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Good-bye Clinics & Nursing Homes, Welcome Corporate Hospitals

The friendly neighbourhood physician, as well as the small husband-wife run nursing home, is soon to be phased out. These clinical establishments dotting the country in every nook and corner and providing 70 per cent of the total healthcare services are now becoming history. The medical scene in the country is about to change drastically and we only have our own lethargy to blame. The Ministry of Health and Family Welfare has put on its website the Draft Minimum Standards under the Clinical Establishments Act (CEA). Not only are some of these outright hilarious, they are mostly out of sync with the reality.

Dr Neeraj Nagpal

Need for a (building) completion certificate in legal requirements is an example. Completion certificates are commonly refused for minor building byelaw violations and in any city this may include upwards of 60 per cent buildings. Also need of dependence on landlord for this requirement under the CEA will close many healthcare facilities, as the level 1 or 2 hospital may not be in a self-owned premises. How the clinical standards of a facility are to be determined on the fact whether or not the building has completion certificate is a mystery. What this effectively means is that the facility has to apply to the Estates office for the completion certificate, inspection of the premises by inspector, objections, removal of these objections by any means (usually unfair) and overall wait of average one year for the certificate. Meanwhile, the healthcare facility should close down awaiting its certificate.

This, however, is also not in isolation, the NOC from the fire department, now under the new rules for hospitals whether level 1 or tertiary care, has extremely stringent requirements of roof top water tanks, sprinkler systems and smoke detectors. To get this NOC is going to be another formidable challenge for the establishments already in existence in older buildings. Under the draft rules one has to provide 24-hour power backup but you need a diesel storage license, DG (Diesel Generator) set approval for commissioning, air and water pollution control certification etc. Each of these licences can be a 2-3 year plan for the doctors.

Surprisingly none of these requirements are necessary for AYUSH facilities even of 100-bed strength. All the legal requirements, so far mentioned, relate to the allopathic level 1 and level 2 hospitals. Despite operation theatres and labour rooms in AYUSH facilities there is no requirement for such building and legal certifications for them. How can two facilities of similar size providing treatment to general public need to fulfil two different types of certifications. There is a bias against allopathic healthcare facilities in these draft minimum standards published.

There is also a need for Spirit license, medical gases / explosive Act license, boiler license and a wireless operation certificate from the Department of Posts and Telegraph to operate wireless equipments like nurse call systems or monitors. It does not require high intellect to know how these licences are to be obtained and what the procedure entails. An individual or couple managing a small nursing home or level 2 hospital will find it impossible to comply with the requirements of all these certifications. This will leave no option but for these units to close down. Only the corporate hospitals with their deep pockets and required administrative staff will be in a position to satisfy all these requirements. Unfortunately corporate penetration in India is limited to less than two per cent. Should the remaining 98 per cent Government as well as Private hospitals shut shop.

The Govt clinics/dispensaries, Primary Health Centres, Community Health Centres and Civil Hospitals will be hard pressed for these certifications. Where is the need for a four-wheel drive vehicle in a city based level 2 hospital? Even tertiary care institutions like PGI will be hard pressed to explain 2 or 3 patients on one bed, which is the norm in the obstetric wards. These standards have been prepared without adequate and appropriate consultation with stakeholders. There appears to have been a group within the MOHFW which is out to promote corporatization of healthcare which cannot be in overall good for the country.

We request the Government to be sensible and practical. Minimum standards should mean minimum standards necessary for a clinic/hospital to provide adequately satisfactory healthcare to its consumers. CO2 monitors and Endoscopy washers are not minimum standards. But more importantly minimum standards have to be uniform across government, private, allopathic, ayurvedic, homeopathic, naturopathy, siddha, sowa-rigpa, unani, yoga or physiotherapy. A level 2 allopathic hospital with 10 beds and surgical facility cannot have different and highly stringent requirements from a 100-bed ayurvedic hospital with OT and labour room.

Dr Neeraj Nagpal
Convenor, Medicos Legal Action Group
Ex-President, IMA Chandigarh

14 Comments

  1. Dr kanhaiya jha Dr kanhaiya jha Monday, April 7, 2014

    Another Inspector Raj,What will a fresh medical graduate do?Only way just to join Corporate hospital in big town.What about rural health policy?By closing the scope of opening small clinics in Rural areas & in small town, Indian goverment
    wants to remove poor by depriving them cheap health care.

  2. Dr Kusuma Kumari G Dr Kusuma Kumari G Thursday, April 3, 2014

    The goverment must immediate steps to encourage small hospitals in smalker towns. Otherwise all people in small towns in will suffer. My husband once wanted to start a small Hopsital in my home town however he did not succeed because he felt its hard to start becuase of stringet regulations. He gave up the idea. My brother in law who is an ophthalmologist also failed in same way. I feel goverment must encourage smaller Hospitals.

  3. rajesh rajesh Thursday, April 3, 2014

    This type of act is ”MURDER” of small clinic as well as doctor.This step will increase corruption deffinately. Its not good for Public as well as doctor.

  4. Dr Y Sujatha (Ophthalmologist) Dr Y Sujatha (Ophthalmologist) Wednesday, April 2, 2014

    This step will definitely promote the corruption at various govt offices to get the required certificates…Not good for the society.

  5. Dr.Kavitha Gone Dr.Kavitha Gone Wednesday, April 2, 2014

    Good suggestion by Dr.K.N.Pandey.Government should establish such centres and ensure access to healthcare for poor and less affordable society.Atleast some of the malpractices by these smaller hospitals probably will be avoided.
    I would support that there should be some regulations in place atleast ,as some of these smaller hospitals are worse than a cattle shed in my area atleast.

  6. Dr.Zek Dr.Zek Tuesday, April 1, 2014

    one must be DREAMING ….to have all these criteria fulfilled …. in INDIA. then to recover all d cost into setting up such a facility would mean very HIGH FEES for patients …like say i) Normal Delivery = Rs. 50,000 ii) Lap. Cholecystectomy = Rs. 1 lakh …..then tell me, will poor patients come to Hospital ? Indian Patients will die of illness at home !! There is no JUSTICE in this kind of proposed LAW…of course m also aware of side effects of UNREGULATED MUSH ROOMING of Hospitals !!

  7. Dr.Mahendra Joshi Dr.Mahendra Joshi Tuesday, April 1, 2014

    for the survival of corporate hospitals, where politicians, govt. officers and corporate houses put black money in investment; unless small hospitals are shut down, they can not survive in profit. so govt, insurance companies and corporate houses with the help of govt. are in great need to shutdown small hospital. so doctors get ready either to shut down the hospital or get ready to share your profits with these people.

  8. Dr.Kalavathy Gurusamy Dr.Kalavathy Gurusamy Monday, March 31, 2014

    India is a DEVELOPING country and not a developed country. Do not seek for treating patients in first class safe model hospital- rather look if there are enough doctors/nursing homes to treat people near their places of dwelling!
    Nothing wrong in making all hospitals CORPORATE!! who is going to bear the cost?? Will this act also include a uniform tariff banner and dare to announce the same in public so that any one procedure will cost the same in all hospitals and also it would be in par with the small nursing home/ or a flat rate in all corporates- does this mean we are getting a ceiling to all the tariffs laid for all ailments?

    Great….so it would be possible even for the lower income group to enter corporates!! So this also means even the oldest medical colleges/hospitals in the country will be closed till they get their recogonition- putting all the ailing patients in for near death experiences!

    Beware of the following points: 1) this move will sure kill allopathic medical practice 2) leave many sincere doctors jobless 3) chase allopathy docs out of the country 4) mass massacre of ailing patients 5) make the other forms of medicine more commercialized 6) discourage the younger generation from taking up medicine as profession!

    Dr.G.Kalavathy
    Head, Penn Nalam, Chennai.

  9. Dr.M.Arulpitchai Narayanan. Dr.M.Arulpitchai Narayanan. Monday, March 31, 2014

    We, the Doctors have to be United in sensitising the consumers of the Health Care. Doctors do not have lobby.
    Even when so much of noise was made by the small traders all over India, FDI was permitted by the Government of India.
    What was achieved by Corporates in the last two months of the present Government before Election notification, the common man was not able to get any benefit.
    This is the time, the Doctors of India should stand united for common cause for better affordable accessible Health Care to the Rural population and the poor of this Country.
    Dr.M.Arulpitchai Narayanan.
    Chairman,
    ARMA MEDICAL FOUNDATION,
    Chennai.
    http://www.armafoundation.com

  10. Dr.K.N.Pandey Dr.K.N.Pandey Monday, March 31, 2014

    Why not first govt.establishes a modular P.H.C.in each area, District hospital, Medical college where all these ‘facilities’with ‘no objections’from all mentioned departments so all private hospitals big or large can copy !!

  11. half-baked half-baked Monday, March 31, 2014

    1) So, does an RTA head injury case or a lady in labour in a village need to be directly shifted to a big city hospital for even first line treatment? No small hospital will be allowed to operate for not “living up to the mark.”

    2) Will all PHCs, BPHCs, RHs comply with this or will it remain fancy dreams in places where even the broken beds need to be propped up with bricks? Shouldn’t the proposers lead by example?

    3) This should stop “white-coat quackery” by allopaths, but will it stop the same by non-allopaths or non-medical people? Will the other systems of medicine be made to “living up to the mark.” Obviously not. They even promote certain systems that cannot show scientific evidence of efficacy.

    4) Can the government guarantee the uninterrupted electricity needed to run the fancy equipments listed out. They are essential, but they cannot run on thin air. Well, obviously not – the draft mandates the need for power backup! Well, at least they admitted that they cannot.

    5) All this expensive equipment needs to be purchased and maintained. Does the government expect that this would make allopathic medicine more financially accessible to the masses? ‘Social medicine’ anyone?

    6) With so many licenses being required, wouldn’t this lead to License Raj 2.0?

    7) Who is going to man these high-tech equipments when the country is facing such a massive dearth of post-graduates? Will the MoHFW begin a new UG course to tide over the shortfall there too?

    I can guarantee, that this proposal will be sent back to the drawing board, and I hope that the next group of people who draft the next set of rules, contain at least a few individuals who have the practical knowledge and sense of working on the ground.

    They talk of bottom-up approach to planning, but this proposal shows a complete lack of it.

    This is another half-baked half-thought-out idea by Azad sahaab; another one in a string of bad decisions. God help Indian patients and Indian allopaths from the Tughlaqs of Nirman Bhawan.

  12. ritu gupta ritu gupta Monday, March 31, 2014

    Novel way for population control. Kill Indians in sickness and disease. See the apathy of government institutions and now small nursing home providing low cost care will also close down.

  13. Dr Y Sujatha (Ophthalmologist) Dr Y Sujatha (Ophthalmologist) Monday, March 31, 2014

    No…it looks like more of a Allopathy Hatao program…

  14. Mahesh Sinha Mahesh Sinha Monday, March 31, 2014

    This is part of the national “Gareeb Hatao” program

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