIR was filed by the Maharashtra Medical Council. Also, the Maharashtra Medical Council revoked the practising license of all these doctors.

According to sources, the Delhi Medical Council had also asked the police to register FIRs against 422 people who had not registered with any of the state council and were not having any valid degree to treat patients in the year between 2012 and 2015. It was also reported that there were at least 50 FIRs that had been registered by the Medical Council of India against the fake medical degrees.

Punishment

According to the Indian Medical Council Act 1956, section 15 states that the doctor shall get himself registered under the State medical register, only after that, he is entitled to practice medicine, hold his office, will be entitled to sign or authenticate a medical/fitness certificate, If the above provision is not complied with, then that person is liable for imprisonment, which may extend to one year or with a fine which may extend to one thousand or both.

Section 468 of the Indian Penal Code deals with ‘Forgery’ for the purpose of cheating. It states that anybody who commits forgery, intending that either the document or electronic record forged in order to cheat then the person shall be punished with imprisonment which may extend to seven years and will also be liable for a fine.

Conclusion

Hence, we can conclude that the medical practitioner can face many consequences of using a fake medical degree. The medical license can get revoked by the Medical Council of India or State Medical Council. He can be punished under section 15 of the Indian Medical Council Act 1956. An FIR can also get registered against him. He can also be punished under section 468 of the Indian Penal Code.

Not only the patient, but even the life of the fake medical practitioner is affected if he operates on the patient or uses a fake degree to run his clinic. Therefore, to avoid any such circumstances it is advised that the doctors should not indulge in such activities.

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Healthcare Security

By: admin Medical Negligence 09 Mar 2020

The Ministry of Health and Family Welfare issued a draft of the Digital Information Security in Healthcare Act in November 2017. The draft was released for the purpose of bringing a healthcare security law. On 21st March 2018, the Ministry of Health and Family Welfare published the Digital Information Security in Healthcare Act. The Government had introduced the Digital Information Security in Healthcare Act in March 2019. The main aim was to ensure the privacy, confidentiality, standardization and security of the healthcare data. The Digital Information Security in Healthcare Act (DISHA) will enable the digital sharing of an individual’s health records with the hospitals/clinics and between the hospitals and clinics. To overcome incidents such as data breach, cybersecurity, etc. occurring in the healthcare industries, there is a dire need for this law.

Introduction

The Digital Information Security in Healthcare Act lays down the provisions relating to the generation, collection, accession, transmission and storage of the digital health data of an individual. The DISHA will consist of the data that is related to a clinical establishment that is used by the individual, any information pertaining to the physical or mental health of an individual, any information that is related to the organ/blood which has been donated by an individual, any information that is related to the individual’s health service provider, any information that has been found out from examining a body part of an individual, etc.

The DISHA lays down the provisions relating to the Digital health data. Itis considered as an electronic record of an individual which will include the information regarding the age of the patient, his contact number, his lab reports, medical history of the patient, information relating to the medications, information relating to the allergies, etc. The Act also lays down the provisions relating to the personally identifiable information. It is defined as any information which can be used to identify, locate, or contact an individual. It also includes necessary information such as the name, address, date of birth, etc.

The Act shall consist of a central regulator known as the National Electronic Health Authority and various other State Electronic Health Authorities. There is an adjudicatory body that has been set up by the Digital Information Security in Healthcare Act. The adjudicatory bodies are at the State level and also at a National level. The orders of the State adjudicatory can be appealed before the National adjudicatory. However, the orders passed by the National adjudicatory can be appealed before the High Court.

Rights of the data owner

Following are the rights which are available to the owner of the digital health data:

  1. He has a right to either allow or refuse the clinical establishments to generate and collect his data.
  2. He has a right to access his data.
  3. He has a right to get compensation, in case if there is any breach of his data.
  4. He has a right to be known where his data is being transmitted and to whom it is being transmitted.
  5. He has a right to allow, refuse or even withdraw his consent from both storing and sharing his data.
  6. Based on the purpose of the data, he also has a right to choose the data that has to be collected or not.
  7. He has a right to get notified by the clinical establishment at the time whenever a clinical establishment has accessed his data.
  8. His data will be shared with the family members whenever there is any medical emergency.
  9. He can also refuse any clinical establishment from either exposing or accessing his data.

 

Duties of Healthcare Organizations

Following are the responsibilities of the Healthcare Organizations in India:

  1. It is the duty of the Healthcare Organizations to inform (take consent) the owner before collecting his data.
  2. It is the duty of the Healthcare Organizations to inform the owner about sharing his data with the entities. It must be notified within a period of three working days.
  3. It is the duty of the Healthcare Organizations to inform the owner about the purpose for which his data is being collected.
  4. It is the duty of the Healthcare Organizations to share the identity of the people that can access the data.
  5. It is the duty of the Healthcare Organizations to ensure that all the records are secure, private and confidential.
  6. It is the duty of the Healthcare Organizations to hold and store the data of an individual on behalf of the National Electronic Health Authority.

Non-Compliance

There is an obligation upon the Health Information Exchange and Clinical Establishments to give notice to the owner of the data within a period of three days for any breach of his data. In case if there is any breach of the Act, then the person/organization involved in the breach of the data would be liable to pay compensation to the owner of the data. The minimum penalty amounts to Rs. One lakh and addition of Rs. Ten thousand per day, during which the breach continues. However, the maximum penalty shall be of Rs. One crore/ten million. In case if there is any data theft, then there is a punishment of imprisonment which may extend to a period of five years.

Conclusion

We can conclude that the present data protection law in India is facing many issues, so in order to overcome these issues; there is a need for a proper framework to regulate the Activity. It will be considered as a foundation for creating digital health records in India. If the personal and confidential information of the patients is exposed, then it may result in discrimination, embarrassment, and also cause harm to an individual. Hence, the Digital Information Security in Healthcare Act would ensure that the healthcare data will be secured and kept private and confidential. It would also help in regulating the exchange of electronic records between an individual and the hospitals/clinics.

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Rights of Doctors with respect to Medical Negligence

By: admin Medical Negligence 06 Mar 2020

Medical Negligence is a breach of duty which is legal in nature as it is the duty of the doctor to take care of the patient till the patient recovers. Lately, the health care industry is facing lots of complaints with respect to hospital facilities, professional excellence, the form of treatment and method of diagnosis and many more complaints.

After the doctor-patient relationship has come under the ambit of the Consumer Protection Act, many patients have filed complaints against reputed doctors and have also got compensation for the mistake that medical professionals have committed.

However, one must know that even doctors can commit mistakes while rendering treatment to the patient or diagnosing the health condition.Therefore, certain rights must be given to the doctors in cases of medical negligence with an opportunity to hear them out too before taking the final decision.

Burden of Proof

To prove that medical negligence has been committed by the doctors, one has to fulfil all the required criteria of medical negligence.

  • The duty of care on the part of the doctor.
  • The breach of duty by the doctor.
  • Facts of the case.
  • The proximate cause of the negligent act.
  • Damage caused to the patient that is irreversible.

There is an exception in cases where a doctor has charged no fees for the treatment or operation of the patient. In such cases, that particular doctor cannot be sued in the court of law for medical negligence as mentioned in section 2(1) of the Consumer Protection Act 1986.

The National Disputes Redressal Commission, along with the Supreme Court of India has held that the doctor is not always liable in cases of medical negligence. If the patient’s body does not react toward a particular set of treatment, there are chances that the doctor will not be held liable.

Vicarious Liability of the Hospitals

This term has been taken from the basis of a Latin maxim that is “qui facet per alium facet per se” it means that one who acts through another’s actions for their own benefit. With respect to doctors and medical hospitals, it means that the patient who needs proper care and treatment, and if the hospital staff is not able to deliver, the staff, as well as the hospital, will be liable. This is a case of vicarious liability. Vicarious liability is the situation where the act of one person causes the liability on the other person.

Few Defenses Available to Doctors

  1. Risk Factor -The operations which are carried out by trained doctors are usually conducted after calculating the approximate risk and on a joint decision made by the patient and the operating doctor. It is said that there is always a complication factor involved in surgeries and operations which are performed by the doctor and thus, in those cases, the doctors cannot be held liable for the medical negligence caused to the patient as the patient after knowing all nuances of the operation has given consent for the same.
  2. Due Care - No case of medical negligence shall be valid against the doctor or the hospital if the doctor has taken due care and diligence during the treatment and the operation.
  3. Patient Negligence - If some damage is done due to the patient’s negligence then in such cases the jurisdiction of medical negligence may be limited as such injury is caused due to the patient’s own mistake and not that of the doctor.
  4. No Breach of Duty - If the plaintiff or the appellant is not able to prove that the doctor has committed medical negligence, then this can be a ground of defence that can be used by the doctor.
  5. If the Appellant has sued the Wrong Party – The accused party to the case must be proved. Otherwise, the accused doctor will have an upper hand and can use this as a defence.

 

In cases where the individual who is suing the medical professional is not clear about the complaint, then the doctor has a chance to prove his/her innocence. Thus, the above defences are available to the doctor where negligence has been proved but the proof is not substantial. In cases where the medical negligence has been proved, and the punishment is given, then the professional involved can move the higher court.

 

Conclusion

The medical profession is one of the oldest and noblest professions in India; they provide a new life to the patient. Thus, it is very important that flexible laws are made so that the doctors are assigned adequate rights in order to prove them innocent. This will help to upload the dignity of the doctors in India.

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Importance of Consent

By: admin Medical Negligence 06 Mar 2020

When a patient agrees to go ahead with surgical procedure or the treatment and the patient is provided knowledge by the operating doctor or any such medical practitioner, regarding the advantages, risk factor and whether any other alternative treatment is available or not. Although the degree of danger cannot be determined, it is the decision of the patient whether he/she wants to go ahead with the treatment procedure or not. It is also a legal document which has to be recorded and maintained and to be produced in the court of law when called upon to do so.

The patients or the relatives of the patient are asked to sign the consent form. This consent form has details regarding the advantages of the treatment as well as the risk associated with such treatment.

Legal Right

The importance of consent is one of the critical issues which is raised in cases of medical negligence. The patient has a legal right, as mentioned under Article 21 of the Indian Constitution, which states that a citizen has the right to personal life and liberty. The patient can refuse treatment at any point in time. However, in certain emergency situations, it is not always necessary to take consent from the patient. It is important that the consent should not be illegally obtained as consent only stands valid if it is obtained legally. According to the law, it is always presumed that the doctor is at the dominating position; thus, it is the duty of the doctors to obtain consent after giving all the necessary information related to the treatment, surgery or minor operation. If a medical professional treats a patient without his/her permission, then they shall be punishable under appropriate sections of law.

Importance of Consent

Consent is an essential principle under the different Indian medical laws, and it is an acceptable practice followed worldwide by the health fraternity. Informed consent is an important concept which is usually ignored or only partially accepted in India. The importance of consent can be traced through two directions; ethical angle and the legal perspective.

The Medical Council of India has laid down rules under the Indian Medical Council (professional, conduct, Etiquette and ethics) regulations 2002. It states that a doctor or a physician before conducting any operation should collect the written consent from the guardian, or other relatives if the patient is minor, in case of an adult the patient himself can give consent for his/her operation. If the doctor does not collect the consent from the appropriate patient or their relatives, then he/she shall be liable for professional misconduct which shall further lead to disciplinary action by the medical council of India.

Legal Perspective

In cases where the consent is obtained illegally or where the patient has not been provided with the necessary information regarding the risks involved during the treatment or whether any other alternative treatment is available in this particular case, the consent will be deemed incomplete or invalid. And if medical professional attempts to treat a patient without acquiring proper consent, he/she shall be liable under appropriate sections of the law (law of torts, criminal law and consumer protection act). The doctor can be sued for medical negligence if proper consent has not been taken by the patient.

Case Law

DR. Thomas Vs Elisa Air 1987

In the above case, the court had given the judgement that the doctor was guilty of committing the act of medical negligence as the doctor decided not to operate the appendix and the risk of losing the life was involved. The doctor did not carry out the operation because the patient did not give consent, and the relatives of the patient were not available.

Parmanand Katara Vs Union of India

Ruling out the High Court judgement, the Supreme Court held that it is the duty of the doctor to treat the patient and give his 100 percent. Lack of valid consent need not be taken into consideration in cases of life-threatening situations.

 

Conclusion

It is essential that the patients understand that in some treatments, side effects may arise which even the doctor is unaware of. The patient should understand the benefits and the risk factor of the treatment or surgery, which is going to be conducted by the doctor. Therefore, it is not always that a doctor should be blamed for the mishap that has aroused from the treatment or the surgery performed by him. In some cases, it is essential that the benefit of the doubt should be in favour of the doctors and the health industry at large.

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Faulty Machine Aids Medical Negligence

By: admin Medical Negligence 05 Mar 2020

Medical negligence is an unethical practice on the part of doctors or nurses and other medical practitioners. Negligence occurs when the treatment of a patient is not done in accordance with the medical procedure by any professional who is associated with the health industry. Malpractice occurs when the doctor lacks to provide standard care to the patient while doing his/her treatment. In the medical field, if a doctor fails to treat a patient with utmost care and responsibility, it is said to be medical negligence.

Medical negligence is a punishable offence under the Consumer Protection Act, Law of Tort, Indian Penal Code, Contract Act etc. In any case where the death is caused due to the medical negligence, but such death which does not amount to culpable homicide shall amount to imprisonment up to 2 years or fine or both according to the history of the case which is the subject matter. This law is covered under the Section 304A of the Indian Penal Code.

Medical Negligence due to Faulty Machines

  1. Outdated methods: One of the primary reason which leads to medical negligence by doctors is the use of outdated machines in the hospitals to diagnose health conditions of the patients. In India, the technology growth rate is fast and rapid. Therefore, it becomes necessary for the hospitals to keep themselves updated with the new technology.
  2. Lack of knowledge: The main reason for medical negligence that arises due to the faulty machine is the lack of experience with the machine and the limited understanding of its know-how in the hospital. This point is further elaborated below.
  3. Human errors: Errors can arise while operating the machine due to a lack of training on how the machine should be operated.  Once in a while, the doctors should be given the training to use the updated machines. It’s a time-consuming process for any hospital, but the results accomplished are worth the time. By following such process, the chances of medical negligence reduce.
  4. Corruption: Sometimes, the cases of medical negligence also arise because of corruption. Money kept aside for technology development never gets used and instead is used for personal benefits leading to no updates in the technology.
  5. Lack of regular maintenance check of equipment: Malfunctioning or failure of machines may be caused due to lack of maintenance and the effectiveness of the machine. When machines are not checked on a regular basis, such a situation may arise. In case if a machine is related to heart surgery and is not checked for a long period of time, it can give wrong diagnosis leading to improper treatment of an individual.
  6. Reports not being maintained: In cases where the doctors and the hospital staff do not maintain proper records, then during legal proceedings, they won’t be able to save themselves from situations which arise due to faulty machines.
  7. Lack in monitoring the machines regularly: If the machines that are going to be used by doctors during surgery or other minor operations are not monitored continuously and checked regularly, then a situation of medical negligence may arise.

The above are a few reasons why medical negligence arises due to faulty machines. However, the benefit of the doubt can be given to those hospitals and doctors who have taken due care in maintaining the condition of the machines and updating them time to time with the technology advancement.

Guidelines to treat Faulty Machines 

  1. Spreading awareness: It is crucial that awareness should be spread across the health industry regarding the latest technology, and the new machines that have come into force which can be useful in treating diseases.
  2. Equipment cleaning: The health care hospital or other health organisations must make written policies and layout a procedure on how a machine must be cleaned and disinfected after every use. The responsibility for cleaning such machines must be delegated appropriately.
  3. Multiple checks: The types of equipment that are used or going to be used in future must be checked regularly. Also, multiple check tests should be conducted, and the record of the same should be maintained.
  4. Training: Technical training can be given to the medical staff how a machine should be used. This can reduce human errors amounting to medical negligence.
  5. Outdated method: Medical practitioners are expected to be updated on the new techniques for treating diseases and also the latest technology with regards to machines.

The MRI Machine Case

A Lalbaug resident, Rajesh Maru, was sucked inside the MRI machine and was found dead. He was pulled out of the MRI with the help of an oxygen cylinder. This was termed as a negligent act by the doctors and the staff of the hospital due to the use of a faulty machine. Bombay high court passed an order granting interim concession of Rs 10 lakh to his family.

Conclusion

Indian patients suffer a lot due to faulty machines, and sooner or later, patients shall be empowered to claim compensation for health issues and other physical injuries that arise due to the use of such faulty machines. Recently the drug technical advisory board proposed that the medical rules of the country should be amended and compensation should be given to mishaps that arise due to the use of faulty machines.

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National Medical Commission Act 2019

By: admin Medical Negligence 24 Feb 2020

The National Medical Commission Act (NMC) 2019 has come into force on 8th August 2019. The main aim of this Act is to provide a high quality of medical education, adequate availability of medical professional, equitable and universal healthcare facilities and to establish an effective grievance redressal system. Earlier the Medical Council of India (MCI) was held responsible for regulating medical education and practice. The NMC Act 2019 has repealed the Indian Medical Council Act 1956 and has replaced the MCI with the NMC. There are 8 chapters and 1 Schedule mentioned under the NMC Act 2019. Under NMC, the states shall establish their respective State Medical Councils within a period of 3 years.

Composition of NMC members

Chapter II of the NMC Act deals with the provisions relating to the constitution of the NMC. The NMC consist of 25 members. The members of the NMC will be appointed by the Central Government based on the recommendation of a committee.

Following members shall be included:-

  • A chairperson (who must be a senior medical practitioner and an academic with the experience of at least 20 years).
  • Ten ex-officio members (which will include the director-general of Indian Council of Medical Research, director of one of the AIIMS and the presidents of under-graduate and postgraduate medical education boards).
  • Fourteen part-time members (which will include the nominees of the states and union territories and experts from the field of law, management, medical ethics, etc.).

Functions of the NMC

The Functions of NMC are as follows:-

  • To lay down the policies for maintaining high quality and high standards in medical education.
  • To lay down the policies for the regulation of medical institutions, medical researches and medical professionals.
  • Assess the requirements in healthcare (including human resources for health and healthcare infrastructure).
  • To promote, co-ordinate and frame guidelines for the proper functioning of Autonomous Boards.
  • Any other function as mentioned under the Act

National Examination

Chapter IV of the NMC Act deals with the National Examination. There will be a uniform National Eligibility-cum-Entrance Test for the admission to undergraduate and postgraduate medical education. NMC has also introduced a standard final year undergraduate examination called the National Exit Test. The National Exit Test will serve multiple purposes such as to grant the license to practice medicine, as an entrance exam for the admission in postgraduate course and also a screening test for foreign medical graduates.

Autonomous Boards

Chapter V of the NMC Act deals with the provisions relating to the constitution of Autonomous Boards. There are four regulatory bodies that are set up under the NMC Act, and they are as follows:- the Under-Graduate Medical Education Board, the Post-Graduate Medical Education Board, the Medical Assessment and Rating Board and the Ethics and Medical Registration Board. The Ethics and Medical Registration Board will maintain a national register of all the licensed medical practitioners and the community health providers in the country.The NMC Act also states the provision for granting a limited license to community health providers.

Complaints Redressal Commission

The complaints relating to the professional/ethical misconduct against the registered medical practitioner shall be made to the State Medical Council. Before taking any action against the medical practitioner (including the imposition of fine), the State Medical Council shall give an opportunity of the hearing to the concerned medical practitioner or professional. An appeal can be filed by the medical practitioner or professional to the Ethics and Medical Registration Board against the order of the State Medical Council.The NMC act as an appellate authority. If the medical practitioner or professional is aggrieved by order of the Ethics and Medical Registration Board, then an appeal can be filed to the NMC.

Effects of NMC

Under NMC, the term Community Health Provider has been defined vaguely as “a person who is connected with modern scientific medical profession” and is empowering the commission to grant limited license to practice medicine at mid-level. Community Health Provider will allow people to practice medicine without having sufficient medical knowledge and background. Under MCI, there was no requirement of giving test (National Exit Test) in order to obtain a license. The only requirement was to get registered with a State Medical Council to practice. Under NMC, the commission will frame guidelines for determination of fees and all other charges in respect of only 50% of the seats in private medical institutions and deemed to be universities. Earlier under MCI, 85% of the seats were decided by the State Government.

Conclusion

The MCI consist of 70% of the elected representatives, whereas the NMC consist of only 20% of the elected representatives. Under MCI, the action against the president of MCI could be taken only on the directions of the court whereas, under NMC, the Central Government has the power to remove the chairperson or any other member of the NMC. Earlier the decisions of the MCI were not binding on the State Medical Council whereas now under NMC, the ethics board has the power to exercise the jurisdiction relating to the compliance of the ethical issues over the State Medical Council. NMC is thus considered as a government-controlled regulatory body.

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