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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