Patna: In a bid to regulate private and government hospitals, single-doctor clinics and diagnostic centres in the state, Bihar cabinet recently gave approval to the Bihar Clinical Establishments (Registration and Regulation) Rules 2013.
With this, the state is finally going to enforce the Clinical Establishments (Registration and Regulation) Act, 2010 which was adopted by it in July 2011 but could not be implemented as the rules of the Act were still being framed. One of the major reasons for the delay in framing and implementing the rules was the opposition to the move by a section of doctors including the Indian Medical Association (IMA) and Bihar Health Services Association (BHSA).
The rules are enacted for registration and regulation of the clinical establishments with a view to ensuring minimum standards of facilities and services.
According to the provisions of the Clinical Establishments Act, a clinical establishment, be it ayurvedic, allopathic or homeopathic, has to get it registered and is supposed to maintain records of outpatient, inpatient, operation theatre, labour room, MTP (medical termination of pregnancy), case-sheets, laboratory register, discharge summary, complaint register, number of beds, system-wise and speciality-wise in the establishment, rates of different services etc.
The approved rules also have a provision under which the government will constitute a state council for clinical establishments and the principal secretary of the health department will be the ex-officio chairman of the council. The responsibility of the council would be to compile and update the register of clinical establishments in the state and send monthly returns for updating the national register.
The rules also prescribe the setting up of a registering authority for clinical establishments in each district. The district magistrates would be chairman of the authority. If a person running a private nursing home or clinic violates the provisions of the Act, he or she would be fined with Rs 10,000 for the first offence, Rs 50,000 for the second offence and Rs 5 lakh for any subsequent offence. Any person aggrieved by the authority’s decision can appeal to the state council within three months.
Dr Harihar Dikshit, professor and head, department of pharmacology, Indira Gandhi Institute of Medical Sciences (IGIMS), Patna told India Medical Times, “The Act and Rules are similar to the Central Clinical Establishments (Registration and Regulation) Act, 2010 (CEA-2010). But I personally oppose the clause that states in an emergency case, the doctor present would have to stabilise the patient before referring him/her elsewhere. There should be more clarity in that clause. It is not always possible for a doctor to stabilize the patient and this strains the doctor-patient relation. The doctor would not want to put a patient’s life in peril himself; he might not be equipped with the state of the art infrastructure, but the clause puts a mandatory accountability on him.”
Dr Bimal Kumar, professor, department of paediatrics, Darbhanga Medical College and Hospital, Darbhanga told India Medical Times, “The Act was opposed initially by scores of doctors in the state. The Act is good and has a lot of positive things too. It will put a tab on quacks as the Act prescribes the minimum standards of facilities and services without compliance with which a clinical establishment can’t be registered. Another is, with the mandatory registration of hospitals, clinics and establishments, the government would be able to know where and how many health facilities exist and where are they needed to be created.”
“But there is also a downside, The cost of treatment for poor patients could rise as any clinic or centre which is into 24×7 service or not has to stabilize the emergency cases and can’t deny treatment, so the infrastructure has to be strengthened and the cost will shoot up. The clause to stabilize the patient should not be imposed on those who are only into consultation services; only those who have the infrastructure should be mandated to follow it,” he said.
“Also, the minimum standard approach to be followed for setting up a clinic will further spoil the level playing field as private players would hesitate in opening up clinics in rural areas in a scenario of strict rules and regulations. How can we fulfil the doctor-patient gap this way? When lawyers can do personal practice freely, why can’t a doctor? This looks like a half-hearted approach by the government. The vague clauses should be made more transparent,” Dr Kumar added.
Rajasthan, Uttar Pradesh and Jharkhand are some other states that have adopted the CEA-2010 and other states have also been requested by the union government to adopt this Act. As the Act aims to strengthen medical facilities across the states and bring transparency, the question remains how it will be implemented in the letter and spirit when some clauses are still vague and cannot apparently be applied to every clinical establishment?
by Vidhi Rathee