April 30, 2011

New MCI rule bars 6000 DNB doctors from teaching

A Union health ministry notification has deprived India of the services of around 6,000 doctors as teaching faculty in medical colleges — hamstrung as it is by an acute shortage of doctors and teaching professionals.

The ministry approved Medical Council of India's (MCI) recommendation bars Diplomate of the National Board (DNB) degree-holders from teaching if they do not have the one-year additional teaching experience to make them on a par with MD/MS candidates.

The directive bars around 3,000 DNB degree-holders, who have taught for several years as faculty members. It also disqualifies another 3,000-odd doctors, who are pursuing senior residency from teaching, said an official.

According to the new rule, DNB degree-holders, who have passed out from private or non-MCI recognized medical colleges, are required to undergo an additional year of senior residency in a teaching medical institution.

National Board of Examination (NBE) has dubbed the move "discriminatory". Pointing out that the directive is in direct conflict with various judgments of High Court and Supreme Court, the Board claimed that amendments are irrational and a breach of statutory powers.

Surprisingly, the ministry revoked its own notifications of July, 2006; and February, 2009, that had done away with the need for an additional year's teaching experience on 'unilateral' recommendation of MCI without consultation with stakeholders like NBE.

These notifications, which had suggested that the teaching experience gained during DNB courses should be treated as experience for teaching in medical institutions, were based on reports of expert committees and in adherence with statutory process as prescribed by the Indian Medical Council Act.

Many within the ministry and NBE were taken aback by the move seen as a U-turn. "There is neither a cause nor any justification at this stage to backtrack on the 2009 notification and approve these amendments," Dr K Srinath Reddy, president, NBE, wrote in a letter to the Union health secretary. "The amended qualification reveals that uniformity of the prestigious DNB qualifications has been breached unilaterally," the letter stated.

The ministry, in turn, has asked MCI to address NBE's demand of a rollback of the 'discriminatory' notification.

An official said MCI is dragging its feet because the Council has been asked to reconsider its own recommendation. "Indian Medical Council Act does not empower MCI to consider or adjudicate the issue," he added. MCI cannot regulate post-graduate courses.

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April 29, 2011

No superbug threat: Health ministry

There is no major health threat by the presence of a multi-drug resistant bacteria in Delhi's environment, the union health ministry said on Monday, even as a prestigious medical journal accused the Indian government of "suppressing the truth" about the presence of the superbug. "We have rejected it and we still reject it," Director General Health Service RK Srivastava told IANS.

However, he said that a final statement can be made only after the research wing of the health ministry (Indian Council of Medical Research) completes its study.

"The research wing will examine every thing, the protocol and the method of research, all will be examined and only after that, a final statement can be given by the concerned authorities," he said.

Days after health ministry rejected the study on the presence of the superbug in Delhi's environment, published in British journal The Lancet, study co-author Mark Toleman accused the government of India of "suppressing the truth".

The study, published last week, said the New Delhi metallo-beta-lactamase (NDM-1) gene, which makes bacteria resistant to an array of antibiotics, including the most powerful ones, has been found in open water pools, water from overflowing sewage and even a couple of drinking water samples in the Indian capital.

The health ministry, however, said such bacteria existed all over the world and the study was targeting India.

Delhi Chief Minister Sheila Dikshit also reiterated on Monday that water in the city was safe for drinking and there was nothing to panic about.

"Please don't spread panic when there is no panic. The Municipal Corporation of Delhi (MCD) has been saying and I think Delhi Jal Board (DJB) has said that this is not so and water is safe for drinking," Dikshit told reporters here.

DJB CEO Ramesh Negi said the water quality in the city meets the official standards.

"We are testing the water as per the Bureau of India Standard (BIS) standard and we are following it. Delhi's water is safe for drinking and quoting the same (Lancet) study, it says chances of this bacteria growing in this water is very less," he said.

Link: Original Article

April 28, 2011

Hospitals seek patient feedback to better service

As soon as a patient dials the ‘quality and safety hotline’ number of Hinduja Hospital at Mahim, a gentle voice encourages the patient to record his suggestions or concerns related to the hospital’s service. The pre-recorded voice assures the patient that the message would reach the authority concerned and will be addressed on priority basis.

Hinduja Hospital is one of the few city hospitals, which have introduced a patient feedback system to understand their views and suggestions.

In the last four months, the hotline’s recording machine kept in the hospital director (administration), Joy Chakraborty’s cabin, has received more than 60 calls.

The feedback is helping the hospital to make patient-friendly changes in services.

“Every day we get at least two calls from our patients. The hotline has provided us a direct communication link with our patients,” said Chakraborty. “Patient feedback is important to bring in changes to the system, culture or any intervention.”

Feedback from patients has included requests to simplify insurance claim procedures via the third party administrators (TPAs). “Now, our staff personally call TPAs and co-ordinate to expedite the process,” said Chakraborty. Based on the patient requests, the hospital has also started admitting recently discharged patients on priority basis in case they require urgent medical attention.

Patients can dial this hotline number from within or outside the hospital. “The feedback has been encouraging. Patients feel delighted when we address their concerns,” said Chakraborty.

Jaslok Hospital, in the last one year, has made an effort to expedite the billing and admission process, thanks to feedback gathered from its electronic patient feedback system. The system comprises a device on which a patient punches in feedback on the hospital’s services in response to set questions.

“After we got feedback that the admission and discharge process was slow we have increased the staff strength and also begun training them,” said Dr SK Mohanty, medical director, Jaslok Hospital. The hospital has also invested in an online hospital information system, which has helped in speeding up the billing procedure.

“We have at least 15 feedback devices at various places in the hospital. The data on the devices is analysed every month to understand what patients expect from us,” said Dr Mohanty.

Link: Original Article

April 27, 2011

Supreme Court slams lapses in medical college admissions

In an apparent expression of its exasperation over the state of medical education in the country, the Supreme Court slammed the authorities for ignoring the admission procedures and virtually selling the seats.
‘The best way for medical test (admission) is to put the seats to auction and whosoever bids successfully should be awarded admission,’ sarcastically said the apex court bench of Justice B. Sudershan Reddy and Justice S.S. Nijjar Friday.
The court’s observations came in a case in which a medical college admitted six Class 12 students without their appearing in a pre-medical test. The students and the college defended the admissions.
Senior counsel K.K. Venugopal, appearing for the students, questioned the Rajasthan High Court’s order faulting the students’ admission to a medical college affiliated to the Rajasthan University of Health Sciences.
He said, ‘It is the court that holds force against me’, prompting Justice Reddy to say: ‘We also seem to be suffering from the same syndrome.’
‘I have great reservations over the state of medical colleges in the country,’ said Justice Reddy, adding ‘(It is) not that we discount our (apex court) contribution (in the existing state of medical education)’.
When Venugopal argued that after pursuing the course for two-and-half years, the question mark on the admission of the six students may affect their career and leave the six seats vacant, the court said: ‘Are there no higher principles involved than the argument that let no seat go vacant’.
The Jaipur-based medical college admitted the six students against vacant seats for which there were no takers among the candidates who succeeded in the Rajasthan Pre-medical Test (RPMT), a common entrance exam.
These six students did not appear in the RPMT and had merely cleared the Class 12 exam.
Senior counsel Pallav Shishodia claimed that Class 12 was the eligibility criterion for admission to medical courses and not the pre-medical test.
Venugopal said the court ‘may be satisfied that in this case there was no ‘hera pheri’ (wrongdoing)’.
The court said it wanted to hear the Medical Council of India’s counsel before deciding the matter and adjourned the matter.

Link: Original Article

April 26, 2011

Superbug: Doctors can hang their white coats

Doctors and white coats. For years, the white coat has been the iconic symbol of doctors. But, the state health department may restrict the use of white coats for doctors at government hospitals as the coats have been shown to increase infection rates.

A recent study by the liver transplant team at Government Stanley Hospital showed that doctors' coats, ties and stethoscopes carried mircrobes including superbugs,' which are antibiotics-resistant bacteria. It showed that even if doctors follow stringent handwash protocol, the microbes may settle down in their sleeves, watches, finger rings and ties.

As part of a pilot study, doctors in the team were then asked to use disposable aprons and gloves or simply be naked below the elbow. They washed their hands thoroughly, separated patients with infections, restricted visitor entry and ensured clean air flow in sterile wards. Patients who came to the hospital with infections or who had developed them at the hospital were shifted to a septic ward to prevent others from getting infected. The department reduced infection rate by 80% in six months and reduced antibiotic prescriptions to 6%, says pathologist Dr Rosy Vennila, who worked on the project. "It's a practice we are now addicted to," she said.

In other wards of the hospital the use of antibiotics is at least 70%. The team submitted its recommendation for infection control in all government hospitals. It has said that doctors must be allowed to hang their coats. "We may ban white coats in all government hospitals. It's safe to prevent than cure," said health secretary VK Subburaj, on the eve of the World Health Day. The theme for this year is anti-microbial resistance, and international agencies like WHO have called for action.

At the Global Hospitals, for instance, doctors in the hepatology unit remind staff nurses to use antiseptic sanitisers. "There is a nurse on duty just to do infection audits," said Dr Olithselvan, hepatologist, Global Hospitals. If patients are infected, most hospitals are now insisting on a blood culture test to ensure they are giving the right antibiotics. "When we choose the right antibiotic, we kill the bug. If we don't, there are chances we will teach the bug to fight some drugs," said Apollo Hospitals medical superintendent Dr Bhama. "In some cases, giving wrong antibiotics can be fatal," she said.

Hospitals say that rules for infection control are constantly evolving. For instance, Apollo hospital has only selectively restricted white coats. They are not used in intensive care units. Apollo wants to do away with white coats in wards, too. "But coats have for long been identified with doctors. We fear it may become difficult for patients identify doctors in a crowded ward," said Dr Bhama.

Link: Original Article

April 25, 2011

In reform mode, MCI considers national exam for doctors

The Medical Council of India (MCI) is considering a National Licentiate Examination for doctors after the completion of their medical education. This comes in the wake of a vision document for 2015, launched to bring reforms in medical education in India.

At the concluding session of the National Consultation on Reforms in Medical Education held at Pramukhswami Medical College in Karamsad, Prof Prof S K Sarin, Chairman of the Board of Governors, MCI, said that such an examination will set the benchmark for Indian doctors.

At present, India does not have a common licentiate examination for doctors after completing their undergraduate degrees. Usually, the university or the college attests the doctors’ degrees based on their performance, and after a year-long internship, the MCI awards them licences.

Dr Himanshu Pandya, a professor in the Department of Medicine at Pramukhswami Medical College, said: “These licences are given to doctors based on the results of the degree examination and the success during the internship. But an examination will test the skills of the doctor at a national platform, making the assessment of the medical education even better.”

Prof Sarin said: “Assessing medical colleges could be done through these tests, which can be National Exit Tests.”

According to officials, the proposal for such an examination will be reviewed in the coming days by various groups working under MCI.

According to the Vision Document 2015, the time frame for the implementation has been set for April 2013. The advantages of this examination has been stated in the document as “enhancing skill development and competency building for a basic doctor”.

The proposed examination is likely to be online, and could be optional till 2017.

Link: Original Article

April 24, 2011

Optional licentiate exam for MBBS students likely by 2013: MCI

The Medical Council of India (MCI) intends to introduce the licentiate examination' for the MBBS students -- before they qualify for their graduate degrees -- by 2013, a top official said.

"If government agrees to the proposal, licentiate examination to assess standards for an Indian Medical Graduate (IMG) could become optional from 2013, and mandatory from 2017," chairman of MCI, SK Sarin told reporters.

He was here to attend a conference, National Consultations on Reforms in Medical Education, organised by the Charutar Arogya Mandal.

The MCI intends to conduct licentiate examinations after completion of internship, to qualify for the Indian Medical Graduate (IMG) status.

"Our aim is to standardise the output of graduate medical education throughout the country in the form of IMG," Sarin said.

"The objective behind introduction of this examination is to assess the minimum defined standards for a doctor passing out from any of the medical colleges in India," he said.

"Foreign graduates who intend to practise in India will have to qualify in the examination," Sarin said.

The online examination for MBBS students, who complete internship after March 2013, is scheduled to be conducted in four sessions, commencing April 2013.

Link: Original Article

Supreme Court tells pvt hospitals to treat poor for free

The Supreme Court on Monday directed Delhi's private hospitals, which had got land at concessional rates from the government, to provide free treatment to 25% of outdoor and 10% of indoor patients who are poor and are unable to afford health care costs.

A Bench comprising Justices R V Raveendran and A K Patnaik passed the interim order after senior advocate Rajeev Dhawan informed it that efforts were on to resolve the impasse between the government and hospital managements over free treatment to poor patients.

One of the petitioners – Dharamshila Hospital, a super specialty cancer hospital – had said it was impossible to give free drugs and consumables as directed by Delhi HC. The HC had given this direction to all hospitals which had been allotted land by the Centre at concessional rates. "Even government hospitals like AIIMS are not providing free medicines and consumables,'' it had said while pleading that if such a condition was insisted upon, the super specialty hospital would have no option but to shut down.

Link: Original Article

April 23, 2011

MCI mulls CME Credit Conferences

Medical Council of India (MCI) is all set to send doctors back to lecture halls, failing which they would lose their license to practice.

According to the new rules, which will be announced on Tuesday, MCI is planning to make it mandatory for all doctors to attend 30 hours of continuing medical education (CME) every five years. If they fail to attend CME, their registration to practice would be suspended.

The maiden national guidelines on CME Credit Hours will be unveiled at MCI's ethical committee meeting here on Tuesday.

Any paper published in "indexed national/ international" medical journals will entitle the author and the co-author to CME Credit Hours. Doctors pursuing post-graduate courses — like diploma, MD, MS, DNB and DM from recognized/ reputed institutions in India — will get four credit hours per year for the duration of the courses. The additional credit hours will be awarded for participating in departmental and institutional activities like journal club meetings, mortality conferences etc.

Medical associations or organizations caught issuing fake certificates to doctors — claiming they attended the conferences — will be barred. Doctors can attend international conferences. CME Credit Hours will be awarded following the submission of attendance proof.

If CME is organized by a drug/ equipment company for promotion of its product, then it won't be considered. Similarly, the ones organized by individual nursing home, hospitals and for marketing purposes won't get any credit.

Dr Arun Bal, chairman of MCI's ethics committee, told TOI, "We are ready with the national guidelines to make CME mandatory. At present, very few state councils have guidelines for CME credits. Only Delhi, Maharashtra, Kerala, Punjab have structured guidelines. However these guidelines are not uniform. For example, Maharashtra gives CME credits for papers published in indexed journals and for writing chapters in books."

Link: Original Article

April 22, 2011

National Health Research Policy finalised

To overcome the weaknesses of the publicly funded health structures that restricted research in priority health areas, the Union Health and Family Planning Ministry has finalised the National Health Research Policy. It would maximise the returns on investments in health research through creation of a health research system to prioritise, coordinate and facilitate conduct of effective and ethical research and its translation into products, policies and programmes aimed at improving health especially of the vulnerable population. It proposes to ensure at least two per cent of the national health funding is utilised for research.

Representation

The Policy envisages creation of an overarching National Health Research Management Forum having representation from all stakeholders and will function from the Department of Health Research that has drafted the new proposed policy.

The Forum will advise on and evolve national health research policies and priorities and evolve mechanism and action plans for their implementation. It will develop a five-year projection of the plans for health research and prepare an annual National Health Research Plan, do a mid-Plan appraisal for course correction, if needed.

In addition to suggesting mechanisms to nurture a scientific environment to attract talent and to develop human resource for biomedical and health research, the Forum will facilitate utilisation and dissemination of results of health research. To be chaired by the Minister of Health and Family Welfare, and co-chaired by the Minister of Science and Technology, the State Health Ministers would be its vice-chairpersons and the Secretary, Department of Health Research, its member-secretary. All Union Secretaries of various departments of Science and Technology will be the members as also the Directorate-General of Health Services and some health experts.

The policy, which was proposed in 2007 after the Ministry created a separate Department of Health Research, is aimed at ensuring that the results of health are translated into action. It will foster inter-sectoral coordination in health research including all departments within the government, private sector and the academia to promote innovation and ensure effective translation to encourage indigenous production of diagnostics, vaccine, therapeutics and medical devices.

Needed: clear policy

Accepting that there was also a “compelling need to build multidisciplinary research blending physical, medical and social sciences, the final draft says the increasing international collaborative research in priority areas of national health also necessitates a clearly spelt-out policy to ensure that the contributions of our international partners can enhance the ability of the partnership to improve national health. Some of the conflicts and failures of Indian health research can be attributed to the absence of such an overarching policy, it says.

Propelling development

The Policy will be implemented through a National Health Research System wherein all research agencies, cutting across Ministries and sectors, identify priority areas of research and coordinate with each other to avoid duplication, fragmentation, redundancy and gaps in knowledge, to enable the results of research to transform health as a major driving force for development.

Health research is a systematic generation of knowledge that can be used to promote, restore, maintain or protect health of individuals and populations. According to the draft policy, in 2007, 96 per cent of the research publications in India emanated from nine medical colleges out of a total of 300.

Link: Original Article

Apollo Hospitals to launch private label generics

Apollo Hospitals Enterprise Ltd will expand the range of its own branded products for retail from its pharmaceuticals stores.

Last year Apollo set up 200 stock keeping units to introduce 50 non-pharma FMCG products, including toothbrushes, toothpastes, lotions, creams, under the Apollo brand for retail.
“This helped us improve margins,” said Suneeta Reddy, director (finance), Apollo Hospitals.

At present, the Apollo range contributes about 2% to the turnover of the pharma business. “We are expanding the product range and penetration, and hope to scale up the contribution to 10% of turnover in two-three years,” said Obul Reddy, vice-president, finance, pharma division.

This year, the brand will be expanded to include products in generics and over-the-counter drugs such as cough syrups, cough lozenges, paracetemols. “We have identified quality sources and the products will be ready to hit the market in two-three months,” said Obul Reddy.

Apollo also plans to expand to 3,000 stores by the end of five years from the current 1,200 stores. “We are looking at adding about 300 stores per annum,” said Obul Reddy.Investment per store is Rs12-14 lakh, and the company is looking at investing Rs50 crore per annum in this business.

This fits in with its strategy for structural re-organisation, where it plans to consolidate profitability in the retail pharmaceuticals business and hive off 50% stake to a strategic partner.

“We will look for the right strategic partner who can add value to the business, and then hive it off. We will use the capital to add more beds. Core healthcare will always be our focus,” said Suneeta Reddy.

For the quarter ended December 2010, Apollo’s revenues from retail pharma grew 45% on year. Ebitda (earnings before interest, taxes, depreciation, amortisation) losses were contained and Ebitda margins improved by 303 basis points. “With Ebitda turning positive, we want to build up scale,” said SK Venkataraman, chief finance officer.

Apollo’s pharma business is at present the largest organised pan-India player in the segment. Next in line is MedPlus Health Services with 800 stores mostly in south India, followed by Religare with 150 stores.

Himalaya Drugs retails only its own products at its speciality stores, while Guardian Lifecare and 98.4 are smaller players focused in North India.

“Building up scale will give us the leverage to negotiate with suppliers, especially with Goods and Service Tax expected,” said Obul Reddy. Scale will also make the pharma business a more attractive proposition when Apollo decides to hive it off.

Indian and American equity firms are reportedly considering buying a 35% stake in the Hyderabad-based MedPlus Health Services for `410 crore. While refusing to comment on whether Apollo had done a valuation of its pharma business, Venkataraman referred to the MedPlus deal as a likely pointer to values.

Organised retail accounts for less than 3% of India’s `45,000 crore pharma retail business and there are about six lakh pharmacies in the country today.

Suneeta Reddy also said that although medical tourism is a growing business, she expects it will taper off over a period of time. “In, say, 10 years or so, every country will have to have its own healthcare system. It will be hard to send patients abroad for surgery. That is why Apollo is helping countries build their own capacities. We provide technical knowledge to countries in the Middle East, Africa, etc,” she said.

Apollo has a projects team that goes out to various locations and consults on a turnkey basis, and sometimes Apollo also manages the hospital. For instance, the hospital in Dhaka is a managed hospital. At present, the consulting business contributes about 2% to Apollo’s turnover and about 8% to profits.

“We have no plans to expand this business; our hands are full with getting our own projects off the ground,” she said.
As of now, medical tourism contributes 15% to Apollo Delhi’s revenues, and 8% to its total revenues.

Apollo’s Reach programme to tap Tier II cities is also well underway. “Tier II cities have tremendous growth potential,” said Suneeta Reddy. “For us, the cost of a Tier II project is one half of what it would be in Tier I because of low real estate prices.

Therefore, viability and Ebita break-even is much faster. The cost per bed is about Rs35 lakh and we are expecting an Ebitda breakeven in 12 months in these locations,” she said.

At present, Apollo is not able to do real tertiary care work in these hospitals. “We do cardiac, orthopaedic work and so on, but we want to do transplants. Over a period of time, we want to introduce oncology,” she said. This will take time because the capital investment is heavy.

Land has been acquired in six cities, including Thane, Trichy, Vizag, Nashik and Nellore, and construction work is due to start. “Till 2013, our list of Tier II cities is ready,” said Suneeta Reddy.

Link: Original Article

April 21, 2011

New 'quality' test for medical students

ndia will soon have two new examinations for medical students” one each for undergraduate and postgraduate students.

From 2013, Medical Council of India (MCI) has proposed the introduction of Indian Medical Graduate (IMG) degree ” a national examination to enhance credibility quotient, "similar to an ISI mark, guaranteeing quality".

This test will take place two months after an UG student appears for the MBBS examination. MCI governing body chief Dr S K Sarin on Tuesday said that this examination would be voluntary and any UG student can appear for it between 2013 and 2016. Plans are afoot to make it mandatory for all UG students from 2017.

MCI also recommended the introduction of a Master of Medicine (MMed) examination — a two-year course after MBBS — for PG students.

As per the proposal, doctors, who obtain the MMed degree, will become a specialist in any field they want. These PG students will be trained mainly to enhance clinical skills rather than basic research. Those opting for MMed can also choose to do a six-month rural stint within that two-year timeframe. MMed degree-holders will get an additional 5% marks when they apply for a doctor of medicine (MD) or master of surgery (MS) degree.

"Now, students, at times, miss a PG seat for MS or MD for only one mark. This additional 5% marks will give them an added advantage," Dr Sarin said. MCI is also giving utmost importance to the one-year compulsory internship that students do after they appear for the MBBS examination. For the first time, students will be graded on how they perform during their internship. Almost 50% of their MBBS marks will be on the internship, which will be added to their IMG theory score.

At present, there is no evaluation to figure out if MBBS students take their year-long internship programme seriously. Most students utilize the time to prepare for their PG examination.

Link: Original Article

April 20, 2011

Medical Council plans to scrap PG exam

If the Medical Council of India (MCI) has its way, medical students may not have to sit for post-graduate exams. The proposal of the MCI, however, will only be valid for those who clear the newly proposed ‘Indian Medical Graduate Exam’ and the final MBBS/exit exam.
According to MCI president Dr S K Sarin, “50 per cent weightage each will be given for deciding ranking in the post-graduate course”.

This was one of the proposals made by the MCI on Tuesday in a meeting with about 300 experts, including vice- chancellors of medical universities, state or Union Territory directorates of medical education, principals and deans of medical colleges, heads of post-graduate institutes, management officials and key representatives from the Ministry of Health and Family Welfare.

As part of medical education reforms, the regulatory body plans to start the national-level ‘Indian Medical Graduate Exam’ which will have credibility beyond any particular university or college. The idea behind the move is to bring uniformity. “The students will no more be classified on the basis of universities/colleges they are coming from but on the basis of this national-level exam,” said Prof Ranjit Roy Chaudhary, an MCI member.

While the MCI has proposed the exam to be elective for students from next year, it is of the view that from 2017 the exam should be made mandatory. “This process will restore internship which can be utilised for development of a basic doctor catering to the Indian population. As of now, the medical students are seen to be busy preparing for PG after MBBS. After this is done, they can instead relax and concentrate more on practical aspect of the profession.”

“After internship, the student will have to take a licentiate exam that will make him an Indian Medical Graduate,” added Dr Sarin.

For the newly proposed MBBS curriculum two new elements have been added — a ‘foundation course’ will give an insight to students about the profession catering to information about ethics and developing an aptitude for becoming a doctor and a two-month ‘elective learning’ in the beginning of the third year of MBBS.

The MCI has also proposed another concept called ‘Master of Medicine (M.Med)’ to generate specialists required for the community. After completing MBBS, an aspirant will have an option to pursue M.Med — a two-year course.

“After M.Med, he may pursue multiple career path — after a year he can become an MD, in two years he can have dual degree (MD+hospital administration) and after putting in three years, he can be a PhD,” added Dr Sarin.

The proposals will now go to the Health Ministry for approval.

Link: Original Article

April 19, 2011

Aetna sues 6 NJ doctors for overbilling

Aetna Inc. is suing six New Jersey physicians, claiming they filed "unlawful and excessive" bills, including nearly $57,000 for a 25-minute consultation.

The lawsuits stem from hospital care where patients were referred to in-network hospitals but received care from out-of-network physicians. The doctors don't have contracts and set their own fees.

Aetna spokeswoman Cynthia Michener told The Record newspaper the six doctors were reimbursed $8.3 million in 2009, up from $4.9 million in 2008.

The spokeswoman said you can't charge $56,000 for a $74 ultrasound procedure.

The lawsuit alleges cardiologist Deepak Srinivasan at Hackensack University Medical Center increased his fee from $1,400 to $16,380 for the first 30 to 74 minutes of services for critically ill patients.

The doctor's lawyer, George Frino, called Aetna's suit "a gross abuse of the judicial system."

Link: Original Article

April 18, 2011

PAC calls National Rural Health Mission a fiasco

Coming down heavily on government’s flagship program, the National Rural Health Mission (NHRM), the Public Accounts Committee (PAC) has termed it is a ‘fiasco’.

The committee found glaring deficiencies, loopholes, and virtually no effective monitoring mechanism, and called for a through restructuring.

“A large number of sub-centers, primary health centers and community health centers are located in sub-standard environment such as garbage dumps, cattle sheds and stagnant water bodies, and functioning in unhygienic conditions,” the report said.

Report’s findings
PAC, in its report tabled in Parliament on Thursday, expressed dismay that the health centers were being used as "godowns for storage of food grains and cow dung".

In its findings, PAC found that these centers lacked whole lot of necessary infrastructure like water supply and storage tanks, facilities for disposal of sewage and biomedical waste and separate utilities for men and women.

In addition to these harrowing conditions, the centers were substandard and expired medicines. There was also the lack of competent, trained health workers.

Calling for a thorough restructuring of NHRM, the PAC expressed surprise as to how the government had not conducted any study after the launch of the NHRM to assess its performance.

Also, district and vigilance monitoring committees should be constituted by the government, the committee felt.

The PAC report mentioned that there was no common formulary for essential drugs and that there was the lack of integration of Indian systems of medicine with the national health care system.

Link: Original Article

April 17, 2011

Hyderabad docs run for 'cover' as legal cases soar

The city touted as a world-class healthcare hub now has adopted a new 'Western' practice — legal cases of medical negligence are routinely slapped on hospitals and doctors.

For the first time in city's healthcare history, doctors and hospitals are running for cover, literally. If five-star swanky hospitals now have lawyers on their payrolls to fight cases filed against them, 90 per cent of the city doctors are now covered under the 'Professional Protection and Welfare' policy offered by private insurers and even the Indian Medical Association (IMA).

The reason for this legal or insurance cover (insured doctors enjoy a cover of Rs 10 lakh to Rs 25 lakh along with legal support) is rooted in a new-age healthcare reality. As per IMA's state chapter's records, the number of medical negligence cases filed against doctors and hospitals has gone up by 200 times in the past five years. During the same period, hospitals and doctors have paid up a whopping Rs 3 crore in the form of compensation to 'wronged' patients. About 100 cases have been settled in the last few years, 25 of which have seen rulings against doctors or hospitals. Over 100 medical negligence cases are at present pending in the courts.

Grievances are related to inflated bills and attendants of deceased alleging negligence as a reason for death. "When things go wrong, the first thing they do is hire a lawyer," says a doctor. While the spurt in cases is being attributed to better awareness, the legal fraternity is also said to be partly responsible for the same. Doctors say that lawyers actively pursue or look out for cases of medical negligence and even offer deals to patients wherein they are not charged any fee. "If they win the case, the lawyer takes 50 per cent of the compensation the patient is awarded," says a doctor.

City hospitals on an average are recording a minimum of one to two cases a month and some have gone on a defensive treatment track, albeit at the cost of the patient. "We are prescribing a battery of diagnostic investigations, which is increasing the healthcare costs enormously and burden is invariably passed on to the patients," says a senior official of a private hospital, which has 25 cases pending against it in courts. The investigations, officials say, are to gather evidence for a treatment that might go wrong and land them in court.

"This year, among the three doctors suspended by the AP Medical Council, one was (suspended) for medical negligence. But unfortunately, all the three doctors got stay orders from court," says Dr K Ramesh Reddy, vice-chairman, AP Medical Council, which has an ethical and malpractices committee dealing with matters of complaints against doctors. While a majority of cases are filed against private hospitals (sources say most cases are against 10-12 specific tertiary care hospitals), doctors from government hospitals have also 'professionally' insured themselves.

Link: Original Article

Soon, autopsy in private medical college hospitals

From the next academic year, the state government would consider allowing private medical college hospitals do post-mortem examinations, senior health department officials in Chennai said.

Presently, post-mortems are done by the government medical college hospitals and district headquarters hospitals across the state. The only private hospitals authorised to do post-mortem examination is Sri Ramachandra University.

However, the announcement is being withheld as the election commission has enforced the model code of conduct. "When private hospitals can treat victims of road accidents, assault or murder, they should be able to handle post-mortems as well. This will also help the students in the medical colleges as forensic science is part of MBBS syllabus in the second and the third year," the official said. The private colleges willing to do post-mortems have to apply and permission will be granted after inspection, the official said.

The department had so far rejected applications from private colleges. But with shortage of forensic experts in the government sector, it has decided to reconsider the decision. The Karnataka government has already permitted private hospitals to conduct post-mortems.

Presently, for the 17 government medical colleges, there are just 20 qualified forensic surgeons. Eight of them are in the city colleges and hospitals. Madras Medical College has five, Stanley Medical College has two and Royapettah Government Hospital has one. There are two forensic surgeons each in Madurai, Thoothukudi and Theni, and one each in Chengalpet, Coimbatore, Kanyakumari and Vellore. In the government medical colleges in Tiruchi, Thanjavur and Dharmapuri, there are no qualified persons.

In the government hospitals, a MBBS or post-graduate doctor with any specialty is deputed to the forensic department for conducting post-mortems. A forensic expert is given only cases where the cause of death is a mystery or suspected murder. Doctors deputed to the department mostly handle accident cases. They will hand over the case to forensic experts if they think it deserves expert opinion. "Private hospitals can also do this," the official said.

Forensic experts at the government hospitals feel that this will bring down the work load in government hospitals and also offer medical students in private colleges a better learning environment. "Most students in private colleges do get to see a real-time post-mortem," he said.

Link: Original Article

April 16, 2011

Finance Minister withdraws healthcare service tax

Yielding to pressure from across the board, Finance Minister Pranab Mukherjee on Tuesday withdrew the proposed 5 per cent service tax on air-conditioned hospitals with more than 25 beds and on diagnostic services. The tax was imposed in the budget proposals for 2011-2012.

Mr. Mukherjee also raised the abatement available for levy of taxes on the retail price of some branded garments and textile made-ups that would bring relief to readymade garment manufacturers.

Moving the Finance Bill for passage in the Lok Sabha amidst a walk-out by the National Democratic Alliance for the government's refusal to take up a short duration discussion on the Prime Minister's response to the WikiLeaks revelations before the last leg of the budgetary procedure was taken up, Mr. Mukherjee said the purpose of the new healthcare tax was not merely to mobilise revenue, but to pave the way for introduction of the Goods and Services Tax.

“However, I have decided to exempt the new levy in its entirety both in respect of services provided by hospitals as well as by way of diagnostic tests until the GST comes into force,” Mr. Mukherjee said.

Both these proposals evoked sharp reaction from the interest groups. During the general discussion on the budget almost all political parties wanted the Finance Minister to withdraw the healthcare service tax proposal, which was dubbed as “misery tax.”

“To address this concern, I propose to enhance the abatement of 40 per cent to 55 per cent on the retail sale price. With this relief a unit will continue to be eligible for small scale industry exemption in 2011-12 even if it had a turnover based on retail sale price of Rs. 8.9 crore in the current year,” the Minister said.

“I would like to emphasise the importance of staying our course on the tax reforms, the enactment of the Direct Taxes Code (DTC) and the Constitutional amendment to facilitate the implementation of the GST from the next fiscal year,” he said.

Half-measures in these reforms, by insisting on concessions and exemptions, will only add to the complexity and distortions of the tax regime, which will compromise the intended benefits from these measures, the Minister explained.

Beginning his speech with reference to the devastating earthquake and tsunami in Japan and the their implications on the global market, the Finance Minister said there was growing political uncertainty in the Middle-East and Libya that had profound implications for the global oil markets and for the fuel-oil costs and inflation in the Indian economy.

“Even as we plan and prepare for the uncertainties in a globalised world, I want to emphasise that there will always be events that one cannot anticipate or plan for,” he said, adding “we need to do more when the going is good.”

Mr. Mukherjee said he opted for a significant fiscal consolidation when he could afford to do so without dislocating the growth momentum as it would also help in strengthening the domestic medium-term macro-economic environment.

Mr. Mukherjee said the government would pursue three more financial sector legislation — Pension Fund Regulatory and Development Authority Bill, the Bill on Factoring and Assignment and the State Bank of India Subsidiary Bank Law Amendment Bill shortly.

Link: Original Article

"Why two different Bills on mental Health?"

Disability rights groups are up in arms against the divergent views being taken by the Ministry of Health and Family Welfare and the Ministry of Social Justice and Empowerment on the rights of persons with disabilities.

As per the United Nations Convention on the Rights of Persons with Disabilities, ratified by India, all human beings are presumed to have legal capacities. However, while the new Persons with Disabilities Act, 2011 under the Ministry of Social Justice and Empowerment propagates the concept of “full legal capacity” of persons with disabilities as per the Convention, the draft of the Mental Health Care Act, 2010 being piloted by the Ministry of Health and Family Welfare goes against the tenets of the UNCRPD.

“As someone explained to me the other day, the old Mental Health Act could forcibly cage people in a mental asylum for up to 90 days; whereas the new draft envisages caging people for up to 30 days. And, the signature of two psychiatrists is enough to make that happen,” says Javed Abidi, Director, National Centre for Promotion of Employment for Disabled People.

Wondering why there was a need to have two different laws as mental health was covered in the draft Persons with Disabilities Act, Mr. Abidi told The Hindu that the two views were diagrammatically opposite. “So, which view will ultimately prevail? What is Government of India’s position on legal capacity and the rights of people living with mental illness? The time has come to settle this extremely complex and yet critical matter,” he said, adding that he had brought this to the attention of the Union Social Justice and Empowerment Minister Mukul Wasnik.

“Logically, this should have been settled long ago. That is why we have been saying that the Social Justice and Empowerment Ministry has failed to discuss, debate and settle substantive issues. The non-governmental organisations in whom trust was placed were just too happy in each other’s company, listening to each other’s voices and patting each other’s back. Neither did they listen to people with disabilities, nor did they engage with the bureaucracy,” Mr Abidi said.

Pointing out that there was a huge gap between the positions of the two Ministries, Mr. Abidi said the draft of the Mental Health Care Act had been sent to the Ministry of Social Justice and Empowerment, but have received no comments have been received so far. “While Ministry of Health and Family Welfare is going ahead with another consultation next week, the Ministry of Social Justice and Empowerment should attend the meeting and sort out the issues,” Mr. Abidi has suggested to Mr. Wasnik.

The Persons with Disabilities Act grants all legal rights to the differently abled persons to decide even on their treatment, the proposed law drafted by the Health and Family Welfare Ministry categorises persons with mental illness as those who do not need any support or need minimal support and those who do need support.

Link: Original Article

April 15, 2011

Term of MCI Board of Governors extended by a year

The Union Cabinet on Thursday extended by a year the term of the existing Board of Governors of the Medical Council of India. The amendment awaits approval from Parliament.

The term of the six-member Board of Governors, headed by S.K. Sarin, ends on May 14.

The government had issued an ordinance to supersede the MCI with the board after its president, Ketan Desai, was arrested on April 22 last year by the Central Bureau of Investigation for allegedly taking a bribe of Rs. 2 crore to recognise a medical college in Punjab though it did not meet MCI standards.

The MCI, a statutory body, tasked to oversee the standards of medical education in India, grants recognition to medical degrees, gives accreditation to medical colleges, registers medical practitioners and monitors medical practice in the country. The government subsequently amended the Indian Medical Council Act, 1956, to inserted Article 3 (a) through an ordinance that authorises the government to intervene in matters of “national policy.”

The MCI general body had been superseded only for a year as the government planned to bring in the National Council for Human Resources in Health (NCHRH) Bill before the term ended. NCHRH would have subsumed the MCI and all other regulatory bodies. However, the Bill is yet to be cleared by the Cabinet.

Link: Original Article

April 14, 2011

I have not written a will: Apollo's Reddy

A blanket of silence and white envelopes you as you make your way to Dr Prathap Chandra Reddy's chambers perched atop the main building of the bustling Apollo Health City campus in Hyderabad.

It's difficult to fathom that the Apollo Hospitals group founder-chairman is pushing 80; his energy levels make him appear at least a decade younger. But then, the healthcare baron surely knows how to keep himself in good health-a daily regimen of meditation, brisk walk and that absolutely essential weekly swim routine-even as he continues to perfect his hospital enterprise.

It was incidentally this interest in health that sowed the seeds of Apollo Hospitals 32 years ago in 1983, when he helplessly wat-ched a young patient die of a cardiac condition.

The cardiologist chucked a flourishing practice abroad to come back to India, and pioneered the concept of private modern healthcare in the country when he set up the first Apollo Hospital in Chennai.

Today, the Rs 2000-crore healthcare giant not only boasts of 53 hospitals with around 8,234 beds, straddling the Indian subcontinent and other parts of the world, but also healthcare insurance with Apollo Munich health insurance, Apollo clinics and pharmacies, stemcell research and healthcare outsourcing services with Apollo Health Street. Recently, it also forayed into telecom with Aircel, where the Reddy family holds a 26% stake and Maxis Communications Berhad of Malaysia the remaining 74%.

Many years and several innovations later, Dr Reddy is very modest about his achievements. "I think I have just done 0.0001% of the country's requirement in healthcare. But there is 99% satisfaction that we have done something."

Today, he is focusing on preventive healthcare and the innovative use of new technology to further the cause of healthcare in the country. Yet he's still hungry for more. "I think we can do another 50 hospitals in the next five years.

"We have over 200 telemedicine centres in India and 52 in African countries connected to us. Our plan is to ramp it up fast and try and connect with several small hospitals that cannot handle acute emergencies so that they can have the benefit of our expert advice. We also want to connect all primary health clinics in villages and private nursing homes through a project called 'Health Highway' with live telemedicine connectivity so that patients can go for teleconsultation and don't have to all the way from the village to the hospital in the city," he explains.

But the bigger problem, he feels, is adequately trained manpower. "We train about 500 superspecialists and I have 13 nursing colleges. I must double that number. I don't take undergrads so I need undergrad colleges. In the next five years our goal is to train 40,000 people," he says matter-of-factly.

According to him, the country needs over 100,000 hospital beds over the next 10 years to bridge the existing gap in healthcare facilities along with adequate manpower to man these hospitals. "We need to double the number of doctors from 7 lakh to 1.7 million, treble the number of nurses from 8 lakh to 2.7 million and quadruple the number of paramedics," he says.

And all this can happen, he feels, only when the government gives priority or infrastructure status to healthcare, which will give the sector access to long-term funding. He also dreams of setting up a global health city in the country, for which he is looking for 500 to 1,000 acres of land in Karnataka or Maharashtra. "My dream is to make India a global healthcare hub."

Ask him about his succession plans and pat comes the reply; "I have not written a will but my four daughters will succeed me. All of them are excellent and they are each playing different roles. Though they live in four different families they are one and have a great understanding," he says. Dr Reddy's daughters Preetha Reddy, Sunitha Reddy, Shobhana Kamineni and Sangeetha Reddy already handle various aspects of the business.

Link: Original Article

Health Ministry, MCI oppose foreign varsity Bill

That the Foreign Universities legislation also does not provide for the MCI’s scrutiny on foreign institutes offering medical education in India, they pointed out, could also lead to ethical issues and quality concerns. The MCI has already communicated this concern to the HRD Ministry and has suggested that its scrutiny should be mandatory before permitting any foreign education provider to set up a campus where medical education is offered.

Link: Original Article

April 13, 2011

MCI to grade medical colleges

For medical aspirants across India, the options during admission broadly boil down to two. Their first preference is almost any public college which offers the MBBS degree at throw-away rates, followed by the private colleges where education is a lot dearer.

But, which is the second best college among the government institutes in Maharashtra or Tamil Nadu or Karnataka? Making that choice will get a lot more hardboiled as the Medical Council of India (MCI) has decided to assess and grade their colleges. A student will now be able to make a tough call on whether to sign up at JIPMER, Puducherry, Christian Medical College, Vellore, or at the All India Institute of Medical Sciences.

The Council, which has so far been a college-recognising and doctor-licencing body, is now looking at expanding its mandate. "We want to see how we can improve the quality in medical education. To date, we just checked the faculty strength, infrastructure and looked at other parameters. Now, we need to see how to up the quality of the country's medical colleges," said Dr Devi Shetty, a member of the MCI board of governors.

Stemming the rot that has set in will not be easy. But improving quality of medical institutes is in sync with the larger framework that the MCI's vision document 2015 spells out: raising the bar for Indian healthcare to match the global standards.

The Vision-2015 document prescribes sweeping reforms for the under-graduate and post-graduate medical education programmes. The document aims at evolving strategies for the road ahead in an ever-expanding medical education sector that has not been able to focus on quality.

So, from the quality of the curriculum to the patient inflow, from adopting new technology in teaching-learning to the quality of research carried out, the assessment process will consider all that before a college is graded. While the National Assessment and Accreditation Council, has graded some medical colleges of the country, not all the institutes are graded.

It is unclear if the MCI will make assessment mandatory or not, but Dr Shetty added, "We are in the process of taking inputs from the NAAC and the National Accreditation Board for Hospitals & Healthcare Providers on the quality processes we need to develop."

With the MCI rethinking the direction medical education should take, colleges will have to put the quality factor on steroids.

Link: Original Article

April 12, 2011

More practical training proposed for medical students

Undergraduate medical students are all set to get more practical training with the Medical Council of India proposing an innovative curriculum to bridge the gap between theory and practice.

The curriculum proposed by a special panel set up for the purpose by the MCI would be structured to facilitate horizontal and vertical integration between disciplines, bridging gaps between theory and practice and between hospital-based medicine and community medicine.

Basic and laboratory sciences (integrated with their clinical relevance) would be maximum in the first year and will progressively decrease in the second and third years as the curriculum progresses, according to the proposed curriculum.

The essentials of basic and laboratory sciences would be taught in the first year and built on in the subsequent years.

Similarly, certain subjects will get extra lectures from the first year onwards for example approximately eight radiology lectures can be included in anatomy to teach students cross sectional anatomy of brain, abdomen, foetal anatomy during embryology teaching etc. during first year itself.

This practice is already being followed by Maulana Azad Medical College, New Delhi. This model can be adopted by other colleges as well, without changing the number of lecture hours (by integration).

Forensic Medicine can be effectively taught during gynaecology and obstetrics (rape, assault), surgery (injuries), pharmacology (toxicology). Legal experts can be called for medico-legal issues, the committee said.

Forensic medicine skills can be acquired during internship such as documentation of medico-legal cases of alcoholism, suicide or homicide, rape, assault and injury cases.Infection control section in hospital in now an important component and that should be included, the committee felt.

Both horizontal and vertical integration will be used for making the curriculum more efficient and student friendly.

Details of this are being worked out by expert committees constituted by MCI in co-ordination with the undergraduate working group.

Link: Original Article

Doctors' panel has freedom to regulate medical education: Govt

The six-member panel of eminent doctors, which replaced a tainted Medical Council of India last year, has ''total freedom'' to regulate medical education in the country, Rajya Sabha was informed today.

"Board of Governors (of MCI) has total freedom whatsoever. We do not interfere except for policy directions," Health and Family Welfare Minister Ghulam Nabi Azad said during Question Hour.

The government had in May last year dissolved the MCI, which was set up 76 years ago to regulate medical eduction in the country. The general council of the MCI was superseded on May 15, when the Centre promulgated an ordinance following the arrest of MCI president Ketan Desai by the CBI on charges of corruption.

It was replaced by a six-member panel of eminent doctors led by gastroenterologist S K Sarin. Azad said applications for six new medical colleges in Gujarat were received by MCI for 2011-12, of which four were government-run while two were private societies run institutions.

The Board of Governors of MCI approve of any medical college after inspection of facilities including faculty, hospital infrastructure and clinical materials. In case of the proposed medical colleges in Gujarat, deficiencies were found in infrastructure, clinical material and faculty and so approval has not been granted.

To a separate question, Azad said the Government has enacted the Clinical Establishments (Registration and Regulation) Act, 2010 that will prescribe standards and a range for price that private and government hospitals can charge for a particular procedure.

"After the act is enforced, public will get relief" from overcharging and sometimes unnecessary medication or hospitalisation by some hospitals, he said.

"When range and standards are decided, these complaints will reduce if not completely be eliminated," he said. But so far only four states - Himachal Pradesh, Arunachal Pradesh, Mizoran and Sikkim - have passed resolutions in their respective assemblies for adopting the act.

The act will also be applicable on UTs, he said adding states have been requested to pass relevant resolutions in their assemblies. Health is a state subject and it is primarily the responsibility of the state governments to regulate or monitor the functioning of clinical establishments.

Link: Original Article

April 11, 2011

Medical CET may be held this year

Medical Council of India (MCI) is trying to hold the common entrance test (CET) for admission to government and private medical colleges from the 2011-12 academic year, as directed by the Supreme Court (SC).

A senior health ministry official had said last week it would be difficult to implement the Supreme Court order this year as many states had already issued notifications for pre-medical tests. But an MCI member said on Monday not all states and institutions had notified and CET could still be held.

Another reason MCI wants to hold the test from this year itself is the worry that an appeal against the SC order could delay it further.

“Discussions are on and we are working on conducting CET this academic session itself. We know it is late, but not too late. It will be difficult, but not possible,” a member said.

Link: Original Article

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