Tuesday, May 30, 2023
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HomeTalk PointGovernments have to step in to lay down the rules of the...

Governments have to step in to lay down the rules of the game, not close down the hospital

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ThePrint asks:

Is Delhi government’s decision to shut down a branch of Max Hospital an overreaction?

Initially, I had said that cancelling the licence was a fair decision. I said it on a TV interview because things have become so bad that hospitals are doing as they please, be it in private hospitals or public hospitals there being no regulation whatsoever. Governments are just not acting.

In the case of the Max hospital, I don’t know if the authorities followed the procedure. Under the principle of natural justice, you have to hold an inquiry, give a show-cause notice, wait for the reply and then pass the order as to why action was being taken to suspend/ cancel the licence. It has to be a detailed speaking order as it is bound to be disputed and challenged.

In hindsight, I do feel that it was unnecessary to have closed the whole hospital; it was enough to close the neo-natal wing or maybe get the state medical council to take away the licence of the doctor who certified the live child as dead. That would have not upset so many patients who might have been on dialysis or having been given doctors’ appointments. If the whole hospital is closed, how do patients deal with critical situations like dialysis or where a patient has been listed for procedures and tests for the heart, brain or the gastrointestinal system? Why should all patients suffer because of a particular incident that took place on a particular day in a particular unit of the hospital?

Nobody has ever cancelled a licence like this. The Clinical Establishment Act was passed by Parliament in 2012, which requires all establishments to register themselves, specifying the services provided, the qualification of doctors and other technical support staff. But many state governments have been dilly-dallying over adopting the Act through prevarication. Even in the states that have adopted it, they have not framed the rules, or provided the staff or infrastructure to implement the legislation.It is just a situation where a law has been passed but officials are lacking the will to actually implement the law.

Read other perspectives on the issue:

Amir Ullah Khan, professor of Economics

This is because there is huge pressure from the state-level, Indian Medical Association (IMA) representatives who are just members of a ‘society’, which is a voluntary body of doctors. It has no legal status or statutory authority. IMA exists for looking after doctors’ welfare and has not been established for patients’ welfare. So, for the political executive and the bureaucracy not to have taken action to compel the adoption of the Clinical Establishment Act has not been in the interest of patients for whose protection the Act was made.

It will be wrong to see all private hospitals as being greedy, apathetic, or incompetent. They are not, they are doing a great service by offering super specialty hospitals services of high standard.

It’s another matter that we don’t have insurance in this country and so people are paying out of their pockets leaving everything to market forces.When the health sector enjoys the status of industry, the promoters will look on it as a business and the charges will be determined by what people can pay. That is hazardous as it leaves the patients with no protection or safeguards. That is where governments have to step in to lay down the rules of the game and to exercise a regulatory and oversight role to protect consumer interest.

On the other hand, Gorakhpur was a case where children were dying one after another. This situation needed a medical audit to be conducted by a peer group of doctors from outside the hospital and preferably from outside the state to avoid partisan findings. Many questions remain unanswered. Was it oxygen, was it lack of funds, was it lack of concern, was it the fact that budget was available but was not being spent? Heads should have rolled over whatever reason was found in the inquiry. All these problems boil down to purely administrative lapses and should have been placed on the shoulders of whoever released funds for hospital procurement.

On the other hand, it may not all have been a failure of doctors or of the hospital and could have been a failure of the public health machinery, which was responsible for preventive measures like anti-larval spraying or responding to a huge increase in morbidity long before the kids were taken to hospital.

The Gorakhpur hospital situation is not comparable to the Max hospital case because here doctors declared a live child dead. It simply meant that the doctors did not know how to read the vital signs in infants. That is a reflection of sort of medical education being imparted and calls for re-training doctors through CME courses.

Shailaja Chandra is a retired civil servant and former health secretary.

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