Friday, March 30, 2018

The battle is still far from being won; the struggle must continue

Dr KK Aggarwal
Padma Shri Awardee

The Union Cabinet has cleared some amendments to the proposed National Medical Commission (NMC) Bill, which will now be debated in both Houses of the Parliament. Will they pass the amended Bill or will the Bill be passed by vote of voice remains to be seen. IMA and all doctor MPs should continue their efforts to get more amendments done before the Bill is passed.

·         Final MBBS Exam to be held as a common exam across the country as an exit test called the National Exit Test (NEXT): This is a victory of all. IMA had proposed last year. Now, the students would not have to appear in a separate exam after MBBS to get license to practice. NEXT would also serve as the screening test for doctors with foreign medical qualifications to practice in India. It will make more doctors available to practice. The next debate ….Who will conduct the exam?

·         Provision of Bridge course for AYUSH practitioners to practice limited modern medicine has been removed. But it has been left to the State Governments to take necessary measures for addressing and promoting primary health care in rural areas. This is a win for both Modern medicine and AYUSH systems of medicine. Ayush will now be able to continue research in their disciplines. If they had entered modern medicine, as had been earlier proposed, their very existence would have been at stake.

·         Fee (including all charges) regulation for 50% seats in private medical institutions and deemed universities. More details are needed, or the private institutions will increase the fee for 50% of seats in crores. A solution to this can be to increase number of government and district medical colleges.

·         Number of nominees from States and UTs in NMC increased marginally from 3 to 6. The NMC will comprise of 25 members of which at least 21 will be doctors. Not been able to increase the seats of registered medical practitioners is a major failure on our part.

·         Only 5 representatives from the registered doctors in states, as suggested to be 9 by the parliamentary committee, is too low a number. It seems that the government does not want IMA or professional representatives to be a part of it. It will be our collective failure if we are not being able to challenge it. Only one representative from each zone or all five from all India elections will make it interesting?

·         Monetary penalty for a medical college non-compliant with the norms has been replaced with a provision for different penalty options (warning, reasonable monetary penalty, reducing intake, stoppage of admission leading up to withdrawal of recognition etc). This needs to be studied in detail.

·         Stringent punishment for unqualified medical practitioners or quacks: The punishment for any unauthorized practice of medicine has been made severe by including a provision for imprisonment of up to one year along with a fine extending up to Rs. 5 lakhs. It’s good that it is ‘AND’ and not ‘OR’. Once convicted the imprisonment is a surety. We need to study the loop holes further.

Our struggle was not only against NMC…It was but one of our many demands.

The battle is still far from being won.

We were also fighting for suitable amendments in the Clinical Establishment Act (replacing police representative from DRA with a representative of the association; exempting single doctor establishment; doing away with NABH inspection, suggestion with respect to standard treatment guidelines to be provided by IMA and to define the change in the word ‘to stabilise’) and PCPNDT Act (graded punishments and non penal provisions for clerical errors).

A stringent central act against violence and capping of compensation (to be based on the lines of Drug and cosmetic rules in a clinical trial and not based on annual income of the patient) have been on the forefront of our agenda.

We also need to continue to voice our demands for increasing the health budgetary allocation to 5% of GDP; introduction of IMS on the lines of IAS and implementation of MCI Code of Ethics 8.6 to decide professional negligence and misconduct and MCI-IMA recommendations on police actions as recommended by the Hon’ble Supreme Court in any alleged criminal negligence.

Our demands of omission of penal provisions on doctors during practice, uniform pay scale for service doctors across the country and better service conditions for doctors and patients in government hospitals still remain unresolved.

Any government listens to pressure.

Events like IMA Dilli Chalo or IMA Mahapanchayat should be a part of our annual calendar of events and should become the extraordinary general body meeting of IMA and FOMA.

We should continue to fight for our rights as well as that of our patients till we achieve what we set out to do when we embarked on this journey. Even Rama, Krishna, Jesus had to fight for their principles.

What shape the NMC would ultimately take may well depend on how steadfast we are.

All resolutions must be adopted and fought for till they are achieved.

IMA will be taking further call on its plan of action on 2nd April after meeting with the Health Minister. 

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