A professional protest

Once*AN HEARTFELT INTROSPECTION OF EACH IMAKSB MEMBER*

For the *first time* probably in a strike/bundh/gathering/ agitation
1. No stone was thrown at public or private property/ police etc
2. No vehicles/buildings were torched
3. No fire by burning any effigy/ photo/ stuffed doll/ etc
4. Only education n explanation to all concerned parties...public n politicians
5. No paid / hired hooligans to participate in rallies.
6. *Voluntary unity shown involuntarily by every member of the profession.*
7. Self finananced/ supported agitation
8. Members from other association( pharma/homeo/paramedical/etc/) supporting spontaneously/ voluntarily
9. No paid news in any media to any media person.
10. Respecting *GREAT* leadership n their decisions.
11. Realistic HONEST demands n expectations. Clarity of thoughts.
*We have shown how a civilised society fights for their rights in a sensible decent way.*
And no doubt whatsoever be the one against whom we are fighting... justice cant be denied.

*3 cheers to IMAKSB*

Doctors question

I have a few thoughts for everyone to introspect on and invite comments and opinions:
1. In Namma Bengaluru - on a certain bus route - the ordinary BMTC bus ticket costs ₹10. On the same route a BMTC Volvo bus ticket costs ₹80! Both are fees fixed by the government of Karnataka.
2. In NIMHANS, patients from different SOCIOECONOMIC backgrounds pay differential amounts- even for a simple MRI scan, leave alone surgery!
3. No doctor is given even 0.1% concession on land, water, electricity etc even if he is setting up a hospital in a rural or backward area
4. Majority of the investors in big corporate hospitals are BUSINESS PEOPLE AND NON-DOCTORS. they are only interested in RoI and not the patient or treatment. Should this be allowed? But the flip side is- they have the money!
5. Doctors can be legally prosecuted in 5 fora - State medical councils, MCI, consumer court, civil and criminal courts. But even a murderer and rapist can be tried only in one court! So, how is this a Noble profession????
6. When everyone wants capping and reasonable rates for treatment, why is the consumer court no capping the compensation amounts? Isn't that a natural fallout of capping rates?
7. Why should Barista or cafe coffee day charge ₹100 for a cup of coffee (which has 50% froth!) when the Kamat hotel charges ₹10? The milk and coffee powder is probably the same!
8. Doctors on an average have to study much longer and work for much longer and unpredictable hours- so is it a sin to earn more money by working harder?
9. How can we in the healthcare industry charge peanuts and then deliver world class healthcare and also guarantee good minimum wages to our employees like nurses, technicians, ward boys, Ayahs, etc?
10. For the same case - the lawyer in a local court charges a few thousand rupees, but a HC lawyer charges ₹50k to ₹1 lakh and A SC lawyer charges ₹2-5 lakhs? Case and petitioner is the same - all courts are government courts.
11. How come the salaries of junior inexperienced lawyers and judges are much lesser than senior and more experienced ones? Any particular reason? And is this reason exclusive to the judiciary?
12. Why are the same IAS officers who want to cap our charges want VIP treatment in our hospitals FREE and also salary raises?

KPMEA ACT - ANTI PEOPLE

Over 60,000 doctors and 5,00,000 health employees are protesting against the controversial KPMEA Act 2017 (Amendment), which is scheduled to be introduced in the forthcoming Assembly session. We are not opposing KPMEA Act per say, but it has to be enforced as per the recommendation of the government-appointed Justice Vikramjeeth Sen Commission. This Act, in its present form, is detrimental not only to the entire healthcare providers, but also to patients/public eventually. Let me explain our concerns and clear all the confusion. 

* Why is the Act controversial?

In India, private healthcare providers play a major role in supporting government healthcare initiatives as government-funded hospitals alone cannot fully cover the entire country. However, there has been a concerted effort by the present government to introduce a legislation which is against private doctors and private hospitals. The Act in its present form will adversely affect more than 10 lakh health workers across Karnataka, including 60,000 private doctors, para-medical staff, nurses, medical stores, diagnostic centres and hospital staff. This will be evident if we look at merit and demerits of this Act logically.

* It's said that private hospitals are costly and not affordable to public. Hence, the government is trying to put in a system to control the charges of operation, procedures, diagnostic tests and professional charges etc.
India has one of the most affordable healthcare systems in the world. That is why medical tourism is on the rise in India. Foreigners come in droves because because of the low-cost health care system in India. This is so despite the escalating costs of medical equipment, import duty, changing technology, minimum wages act, commercial building tax, commercial charges for electricity & water, increasing demands from patients etc. The government is not providing any subsidy or concessional rate of tax or tariff for private hospitals. If government is intending to reduce the cost of treatment, then it must consider concessional tax and tariff for private hospitals.

* But hospitals are making huge profits.

The businesses of all major hospitals are available in public domain and for most of them, the net profit margin is either negative or in single digits. Due to heavy initial investment, most new hospitals don not break-even even after five years of operations. Most hospitals make a net profit of 8 per cent. After investing huge amount and often funded by bank loans, the return on investment and the return on effort is meagre. Most nursing homes and small/medium hospitals are run by doctor owners by passion. Half of the small hospitals are on the verge of closure. All private hospitals contribute hugely to public exchequer by way of taxes and employment.
* The new Act can penalise private hospitals if they do not allow the body of a dead patient to take home even if bills are not cleared. Is it fair?

Usually large portions of these bills are settled during discharge. By bringing in this clause, the government is actually encouraging hospitals to insist on payment even before the service is rendered as being done in most government departments. This clause may also lead to a situation where the bills may remain unpaid in all death cases. If the government is seriously concerned about the patients in this regard, it must put in place a system to compensate for the loss rather than simply put the burden on private hospitals. This is the only way to solve this problem.

* If government fixes rate for investigation and procedures that will give transparency to the public, why are you opposing it?

All Hospitals will have their rate displayed. However, the rates of procedures and investigations vary from place to place, depending on the infrastructure, type of equipment, technology , service standards, qualification and skills of doctors , efficiency of the staff and other parameters. This cannot be generalised. Besides, many procedures may come unplanned and cannot be defined as a particular package. Hospitals cannot completely forsee the financial implications at the time of admission.

* Doctors over-charge and KPMEA Act bars it.

The fee charged by doctors differ based on the qualification, skills, special training etc. as in any other profession. In India, doctors fee varies from Rs.50 To Rs. 2,000 per consultation. But most doctors reduce their fee if patients are not in a position pay it and requests reduction. It is unfair to restrict fees to one profession alone while other professionals like architects, charted accountants, engineers and advocates have no restrictions.

* So what's the final point?

The common man will have to bear the ultimate brunt of the ill-conceived policy and hence will never support it. Once introduced ,this Act has to potential to create irreparable damage to the Karnataka healthcare landscape.

THE PLANNING OF KPMEA - A DISASTER

Proposal to drop word ‘private’ from Karnataka Private Medical Establishments (KPME) Act, 2007 

What started as an effort by the Health Department to regulate the functioning of private hospitals appears to be ending up as an exercise at reining in both private and government hospitals.

The State government-appointed expert committee, headed by former Karnataka High Court chief justice Vikramjit Sen, set up to amend the Karnataka Private Medical Establishments (KPME) Act, 2007, has recommended that government hospitals too be brought under the Act.

The committee, which submitted its report to Health Minister K.R. Ramesh Kumar on Friday, said that the word “private” will be dropped from the Act and it will be renamed as Karnataka Medical Establishments Act. The amended Act will be tabled in the June session of the Karnataka Legislature.

Addressing a joint press conference here, Mr. Sen and Mr. Ramesh Kumar said there was a need to amend the Act to ensure quality and affordable healthcare for all. Although the rules of KPME Act, 2007, were enacted in 2009, many healthcare institutions have slipped out of the Act and the purpose was not being served. 

“Our intention is to bring all hospitals on a par and make affordable healthcare easily available for people from all strata of society. At the same time, we want to ensure transparency and accountability in functioning of hospitals,” the Minister said.

Mr. Sen said the committee had come up with the recommendations following a series of meetings since July last year. The committee had representation from private hospitals, non-governmental organisations and professional bodies, he said, adding that the report was finalised after “mature deliberations and brainstorming among members”.

On the inclusion of government hospitals under the ambit of the Act, Mr. Sen said it was essential to ensure medical treatment is same for all. “It is essential to maintain standards and transparency in the costing of healthcare services. Patients’ interest is of prime importance whether they go to a private or government hospital. If patients’ charter is not adhered to in government hospitals, it will mainly be those who cannot afford private charges who will be at the receiving end,” he said.

Principal Secretary (Health and Family Welfare) Shalini Rajneesh circulated a note that said the committee deliberated on bringing all healthcare institutions, including AYUSH, under the Act. A single window for registration, adjudicating body to look into violations by hospitals, grievance redressal body, State and district authority, patients’ charter in line with World Health Organisation guidelines, are some of the other issues that were deliberated upon, she said.Following the committee’s report, the government has asked Professor O.V. Nandimath from National Law School of India University to incorporate the recommendations into the proposed amendments, she added.

Recommendations strengthen private lobby: Activists 

Alleging that the expert committee and the Health Department had “deliberately excluded” activists and members of like-minded groups led by Karnataka Janaarogya Chaluvali (KJC) and Alternative Law Forum from the final meeting on Friday, the activists condemned the committee’s recommendations.

“The recommendations are anti-people and designed to strengthen the private health sector lobby. We are dissociating ourselves from the committee and its recommendations. We do not want to be party to its anti-people recommendations that are designed to fail the people of this State and to destroy the public health system,” said Akhila Vasan of KJC.

“That the final deliberations were held with only representatives of the private health sector illustrates how vested interests are allowed to dictate terms to the government. It is no surprise that the drafting committee has decided to drop the word “private” from the Act thereby, bringing in the government health system also under the ambit of the Act,” she said.

However, Ms. Rajneesh said the final meeting only involved the legislation drafting committee members and the expert committee.

Proposal to drop word ‘private’ from Karnataka Private Medical Establishments (KPME) Act, 2007 

What started as an effort by the Health Department to regulate the functioning of private hospitals appears to be ending up as an exercise at reining in both private and government hospitals.

The State government-appointed expert committee, headed by former Karnataka High Court chief justice Vikramjit Sen, set up to amend the Karnataka Private Medical Establishments (KPME) Act, 2007, has recommended that government hospitals too be brought under the Act.

The committee, which submitted its report to Health Minister K.R. Ramesh Kumar on Friday, said that the word “private” will be dropped from the Act and it will be renamed as Karnataka Medical Establishments Act. The amended Act will be tabled in the June session of the Karnataka Legislature.

Addressing a joint press conference here, Mr. Sen and Mr. Ramesh Kumar said there was a need to amend the Act to ensure quality and affordable healthcare for all. Although the rules of KPME Act, 2007, were enacted in 2009, many healthcare institutions have slipped out of the Act and the purpose was not being served. 

“Our intention is to bring all hospitals on a par and make affordable healthcare easily available for people from all strata of society. At the same time, we want to ensure transparency and accountability in functioning of hospitals,” the Minister said.

Mr. Sen said the committee had come up with the recommendations following a series of meetings since July last year. The committee had representation from private hospitals, non-governmental organisations and professional bodies, he said, adding that the report was finalised after “mature deliberations and brainstorming among members”.

On the inclusion of government hospitals under the ambit of the Act, Mr. Sen said it was essential to ensure medical treatment is same for all. “It is essential to maintain standards and transparency in the costing of healthcare services. Patients’ interest is of prime importance whether they go to a private or government hospital. If patients’ charter is not adhered to in government hospitals, it will mainly be those who cannot afford private charges who will be at the receiving end,” he said.

Principal Secretary (Health and Family Welfare) Shalini Rajneesh circulated a note that said the committee deliberated on bringing all healthcare institutions, including AYUSH, under the Act. A single window for registration, adjudicating body to look into violations by hospitals, grievance redressal body, State and district authority, patients’ charter in line with World Health Organisation guidelines, are some of the other issues that were deliberated upon, she said.Following the committee’s report, the government has asked Professor O.V. Nandimath from National Law School of India University to incorporate the recommendations into the proposed amendments, she added. – The Hindu 

The Need To Re-Look At the Karnataka Private Medical Establishments Act (KPME Act)

Unfortunately, a lot of controversy and mistrust between the medical fraternity and the government has been generated by the introduction of the KPME act. We witnessed the unusual situation of thousands of doctors, health care workers and representatives of medical establishments taking to the streets (a very unusual situation in the medical fraternity) to request the government to reconsider the provisions of the act.

To cut a long story short, though all of us would like the common man and our patients to be treated well and get the benefits of modern healthcare, we believe that some of the provisions in the bill are unfair and draconian.

First and foremost introducing price control in the era of the free market economy will destroy the private health care industry which controls over 70% of tertiary health care for sure. It is important to point out that this 70% includes a large no of neighborhood small hospitals and mission hospitals which are in tier 2 and 3 cities and not just large corporate hospitals in the metros. If this act is enacted in the current form, we may have to go back to the olden days of control raj where for any serious ailment you had to go out of the state or country for treatment because no one would dare invest in the private hospital industry anymore.

Unfortunately, the private (PVT) sector had to fill in the vacuum created by very poor facilities in the public sector because of lack of funding (less than 2% of GDP for health care) poor infrastructure, inability to attract talent etc.
We feel it is unfair to only target the private sector when healthcare should be a fundamental right and the government should also be equally responsible if not more for providing this. The general impression that the public healthcare is free is a myth because it is the taxpayers who fund this and it is public money that is utilized against private investment in the private sector hospitals. Hence, whatever rules are made it should encompass both the sectors as mentioned in Justice Vikramjit Sen committee report constituted by the Govt.

Some of the provisions of imprisonment and hefty fines seem draconian. There are already many regulatory bodies like the medical councils, consumer courts and the judiciary to protect the citizens and adding one more layer will only lead to more confusion. Though it may be true that there are some rotten apples in the medical community like in other sections of the society, it is unjust to label the entire community as corrupt and dishonest.

In my opinion, since all of us have the common interest of providing the best of medical care to our fellow citizens, let us work together in coming out with reasonable fair solutions to these problems. It would be very unfortunate if we get into we (private ) vs them (govt.sector) in providing the fundamental right of health care for all.

What is the way forward?

Certainly, all of us would agree that emergency care needs to be offered in all cases and we need to prevent exploitation and price gouging by any health care provider.

The way forward would be to strengthen the public sector especially in rural semi-urban areas in the fields of preventive, primary and secondary care. Any government spending on preventive, primary health care saves a lot more lives than funding tertiary and quaternary care. Look at universal health care like the Medicare in the USA and NHS in the UK with a reasonable reimbursement for the care delivered after holding dialogues with experts and representatives from both the public and private sector The government should don more of a role of an insurer rather than provider of health care especially in tertiary and quaternary care.

Most of all let us not destroy the faith that the public have on doctors and health care facilities by insinuations that they are all rotten and need to be fixed.

Why not include public hospital IN KPMEA ACT

The IMA also also said that the Bill was discriminatory because it does not bring public sector hospitals into its ambit. “The private sector covers 80% of the health sector, and are filling in for the government,” said Ajaikumar. “They do not mind lower standards for public sector, whereas higher standards for us.”

Health Minister Kumar said that the government already works under a framework under the Directorate of Health Services that keeps their establishments accountable. Besides, the standards for the hospitals are already set by the central government under the Indian Public Health Standards.

Shukla disagrees on this count and believes that public health facilities, which have additional responsibilities of providing free immunisation, carrying out disease surveillance and handling epidemics, can also be held to the same standards as private facilities. “While we can agree public medical facilities need to have standards and should be regulated, we should perhaps have a caveat that they cannot shut down if the standards are not met,” he said. “The drop in standards should be treated as an emergency and should be improved.”

Other activists agree that there should be better standards for government hospitals too, but since more people access private hospitals, they need to be more transparent.

“We direct people who ask for our help to the public sector, but often the private hospitals are nearby,” said Gauri from Mahila Munnade, a women’s rights organisation. “Many women have complained that they have been given exorbitant bills. We have not been able to get any help for them. We need the government to have some control over them.”

Said Vasan, “If [private medical establishments] provide 80% care in the health sector, then you should also be regulated democratically accountable.”

GLORIFYING THE KPMEA ACT

According to that Act as well, all private clinical establishments must follow 24 conditions, which include

• Not resorting to any unethical or unfair trade practices, including unfair pricing for different services
• Treating accident, acid attack and rape victims even if they cannot pay for treatment immediately. The hospital would have the right to recover the cost of treatment “in due course”.
• Releasing the body of a patient even if the bill for treatment has not been paid.
• Maintaining grievance cells for patients and their kin to accept complaints about treatment, billing and staff behaviour.
• Setting up a help desk each to ensure proper communication with patients.
• Implementing the e-prescription system, maintaining medical records electronically and providing a copy each of all medical records and treatment details at the time of a patient’s discharge.
• Following “fixed rates and charges, including the package rates for investigation, bed charges, operating theatre procedures, intensive care, ventilation, implants, consultation and similar tests and procedures.” Any additional treatment or procedure shall not attract additional charges “over and above the fixed rates and charges, including the package rates”.
• Providing proper estimates of cost of treatment “not covered in fixed rates and charges, including the package rates”. The final bill cannot exceed the estimate by more than a percentage fixed by the government.
• “Endeavouring” to set up fair-price medicine shops and diagnostic centres, if it has more than 100 beds.
• Providing “completely free treatment” to 20 per cent of the patients in the outpatient departments and 10 per cent of admitted patients if the hospital has taken land or other help from the government.

It also has stringent penalties upto Rs 10 lakh, including compensation for victims of medical negligence. Clearly, therefore,  the need for strict regulation and monitoring of the private medical sector has been felt in other states as well.

The intense and vitriolic opposition to the Karnataka Bill by the private hospital lobbies is unjustified especially in the light of large-scale violations of patient rights and complete lack of their accountability. On June 20th, the Assembly debated the issue for nearly five hours and decided to refer the Bill to the Joint Select Committee with a timeframe to revert within one month.