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Fortis Hospital in Gurgaon, India. | Ramesh Pathania/Mint via Getty Images
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The state health department has responded promptly to allegations of medical negligence against Fortis Hospital in Gurugram, but failed to frame rules under the Haryana Clinical Establishment (Registration and Regulation) Act.

Chandigarh: Haryana’s health department has responded to the allegations of medical negligence in the death of a seven-year-old dengue patient in Fortis Hospital in Gurugram with uncanny alacrity and ordered investigations.

But, it turns out that the department has not framed rules to regulate the functioning of private hospitals for more than three years after making a law for the same as doctors have been pressuring it to make a series of changes.

As a result, the Haryana Clinical Establishment (Registration and Regulation) Act passed by the state assembly in March 2014 has not been implemented yet.

While the law aims to regulate the working of all categories of private clinical establishments in Haryana, it also applies to government hospitals and diagnostic clinics.

It also provides for the registration of each clinical establishment with the government and states that unregistered clinics would have to shut down. Every registered clinical establishment would be required to maintain certain minimum standards of service and facilities laid down by the government, and these establishments will be subject to regular inspections and checks. The law also provides for receiving and inquiring into complaints against registered establishments.

Moreover, it stipulates the setting up of district level bodies which will in turn be controlled by state level bodies.

Although a draft set of rules under the law has been doing the rounds since 2015, the main reason for the delay in framing and notifying the rules has been the intense and sustained pressure by the state chapter of the Indian Medical Association and the Haryana Medical Association against the implementation of the law until amendments suggested by them are made.

“If the changes we have asked for are not incorporated, we are clear in what we have to do next. We will shut down all private nursing homes. We have 7,500 members across the state, and we are responsible for 80 per cent of patient care services in the state. If the government wants to regulate us, we have to be consulted,” said Dr. A.P. Setia, President, IMA Haryana.

The doctors’ association is demanding almost 90 changes in the law along with its draft rules. But significantly, it is asking for the deletion of the provision in the law that allows the government to regulate the “professional conduct” of a medical practitioner in terms of choice of line of treatment followed with a patient.

“The government can, under this act, register our nursing homes and hospitals, it can regulate their functioning in terms of staff, building, infrastructure, facilities etc. But the government has no business to regulate how the doctor does his work, what treatment he chooses to give, what protocols he follows. Conduct of doctors is regulated by the Medical Council of India (MCI) and state medical councils, it cannot be a part of this act,” Setia said.

The IMA has also objected to the provision which binds every clinical establishment registered under the law to provide emergency services good enough to ‘stabilise’ a patient before he/she is referred elsewhere. “This is not possible. Nursing homes are heterogeneous, sometimes specialising only in certain fields, and beyond giving first aid, medium and small nursing homes, and clinics cannot stabilise patients. This provision too is unacceptable,” said Setia.

Following a series of meetings over the past one year, the health department agreed to some of the changes demanded by the doctors’ bodies. The last meeting was held in the first week of August, and the IMA claims that the government has agreed to almost 45 of the 90-plus changes suggested.

Yet, the changes are not likely to dilute the law, believes Haryana’s principal secretary for health, Amit Jha. “Certain changes suggested by the IMA and the Haryana Medical Association have been accepted but none of these changes compromise the act,” said Jha.

“The rules under the act could not be notified because of the objections by the doctors’ bodies. Now we have reached a mutually acceptable set of provisions and things are moving faster. However, since the changes have to be made to the act, it will need a separate bill to be passed by the assembly,” he added.

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