Friday, January 25, 2019

On this Republic Day, what constitutional amendments do we need in health sector?

Tomorrow, the whole country will celebrate the 70th Republic Day, which marks the day when the Constitution of India first came into effect on 26th January in 1950. The Constitution was first adopted by the Indian Constituent Assembly on Nov. 26, 1949, which is observed as the “Constitution Day”.

Amendments are needed to keep pace with the changing times and conditions. This is how the constitution evolves and also how we evolve as individuals and as a society.

The medical profession is going through difficult times. Somewhere along the years, the image of this noble profession has been damaged; trust, which forms the foundation of the doctor-patient relationship, has corroded and must be restored urgently.

The medical fraternity has been awaiting action from the Government for their various demands for the last few years.

On the eve of this national celebration, here are few constitutional amendments that we need with regard to healthcare.

This is an open letter to the Prime Minister and the Health Minister seeking their intervention to expedite matters in this regard.

1.      No penal provisions for clerical errors in the PCPNDT Act: There is a need for amendment in the PCPNDT Act by which only acts relating to sex selective abortions are penalized and acts such as “clerical errors in Form F, not wearing of apron, non-display of notice board, not keeping a handbook on the PCPNDT Act” should not be equated with criminal offense. Currently, the Act provides for equal punishment for sex determination and aforementioned clerical errors.

2.      Health insurance should be a “must” and not an “option”: Everyone should have health insurance. Govt./PSU employees are automatically insured; corporates also have their insurance policies. Yet there are many who still do not have a health insurance. Ayushman Bharat, launched last year, envisages taking care of more than 50 crore, is a welcome initiative. The govt. should provide 100% insurance in general ward category; those who want private care, higher than this, should opt for private insurance. Once 100% people are insured, health care will become affordable over time to everyone. Treatment costs will automatically reduce. Ayushman Bharat should be implemented across the country and be made mandatory for every hospital.

3.      One India-One Health Policy: Similar to the Goods & Services Tax (GST) which stands for “One Country, One Tax”, there should be “One India-One Health Policy”. All public health initiatives or national health programs need to be routed through the states.

4.      One drug - One company - One price: Uniformity in pricing of medicines in India still remains a distant dream. The answer to high cost of drugs is a “one drug-one price-one company” policy and the govt. should ensure that the manufacturers market drugs under this policy. This has been a major demand of the medical fraternity for quite a long time now.

5.      Central law for prevention of violence on doctors and health establishments: Violence against doctors is escalating across the country. Enactment of a stringent central act against violence making violence against doctors a non-bailable offense punishable with up to 14 years imprisonment on the lines of abatement of a murder is an urgent need of the hour. This was also a recommendation of the inter-ministerial committee in 2015, which is yet to be implemented. About 18 states have acts against violence, but unless there is amendment to the CrPC and police manual through a central act, the state acts could still be weak and ineffective.

In his speech on the occasion of the centenary celebrations of Sabarmati Ashram in Gujarat in June last year, the Prime Minister Shri Narendra Modi had addressed the issue of violence against doctors. “If a patient dies due to an unsuccessful operation, relatives burn down hospitals and beat up doctors. An accident is an accident. When people die or are injured in accidents, a group of people come together and burn vehicles,” he said (Indian Express, June 30, 2017). He had also taken a clear stand against violence, when he had said, “No person in this nation has the right to take the law in his or her own hands in this country.” We still await these words to come to fruition.

6.      Amendment of Section 152 IPC to also include doctors: Section 152 of The Indian Penal Code protects public servants from assaults. It states: “Whoever assaults or threatens to assault, or ob­structs or attempts to obstruct, any public servant in the dis­charge of his duty as such public servant, in endeavouring to disperse an unlawful assembly, or to suppress a riot or affray, or uses, or threatens, or attempts to use criminal force to such public servant, shall be punished with imprisonment of either description for a term which may extend to three years, or with fine, or with both.” A similar immunity should be provided to doctors, so that they can work with a free mind without the fear of criminal prosecution.

7.      Capping of compensation: There is a need for amendment in the Consumer Protection Act to cap the maximum allowable compensation awarded in any case of medical negligence. Sometimes, compensation is awarded on emotional grounds and sometimes multiplier method is used to award compensation.  There is capping of compensation in sterilisation failures and related deaths, deaths due to natural calamities, plane crash/ train accidents, death occurring in the course of clinical trials etc. so why not in medical negligence cases.

8.      Amendment in Clinical Establishment Act: The CEA Act should be amended to exclude single doctor clinic, family doctors and general practitioners from the purview of the CEA and to facilitate single window registration of medical establishments.

9.      National list of essential devices, equipments, disposables and reagents: Similar to the National List of Essential Medicines (NLEM), a National list of essential devices, equipments, disposables and reagents should be created. It is only through such a list that the govt. can cap the cost of essential drugs.

10.    Uniform age of definition of child under POCSO, for marriage, juvenile act, etc: The POCSO defines child as “any person below the age of 18 years”. The legal age of marriage in India is 18 years for girls and 21 years for boys.  The voting age is 18 years. The legal drinking age for alcohol varies from state to state and ranges between 18 and 25 years. There should be a uniform age of definition of child.

11.    Nationalization of disease treatment protocols of diseases of national importance: To eliminate or eradicate diseases, all health programs in the country and diseases of national importance such as TB should be “nationalized” with uniform diagnostic and treatment protocols across the country, whether in the govt. sector or private sector. The only difference may be that in the private sector, the doctors can charge their consultation fee.

12.    Pay parity in govt. and private sectors: A uniform pay scale across the country, in both the govt. and private sectors should be implemented.

13.    All doctors should be covered under CGHS: Not just govt. doctors, doctors in the private sector too should be made beneficiaries of the Central Government Health Scheme (CGHS) and be allowed to seek treatment in empanelled hospitals.

14.    Health in concurrent list: Public health is a state subject. This has been the reason for discordance between the state and the center, when any centralized healthcare scheme is rolled out. The government must pass an ordinance to bring health under the concurrent list.

Dr KK Aggarwal
Padma Shri Awardee
President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Past National President IMA

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