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.

KPMEA ACT - BIASED

In Karnataka, the KPME Act came into being to register private hospitals and monitor their functioning in terms of their adherence to certain minimum standards, to get them to display rates of services provided in their hospital, maintain and report crucial data related to the National health programmes. Clearly, however, in the present form, the KPME Act is weak in both content and form.

Drawbacks of the existing legislation

The KPME Act as its stands does not contain provisions related to certain key areas requiring regulation. For example,

• It does not safeguard or protect  the rights of patients who seek care in private hospitals.
• It has no grievance redressal mechanism to address issues of health/patients’ rights violations, unethical practices or medical malpractice and misconduct by hospitals.
• It does not provide a rational, scientific formula for arriving at the costs of procedures, tests and consultations. It does not cap the costs of health services in the private sector which has been one of the main causes of catastrophic out of pocket expenses.
• The Act does not have a separate, dedicated architecture or resources for its implementation, which was one of the main reasons for its poor enforcement.
• Significantly, it includes representatives of the Indian Medical Association (IMA) within the registration body. Given that a sizable membership of the IMA is from the private sector, having the IMA as part of the regulatory body is a conflict of interest.

Amendments

In view of the above, the government’s move to amend the Act to make it “citizen-centric” and to “protect the welfare and ensure safety of citizens” in private hospitals was seen as a progressive one.

In July 2016, the government appointed an expert committee headed by Justice (Retd) Vikramjit Sen was to recommend amendments to the Act.  The amendments were to focus on strengthening regulation of private hospitals.

The government’s proposal also suggested obtaining “first-hand information from persons that have faced hardship or have any sort of grievances against the present-day functioning of Private Medical Establishments in the State, to be able to incorporate deterrent provisions in the amended Act and to ensure that citizens do not endure these grievances in the future”.

But again, this committee was dominated by pro-private elements like the Indian Medical Association, the AYUSH doctors’ association, private research agencies and public-private partnerships. The committee to make the Act citizen-centric had only one member representing citizens’ groups.

On April 28, the committee held its last meeting to finalize its recommendations to the government. The ‘expert’ committee decided:

• To include government hospitals also under the Act
• Not to have a separate authority to oversee the enforcement of the Act
• Have IMA as part of the registration body/ enforcement body
• Not to have a separate grievance redressal mechanism for patient rights violations
• Not to cap costs of health services in the private sector or provide a scientific rational formula for arriving at costs of services

There was no guaranteed protection of key patient rights and violations of the same were not justiciable, meaning that cases of such violation could not be tried in a court of law.

The government retained some of these recommendations and rejected some. The draft presented in the Assembly decided to continue to focus only on private hospitals as before and includes a charter of patient rights.

It was decided that costs of healthcare would be regulated by setting up expert committees under the Act with representation from private medical establishments to categorise the various private medical establishments, draw up standards for each category and arrive at cost of procedures based on that .

It is not that the government will decide unilaterally on the costs but the Bill provides for a fair process to arrive at costs scientifically. There are also district level grievance redressal committees (with representation from private medical establishments) headed by the Zilla Panchayat (ZP) CEO with the powers of a civil court.

The Act also says private hospitals cannot withhold dead bodies until payment of dues and cannot demand advance payment in medical emergencies. All these are ‘citizen-centric’ moves even as they ensure adequate space for private hospitals to have their say, particularly in regulation of costs and in grievance redressal.

A few loopholes

From a citizens’ perspective, several concerns persist, particularly about the grievance redressal mechanism and related issues.  For example the Bill provides for a district level grievance redressal committee headed by the ZP CEO, but

• This committee is not exclusive to patient rights violations and will hear grievances from both patients and medical establishments related to registration issues.
• The Bill does not specify who will head the committee in urban areas (the ZP CEO is in charge of only rural areas)
• The Appellate body at the state level has three senior officers from the department (the Health Commissioner, Director of Health services and AYUSH services) but no citizen/patient representatives.
• While the district level body has powers of the civil court, the Bill does not specify the powers of the Appellate body
• Both at the district level and the state level, it is senior government officers who are heading the grievance redressal bodies. Given that they have several other responsibilities, one is not sure about how much attention grievances will receive. In fact one of the problems with the previous Act was precisely that it did not have dedicated full-time officers for its implementation.

KPME Act Amendments Part 2: The road to disaster is paved with good intentions

Interestingly, in a letter dated November 7, 2017, honourable health minister of Karnataka has suggested that "there is a huge information asymmetry" between private medical establishments and the patients. KPMEA amendments hope to correct the same. This "information asymmetry", to my understanding, means absence of detailed education and counselling by the private doctors regarding the ailment, absence of justification for particular tests and investigations requested, lack of explanation regarding different treatment options available and absence of justification for the cost of treatment.

This, in my opinion, is a valid observation but this information asymmetry exists across the board and includes government doctors and is not limited to private doctors. Every patient, irrespective of whether he/she is attending a private or government facility, has a right to be educated and counselled as mentioned above. In other words, the entire medical community should be expected to follow basic minimum standards in this regard.

I was trained at some of the premier institutes in this country before moving on to the UK for further training. I had to first pass a licensing exam to allow me to practise in the UK. The exam requires basic skills such as appropriate communication in complex clinical scenarios, attention to patient confidentiality, privacy and dignity apart from clinical skills. Over the number of years I trained in that country, I observed that these vital skills were inculcated in the medical graduates at a very early stage in their professional life. In fact, I had to "unlearn" some of the faulty behavioural patterns I had acquired in the course of my education in India.

The medical education in India is unfortunately quite archaic when it comes to the above mentioned skills. The focus is more on learning disease than understanding the patients’ concerns. The Medical Council of India still focuses on outdated benchmarks such as number of beds in the hospital than quality of training and treatment before certifying medical colleges.

In my observation, the medical graduates who pass out of Indian medical colleges have significantly better clinical and surgical skills when compared to their UK and European counterparts. Most doctors in India work 24x7, 365 days a year and are extremely hardworking (as a consultant in the UK, I used to work only 5 days a week - 9 am to 5 pm and earn three to four times what a comparable consultant earns in India). Despite this, they lose out due to the absence of any targeted training in communication, leading to "information asymmetry". This, along with a few stray cases of mismanagement and unscrupulous behaviour by a minuscule section of the medical fraternity, leads to dissatisfied patients and breakdown of trust between doctor and patient.

The governments (Central and State), if serious about eliminating this information asymmetry, should urgently reform medical education and prioritise patient dignity and rights over everything else. Senior members of the medical fraternity have particular responsibility in initiating these reforms. The public should lobby for overhauling of medical education at grassroots level instead of blaming the hapless doctors who are actually the victims of a very dysfunctional system and not culprits.

Amendments to KPME Act: Good, bad or ugly?

The proposed amendments to the KPME (Karnataka Private Medical Establishments) Act have been in the limelight for the last two weeks due to strong opposition from private medical practitioners. An open debate is essential to understand the issues both from public and doctor’s perspectives.

First of all, let us understand the background for the government’s purported intentions to amend the act which was originally enacted in 2007 with a view to regulate private medical establishments. It is supposed that there is a significant socio-economic disparity in the society preventing citizens from deprived backgrounds from accessing the highly advanced healthcare available in private hospitals. There is a suggestion that private medical establishments are charging exorbitantly and unscrupulously thereby causing severe hardships to the common man. 

There is a perception that treatments are being recommended recklessly, resulting in complications and in some cases, death. Overall, the government suggests that private medical establishments have been insensitive to the plight of the poor. The amendments aim to set these problems right by imposing severe penalties and even imprisonment if the doctor concerned has been found negligent. The amendments provide for "capping" the rates for treatments, investigations and charges. An appellate will be formed at the district-level to provide "immediate justice" to aggrieved patients. This appellate will comprise members from local governing bodies as well as an AYUSH doctor.

The doctors in general and private medical practitioners in particular, are vehemently opposing the amendments for several reasons. Private medical establishments come in several categories starting from stand-alone clinics to high-end multi-speciality corporate hospitals. Vast majority of establishments are small to medium nursing homes and hospitals which cater to 70% to 80% healthcare in the state according to various estimates. Most of these establishments are owned by doctors themselves who would have taken huge loans to purchase land, construct the building, purchase equipment and install infrastructure. Many of them will have to pay EMIs for several decades. Simultaneously, they have to appoint and maintain staff as well as pay decent salaries to prevent attrition. In addition, healthcare sector is a rapidly progressing field with new developments coming up almost everyday. To keep oneself up-to-date, one has to subscribe to journals, attend (expensive) courses and conferences as well as regularly invest in new equipment. In other words, running a successful practice is an extremely expensive and intensive project for a professional from middle-class background. There is practically no help and support for these doctors-cum-entrepreneurs from the government.

For the above reasons, healthcare in the USA is completely dominated by the insurance industry. In the absence of insurance, one would not have access to any healthcare except for the most basic provision. In the UK where I worked for several years before returning to India, private healthcare is practically non-existent as the British Government takes almost complete responsibility for health of the country through National Health Service (NHS). NHS hospitals are some of the best in the world, equipped with ultra-modern equipment and skilled nurses and doctors. One would get excellent care irrespective of socio-economic background. However, it is important to bear in mind that the government has prioritised health over everything else. The situation in Scandinavian countries is even better. Private doctors in India are doing what NHS in UK is doing, albeit at a much smaller level. They may not always be doing an excellent job because they are after all ordinary humans and not governments with near-infinite resources at their disposal. 

Human body is a mystery and it is often difficult to predict how it will react to a particular treatment even when a highly experienced clinician is treating the patient. In the event of complications or death, doctors in India have to often deal with physical violence, which is unheard of in the western world. Any death or complication in the UK is investigated and analysed by highly respected bodies such as the General Medical Council who have the necessary knowledge and experience to deal with same. Whilst it is absolutely essential that any negligence on the part of doctors has to be dealt with severely and appropriately, it should be done fairly and by a body which has the necessary understanding of the nuances of clinical science.

In summary, many of the concerns which the public and the government have are valid. They need to be addressed in a calm, systematic and dispassionate manner if we are really sincere about achieving health indices comparable to developed world. Blind and brutal legislation, that too targeting the very foot-soldiers who are providing 80% healthcare in the state will only lead to long-term deterioration of health of the state of Karnataka.

KPMEA against Doctors 2

You must know that Karnataka state which has the largest number
of medical colleges, has one of the worst rate of maternal mortality
(MMR) in the country, worse than states like West Bengal, Haryana,
TN and Gujarat. Maharashtra, which is twice the size of Karnataka
in population, which has four times the tribal population, has the
second best figure of Maternal Mortality in India, just below Kerala
which is the topper. Maharashtra did it just by regulatory changes
in Medical Education and converting the MBBS doctors working for
the government as Diploma degree holders. In spite of repeated
requests from the senior doctors, Karnataka government did not
bring about the regulatory changes and made thousands of
innocent village girls and their new born babies lose their life. Have
you questioned the government why we have shameful maternal
mortality and India is occupying a shameful position of number
112nd slot below Venezuela, Bangladesh and Iraq in WHO Ranking
of Health Systems of Countries?
You must remember that the custodian of healthcare delivery is the
state government and private sector exists only to supplement the
needs of the complex procedures and people seeking personalized
care.
You must know that private sector can never change the maternal
mortality, infant mortality, rural healthcare and complexity of
public health. At the most they can just assist the government job which should take responsibility of delivering at least 80% of
healthcare delivery.
Instead of writing all the wrong doings in the private hospitals,
please ask Karnataka government the following questions:
1. Why our maternal mortality is at a shameful figure below even
states like West Bengal, Haryana, Gujarat, Maharashtra and
TN?
2. Why large vacancy of specialists in Karnataka government
hospitals is noticed in spite of us having the maximum
number of medical colleges in the country?
3. Why every dengue season Bangalore hospitals get filled with
terminally ill dengue patients because our garden city is
converted as a garbage city
4. Why over 90% of the government scheme patients refuse to be
treated in a government hospital?
5. Why should private hospitals offer free surgery for a rich man
entering the hospital in an SUV flashing BPL card depriving
the life saving opportunity of a rural poor?
6. What incentive have you given to the private hospital to offer
treatment at less price than what it costs as shown by the IIM
study?
7. If the private hospitals close down what alternate
arrangements have you made to take care of the citizens? You must know that the root cause of poor healthcare delivery and
high cost is because India with a population of 1.2 billion has:
1. Less than 650 diabetologists in the country which has over 65
million diabetics
2. Less than 1,500 medical oncologists to treat all the cancer
patients.
3. About 10,000 radiologists when the need is over 1.5 lakhs.
4. Less than 50,000 gynecologists, anesthetists, pediatricians
when there should be more than 2 lakh each of these
specialists.
You must know that it is the government which makes policies on
medical, nursing education and not the private hospitals. With
massive shortage of specialists, how do you expect private hospitals
to live up to your expectations?
You must know that nursing profession is dying because of lack of
career progression. An Indian nurse with over 20 years’ experience
in ICU is legally not allowed to prescribe even a pain killer.
Whereas, a nurse anesthetist in US can anesthetize a patient for a
complex brain or heart operation without the presence of a doctor
anesthetist. In fact 67% of anesthesia in US is administered by nurse anesthetists.You must know that all the criticism against the doctors is driving
the bright youngsters away from the medical profession. This will be
disastrous for the country’s future since these are the kids who will
decide the future course of Indian health care. Youngsters accept
to become doctors or soldiers not because of the salary but because
of the prestige and passion to make a difference. If prestige and
passion is lost, when you grow old, you will have third class doctors
taking care of you, choice is yours.
Private hospitals and doctors are simply the prisoners of perception
created by the government to cover for their inability to offer
healthcare and persecuted by the society without understanding
the root cause of who is responsible. Right answers will only
emerge when the right questions are asked. Our effort is to inform
you about the right questions to ask. In the end, we doctors have
an option; whole world wants Indian doctors, sadly, you have no
option. If you do not make the government accountable for
delivering healthcare in public hospitals, no matter how much you
flog the private hospitals and doctors, will give you the necessary
result other than helping the politicians to win the elections.

KPMEA against Doctors speaks

Dear Citizens,
You are probably not aware that your government has failed in its
duty to take care of your health and actively driving you away from
the public hospitals to the private hospitals.
You are probably not aware that our government manages about 14
lakh beds, one of the largest number of beds in Asia owned by a
single entity and Indian private sector has less than 7 lakh beds.
Government is pushing 70% of the secondary and over 90% of
tertiary care of the country to the private sector through various
poorly planned health schemes. Private hospitals simply do not
have capacity and the capability to manage over 80% of the
advanced healthcare needs of 1.2 billion population.
You must know that private hospitals cannot offer more than 20%
of their beds at concessional rate for the poor since most private
hospitals are built as a company acquiring land at market rate,
borrowing money at more than 10% interest rate like any other
companies, paying salaries and taxes like any other Indian
companies. In fact private hospitals pay taxes and charges much
higher than other industries, as in the case of electricity for E.g.
Industries pay Rs.5 per unit whereas hospitals pay Rs.8 per unit.
Every private hospital, big and small, pays over Rs. 500 per day per bed to the government for the electricity supply. In general, when
you pay Rs. 100 at a cash counter of any private hospital, about Rs.
25 goes back to the government as tax under various categories. In
nutshell, the sicker you are, the better it is for the government’s tax
collection.
You must know that GST will increase the treatment charges by at
least 3.6%
You must know that today because of Karnataka Government’s
poorly planned health scheme like SAST rich are getting free
surgeries in private hospitals since they can get the BPL card easily
and the genuinely poor don’t know how to get it. This is in spite of
Karnataka government declaring that it has more BPL cards than
the population. In the process, private hospitals are no longer in a
position to help the poor since their 20% charity component is used
up in treating the rich, influential patients carrying BPL cards.
All of you applauded the government for capping the price of stents.
Before capping, private hospitals charged a premium on the stent
and when a poor man turned up at night with heart attack,
implanted a stent at less than cost price without advertising about
it. We can guarantee that very few private hospitals in India drove
away a patient because of the high cost. They could do it because
rich paid the premium to subsidize the treatment of poor. Today
after the capping of stent price, rich pay less and poor pay more because hospitals have lost the capacity to subsidize the poor. Is it
what the government wanted?
The reason why today private hospitals are in financial mess is
because ten years ago there was only Yeshaswini Micro Health
Insurance Scheme which occupied less than 20 % of their beds.
Today SAST, ESI and other Govt schemes occupy most of the beds.
Recent study sponsored by the Government of Karnataka and
conducted by the prestigious IIM, Bangalore showed that the
government is paying a fraction of what it costs to do the surgery
safely.
Sadly even this measly amount is paid after few months to few
years after the surgery. So most private hospitals are in financial
distress. In the process, you must know that most of the private
hospitals in Tier 2 and Tier 3 cities where over 60% of the
population live will close down. You must know that most of the
specialists post are vacant at government hospitals which means
that staff are not available to even perform simple life saving
procedures called “Bellwether procedures”, emergency cesarean
section, laparotomy for a burst appendix and surgical treatment of
compound fractures. Today even for basic procedures poor people
are pushed to the private hospitals and sell the assets to pay the
medical bills. Private hospitals simply cannot offer treatment at
less than what it costs since they do not get any incentive from the
government.

Public awareness on KPMEA

WHY ARE PRIVATE DOCTORS OPPOSING THE KPMEA AMENDMENT 2017 ACT?

This could happen
To private medical establishments and doctors
Private medical establishments cannot sustain themselves financially
Hafta raj will become rampant
Doctors will have to spend most of their working hours in the court
Risk of being imprisoned and fined by unfair trials
Experienced doctors and state of the art hospitals leave Karnataka or retire
Juniors in the profession face increasing litigations; they too change the profession
Students may not study MBBS
To the public (patients)
Society loses experienced doctors. In medical profession, experience and learning improves quality of care
Lose the neighbourhood nursing home which was convenient for patients and attendants that gave personalised service. Charges were negotiable. Could get all kinds of specialists in the neighbourhood
Lose their friendly neighbourhood doctor who knows them and their family. He was not only a doctor but also a friend, counsellor and guide.
Lose the awareness and detection camps conducted by the private hospitals which offered concession also: diseases will be detected at advanced stages
Have to go to the neighbouring states for treatment; healthcare becomes difficult, inaccessible and expensive
Doctors refuse to treat critical cases because of fear of litigations; lives may be lost
Forced to go to government hospitals: Face long waiting list, lack of appropriate equipment and specialists
Since corporate hospitals close, patients will be denied of advanced medical treatment in Karnataka
Doctor- patient relationship
Spoils completely; encourages patients to treat doctors as enemies
Forces doctors to treat patients with suspicion
Faith and belief which heal many diseases will not do magic any more
Doctors try to defend themselves with more investigations; expensive for patients and delay treatment
Doctors may not treat any serious cases
Why price capping is illogical?
Pricing depends on so many factors like qualification, experience, expertise, facilities, location of practice, reputation, procedures, duration of stay, complications that develop, cost of medicines, etc
A doctor has to spend 5 ½ years in training to treat a patient. Another 2-3 years to become a specialist. Another 2-3 years to become a super specialist. Work for days together continuously in hospital. Forget personal interests. Lose family life. It is only in 30s he starts earning a decent amount.
When a TV mechanic earns Rs 300 on a visit even if he has to change a fuse, how fair is the government to cap the doctors with say Rs 150 for a consultation in Bangalore?
Why does the government invite investors in health care fully knowing that they have a profit motive?
 If a similar act is applied to all other professions
A plate of idli and vada at road side vendors, Indira canteens, Darshinis, restaurants and 7star hotels should cost the same
A fresh advocate in magistrate court should be paid as much as Mr Nariman in high court
An experienced chartered accountant will be paid similar to a fresh B Com graduate
Autos and taxis should charge the same rates as BMTC and KSRTC bus fares
Why not district redressal committee in its present form?
A doctor may be judged by people who do not know the complexities involved in treating a particular case. It is like asking a musician to decide on life and death changing situation of a patient on a ventilator
There are already 7 agencies helping patients to listen and provide justice to them
It does not have any structure of further appealing by doctors
What if a petitioner gets 10 lakhs from district redressal committee and files a case in civil court also?
Doctor is denied an advocate’s help in financial claims. Even Kasab was allowed to get his own advocate. This is denial of justice and discriminatory
Performance of Karnataka State Government in public health care
Budget allocated to health care has dropped from 1.46%  to 1%
25% of health care money is lost in corruption at various levels
40% of government health care is under utilised
Babies dying within 1 year of birth and mothers dying during delivery is the worst in South India
Number of doctors per population is worst in Karnataka
70- 80% health care is provided by private doctors and hospitals
Why do we demand inclusion of government hospitals in the act?
Above statistics prove that it is the government health department which is performing badly and not the private health care
It is the government health care machinery which needs treatment urgently
It is the tax payer’s money which is swallowed at all levels
Government has to make it attractive for doctors to work in their hospitals by providing suitable working conditions, facilities for family and children and proper remuneration
According to the supreme court, it is the responsibility of the state to provide health care to its citizens
It violates fundamental rights of private doctors
FINALLY: The government knows that it does not stand in the court of law even for 15 minutes. But why is it planning to implement? Because it believes that the act brings more votes.
Does it care if the doctor patient relationship is damaged permanently?
Does it care if citizens are denied of right to health and desire to live?
Does it care if hospitals get closed and their employees lose jobs?
Does it care if the patients have to travel to Hosur for treatment?
Does it care if the patient dies on the way to Hosur?
Does it care if the patients have to spend more on investigations which defend the plan of treatment?

SAY NO
To Karnataka Private Medical Establishment Act Amendment 2017
SUPPORT PRIVATE DOCTORS TO BE SUPPORTED

Who pushed me

"WHO *PUSHED* ME"

🐊
A man had one very beautiful daughter. When the daughter was ready for marriage, the father sent news around town that all the eligible young men should come to compete in a test which would determine who was fit to marry his daughter.

🐊
On that day, all was set, all the able-bodied young men came out. Some came with paper and biro and others with cutlasses and swords.

🐊
The rich man took them to his swimming pool and addressed the men: “Any of you who can swim from one end of this swimming pool to the other would marry my daughter.

🐊
In addition, I‘ll give him 15 million dollars, a car and a house so they can start life well. I shall be waiting to meet my son-in-law at the other end. Good luck!”

🐊
As the young men, all very excited at the prospect of winning, started taking off their shirts, a helicopter came over the pool and dropped alligators and crocodiles into the pool. Immediately, all the men turned back and started wearing their shirts again. Disappointed, some of them said, ''That's crazy, let's see who would marry that girl, no one will''.

🐊
All of a sudden, they heard a splash in the pool. Everybody watched in amazement as one gentleman waddled across, expertly avoiding the alligators and crocodiles.

🐊
Finally, he made it to the other side. The rich man could not believe it. He asked the young man to name anything he wanted but the man was still panting uncontrollably.

🐊
🤦🏻‍♂Finally, he got back to his senses and made a request saying, ''SHOW ME THE PERSON WHO PUSHED ME INSIDE THIS POOL!''

🐊
Moral 1:✍
 You don’t know what you are capable of doing until you are PUSHED! Meanwhile, the Crocodiles were Rubber Crocodiles.

Moral 2: ✍
Those seeking to push you into the jaws of alligators and crocodiles may have helped you to reach your promised land!!!

🐊
Sometimes it takes going through the bad moments to bring out the BEST in us.

🐊
Trials are raw materials for Triumphant Testimonies... The push might take different dimensions: some people needed to be sacked before realizing their potentials and reaching their goals in life.

🐊
I PRAY YOU WILL GET A DIVINELY INSPIRED PUSH in your life.🐊

🙏🏻God Bless you as you accept the Push to go for the fulfilment of your purpose in life.

P- Persist 👇🏼
U- Until
S- Something
H- Happens

Will you please *PUSH* this message to someone else?.

What a doctor never tells you?

What Your Doctor Never Tells You

© Dr. Rajas Deshpande

This small girl who had had her third convulsion in last three days was now looking frail. Her mother, extremely anxious, asked me what can be done to “immediately stop” her convulsions. This hyper-mother had stopped all the epilepsy medicines  of this kid few days ago. Patiently, I asked why.

“Because I read on an article describing  ‘what your doctor hides from you’, in which the author had recommended a particular diet of natural ingredients “, she replied, adding “the article said that all allopathic doctors give you medicines that will keep you sick for longer, so that they can earn more. It also said operations like joint replacements or procedures like angioplasty should never be done.”

Needless to say, this lady was buying the “Purest Natural Guilt Free” products  from that website, at a price that was way costlier than all of her allopathic medicine combined.

I told her that it was a mistake to stop the kid’s medicines, and issued her a new prescription. © Dr. Rajas Deshpande

“What do you do, mam?” I asked her.

“We run a bakery, I sell exotic  cakes, muffins etc.” she replied.

“Do you lie to your customers? Do you sell them products that will harm or kill them?” I asked.

“No, never! How will my business run then? We have to obtain licenses for food quality.” she retorted.

“It is the same about us doctors, mam. All the medicines, stents and joints that your article has slammed, are approved by government, and additionally, they are scientific products, not just claims. The government also earns tax on each medicine, stent or joint sold in India”.

I was offended somewhere, and so continued:

“We come from similar families as yours, mam. Even our parents teach us culture, compassion and good habits just as yours do. We doctors learn in the same schools as you, and  common school teachers have taught us the importance of good. We too have parents, spouses and family, kids whom we teach good values by practice. Why will such doctors  hide the truth from you and suggest you something that will harm you, who have come to us in good faith? Do you presume that all of the thousands of brilliant patriotic doctors will hide a cure from patients, and continue to let people suffer? Just because some bakery is selling rotten cakes, how would you like someone badmouthing your bakery, your integrity? ”

“Not you doctor, but not all doctors are like you” she said.

“Thank you for your faith mam, but I know that most doctors are like myself, who have struggled hard to achieve their degrees, to be able to save lives and bring an end to the suffering of millions. It is not an easy task, there are many easier ways to earn money with lesser hard work and sacrifice. You will rarely find the children of stars, sportsmen, industrialists  and other ultra rich becoming doctors, no one wants so much hard work for such less money.” © Dr. Rajas Deshpande

“We cannot advertise, while most of the alternative medicine companies, gurus and babas keep on blatantly claiming cures for incurable diseases, spreading rumors about allopathy and some other recognised pathies, cleverly selling their own products to desperate patients who hope for relief, and spend far more in the wrong direction. Look at who all is earning crores while claiming that allopathic doctors are cheating people”.

She said she agreed, and won’t interfere with the right treatment of her child now onwards.

This is a complication of a deliberate and sick propaganda which has been orchestrated to tarnish the image of especially allopathic doctors, to be able to sell innocent patients one’s own unscientific products. It is sad that the very people who complain about the consultation charges of qualified doctors go and buy extremely costly “magic remedies” like some unproven, unscientific  laser instruments, vibrators, garments, herbals, extracts etc. © Dr. Rajas Deshpande

The fact that vegetables and fruits are costlier than many medicines, that weekly vegetable expenses or family dinners in India are far more pricey than a specialist’s consultation which can be obtained urgently, speak a lot about where we stand. In the developed western world, there are year-long waiting lists to see most specialists. The fact that Indian doctors are the best and hardest working is appreciated all over the world, but so many Indian gurus, babas and fraudulent quacks run campaigns against our own doctors, in our own country! © Dr. Rajas Deshpande

Want to really know what the doctor doesn’t tell you?.

A doctor never tells you to go to herbal babas when you come to the emergency and need immediate attention. A doctor never asks you to take your lot to the websites that slam medical profession, when you need help. A doctor never abandons even a faithless and arrogant ignoramus, does not ask them to go search internet for blogs and natural remedies when someone is dying of a heart attack or a stroke or accident.  While many recent fulminant ads claim that all doctors are greedy and deceptive, there are thousands of doctors in the hospitals all over world, who are not eating, sleeping or being with their family right now: not because they want more money, but because many will die if we don’t work hard. It is so sad that this had to be explained in India!

What a doctor really doesn’t tell you is: how difficult it is to treat and to save lives of the very people who have no faith in the one trying to do them good!

© Dr. Rajas Deshpande

PS: Recently the number of posts circulating to slam all medical professionals, especially allopaths, have increased, especially in an attempt to market certain products. This extremely harmful trend is ignored by all concerned authorities.  This article is an attempt to defend the glorious scientific profession I belong to.

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