3. Let us look into HISTORY of the
new beginning…….
4. CONSTITUTIONAL PROVISIONS
• The preamble to the Constitution of India coupled with the
Directive Principles of State Policy strives to provide a welfare
State with socialist patterns of society.
It enjoins the State to make the “improvement of public
health” a primary responsibility.
• Articles 38,42,43 and 47 of the Constitution provide for
promotion of health of individuals as well as health care.
5. Regulation relating to medical
profession
• There exists legislation with respect to licensing of medical professionals
such as doctors, nurses, dentists and pharmacists with a view to control their
entry into the market
• Statutory regulatory councils have been established to monitor the
standards of medical education, promote medical training and research
activities, and oversee the qualifications, registration, and professional
conduct of doctors, dentists, nurses, pharmacists, and practitioners of other
systems of Medicine such as Ayurveda, Yoga, Unani, Siddha and
Homeopathy
e.g.
Indian Nursing Council Act, 1947,
Indian Dentists Act, 1948
Pharmacy Act, 1948
Indian Medical Council Act, 1956,
Indian Medicine Central Council Act, 1970,
Homeopathy Central Council Act, 1973,
6. Directive from the National
Human Rights Commission – 1996
• Much later, in 1996 the death of Ina Raja in a private hospital
due to medical negligence was reported to the NHRC. The
Commission directed the Govt. of India, MCI and the Delhi
Govt. to examine:
1) Registration of private hospitals after ensuring availability of
minimum facilities
2) Monitoring to ensure availability of facilities,
3) Framing of regulations,
4) Violation to be made a cognizable offence,
5) Shifting of non-conforming hospitals that are health hazards
from nonconforming areas.
7. Resolutions of the Central Council
5th Conference
of Health & Family Welfare
The Central Council of Health and Family Welfare in its 5th
Conference held in January 1997 had resolved that: -
a) States may enact laws to provide for registration of only those
private hospitals that have minimum facilities for different
forms of treatment
b) Monitoring mechanisms should be developed by the State to
ensure that the facilities and services created in private and
voluntary sector hospitals continue to be available and are
maintained at the desired level
c) Private Hospitals in non-confirming areas that are posing health
hazards may be considered for shifting to other areas
d) The accreditation system would however, require to be studied
8. Legislations by States
As ‘ health’ is a state subject, some State legislation had been brought out by
UTs/States quite early such as:
1) Bombay Nursing Homes Registration Act, 1949 (Annexure V)
2) The Andhra Pradesh Private Medical Care Establishments Act, (Annexure VI)
3) Delhi Nursing Homes Registration Act, 1953 (Annexure VII)
4) Orissa Clinical Establishment (Control and Regulation) Act, 1991 (Annexure VIII)
5) Punjab State Nursing Home Registration Act, 1991 (Annexure IX)
6) Manipur Nursing Home and Clinics Registration Act, 1992 (Annexure X)
7) Sikkim Clinical Establishments, Act 1995 (Annexure XI)
8) Nagaland Health Care Establishments Act, 1997 (Annexure XII)
9) Madhya Pradesh Clinical Establishments Regulation Act. (Annexure XII-A)
It is also gathered that some more States such as Rajasthan, Karnataka
and Haryana have drafted the regulatory legislations
9. Issues relating to enforcement,
effectiveness and implementation
• Out datedness of existing legislations
• Ineffective implementation
• Absence of rules
• Ineffective content of rules
• Non-coverage of other private institutional providers
• No uniformity in standards
10. From the analysis of past we come to know
that there were age old concerns in the health
care service delivery
• How to bring down cases of negligence??
• How to improve health care quality??
• How to regulate health care service delivery??
• How to ensure minimum standards of facilities and services in
health care throughout the country??
• How to regulate systematic collection of information from
gigantic private health care sector??
• Despite many State Legislatures having enacted laws for
regulating health care providers, the general perception was that
current regulatory process for health care providers in India was
inadequate or not responsive to ensure health care services of
acceptable quality and prevent negligence.
11. Who were concerned??
• General public
• Government
• Professional associations
• Private providers
• Agencies financing health care
• Human Rights Commission
• Judiciary
• Others
12. ULTIMATE OBJECTIVE SET BY
GOVERNMENT
• Creation of a national registry of healthcare establishments
• Comprehensively and efficiently managed regulatory system
• Maintenance of minimum standards and their periodic review
This led to THE NEW BEGINNING of regulation
13. The Clinical Establishments
(Registration & Regulation) Act, 2010
In order to move forward with the understanding of
the act, we need to get familiarised with few terms:
• REGULATION
• REGULATION OF CLINICAL ESTABLISHMENT
• LICENSURE
• CERTIFICATION
• ACCREDITATION
14. The Clinical Establishments
(Registration & Regulation) Act, 2010
REGULATION
• Regulation seeks to ensure quality, accountability, protect the
consumers and control costs as well as the distortions created by
market forces
REGULATION OF CLINICAL ESTABLISHMENT
• There are several actors involved in the regulatory process
namely, the health care professionals, managers, ministry of
health, commercial interests, NGOs, community and consumer
groups amongst others
15. The Clinical Establishments (Registration
& Regulation) Act, 2010
LICENSURE
a government administered mandatory process that
requires healthcare institutions to meet established minimum
standards in order to operate
CERTIFICATION
a voluntary governmental or non-governmental process
that grants recognition to healthcare institutions that meet
certain standards and qualifies them to advertise services or to
receive payment or funding for services provided
16. The Clinical Establishments
(Registration & Regulation) Act, 2010
ACCREDIATION
a process by which a government or non-
government agency grants recognition to healthcare
institutions that meet certain standards that require continuous
improvement in structures, procedures or outcomes. It is
usually voluntary, time-limited and based on periodic
assessments by the accrediting body, and may, like
certification, be used to achieve other desirable ends such as
payment or funding.
17. Definition of clinical establishment
• (i) a hospital, maternity home, nursing home, dispensary, clinic, sanatorium or an institution
by whatever name called that offers services, facilities requiring diagnosis, treatment or care
for illness, injury, deformity, abnormality or pregnancy in any recognized system of medicine
established and administered or maintained by any person or body of persons, whether
incorporated or not; or
• (ii) a place established as an independent entity or part of an establishment referred to in
sub-clause (i), in connection with the diagnosis or treatment of diseases where pathological,
bacteriological, genetic, radiological, chemical, biological investigations or other diagnostic
or investigative services with the aid of laboratory or other medical equipment, are usually
carried on, established and administered or maintained by any person or body of persons,
whether incorporated or not, and shall include a clinical establishment owned, controlled or
managed by:
• Government or a department of the Government;
• a trust, whether public or private;
• a corporation (including a society) registered under a Central, Provincial or State Act,
whether or not owned by the Government;
• a local authority; and
• a single doctor
18. Coverage & Applicability
Coverage
• All clinical establishments including diagnostic centres and
single doctor clinics, across all recognized systems of medicine
in both the public and private sector.
• Only exception is in case of clinical establishments of the
Defence Forces
Applicability
• States of Arunachal Pradesh, Sikkim, Mizoram, Himachal
Pradesh and all Union Territories
• Such other States which adopt this Act by resolution passed in
this behalf under clause (1) of article 252 of the Constitution.
19. Institutional Mechanisms to be
established under the Act
Central/National
Council of Clinical
Establishments
State Council /
Union Territory
Council of Clinical
Establishments
District Registering
Authority
20. National Council for Clinical
Establishments
Ministry of Health
&
Family Welfare
Directorate General of Health Services
(DGHS)
DGHS subordinate offices all over the country
a) Director-General of Health Service, MOHFW, ex officio, who shall be the Chairperson;
b) Four representatives out of which one each to be elected by the
(i) Dental Council of India constituted under section 3 of the Dentists Act, 1948;
(ii) Medical Council of India constituted under section 3 of the Indian Medical Council Act, 1956;
(iii) Nursing Council of India constituted under section 3 of the Indian Nursing Council Act, 1947;
(iv) Pharmacy Council of India constituted under section 3 of the Pharmacy Act, 1948;
c) Three representatives to be elected by the National council of Indian Medicine representing the
Ayurveda, Siddha and Unani systems of medicine constituted under section 3 of the Indian
Medicine National council Act, 1970;
d) One representative to be elected by the National council of Homoeopathy constituted under section
3 of the Homoeopathy National council Act, 1973;
21. National Council for Clinical
Establishments
e) One representative to be elected by the National council of the Indian Medical
Association;
f) One representative of Bureau of the Indian Standards constituted under section
3 of the Bureau of Indian Standards Act, 1986;
g) Two representatives from the Zonal Council set-up under section 15 of the
States Reorganisation Act, 1956;
h) Two representatives from the North-Eastern Council set-up under section 3 of
the North-Eastern Council Act, 1971;
i) One representative from the line of paramedical systems excluding systems
that have been given representation under clause (b);
j) Two representatives from National Level Consumer Group to be nominated by
Central Government;
k) One representative from the Associations of Indian Systems of Medicines
relating to Ayurveda, Siddha and Unani to be nominated by the Central
Government;
l) The Secretary-General of the Quality Council of India, ex officio.
22. Functions of National Council of
Clinical Establishments
• Compile and publish a National Register of clinical
establishments within two years from the date of the
commencement of this Act;
• Classify the clinical establishments into different categories;
• Develop the minimum standards and their periodic review;
• Determine within a period of two years from its establishment,
the first set of standards for ensuring proper healthcare by the
clinical establishments;
• Collect the statistics in respect of clinical establishments;
• Perform any other function determined by the Central
Government from time to time.
23. State Council of Clinical
Establishments
a) Secretary, Health ex officio, who shall be the Chairman;
b) Director of Health Services — ex officio member-secretary;
c) Directors of different streams of Indian Systems of Medicine -ex officio
members;
d) One representative each to be elected by the executive committee of-
i. State Medical Council of India;
ii. State Dental Council of India;
iii. State Nursing Council of India;
iv. State Pharmacy Council of India;
e) Three representatives to be elected by the Executive of the State Council or
Union Territory Council, as the case may be, of Indian Medicine
representing the Ayurveda, Siddha and Unani systems of medicines;
f) One representative to be elected by the State Council of the Indian Medical
Association;
g) One representative from the line of paramedical systems
h) Two representatives from the State level consumer groups or reputed non-
governmental organizations working in the field of health
24. Functions of the State Council
• Compiling and updating the State Registers of clinical
establishment;
• Sending monthly returns for updating the National Register;
• Representing the State in the National Council;
• Hearing of appeals against the orders of the authority;
• Publication on annual basis a report on the state of
implementation of standards within their respective States.
25. District Registering Authority
• The State Government shall, by notification, set-up an
authority to be called the district registering authority for each
district for registration of clinical establishments, with the
following members:
• District Collector - Chairperson
• District Health Officer – Convenor
• Three members with such qualifications and on such terms and
conditions as may be prescribed by the Central Government.
26. Condition for registration
Every clinical establishment shall fulfil the following
conditions:
• Meet the prescribed minimum standards of facilities
and personnel
• Maintain records and reporting as prescribed
• Provide staff and facilities as may be required to
stabilize emergency medical condition of any
individual
27. Procedure for registration
• Application in the prescribed Performa along with prescribed fee
to be made to district registering authority.
• Application can be filed in person or by post or online.
• If any clinical establishment is in existence at the time of the
commencement of this Act, an application for its registration
shall be made within one year from the date of the
commencement of this Act
• A clinical establishment which comes into existence after
commencement of this Act, shall apply for permanent
registration within a period of six months from the date of its
establishment.
28. Provisional registration
• The registering authority within a period of ten days from the date of receipt of application, shall
grant a certificate of provisional registration in such form and containing such particulars and
such information, as may be prescribed.
• The authority shall not conduct any inquiry prior to the grant of provisional registration.
• The authority shall, within a period of forty-five days from the grant of provisional registration,
shall publish (as per prescribed manner) all particulars of the clinical establishment so registered
provisionally.
• The certificate of registration shall be displayed in a conspicuous place by the CE
• The provisional registration shall be valid to the last day of the twelfth month from the date of
issue of the certificate of registration and such registration shall be renewable.
• Provisional registration shall not be granted or renewed beyond:
Period of two years from date of notification of standards in case of establishments which came
into existence after commencement of this Act but before notification of the standards
Period of two years from the date of notification of the standards for clinical establishments
which come into existence after the commencement of this Act but before the notification of the
standards; and
Period of six months from the date of notification of standards for clinical establishments which
come into existence after standards have been notified.
29. Permanent registration
• Application for permanent registration would be made in such
form and accompanied by such fees, as prescribed
• Along with form, the CE shall submit evidence of having
compiled with the prescribed minimum standards as per
prescribed manner
• Information submitted by CE shall be displayed for information
of public at large and for filing of objections, if any for a period
of 30 days before processing for final grant of permanent
registration
• In case of objections, the same shall be communicated to CE for
response within a period of 45 days
30. Cont……
• Permanent registration shall be granted only when a CE fulfils
the prescribed standards for registration by the Central
Government
• The certificate of permanent registration shall be valid for a
period of 5 years from date of issue
• Cancellation of registration, would occur at any time, if the
conditions for registration are not compiled and show cause
notice would be issued to the CE
• Authority after cancellation of registration for reasons to be
recorded in writing, may restrain immediately the CE.
31. Inspection and power to enter
• The authority or its designated officer shall have right to
undertake an inspection of any registered establishment and its
work through a multi-member inspection team
• Results of the inspection shall be communicated to the
establishment and after ascertaining the opinion of the
establishment shall advise upon action to be taken
• The authority or its designated officer has the power to enter,
with prior notice to the establishment, if there is any reason to
suspect that the clinical establishment is carrying on without
registration
32. Appeals
• Any person, aggrieved by an order of the registering authority
refusing to grant or renew a certificate of registration or revoking
a certificate of registration may, in such manner and within such
period as may be prescribed, can refer an appeal to the State
Council
• Provided that the State Council may entertain an appeal
preferred after the expiry of the prescribed period if it is satisfied
that the appellant was prevented by sufficient cause from
preferring the appeal in time.
33. Penalties
• Whoever contravenes any provision of this Act shall, if no penalty is provided
elsewhere, be punishable for the first offence with fine which may extend to
ten thousand rupees, for any second offence with fine which may extend to
fifty thousand rupees and for any subsequent offence with fine which may
extend to five lakh rupees.
• Whoever carries on a clinical establishment without registration shall, on first
contravention, be liable to a monetary penalty up to fifty thousand rupees, for
second contravention with a monetary penalty which may extend to two lakh
rupees and for any subsequent contravention with a monetary penalty which
may extend to five lakh rupees.
• Whoever knowingly serves in a clinical establishment which is not duly
registered under this Act, shall be liable to a monetary penalty which may
extend to twenty-five thousand rupees.
• Whoever wilfully disobeys any direction lawfully given by any person or
authority empowered under this Act to give such direction, or obstructs any
person or authority in the discharge of any functions which such person or
authority is required or empowered under this Act to discharge, shall be liable
to a monetary penalty which may extend to five lakh rupees.
34. Salient Features of the Clinical
Establishment Act 2010
• Comprehensive definition of Clinical Establishments: Includes all types and
kinds of health care providers Includes Indian Systems of Medicines and
Homeopathy
• Typology: Allows for categorization and classification of establishments- public /
private; single doctor to hospitals and laboratories and others
• Database generation: Provision for generation of reliable and comprehensive
database for all types of clinical establishments in the country
• Defines standards: for operation, using participatory approach and ensure
uniformity across all establishments
• Ensure transparency: through online registration system
• An accountable, time-bound system: The Act places the entire process of
registration and the data of clinical establishments in the public domain, making it
mandatory for every district registering authority, the State Government and the
Central Government to compile, publish and maintain in digital format a register
of clinical establishments within a period of two years of its establishment.
35. Salient Features of the Clinical
Establishment Act 2010
Establishment of a National Council, an all encompassing, multi-member body representing :
1. Medical council of India
2. Dental Council of India
3. Nursing Council of India
4. Pharmacy Council of India
5. Indian Medicines representing the Ayurveda, Siddha, Unani and Homoeopathy systems
6. Indian Medical Associations
7. Bureau of Indian Standards
8. Zonal Councils set up under the States Re-organisation Act, 1956
9. North Eastern Council
10. Consumer Group amongst others
The National Council: through a consultative process would discharge following duties:
• Classify clinical establishments into different categories
• Determine minimum standards
• Carry periodic review, compile, maintain and update a national register of clinical
establishments.
36. Salient Features of the Clinical
Establishment Act 2010
• Role assigned to State Government:
1. Designate the DHO or the CMO as district registering authority for registration of clinical
establishments;
2. Compile and maintain State Register
• Role assigned to Central Government:
1. Shall maintain digital All India Register, (an amalgam of the State / UT Registers )
2. Publish in the public domain
• Provisional & Permanent Registration: Allows for provisional registration, which is simply
a process of self declaration, with no inspection. After notification of standards (which is
within 2 years of the enactment of the Act), permanent registration would be undertaken
• Time-bound development: The Act seeks to ensure time bound programme for development
of standards and their subsequent enforcement
• Mandatory to provide emergency care: Mandatory for every clinical establishment to
provide treatment to stabilize the emergency medical condition of any individual brought to
such establishment
• Respecting People’s Right to Information: Details of charges, facilities available would be
prominently displayed at a conspicuous (easily visible) place at each establishment
37. Salient Features of the Clinical
Establishment Act 2010
• New entrant: No person shall carry on a clinical establishment unless it has
been registered in accordance with the provisions of the Act
• Existing oldies: Clinical establishments already in existence may be allowed
for provisional registration to carry out their business. There shall be no prior
enquiry for provisional registration But the authority shall have power to
make enquiry in accordance with such rules as may be prescribed.
• Clinical establishment having provisional registration shall fulfil the standards
which may be notified for the purpose
• Duration & Renewal of Provisional Registration: certificate shall not be
granted or renewed beyond a period of two years from the date of
notification of standards for establishments that come into existence before
commencement of the Act
• Permanent Registration: any clinical establishment may apply for
permanent registration & and shall pay such fee as may be prescribed by the
State Government
38. Salient Features of the Clinical
Establishment Act 2010
• Power to inspect: The authority shall have power to inspect a
registered clinical establishment Any person aggrieved by an
order of the registering authority shall prefer an appeal to the
State Council
• Power to cancel registration: Authority shall have power to
cancel the registration of the clinical establishment which fails to
comply with the conditions prescribed by the Central
Government
• This watch dog has Teeth to Bite: If any person contravenes
any, provisions of the proposed legislation or any rules made
there-under, he shall be punished with fine and wide ranging
penalties
39. Government perceived benefits of The
Clinical Establishment Act 2010
Facilitate :
• determination of standards
• improve quality service delivery
• need and evidence based policy formulation
• resource allocation
• community empowerment
• ease of administration
• good governance
40. Government perspective
• The Act requires that the registration would be at a committee
level headed by a collector level official and assisted by a health
official.
• The registration would be non-transferable and in the event of
change of ownership, one will have to apply for a fresh
certificate.
• The applicants and facilities would be verified physically for
their compliances with the Act by the government authorities.
• Only then, would the permanent registration be issued.
• Healthcare providers will be required to display the registration
certificate so that it is visible to citizens and patients visiting the
establishment.
41. The policy makers perspective
According to government sources there is no data of how many
healthcare centres operate in various states.
Making registration mandatory for all medical establishments
will help the administration compile data on healthcare service
providers.
The Clinical Establishment Bill also aims to fix any loopholes
in the existing Acts.
It will ensure that issues such as ethics, infrastructure, quality
management and bio medical waste are tackled.
The Act would also help in strict implementation for often
flouted norms.
42. CONSUMER PERSPECTIVE
• Unprecedented consumer empowerment due to the provisions of
the law
• Minimum requirement of staff numbers to attend to the patient
needs
• General and medical and especially emergency facilities to
stabilise the medical condition of a patient in case of a life
threatening condition
• Maintenance of records; this would keep the data current and
real time for the authorities
• An expected positive effect on the cost cutting/ price control
44. WHY ARE DOCTORS CRYING?
The Indian Medical Association (IMA) has strongly opposed the
Clinical Establishments (registration and regulation) Act, 2010.
It stated that the act will only escalate the cost of treatment and
adversely affect small and medium size hospitals.
Take an example of Maharashtra-
• A progressive state like Maharashtra does not need such an act. The
existing Bombay Nursing Home Act is good enough and health
indices of Maharashtra speak volumes about good health practices.
• The provisions in the act are such that small hospitals giving treatment
by charging very low fees will have to be closed down.
• This Clinical Establishment Act will only help in widening the
differences between the doctors and the consumers.
45. WHY ARE DOCTORS CRYING?
• According to the new act, doctors will have to take a no-
objection certificate from all neighbours living near the clinic.
• Also, doctors will have to issue a daily prescription audit, which
is almost impossible. If a doctor does not register or fails to
show necessary papers, he will be fined Rs 5 lakh
• This act will have an adverse effect on the patients and is just a
way of bringing corporate and costly hospitals in the country
• Many Indian doctors practicing abroad and now because of this
act this number will increase.
46. WHY ARE DOCTORS CRYING?
• Since clinics, hospitals and private nursing homes would have to be
registered with the state government, the doctors claimed that it would
encourage inspector raj in the state. Helps create more corruption in
the form of Inspections , checking etc.
• One of the doctors said that there are so many points in the Act which
needs to be relooked. Even for a single mistake, a doctor will have to
pay a fine if caught first and second time. Third time, the registration
of the doctor will be cancelled.
• it is just to kill medical profession..what about sub standard doctors
who graduate or post graduate just by giving fat donations in private
college owned by these politicians & there after start looting people to
gain it back..this act will provide a big platform to earn for such ill
minded doctors & then this medical quacks will increase & will over
come the real good doctors.
47. WHY ARE DOCTORS CRYING?
An example from USA
• In emergency situation, a patient should be provided
treatment whether he is capable of paying or not.
• The government, however, refused to pay and
the insurance companies too refused to pay.
• In such circumstances, who will pay for the treatment
of the patient?????
48. WHY ARE DOCTORS CRYING?
The overall impression about the Act was viewed with some
introspection and apprehension from some quarters.
Some medical bodies felt that single doctor clinics may receive
different handling as they may not be able to keep pace with
the situation in view of their size of work.
This law is more suited to big government institution and
corporate private healthcare providers.
Attending emergencies in small clinics may be an issue, which
needs further elaboration.
This may also lead to double registration fees if both systems
exist parallel.
The Act may encourage license raj in medical practice
49. WHY ARE DOCTORS CRYING?
Doctors under the Indian Medical Association’s (IMA) banner have
approached the Delhi High Court to stay the implementation of the
Act.
This act came along at the time when the doctors were already
protesting against couple of other Government proposals on regulating
the medical profession and addressing the rural requirement for
doctors.
The doctors made a serious point when they seek discussion and
clarity on norms that govern them.
Contrary to popular perception, the medical fraternity is not averse
to regulation, they say in their defence.
Dissecting the Act, they say, a doctor is required to “stabilise” a
patient before sending her across to the nearest referral hospital,
failing which he or she could face a non-bailable warrant.
50. WHY ARE DOCTORS CRYING?
On the face of it, it is a much needed, pro-patient move by the
Government. Scratch the surface, and complexities emerge.
The definition of “stabilise” is unclear. Besides, it is not realistic to
expect a regular family physician to be equipped with ventilators and so
on.
The equipment is expensive, and if individual doctors were to invest in
such equipment, who shares their cost, they ask.
And while the Act’s efforts to regulate all clinical establishments is a
good move, to expect all clinics to be at least 500 sq.-ft, for instance, is
practically impossible in expensive cities such as Mumbai, where real-
estate costs are prohibitive.
If a doctor has that kind of money, he wouldn’t need to practice, quips a
general practitioner in South Mumbai. He asks, who pays for this?
51. WHY ARE DOCTORS CRYING?
Having invested in a large room, a ventilator and so on, a doctor
will be under pressure to recover his cost and the most likely victim
will be the patient, he observes.
The Act’s stiff requirements and penalties will encourage
corporatisation of healthcare, as only the big corporates have deep
pockets.
It also opens the door to abuse of power, as authorities can penalise
or shut down the clinic of a good doctor for reasons not connected
with his medical expertise.
The small, neighbourhood doctor will be virtually forced to shut
down.
Such “draconian” measures will also keep young people away from
becoming doctors, says a local family physician, adding that his own
children have chosen to pursue engineering, rather than follow in their
father’s footsteps!
52. WHY ARE DOCTORS CRYING?
On 25th June, 2012 IMA, IDA and several other professional
associations of Medical fraternity had organized a nation-wide
protest in the form of “Rallies” at various locations throughout
the country.
States like Andhra Pradesh, Punjab and Madhya Pradesh have
already rejected the Clinical Establishment Act in their
assemblies.
53. One size does’nt fit all
India does not have a universal emergency services number or support network
like the US’ 911 or the UK’s 999.
And patients here are pretty much at the mercy of government- or privately run
hospital emergency services that could turn out to be good, bad or downright
ugly.
The recently notified Clinical Establishments Act (to regulate medical centres)
sought to address this concern over emergency care.
A key feature in the Act is that no patient can be refused emergency treatment.
The well-intended effort, though, is getting the wrong end of the scalpel, as it
lays more responsibility on the neighbourhood doctor than he or she is
probably equipped to handle.
So while it seeks to protect the patient, the Act’s one-size-fits-all approach
could end up doing quite the opposite — affecting patients and putting the
small, single doctor in the dock.
54. General observation
From a general perspective it is clear that CEA is a reality now and will be
covering all the relevant entities as it is implemented throughout.
All healthcare providers are expected to obey this statute as any other legal
promulgation.
As the implementation crystallises there are several beneficial possibilities.
This will be allowing a formal classification, standardisation and categorisation
of different healthcare institutions, based on their respective location, scale of
services offered and level of specialisation creating to be a national level based
registry.
The mere action of creating a registry, codifying information, monitoring
standards and having access to databases throws up highly exciting and useful
opportunities for the agencies engaged in healthcare.
55. References:
1) The Clinical Establishments (Registration and Regulation) Rules, 2010 Draft Rules for the Central Government
2) Planning Commission Report: Clinical Establishments, Professional Services Regulation and Accreditation of Health care
Infrastructure for the 11th Five Year Plan, Government of India
3) Bhate-Deosthali P. et al Private Health Sector in Maharashtra A study of private hospitals CEHAT 2011
4) Bhate P. et al,Poor standards of care in small, private hospitals in Maharashtra, India: implications for public– private partnerships
for maternity care, Reproductive Health Matters 2011;19(37):32–41
5) Dantas A . ,Mapping of urban health facilities Maharashtra, CEHAT 2011
6) Duggal R. THE PRIVATE HEALTH SECTOR IN INDIA -Nature, Trends and a Critique, May 2012
7) Jesani A.,LAWS AND HEALTH CARE PROVIDERS A Study of Legislation and Legal Aspects of Health Care Delivery,Jan 96
8) Gangoli L. et al ,Review of Health care in India , 2005
9) Nandraj S. , Unhealthy Prescriptions : The Need for Health Sector Reform in India
10) The West Bengal Clinical Establishment (Registration and Regulation) Rules, 2012
11) Report on the Working Group on Clinical Establishments,Professional Services Regulation and Accreditation of Health Care
Infrastructure For the 11th Five-Year Plan Government of India Planning Commission
56. Mithun G Kherde
Bharat Thakare
Manish Khichi
Masters in Public Health
(Health Policy, Finance & Economics)
Tata Institute of Social Sciences,
Deonar, Mumbai, Maharashtra
