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Karnataka Private Medical Establishments Bill - Facts and implications


 

 

 

 

 

 

 

By Dr Ashwini Nadahalli and Dr Ananya Tupaki-Sreepurna


Nov 16: This is a fact-based practical analysis of the proposed amendments to the KPME (The Karnataka Private Medical Establishment) Act. The sole purpose is to let the non-medicos understand the implications of these amendments. Before going into the details, it is important to know that:

1) This Act has been in effect since 2007, comprising all the rules and regulations to contain the unrestrained undertakings of the private medical establishments (PMEs) and prevent quackery.

2) If the intention of the State Government is to provide grievance redressal for the patients who have been victims of medical negligence or harassment, there are already existing bodies such as the consumer court, civil court and criminal court for the very purpose.

3) If the purpose is to provide affordable healthcare of high standards, we need to note that the Centre and State Governments spent 1.3% of GDP on healthcare in 2015-16 while the global expenditure on health care is 8-10% GDP.


Coming to the amendments that have been introduced to the original 2007 bill this year,

1. Is a committee comprising of the CEO of zilla panchayat, a Superintendent of Police, a public prosecutor/lawyer, a District Surgeon and only one PME representative with no lawyer for the accused doctor fair Indian judiciary? Is there a precedent for such a committee? Does this mean that the Consumer Court has thus far been an utter failure?

2. Section 9A of the amended Act deals with “fixation of cost of each health service or treatment” by the State Government Expert Committee “and different rates may be proposed for different class of PMEs”. There is a danger that the hardest hit from this would be the smaller PMEs in remote areas with no nearby Government hospitals while the larger corporates in the city may remain unscathed. How is this good for universal health care?

3. Furthermore, there is no clarification regarding the rates fixed by the State Government, the key members of the Expert Committee and the criteria used to make these decisions.

4. Section 10 of the KPMEA bill (2007) already ensures transparency of charges payable for different medical treatment and other services in the form of brochures or booklets and their display on notice board.

5. Section 12 (2017) deals with amendment of Section 11 (2007) which states “Every PME shall hand over in the event of the death, the body of the deceased immediately without insisting on payment of the dues. The same may be recovered from the representative of the deceased in due course” Can the State Government ensure the payment of the unsettled bills in such circumstances?

6. There is no practical advantage of changing the period of renewal of registration of the PME to every 3 years (from 5 years). In fact, they may lead to impeding of smooth functioning of the PMEs as a result of undue paperwork. A better alternative is to conduct more frequent audits and inspections.


Looking at the long term implications of these amendments,

1) They would lead to the practice of "defensive medicine", that is, excessive and repeat investigations and over cautious management in fear of future legal action by the doctors.

2) The two-way street of the patient-doctor relationship would be ruined on both sides.

3) In fact, they can adversely affect smaller nursing homes, private clinics and deteriorate the existing quality and availability of advanced technology in the bigger PMEs.

To conclude, focusing on the strict implementation of the original 2007 KPMEA by the State Government would result in the accomplishment of their true purpose to contain the escalating costs in private healthcare.

The real and ultimate solution would be to improve the conditions of the existing healthcare facilities in the Government setup where it is not uncommon to find rats scampering in the OTs (operation theatres).


References

• KPME ACT 2007, Amended KPME ACT 2017 from the Govt. of Karnataka website
• WHO Statistics

 

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Comment on this article

  • Mangalorean, Mangalore

    Sat, Nov 18 2017

    Most of the Doctors who have done thier studies on thier own MERIT are mostly genuine ...but most of the Doctors who have paid a couple of Lakhs or a few Crores of rupees for thier education...are the ones who try to squeeze money out of thier patients...

    DisAgree [1] Agree [1] Reply Report Abuse

  • Rajesh KR, Mangalore

    Fri, Nov 17 2017

    A profession is a personal choice, knowing the pros and cons.

    DisAgree [2] Agree [4] Reply Report Abuse

  • Af,,, Mangalore

    Fri, Nov 17 2017

    Is doctors file IT returns for thier all incomes,,if not need to be implemented immediately. bcos most of the doctors deels with hard cash.

    DisAgree [2] Agree [5] Reply Report Abuse

  • Flavian dsouza, chik/bengaluru

    Fri, Nov 17 2017

    Doctor is a very noble profession so dont think we have to dictate how much they should charge .
    They should have at least 20% time dedicated to poor /lower class and free of cost and that's good enough.

    DisAgree Agree [2] Reply Report Abuse

  • Robert Pais, Mangalore

    Fri, Nov 17 2017

    Yes doctors profession is a noble one . But so is almost every other position. In Western countries with so many checks and balances(regulations) still you find bad apples among doctors.
    Absence of proven medical malpractice in India does not mean malpractice does not take place.
    A hospital specialized in heart related matter in Mangalore would have been closed with it's Dil ka doc behind bars if the regulations we're implemented stringently.

    DisAgree [1] Agree [5] Reply Report Abuse

  • shan, dubai

    Fri, Nov 17 2017

    Don't think all doctors are bad...... We will find about 80 percent bad than we got also 20 percent good doctors..... During my last visit to Udupi my wife was have fever, cold. we asked the nearby any doctor is available and they directed me to the doctor. He was above 70 years old and he checked properly and without any test prescribed medicine and my wife was cured and for my surprise I asked his qualification and I found that he is MD and charged me his normal fee of Rs 30/-. Why we have treat all the doctors are cheats or commission agents?????

    DisAgree Agree [11] Reply Report Abuse

  • fred, Mangalore

    Fri, Nov 17 2017

    Every common man at one point has been to a govt hospital as well as private hospital. And we all know how good the facilities are provided in the private sector without/hardly any subsidy from government. Agreed that some clinics and hospital charges are on the higher side which may not be affordable to all and the only way to tackle this is to provide infrastructure in govt hospitals which will cater to the needs of the poor and the uninsured individuals. Which I can assure you all that it will not happen in a lifetime with allocation of 1.5% GDP. And in a state like karnataka which is a booming medical hub patients come from abroad too not only for the quality but also the affordability. This act may have the clause that appear " pro people" (the term used by proponents). But doctors are not the only ones working in hospitals. There are nurses, clerks, attendants, ward boys, security, and many more. And all these people do have lives of their own and need a decent salary to do so. I think government should take a opinion or discuss the issues so that the KPME ACT will not burden the private healthcare. Because doctors are also humans, and with the provisions in the given ACT there are very high chances of collateral damage. Many will move out or just retire whereas a few may select alternate profession where at least a lawyer can represent you in case of any adverse events. If the ACT comes into effect, over a period of time the quality of care In private clinics and hospitals will be on par with most of the government hospitals and people will be forced to go to other states or countries for the same treatment where doctors from karnataka itself would be probably treating them just because the policymakers did not think and the people did not act in time. Hope people will try to understand the long term effects.

    DisAgree Agree [12] Reply Report Abuse

  • Robert Pais, Mangalore

    Fri, Nov 17 2017

    It is heartening to know there is good debate and highlighting of issues relevant both end user ( patient, consumer, client) as well as the health care provider and their rights.

    1. government medical colleges get their funding ultimately from tax payers money. True , merit students are getting the seat. However the Colleges are funded by the government.

    2. I am in agreement with the view that through this act, there will be a flow towards younger and less charging doctors.
    3. Evidence based medicine may not be perfect but will be a necessity.

    We may not agree with every ones views but debate and clarification is a welcome thing. Accountability of health care providers is a must. I do not think IMA can be a body to resolve the dispute as there is conflict of interest.

    DisAgree [3] Agree [3] Reply Report Abuse

  • Troller, Manipal

    Fri, Nov 17 2017

    Continuation :
    Dear Philip Kadri,
    8. I agree that deceased body has to be handed over immediately. Most of hospitals in Udupi/Mangalore do hand over the body without first insisting on payments. Treating Human life is not like a mechanic repairing a machine, we have yet to identify many treatments for unknown illnesses and complications. Complications will require experience of multiple speciality doctors. Still patient may die despite all care by doctors. When patient dies and bill amounts to lakhs of rupees if the hospital does not recover the amount do you think any hospital in Karnataka will survive? Who will pay the nurses salaries,Electricity bills,Maintaining cleanliness for minimum infection, latest equipment to treat patients effectively? If govt is setting up committee to punish doctors, let them also create committee to punish patients family who does not pay the bill after verifying that doctor has taken adequate care of the patient.
    9. I agree that doctors have taken education from govt medical colleges. But how many of these are reputed? Govt already has conditions that rural practice to be done for few years and so on. If a doctor has spent 30 years of his life to get his qualification does it not mean that he too lives a quality life? Please remember that most of the doctors are the most brilliant minds who have worked hard to get their qualification. If you insist on doctors charging reasonable rates, whether any person will opt for medical profession? He might as well start a business instead of investing money on medical college fees and then live a comfortable life.
    10. Doctors do have accountability, any patient can file a case for medical negligence. It is nothing new.
    11. I sincerely request you to not consider doctors as next to god. They are normal people like me and you but have spent far more money and time in getting their qualification. We have to respect them for that.
    Contd.

    DisAgree [3] Agree [15] Reply Report Abuse

  • Troller, Manipal

    Fri, Nov 17 2017

    Dear Philip Kadri,
    I am not a doctor, but i hope following will answer your points :
    1. You have mentioned that some doctors receive kickbacks. Hence you agree that it is not the general condition of the health industry. Also, KPME Act is forcing harsh punishments for doctors negligence. If it contains such provision, doctor is forced to conduct all the necessary investigations because only these will save him in case the case is fought in a court of law.(As he can prove he has taken all necessary precautions).
    2. KPME does not have any solution to the issue of black money hence discussing this point under this issue is irrelevant.
    3. It is well known that senior doctors with good name and brand are charging more. But that does not mean he is the only doctor who treats the illness. Public can go for second opinion with another doctor with lesser experience whose rates are reasonable.
    4. Village doctors will be hard hit as per the article as fixing rates for charges will force the doctors to have multiple clinics to earn same income, in turn it affects patient quality. Even city doctors also will face the same issue. Finally it affects the treatment quality.
    5. There is no provision to control the Influence of Medical representatives on doctors. KPME Act does not mention any solution to this.
    6. Doctors do have moral and ethical right to go on strike as the govt amendment concerns their profession and livelihood. Govt has not considered their issues yet. Their only request is for Govt to consider their arguments. It is better to oppose before implementation than request for changes in provisions one bill is already passed.
    7. I agree easy legal remedy is required. But as per the KPME Act are the committee members qualified to take such decisions?After all they are dealing with harsh punishments. Hospitals may even be able to pay the committee members to get the doctors cleared of charges. Does this solve anything?

    DisAgree [3] Agree [16] Reply Report Abuse

  • Bollu, Mangalore

    Fri, Nov 17 2017

    It is very much a fact that individual doctors are sincere but the hospital management which is unscrupulous and greedy in their efforts to make money.Therefore doctors should fight the management of the clinic/hospitals they work for to do an ethical business.Many a times these managements bribe the doctors to keep their mouth shut.

    DisAgree [2] Agree [7] Reply Report Abuse

  • Philip, Kadri

    Fri, Nov 17 2017

    Dr Ashwini and Dr Ananya,
    May pls clarify following points.
    1. Doctors work as commission creatures: Not all, but many of them. They recieve the kick back from labs where they prescribe tests. Finally even unwarranted tests are prescribed.
    2. Doctors work as black money holders: Not all, Most of them don't give recipept. They don't show or disclose their income because most transactions are in cash.
    3. Doctors charge exorbitantly:Not all, Most of them. They charge as they like or wish to charge. Even in fish market, certain guidelines are followed. But not here.
    4. I disagree with your opinion that village doctors are hard hit. Actually in villages, doctor is like a family person. But in city areas, doctors squeeze more money.
    5. The influence of medical representatives on doctor is more in city areas than in villages.
    6. Doctors does not have the moral and ethical right to go on strike as they do now.
    7. Legal remedy is surely required in simple and easy way as proposed in this act. Every citizen cannot go to civil court or consumer court which is a tedious process.
    8. Every business has got its own risk. Similarly even for doctors there is certain risk of non payment in case of death. This risk is part of their business. It is not UpTo the government to ensure the payment in case of death.
    9. Most of the doctors have been educated from government medical colleges with negligible amount of fees. Hence they owe a lot to society and state. They have achieved their education from tax payers money. So they cannot always think that they are beyond law.
    10. Like any other profession, even doctors profession have to have some accountability.
    11. We see teachers and doctors as next to God. So let them behave accordingly.
    12. By increasing GDP allotment, you want to make doctors further rich, who are already billioners
    13. Village doctors, kindly excuse for my above comments. Not applicable for most of u.

    DisAgree [17] Agree [17] Reply Report Abuse

  • Dr Vidya Bhat, Mangaluru

    Fri, Nov 17 2017

    1.How many government medical colleges are there ?
    only few get on basis of merit.
    2.Doctors procedure charges cannot be fixed- like a restaurant.
    they may have to use some additional medicines , procedures during surgery. additional operation theatre time etc.-all that will add up to the cost of surgery.
    3.consultation charges can be fixed-- but if doctor spends more time for the patient for some complex disease he can charge more for the time spent.
    4.Doctors profession is no more noble- it is just a contract under consumer a pay money and buy it.
    5.Any procedure, transaction - you have to pay money first and then get it-
    gold/ land/ apartment etc rate is fixed- you dont ask for discount afterwards.
    but- doctor is expected to treat the patient first- and the patient bargains - or curses the doctor !

    DisAgree [6] Agree [17] Reply Report Abuse

  • Troller, Manipal

    Fri, Nov 17 2017

    Continuation :
    Dear Philip Kadri,.
    12. GDP allotment means government has to improve the government hospitals. Invest in infrastructure and equipment. Pay salary on time to Govt doctors,nurses and staff. If this is made efficiently then Mr Philip, you can go to govt hospital for treatment. Why would you prefer private hospitals? Let Government first run its own hospitals properly and later worry on the way private hospitals are run.
    13. Village doctors are also supporting this agitation as they know what the overall medical profession is facing due to such draconian amendment.

    DisAgree [4] Agree [11] Reply Report Abuse

  • Subrahmanya, Vancouver/Mangalore

    Fri, Nov 17 2017

    Any irregularities in the proposed bill can(not) be questioned in Court?

    When we AGREE that medial education is a business in Karnataka & elsewhere, WHY this CRY by govt about the MEDICAL services? Let the Govt provide Good services at Govt Hospital,s then there will be a good healthy competition in the field .

    Private medical services , we need to accept that "IT IS A BUSINESS " Just like imported Goods or Scotch, we have to pay for BETTER(?) services , BUT what is served better need to be informed to the clients.

    As well, some self imposed regulations by private doctors , example:"How many "Caesarean section/normal delivery" performed by them or record of how much ANTIBIOTIC amounts they prescribe By pharma company & price etc.." provide their expertise details to customers.

    DisAgree [2] Agree [12] Reply Report Abuse

  • vivek, hirebyle / abu dhabi

    Thu, Nov 16 2017

    very well written article from medicos .....but frankly speaking i did not understand it.....only i wish IN BETWEEN a Patient (Of course patient is always poor ) and a Multi specialty Hospital there must be a Authority which should work to take things balanced ...........and if government doing so ....i appreciate it ...

    DisAgree [3] Agree [15] Reply Report Abuse

  • Avinash, Mangalore

    Thu, Nov 16 2017

    Doctors profession is no more a noble profession. It's pure business. Children from rich families can only become Doctors as in involves crores of rupees.
    Firstly medical education system should be revamped so that the intelligent kids gets the chance to enter into the medical field.

    DisAgree [10] Agree [23] Reply Report Abuse

  • Rajesh KR, Mangalore

    Thu, Nov 16 2017

    Very true. Also I've heard that senior doctors working in one hospital are lured to another hospital with the assurance of MBBS or MD seat for their children. Isn't it a classic example of fraud? Where's nobility in all this. That seat should have gone to a deserving meritorious candidate.

    DisAgree [5] Agree [8] Reply Report Abuse

  • Dr Vidya Bhat, Mangaluru

    Fri, Nov 17 2017

    MBBS/MD seats cannot be given to anybody who wants it.
    They have to qualify NEET exam and be place in the merit list.
    ofcourse, there is caste based and language based reservation.
    they have to study long , hard working to be able to practice.

    DisAgree [5] Agree [9] Reply Report Abuse

  • Rajesh KR, Mangalore

    Fri, Nov 17 2017

    Dr. Vidya Bhat
    When did NEET start? Very recently isn't it?
    Are you contesting my claim? Isn't what I have written true?

    DisAgree [3] Agree [6] Reply Report Abuse

  • Dr Vidya Bhat, Mangaluru

    Fri, Nov 17 2017

    Before NEET- there was CET....
    anyway- doctors have to study for atleast 51/2 + 3 almost 10 years before they can start practising-
    their non medical batchmates would have been settled in life by then

    DisAgree [3] Agree [8] Report Abuse

  • Bollu, Mangalore

    Thu, Nov 16 2017

    If there was no government control the poor would have been left to the mercy of greedy few.No doubt all governments are someway corrupt.But they are accountable to voters every 5 years.But Doctors? Who knows whether Doctor was doing his/her duty properly when patient is not cured but dead only to leave his survivors to pay the huge bill to satisfy unethical conduct of doctors and hospitals?Nobody can blackmail the government and it is universal fact.

    DisAgree [15] Agree [9] Reply Report Abuse

  • shan, dubai

    Thu, Nov 16 2017

    Some of developed countries Dignity Health is one of several hospital chains that recently began using RP-VITA, which was jointly developed by InTouch Health and iRobot Corp. Nearly 1,000 hospitals in the U.S. and abroad have installed InTouch telemedicine devices, including about 50 RP-VITA robots. these robots will prescribe medicines to the patients..... In future may be demand of doctors may reduce.

    DisAgree [2] Agree [5] Reply Report Abuse

  • Kiran D Souza, Mangalore

    Thu, Nov 16 2017

    Why Doctor's? Everybody should become a doctor for themselves.....
    Be a doctor of your own because you yourself know what is happening to your body,
    Even if you explain to some of the Doctors, they may listen left as right or vice versa.
    So government should make it compulsory for citizens that Self protection & Treat yourself a basic fundamental law......
    Problem solved.....

    DisAgree [17] Agree [6] Reply Report Abuse

  • Rudolf Rodrigues, Mumbai

    Thu, Nov 16 2017

    Most basic things required for a common man i.e. housing, health, n education has gone much much beyond even of the higher MIG group in India!!
    With hospitalization fees, even for minor issues, running into lacs, which can completely ruin families financially is very very concerning n needs to be debated threadbare n a middle path agreed upon before finalizing the bill instead of being adamant or future generations of common people will be ruined!!

    DisAgree [2] Agree [9] Reply Report Abuse

  • Sreepoorna T S, Mangalore

    Thu, Nov 16 2017

    Looks like the KPME act 2017 is more a cover up of the Government's continued neglect of public health and medical education. While it can be argued that the object of the act is pro people it may end up hurting them as the authors of this article justifiably illustrate factually.

    DisAgree [2] Agree [25] Reply Report Abuse

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Title : Karnataka Private Medical Establishments Bill - Facts and implications


 
 
 
 

 
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