Above: All healthcare clinics in Uttarakhand will have to be duly registered
With the Uttarakhand High Court seeking closure of establishments not registered under Clinical Establishments Act, the state faces a dire health situation as 75 percent of its hospitals and clinics are guilty of laxity
~By Atul Chandra in Lucknow
Uttarakhand is facing a looming health crisis. The Uttarakhand High Court has directed the state government to seal all the clinical establishments which are not registered under the Clinical Establishments (Registration and Regulation) Act, 2010. At present only 14 percent of Uttarakhand’s doctors and 25 percent of hospitals/clinics are registered under the Act. According to a report, out of a total of 7,400 doctors, only 1,068 are registered with the health department. Out of these, 910 doctors are with private clinics/hospitals and 158 are government employees.
The Court also directed the government to “ensure that all the clinical establishments registered under the Act follow the Operational Guidelines for Clinical Establishments Act as well as Clinical Establishment Act Standard for Hospital (Level 1A and 1B)”.
Acting Chief Justice Rajiv Sharma and Justice Manoj Tiwari recently passed a slew of patient-friendly directives on a PIL which said that a number of hospitals and clinical establishments were not adhering to the Act. The PIL was filed by Ahmed Nabi who, in a complaint against two hospitals—BD Hospital, Doraha, Bazpur, and Public Hospital, Sarkari Road, Kela Khera, district Udham Singh Nagar—alleged that the persons running these two hospitals did not have medical degrees and were not registered under the Clinical Establishments (Registration and Regulation) Act. Nabi also alleged that those without any medical qualification were performing surgeries in these hospitals.
A probe by the chief medical officer in 2016 revealed that though BD Hospital did not have any doctor with an MBBS degree, it had admitted 10 patients for surgery. The hospital was sealed. With confirmation of similar irregularities in the other hospital, that too was sealed.
The Court pointed out that the two hospitals were given provisional registration on the basis of their having one doctor with a degree in homoeopathic medicine and the other in Unani medicine. This, the petitioner argued, had happened due to the government’s non-adherence to the Clinical Establishments (Registration and Regulation) Rules and the Operational Guidelines for Clinical Establishment Act Standard for Hospital (Levels 1A and 1B).
In its reply, the government tried to put the blame on the Indian Medical Association which had requested that the implementation of the Act be “kept in abeyance” as the cost of treatment would shoot up by five times. The Court rejected the idea and said in its final order: “It is better to have no law than not to enforce it. The state government cannot be permitted to keep the enforcement of the Act at abeyance. The state government has also adopted the Clinical Establishment Act Standard for Hospital (Level 1A and 1B)…” and further stressed its point by saying that “once the enactment has been made, it must be implemented/carried out in letter and spirit”.
The Court, which found it “shocking” that doctors without any prescribed medical degree were “performing surgeries”, said that “Right to Life includes medical facilities to be provided by duly qualified doctors with latest equipments”. The bench said that patients should not be overcharged and be provided medicines at “the lowest rates”. Similarly, the rates for diagnostic tests were to be “reasonable and not exorbitant”. It directed all clinical establishments not to “unnecessarily put patients to diagnostic tests”. Moreover, they have also been directed to prescribe only generic medicines.
While ordering the government to prescribe “rates for various diagnostic tests or procedures or surgeries or treatments extended by clinical establishments” within one month from the date of the order, the clinical establishments have been told to have one side of the intensive care unit’s wall fitted with transparent glass to enable attendants to see the patient.
The Indian Medical Association (IMA) was in no mood to accept the verdict lying down. “We will decide our next course of action at a meeting to be held in a day or two,” said Dr DD Chaudhury, the IMA secretary.
“If the government decides to close down the clinical establishments, let them. They are making it very, very difficult for private doctors to function in the state where primary healthcare, which is the responsibility of the state, is in a shambles.” The IMA plans to first take up the issue at the political level and then go in for a legal remedy.
The Uttarakhand medical fraternity is also in a defiant mood as it says that the High Court did not give them an opportunity to present their case. “Natural justice demanded that we should have been made a party to the case, which was not done. Secondly, the PIL was about two hospitals run by quacks, but the Court passed sweeping orders against all clinical establishments,” the IMA secretary said.
The Court’s orders came even as the IMA was busy thrashing out the nitty-gritty involved in the implementation of the Act. One of the contentious issues was fixing of rates for various diagnostic tests and surgical procedures.
While the High Court has directed the government to fix these rates, the clinical establishments want to decide the charges themselves. “It is corporate hospitals which fleece a patient and have brought a bad name to the profession. Small private clinical establishments are still affordable and follow fair practices,” Chaudhury said. He did admit, though, that only about one-fourth of the total clinical establishments were registered with the government.
Even as the IMA in Uttarakhand prepares for a showdown, the situation in Uttar Pradesh is comparatively calm. That is because the government is still not ready with the rules to be implemented. “We have given some suggestions to the government and requested it to follow the Haryana and Madhya Pradesh models of the Act as they were not unduly harsh on clinical establishments,” said Dr Suryakant, president of the IMA, UP. One of the suggestions was to keep hospitals with less than 20 beds out of the Act’s purview.