On Wednesday night, CNN-News18
broadcast a story which showed ICUs in some private hospitals in both Indore
and Bengaluru did not have an accredited intensivist or a critical care
physician, in charge and instead were being managed by Ayush doctors.
Employing Ayush doctors in
ICUs violates the Code of Ethics Regulations as prescribed by the MCI in
several ways and is a professional misconduct.
There are no ICUs in Ayush
systems of medicine. Hence, their practitioners are inexperienced and/or
ill-equipped in managing critically ill patients even with Ayush therapies.
Critical care medicine is a
highly specialized field that requires skills to diagnose and manage
life-threatening conditions in patients who may be already severely ill.
Minimum standards for ICUs to be adopted throughout the country have been
suggested by a committee in 2012 under the chairmanship of Prof MK Arora, Dept.
of Anesthesiology at AIIMS, New Delhi as below.
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Director /
Incharge
· Ideally an ICU must have a
full time director or in charge, with full time appointment or at least
dedicates 30%- 50% of professional time in ICU (2.1.1).
· Senior accredited specialist
in intensive care medicine with Postgraduate degree (PG) or equivalent
degree in anesthesiology or internal medicine
or surgery or critical care medicine. He should
have formal education/ training and
experience in intensive care medicine with preferably
5 - 7 years (full time) work experience in intensive/
critical care medicine. Available upon request on notice in the
hospital during "off duty hours (2.1.3).
Consultants
· Should possess MCI (Medical
Council of India) recognized postgraduate degree in (PG) or equivalent
degree in Anesthesia, Medicine or Surgery
or Physicians qualified in intensive care medicine (2.2.1.1).
· Should have minimum 3 years
experience after post-graduation of which 3-6 months experience in intensive/
critical care medicine (One with teaching experience in critical
care medicine is preferred (2.2.1.2)
Resident
doctors (Academic or non-academic or fellows)
· A minimum of two resident
doctors must be on duty in an ICU and they must be on duty for 24 hours x 7
days (2.2.3.1).
· One of the resident doctor
must be a postgraduate in anesthesia or medicine or surgery with minimum of 3
months (preferable 6 months) full time working experience in ICU.
The other resident doctor can be a trainee (Academic or fellow trainees after
1 years of training in their primary specialty and within the frame of their
specialty, work in an ICU under clearly defined supervision) (2.2.3.2).
· One resident doctor to take
care of not more than five patients (2.2.3.3).
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Any doctor who employs an
Ayush practitioner as an assistant is responsible for his/her actions. This has
been clearly stated in Regulation 7.18 of MCI Code of Ethics “In the case of
running of a nursing home by a physician and employing assistants to help him /
her, the ultimate responsibility rests on the physician.”
While 7.18 does not “restrict
the proper training and instruction of bonafide students, midwives, dispensers,
surgical attendants, or skilled mechanical and technical assistants and therapy
assistants under the personal supervision of physicians”, it does not allow
issuing directions to Ayush doctors with regard to patient care in ICUs during
rounds or otherwise. This would amount to training of training of Ayush doctors
in critical medicine and violates the provisions of Regulation 7.10, which
says, “A registered medical practitioner shall not issue certificates of
efficiency in modern medicine to unqualified or non-medical person”.
Employing Ayush doctors to
take care of patients in ICUs amounts to fraud, cheating and impersonification
on the part of hospital owners, medical superintendent of that hospital
including other doctors, if they are aware that Ayush doctors have been
employed. Moreover, this does not have the consent of the patients.
All doctors who assign them
duties including those who interview Ayush doctors to hire them in their
hospitals are also liable for professional misconduct.
As per Regulation 1.6 Highest Quality Assurance in patient care: “Every
physician should aid in safeguarding the profession against admission to it of
those who are deficient in moral character or education. Physician shall not
employ in connection with his professional practice any attendant who is
neither registered nor enlisted under the Medical Acts in force and shall not
permit such persons to attend, treat or perform operations upon patients
wherever professional discretion or skill is required”.
As doctors, patient safety and
care is our first and foremost concern.
The Govt., Association and
Regulators should take suo moto cognizance of this report and take appropriate
action.
Dr KK Aggarwal
Padma Shri Awardee
Vice President CMAAO
Group Editor-in-Chief IJCP Publications
Vice President CMAAO
Group Editor-in-Chief IJCP Publications
President Heart Care
Foundation of India
Immediate Past
National President IMA
