Last year, Oxford University Press published a book “Healers or Predators?”, a compilation of insightful articles by prominent medical personalities and social activists. A review of this book was published this week focusing on several critical areas of Indian healthcare delivery system that must be reformed for any improvement of the falling standard of medical ethics and doctor-patient relationship even after the enactment of the far-reaching National Medical Commission (NMC) Bill by Indian government (see the review at this link https://www.downtoearth.org.in/reviews/iatrogenesis-unbound-review-of-healers-or-predators–67614).
Among the most important problem areas in Indian medical system, wide-spread corruption in health regulatory bodies including medical councils and a bungling medical justice system where cases of medical negligence are kept languishing for decades in the Consumer Courts even though the Consumer Protection Act, 1986 (under which cases of medical negligence against doctors/hospitals are decided) contemplated that all cases in Consumer Courts should be decided as fast as possible within a period of only six months. As several authors have echoed, until healthcare corruption is eradicated and medical justice system, both by the peers in medical councils and by the consumer courts) is reformed assuring the ordinary people for speedy and equitable justice against the negligent medicos to restore public trust, the sagging image of doctor-patient relationship will not change.
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Chocking Supply side of Corruption :
Key player in this game of corruption is being ignored. Corporates, PSUs and Govt Dept who sign MoUs with Private Hospitals thus forcing their employees to take treatment at their empanelled hospital. Those do not take admission there are not reimbursed the expenses.
This MoUs are not at all legally complain, neither ensure safety, security and are big channels of corruption between Private Hospitals and the officials of this company. You see, they are not empanelling the public hospitals.
Following must be enforced through Judicial Order from Supreme Court through PIL, to save too many lives. CVC and Govts are not at all interested.
Following is my opinion:
Hospitals have marketing team which targets corporates so that steady flow of employees in form of patient, keep coming to them through Hospital. In turn, they give kickback from excess billing passed by medical section of corporates . They not only over charge to inflate the bill but practice unnecessary treatment and prolonged treatment
Corporates in turn ensure diverting their employees to those private hospital
By having loosely binding agreements, which neither binds either party to ensure safety of that employee from medical negligence and medical malpractice, both manage to escape from any responsibility and patient and his family is left to fend for themselves, while both of those make windfall by cheating the patients and company.
Employee ( patient ) become scape goat of corruption.
This corrupt arrangement affects crores of employee and their family members across the country as most major employers have tie up with private hospitals.
Understandably, Corporate MoUs thus are biggest source of Supply Side of Corruption in Medical Field and that supply side source to be choked by Governments to save thousands of innocent lives and prevent embezzlement of public funds into the hands of money minded private hospitals.
MoUs done by corporates and govt departments with private hospitals are teethless and useless in protecting their own employees from
I have given following suggestions to CVC and Delhi Government who should mandate departments under it to include in Corporate MoUs with private hospitals, for ensuring transparency and safety of beneficiaries:
1. Legal Compliance: MoUs should be complaint and incorporate provisions of 17th point charter of patients right and Medico legal provisions. have provisions with Medico Legal Backing, even to handle criminality under section 304A of IPC ( Delhi Govt’s MoU for e.g), like death of patient due to medical negligence, MoUs should bind organization to take actions on Hospitals legally for Malpractice and Misconduct.
2. Complaince with Patient’s right charter : MoUs should be complaint with charter of Patients’ rights. Just because companies are paying for patient’s treatment, does not mitigate rights of patients. In fact, companies have equal rights and duty to keep copy of medical records, if patient ( employee) has to be provided treatment at other hospital
3. Records of Patients compulsory to be shared :MoUs should make mandatory, to provide complete medical records of beneficiaries employees admitted as patient to organization signing MoU, so that same can be audited Financially and Medically as required. ( Copy does not cost more than 50 Rs to Hospital)
4. Records and Invoice to Employees ( patient) : MoUs should make sharing of invoices of treatment mandatory with beneficiaries patient along with Complete Medical Records of treatment alongwith corporate. Patient has right to know the cost of his treatment and all the details along with.
5. Video Recording of Consultation and consent should be Mandatory and should be shared with Patient and Organization
6. Empanelment of Govt Hospital : CVC should mandate organization to empanel atleast one Govt run Hospital in the City where private Hospital is empaneled
7. Authority to seek review from Govt Medical Officers : MoUs should have authority to seek medical review of case from Govt Hospital Medical Officers. That is govt must bind Public Medical Officers to give review of the case record of treatment at private hospital, received from corporate
8. MoUs should be easily accessible to the beneficiaries : and beneficiaries be given a copy, like the way Insurance Companies are giving whole book of policy. Corporates must be bound to display MoU on its website. Charter of rights already mentioned that rates of treatment should be publicly displayed.
9. Terms of MoUs must to be in lines of guidelines issued by MCI, time to time updated as per as court directives and they should be bound by them.
10. MoUs cannot supersede law of the land: Again, absence of provision in MoU cannot become umbrella to protect hospital’s and medical practitioner’s violation of law of land. That means, because some legal provision not included in MoU does not make legal binding, unbinding.
11. MoUs should be binding to force the corporate to Blacklist the Hospital and the Chain of Hospital, in case of criminal medical negligence.
12. MoU should make mandatory Third Party Medical Audit by specialist of equal rank, of the cases mandatory to ensure that Private Hospitals are not overcharging and doing wrong treatments and medication
13. Standard Universal Format across the country : All depts under CVC should be mandated to follow standard universal format of MoU issued by Central Government, with above terms and condition. Currently, each organization and each department does MoUs as per their convenience and benefits.
14. Grievance redressal Mechanism There has to be strong grievance redressal mechanism in MoUs to handle day to day complains or concerns of patient including escalation, against hospitals. It is surprising that we have grievance redressal helpline to handle anything, even a railway ticket, but not for saving of life of patient and their well being. In case, patient needs to complain, there is no standard mechanism defined anywhere which he can resort for handy help.
15. Quality of Service : MoU terms and Grievance redressal mechanism should ensure quality of service by Hospital.
16. MoUs should have authority to call for cancellation of medical license of doctor and hospital in case of his involvement in negligence and malpractice and also license of operation of Hospital
17. Each MoU with private hospital has to be submitted and approved by health department of state government and legally vetted by Govt. Unless this is done, it should not be considered as valid
18. State Government must order third party independent medical audits not involving health department of state for independent assessment of state of affairs under your Health Department.
19. Defined Penalty and Penal action of Corporate and Hospital for failure to comply MoU
In drafting whole MoU, Employee, Patient and its safety, security and well being should be at centre of whole theme.
I think, the purpose for which Govt Departments and PSUs are extending this facilities is to care for their employees and family and this CARE, SECURITY and SAFETY should be a centerpiece of these MoUs with Hospitals.
I also feel that Govt should bear cost of medical education, it should be free. That is worth in checking corruption and will have cascading benefits from checking corruption to improving healthcare. In the long terms it will give returns many times more then expenditure on it.
Each Patient Admission File should enlist Rights of Patients on one full page of the File Cover and patient should be asked to sign that he has gone through their rights.
Healers or Predators? For many Doctor’s there is no doubt that the answer is “Predators”. These predator’s are supported by a corrupt legal system. Witnessing the blatant negligence and corruption, makes me come to a conclusion that there seems to be no law against them. After committing murders these predator’s walk free – that is the state of the society!
My family is also a victim of medical negligence. I’ve started the petition “Medical Council of India, Lilavati Hospital: Cancel License, expel Corrupt Nephrologist Hemant Mehta, Prashant Rajput who killed my Mom”.
Will you take 30 seconds to sign it right now. Here’s the link:
http://www.change.org/p/medical-council-of-india-lilavati-hospital-cancel-license-expel-corrupt-nephrologist-hemant-mehta-prashant-rajput-who-killed-my-mom
Thanks!
Parag