Medical profession - IMA Hospital Board of India

Doctors and Hospitals Profession or Industry? Challenges in regulation

The Cauldron • Rise of consumerist culture in society. • Transition

in

medicine

from

clinical

medicine to evidence based medicine. • Type of medical practice shifting from

individual practitioners to hospitals.

Why is it a challenge Ethics is a dynamic concept changing with time and space Doctors: Profession : Professional ethics Hospitals : industry: business ethics

The bias Hospitals :Professional service or commerce? For service : Profession

For regulation:trade/industry/business

Lack of sensitivity 1) Consumer protection act 2) Shops and commercial establishment act 3) Dangerous trade and offensive practices act 4) Sales tax/VAT 5) Luxury tax 6) Service tax

Lay man’s approach 1)Clinical establishment(registration and regulation )Act 2010 a)stablisation clause b)fixing of charges c) Licensing nature d) Presence of a police officer in licensing team. e)Complaints cell.

Lay man’s approach 2) The Indian Medical Council (professional conduct,etiquettee and ethics) Regulations 2002 a) display of charges(3.7.1) b) sections 7.23,7.24

Lay man’s approach 3) PCPNDT Act

a) List of indications for scan b) Lack of connectivity to female foeticide.

Under regulation or over regulation ?

Plethora of laws and regulations

Laws governing health care institutions Laws regarding service delivery 1.

The Drugs and Cosmetics Act,1940(Central Act of 23 of 1940) and Rules 1945

2.

The Pre-Conception and pre-Natal Diagnost Techniques(Prohibition of sex selection)Act ,1994 Rules 1996

3.

The Medical Termination of Pregnancy Act,1971 and Rules 2003

4.

The Kerala Intoxicating Drugs(Control)Rules,1983

5.

The Drugs (Prices Control)Order ,1995

6.

The Kerala Narcotic Drugs and Psychotropic Substances Rules,1985

7.

The Mental Health Act,1987 Rules 1990

8.

The Drugs and Magic Remedies (Objectionable Advertisements)Act 1954 and Rules 1955

9.

Laws governing health care institutions The Kerala Corneal Grafting Act and Rules 1963

10. The Creation of Eye –Bank Rules ,1970

11. Blood Bank Licence 12. The Transplantation of Human Organs Act,1994 and Rules 1995 13. The Clinical Thermometers(Quality Control)Order,2001 14. The Poison Act,1919(central Act XII of 1919)the Kerala Poison Rules 1960 15. The Standards of Weights &Measures Act,1976(Central Act 60

of 1976)& The Standards of Weights& Measures (Enforcement) Act, 1985(Central Act 54 of 1985) 16. Atomic Energy Act 1962

Laws governing health care institutions

Laws regarding the Professionals :-

17. The Indian Medical Council Act ,1956 Regulations,2000 18. The Indian Medical Council(Professional Conduct ,Etiquette and Ethics )Regulations ,2002 19. The Indian Medical Degrees Act,1916

20. The T.C. Medical Practitioner Act ,1953 21. The Indian Nursing Council Act,1947 22. The Nurses and Midwives Act,1953 Rules 1972 23. The Pharmacy Act,1948 24. The Pharmacy Council of India Regulations,1952 Rules 1961 25. The consumer Protection Act 1986,(Central act 68 of 1986)and Rules 1987

Laws governing health care institutions

Laws regarding the Institutions:-

26. Clinical Establishment (Registration and Regulation )Act 2010. 27. The Kerala Shops& Commercial Establishments Act,1960 and Rules 1961 28. The Bio medical waste (management and handling )rules 1998 29. The Kerala Panchayat Raj (Registration of private Hospitals and Private paramedical institutions)Rules,1997 30. The Kerala Municipality (Registration of Private Hospitals

and Private Paramedical Institutions)Rules 1997

Laws governing health care institutions 31. The Air Act,1981 32. The Water Act,1974 33. The Kerala Building Tax Act 1975 Act 7 of 1975 34. Dangerous trades and offensive practice act 35. The Kerala General Sales Tax Act,1963/KVAT 36. Luxury Tax Act 37. Service Tax Act

Laws governing health care institutions

Laws regarding Labour:-

38. The Minimum Wages Act,1948(Central Act 11 of 1940)& Rules,1950 39. Payment of Wages Act 1936 40.The Maternity Benefit Act ,1961

41.The National and Festival Holidays Act 42.The Gratuity Act 1972 43.Weekly Holidays Act ,1942(Central Act 18 of 1942)

Laws governing health care institutions 44. The Employees State Insurance Act 45. The Payment of Bonus Act,1965 (Central Act 21 of 1965) &Rules, 1975

46. The Employees Provident Fund and Miscellaneous Provisions Act 1952(Central Act 19 of 1952) 47. The Kerala Welfare Fund Act II of 1977 48. The Kerala Labour Welfare Fund Act ,1975 (Act II of 1977) 49. The Industrial Employment (Standing Orders)Act 1946 50. The Industrial Disputes Act 1947 51. The Kerala Payment of subsistence Act ,1972(Act 27 of 1973

Need for benign approach by state 1)MTP Act 2) Special Protective sections :88,87 and 80 IPC

3) Circular memorandum 1993 Government of Kerala. 4)Supreme court pronouncement

Profession or Trade/commerce/industry? “By any standards that one may adopt, medicine is

and ought to be a profession and not a mere career or just an income earning activity. This can be no different even when the professional activity becomes more and more organized and assumes larger dimensions.

The dividing line between professions and mere careers is getting blurred increasingly, we do

hence find laws and regulations increasingly entering into zones which were left to the sound discretion of the professionals in yesteryears. Ethical professional standards and not the mere stipulations of law must provide the beacon light

for any conscientious professional”. Justice R Basant.

Suggestions:1. All laws regarding doctors, allied professions and healthcare delivery institutions should be based on the ethics and etiquette of medical profession. They should be given special status in law. 2. Single window for all legislations governing health care institution.