On April 30, Dr Najma Heptulla, Member of Rajya Sabha (RS), from the Bharatiya Janata Party posed a very relevant query during the RS session. She alleged that several hospitals across the country did not have relevant documents and were operating illegally. She asked the Minister of Health & Family Welfare whether the Ministry was aware of this and whether it has taken/proposes to take any steps to curb such hospitals.
The query was no doubt triggered by a tragic incident in her home state of Madhya Pradesh. On April 26, part of the roof of Kasturba Gandhi Hospital in Bhopal, the state capital, caved in claiming two lives and trapping patients for a couple of days. The fact that this hospital was managed by the public sector Bharat Heavy Electricals Limited (BHEL) only reinforces the perception that the infrastructure in such hospitals is suspect and the facilities are mismanaged.
It is indeed shocking that some hospitals, supposed to be repositories of life saving equipment, are today themselves turning out to be death traps. To be sure, such ‘rotten apples’ are found in the private sector as well, and the case that comes to mind is the fire at Kolkata’s AMRI Hospital in December 2011, which claimed 89 lives.
But despite so many instances of preventable accidents at hospitals, there is still a ‘passing the buck’ attitude between state and centre which ensures that not much action is taken. Both sides make the usual noises, compensation is paid to the victims/victims’ next of kin and the issue is slowly and conveniently buried and forgotten.
In reply to Heptulla’s query, Minister for Health & Family Welfare Ghulam Nabi Azad predictably made the point that ‘health’ is a state subject, it is primarily the responsibility of the state governments to regulate and monitor hospitals in the states and no information regarding illegally operation of hospitals is maintained centrally.
So while the Centre has enacted the Clinical Establishments (Registration and Regulation) Act, 2010, it has been adopted only by four states (Arunachal Pradesh, Himachal Pradesh, Mizoram and Sikkim) and all Union Territories with effect from March 2012. Uttar Pradesh, Rajasthan, Bihar and Jharkhand have also subsequently adopted this Act. The Act was brought into force to ensure minimum standards of facilities and services in clinical establishments and also looks to regulate rates of procedures and services charged by such establishments in the states. All the MOH&FW can do is to ‘request’ other state governments to adopt this Act as well.
There has been a lot of opposition to this Act as private healthcare players see this as interference by bureaucrats who may not understand the finer nuances of running a hospital. (See Express Healthcare edit: Return to the inspector raj? http://healthcare.financialexpress.com/200807/ edit01.shtml) Smaller hospitals also expressed concerns that their costs would go up if they had to put in place systems mandated by the Act, like computers for electronic record keeping. Would such systems force smaller hospitals to up their rates, thus defeating the very purpose for the Act, i.e. standardising care at affordable costs?
One wonders how certain regulations are enforced with lightening speed while others languish. For instance, the Home Ministry has tightened visa requirements for couples coming to India for surrogacy from last December, apparently with immediate effect. The rules now state that commercial surrogates in India cannot be hired by gay couples, single men and women, non-married couples and couples from countries where surrogacy is illegal. There is confusion on the status of babies to be born out of surrogacies already in progress and industry insiders point out that the Home Ministry should have made this clear as well.
But reports point out that the Home Ministry is merely trying to avoid diplomatic tensions with other governments caused due to the differing legal status of surrogacy in different countries. India has seen unexpected complications (See Express Healthcare edit: The Curious Case of Baby Manji http://healthcare.financialexpress.com/201112/editorial01.shtml) and it is only to be expected that the authorities take a firm stance. So does that mean that unless accidents at hospitals impact the nation’s standing overseas, Acts like the Clinical Establishment Act will remain toothless and in limbo? That is indeed a scary scenario.
Viveka Roychowdhury
Editor
