Once again, the newly enacted Clinical Establishment(Registration and Regulation) Act (CEA) has attracted the displeasure of the doctors. For the doctors affiliated to the Indian Medical Association(IMA) have unequivocally expressed their opposition to the provisions of the act. Their claim: it will just land healthcare in corporate hands and adversely affect smaller healthcare units.

They allege that the Act was introduced to mimic the systems in place in foreign countries. Their concerns included the end of home visits and also free health check-up camps since under the Act, doctors won’t be able to practice medicine outside of their clinics.

As per the Act, all registered clinics must have at least one nurse and pharmacist. Also, it’s the doctor’s responsibility to make the necessary arrangements for emergency equipment. This is applicable for specialists as well. The doctors are of the opinion that this is near impossible owing to the huge costs involved and also the lack of proficiency in emergency healthcare.

Dr.Tanuraj Sihori, the president of IMA, Meerut unit points to inherent problem of corporatization with the Act when he said,

“This Act is a step towards corporatisation of healthcare. All small units of healthcare like clinics will not be able to survive if this Act is introduced. It has been made keeping the foreign countries in mind and this is the biggest flaw in it. According to the Act, each clinic should have one nurse and pharmacist each despite the fact that the WHO, in a 2010 report, has revealed that India is grappling with shortage of medical staff.”

Dr. Shishir K Jain, secretary, IMA, Meerut Unit points to the crucial role that clinics play in the nation’s healthcare:

“At least 70% of the total health services in the country are provided by clinics and they should not be restricted through the guidelines of this Act. Also, medical facilities in rural areas are already in a bad shape and with the requirements being asked at a medical establishment, it is next to impossible to run a clinic in rural areas. Not only will this be a problem for doctors as it needs high investment but also for the patients who will have to bear high cost.”

A state-wide protest against the Act on Saturday has also been planned by the doctors.

CEA and doctors- always uneasy bedfellows

The Lok Sabha passed the Clinical Establishment Act in May,2010 whereas the Rajya Sabha cleared it on 3 August, 2010. Though the Bill was intended to be passed in 2007 it lapsed and had to be re-introduced.

The Bill follows the spiritual direction put forth by Article 47 of the Constitution, which says that it’s the state’s responsibility to improve the public health. In fact, this is one of the primary duties of the state.

To carry out its responsibility, the Government of India enacted the Act with the objective of providing clear guidelines for clinical establishments.

However, almost from the outset itself, the Indian Medical association(IMA) has articulated their opposition to the Bill.

It’s worthwhile looking at a statement made by the IMA back in 2010 in this regard:

“The sincerity of the govt. may be appreciated, if it initiate[s] and strives to eradicate the quacks and quackery from our country which has been crippling our society’s health in the guise of providing first-aid care….[putting] corporate hospitals and rural area hospital in same line to accreditate is unjustifiable as it favors corporatization of health care and jeopardizing the health services within reach of common man”

This was said by G.Samaram, the national president.

Unresolved issues in the Act

While in many ways a regulatory framework is essential, there are still unresolved problems with the Act. Some of them are listed here.

• Section 12(2) 

It states thus: “The clinical establishment shall undertake to provide within the staff and facilities available, such medical examination and treatment as may be required to stabilize the emergency medical condition of any individual who comes or is brought to such clinical establishment.”

What this boils down to is that all clinical establishments are expected to stabilize a patient in an emergency medical condition before transferred to another hospital. Such interventions, the Act says are to be made “within the staff and facilities available.” But one doesn’t have to stretch the imagination to see that its interpretations can vary.

The original Supreme Court directive on this regard was meant for providing life-saving first aid for victims of accidents. It’s quite unrealistic-and potentially unfair to the doctors to extend this to any and all emergency situations.

• Lack of provision for extra machinery for additional workload of regulating private clinics

In this backdrop, it’s hard to see how a fair implementation of the Act is possible-affecting not just the doctors but also the patients. For instance, the Act has called for the establishment of the National Council-which is supposed to have a special secretary: the director-general(DG) of health services, Ministry of Health and Family Welfare as an ex-officio member and chairperson.

This implies that important decisions could be delayed if the DG cannot squeeze out more time for this additional task. There are to be no additional appointments at the state level to manage this work. And at the district level, the situation could be potentially worse. For in the districts the chairperson and the secretary of the registering authority are to be the district collector and the district health officer respectively. Needless to say, this increases their workload by a long stretch, causing further delays in getting things done.

• Those who wish to appeal against the order of the district health authority must approach the state council

Even if a marginal number of establishments from a state wish to go for an appeal, this would amount to a substantial volume of appeals from within distinct district registering authorities. But the doctors must approach the state capital for matters related to the disputes. That’s on ordeal that could be avoided with a simplified provision.

These are but a few of the issues that one find in the Act, giving the doctors substantial basis for opposing it.

Such issues point to the necessity for a more involved discussion between the government and the medical fraternity. The key issue here is the provision of adequate healthcare to a huge number of people. And it’s the state’s job to ensure that care-givers, regardless of the size of their institutions are able to provide that in the best possible manner, facing minimal hassles.

References:

• The Clinical Establishments(Registration And Regulation) Act, 2010.pdf(nic.in)
• An overview of The Clinical Establishments(Registration And Regulation) Act, 2010(mondaq.com)
• Indian Journal of Medical Ethics (The Indian Medical Association and the Clinical Establishment Act, 2010: irrational opposition to regulation, Anant Phadke, Vo.7. No.4)
• Times of India. Clinical Establishment Act against public interest: Doctors(Jul 27, 2016,Internet Edition)

Image credits: The Hindu

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