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.