CLINICAL ESTABLISHMENT ACT

1. DR SHAMBHU N GUPTA
M.S.
CITY HOSPITAL,45 MODEL COLONY
SRI GANGANAGAR

2. What Is Clinical establishment
Act?
 This bill makes it mandatory for each and
every clinical establishment including every
individual clinic, consulting chamber,
laboratory or any other investigative or
treatment place without indoor beds, nursing
homes, hospital etc. by whatever name it may
be called to register and follow minimum
standards of infrastructure i.e. of space /
equipment and qualified para medical staff.

3.  It provides for mandatory registration
of all clinical establishments, including
diagnostic centers and
 single-doctor clinics across all
recognized systems of medicine both
in the public and private sector
 except those run by the Defense forces

4. As-is-where-is'
 Initially, provisional registration would be
granted within 10 days of application on ‘as-
is-where-is basis' upon receiving the
application filed with supporting
documents. Once standards have been
notified, permanent registration would be
provided to all those conforming to the
notified standards.

5. To stabilize the emergency
patient
 (with its grammatical variations and cognate
expressions) means, with respect to an emergency
medical condition specified in clause (f), to
provide such medical treatment of the condition
as may be necessary to assure, within reasonable
medical probability, that no material deterioration
of the condition is likely to result from or occur
during the transfer of the individual from one
clinical establishment to other.


6. The registering authority
can impose fines for non-
compliance and if a
clinical establishment
fails to pay the same, it
would be recovered as an
arrear of land revenue.

7. Penalties for non registration
There are stringent and huge
monitory penalties for non
registration by any professional,
which are more than many
criminal penalties of IPC.
For First Offence, 10,00 FOR
SECOND 50,000,subsequent
offenses Rs.5 Lakhs.

8. Any person serving in non
registered establishment 25,000/-
Disobeying any direction or
obstruction to inspection Rs. 5
Lakhs.

9. Rajasthan and Uttar
Pradesh have already
adopted the Act.

10.  The state government is making an all
out effort to crack the whip on
private clinics and hospitals with an Act
which would require them to declare
the amount of fees they charge, the
number of services they offer and get
registration from the
medical authorities to set up a
health facility.

11.  clinics and private hospitals will have to
mention on a display board about the
services they are providing and the fees
they are charging for that.

12. The proposed Act envisages to
have district level committees,
which would include district
collector, chief medical health
officer and superintendent of
police.

13.  Act would also prescribe minimum quality
standards of services at the private clinical
establishments.
A medical department official said under
the Act, no one can open clinics and
hospitals without applying for registration.
For the first two years, the department
would issue temporary registration and
after two years, permanent registration
would be provided.

14. IMA view point
 This bill unleashes a license Raj.
Draconian powers have been vested
with authorities at all levels with little
provision for appeal.
 Are doctors doing some illegal
work to be harassed like this??

15. What IMA proposes
 - Single Doctor establishment and
clinics to be considered for minimum
registration only without applying
strict rules, these provisions should be
prospective in implementing ( old
clinics, establishments should be
excluded).

16. IMA wants that only those
establishments with indoor
facilities should be included for
registration under this act. Till
date existing establishments
should be exempted from the
provisions of this act.)

17. What IMA proposes
 That every clinical establishment shall try
to provide every possible care for
emergency cases so as to stabilize the
condition of the patient to best of its ability
and refer it to appropriate clinical
establishment. This is already a part of
ethical conduct.
 Ethics and rules are different and
should not be mixed.

18.  There are many more such objectionable
and highly detrimental provisions Govt. has
included in this Clinical Establishment Act.
IMA has given their suggestions in writing
to everybody concerned including Union
Health Minister and the Parliamentary
Standing Committee.
 But nobody cared and Parliament had
passed the Clinical Establishment Bill
without discussion.

20. NATIONAL COMMISSSION
FOR HUMAN RESOURCES
IN HEALTH BILL 2011
(NCHRH)

21.  Decentralization is a slogan of the Union
Government for better organization and
achievements.
 But it is unfortunate to learn that the
benign Government is proposing for
centralization of powers by forming
National Commission and by taking away
the autonomy of all the concerned Board,
Councils and other wings of the Union
Government for health.

22.  The Bill in introduction – States to
supervise and regulate professional
councils in various disciplines of
health sector.
 Page (1) However, subsequently it
dissolves all the existing Councils and
takes away all their duties and fund.

23.  The Medical Council of India,
constituted by Indian Medical Council
Act 1956, has been an autonomous
body regulating medical education in
the country.
 As the majority of the members were
elected and represented different
states, they were able to give unbiased
opinion regarding medical institutions
and medical courses.

24.  This new Commission is constituted
by Central Government appointed
members.
 They will act like a department of
union Ministry of health and family
welfare and will not be able to give
unbiased opinion.

25.  As per the clause 105(1) & (2), the
Commission, the Board, committee or the
National Council will be bound by the
directions of the central government.
 In other words, the Commission, the
Committee and the Council will execute the
orders given by the central government.

26.  9) No elected members from Professional
Associations in National Commission
 1) National Commission the proposed supreme
body with vested powers will have no elected
members and State representatives to represent
their needs and demands
 2) Professionals from other discipline of
Management technology and law are given place
in this Commission will pave way for dilution and
nepotism
 3) It is unfortunate in a democratic country
elected representative Council is brought under
appointed non democratic body

27.  There is no provision for the
representation from the professional
organizations, like Indian Medical
Association or Health Universities in
the Commission, Board or Council,
shunning the voice of the health care
providers.

28. In the circumstances, it will not
be possible for the Commission,
Board, committee or Council to
provide fair assessment of the
medical education or health
care delivery.

29.  Sec. 100 which bars challenging of removal of
name from state register should be deleted. It is
unconstitutional and is against the fundamental
principles of constitution.
 No law can bar the citizen of India from seeking a
judicial recourse for getting relief against the
decision of a regulatory body. Further a single
body can’t be investigating, prosecuting, judging
and then final super punishing authority whose
decision is un- challengeable in the court of Law.
 It is against natural justice.

30. Is the bill is above the existing laws?
Clause 100 & 101 (Page 34) says the
decisions of the Commission
cannot be questioned in the court
of law and the agreed persons
cannot seek legal remedies.

31.  Modern medicine is not defined properly it
is defined only as medicine.
 Health professionals are not properly
defined to discharge their duties.
 Without defining properly the objectives of
the bill will not be accomplished.

32. Similarly the words" medical
practitioner" in section 2(t), should
be replaced with the words
"modern medical practitioner"

33. Doctor doing any other occupation
is misconduct?
 The seventh schedule in continuation of
section 68 in Part I (10) (page 50) says
engage in any business (or) occupation
other than health profession is a
misconduct.
 This prohibits all career opportunities for
health professionals.

34.  The statement of object and
reason for the bill section (2)
page 53 says “……. to reduce
shortage, standardize quality
and bridge the uneven
distribution of existing work
force in the health sector”.

35.  With No roadmap. How is the
Government going to reduce the
shortage of manpower by forming this
Commission?

36.  Use of attractive words will not solve the
problem.
- There is no need to dissolve the
existing health Councils to achieve this
purpose.
- Health is a State subject and resources
cannot be redistributed by the Central
Government.

37.  For example - “There is acute
shortage of water & electricity
in various parts of the country.
Will the Central Government
constitute the Commission to
make even distribution?”
·

38. Audit and Accounting

 Clause 77 says even the accounts of State Councils will
be audited only by the CAG of Central Government.
State will have no role on this


39. The Indian Medical Association
totally rejects the proposed
“National Commission for
Human Resources for Health
Bill 2011 for the following
reasons:-

40. BRMS / BRHC Course

 The Government of India has decided to introduce a
Short 3 years course of Modern Medicine, called
BRHC (Bachelor of Rural Health & Care) exclusively
to serve the Rural population (villages).
 Decision was taken under the pretext that doctors are
not available for rural population.
 It is understood that for this purpose Medical Schools
will be started in District Hospitals.

41.  The recruitment of the students will be
from rural areas and on completion of
the course they will be obliged to serve
in their native rural area compulsorily
for 5 years. Such graduates will also be
given an option to undergo bridge
course so as to enable them to obtain
MBBS degree.
 IMA opposes substandard, short BRHC
Course.

42.  Hon’ble Prime Minister of India said
“India needs more Family physicians
and efforts will be taken to increase
the importance of Family physician.
 Contradicting to this the bill says 4(c)
page 53 “….to ensure uniform
augmentation of trained specialist and
super specialist” as its priority.
·

43.  National Commission, the
proposed supreme body with
vested powers will not have
elected members and State
representatives to represent their
needs and demands.

44.  Professionals from other discipline of
Management technology and law are
given place in this Commission which
will pave way for dilution and
nepotism.
 It is unfortunate that in a democratic
country elected representative Council
is brought under power of non
democratic body.

45.  Health is a State subject.
- Independent Councils is the need
of Medical Professions.
- NCHRH will do more harm to
health education and health care of
India.

46.  In short NCHRH is of the
Government by the Government
and for the Government and not for
health care and medical education.

47.  With No roadmap.
How is the Government
going to reduce the
shortage of manpower by
forming this
Commission?

48. Pay scales for Doctors & stipend for Junior Doctors.
Salaries of sate govt. doctors
should be at par with central govt.
scales. Stipend of the junior
doctors should be at par with those
of central govt. medical
institutions.

49.  Amend the CPA act.
 Medical profession should be exempted
from the present CPA act, which is
crippling the medical fraternity and forcing
the doctors to do defensive medical practice
resulting in denying of proper medical aid
to needy patients.

50. Mandatory rural service
 Indian Medical Association – positively
responds to the Govt.’s newly proposed
compulsory rural service after internship
for MBBS graduates, provided the
‘provisional doctors’ shall get salary and
other perks as of regular service personnel
along with weight age in PG entrance
exam.

51.  IMA stresses that this mandatory rural service shall be
implied to those students studying in Govt. colleges
only.
 IMA recommends to Govt. of India, that this ‘rural
service clause’ shall be optional to those students
studying in private medical colleges. IMA would also
advise the Hon. Health Minister and BOG of MCI to
discuss the matter with all India Junior doctors
association and other stake holders in medical
education, before finalizing the decision.
 Likewise there are so many issues relating to health
care bothering the medical practitioners at local and
state level also.

52.  Doctors not going to rural areas is the
problem of governance.
 Adequate allowances and facilities like rural
service allowances,
 proper free accommodation,
 education allowances for children,
 vehicle or vehicle allowances,
 appropriate reservation for education and
employment for their children,
·

53.  sabbatical leave for academic
enhancement of Doctors, allowances
for attending academic conferences for
updating their knowledge, f
 acility for interest free personal loans
should be provided to doctors serving
in rural areas.
 This will attract doctors to rural areas.

54.  Enhance budgetary allotment for
health care from present meager 2% to
at least 12% of GDP.
 Pay good salaries; make sure the
Government PHCs have adequate
supply of medicine.
 All PHCs should be fully equipped
with required para - medical staff and
nursing staff to help the doctors.

55. Mandatory rural service
 Indian Medical Association – positively responds to
the Govt.’s newly proposed compulsory rural service
after internship for MBBS graduates, provided the
‘provisional doctors’ shall get salary and other perks
as of regular service personnel along with weight age
in PG entrance exam.
 IMA stresses that this mandatory rural service shall be
implied to those students studying in Govt. colleges
only.

56.  IMA recommends to Govt. of India, that this ‘rural
service clause’ shall be optional to those students
studying in private medical colleges.
 IMA would also advise the Hon. Health Minister
and BOG of MCI to discuss the matter with all
India Junior doctors association and other stake
holders in medical education, before finalizing the
decision.
 Likewise there are so many issues relating to
health care bothering the medical practitioners at
local and state level also.