Why Clinical Establishment Act is not a panacea for all that ails the medical profession

Healthcare services for the masses in India are pathetic to say the least. These services comprise of very few institutes of excellence , Gradually growing tribe of Corporate Hospitals in select cities , Government civil Hospitals and Primary Health Centres and the Private Small and medium Care Health Establishments (SMHCE) comprised of small hospitals, nursing homes and clinics. The major chunk of about 70% of the inpatient services (WHO data) and more of the outpatient services are provided by the private SMHCEs.

Clinical Establishment Act was brought with the aim to register all clinical establishments in the country. However during its drafting it became a draconian and monstrous anomaly of its original . Focus shifted from “How the Clinical Establishments are running in the country” to “How to stop Small Clinical Establishments from functioning in the country”. Unfortunately the geniuses who have drafted the Act in its current form have forgotten to create an alternative safety net before creating this situation where all small nursing homes in the country face closure.

Yes it is ideal that clinical establishments should provide quality services , have Fire NOC, Have consent from Pollution control Board under Air and water Acts, Take licence under explosives Act because they have to keep oxygen cylinders, under Boiler Act, to store spirit but it is quixotic to knowingly create a legal framework which no SMHCE can fulfil specially when there is no alternative which has been created to replace them. To fulfil the legal requirements it is possible only by increasing the administrative staff and by investing into non essential infrastructure or by bribing the inspectors of the 26 departments who have to be pleased under CEA and to fill the 17 registers required to be maintained under the Act. However whichever route is chosen by SMHCE who decide to stay in the profession, they will ultimately have to increase their charges and cost will be passed on to the patients which also under this Act will be decided by the Authorities.

Under RTI Medicos Legal Action Group has taken information from UT Chandigarh authorities regarding the health care establishments under it. Not surprisingly one of the large Government Hospital does not fulfil the statutorily required minimum standards under CEA. Disruption of healthcare services is not our aim but we need to create awareness that these standards which have been copied and pasted from documents of western countries are misplaced in Indian scenario. No home visit, no free medical camp in village, no eye camp can exist by definition under the CEA. Your polio campaign by going door to door could not have existed without registering each household where polio drops were administered under the CEA.

Medical care should not be costly. However when Government decides to dictate rates of procedures and consultation of professionals who have not availed any subsidy, or support from the Government it is a dangerous precedent for all other professions and industry. Private enterprise will be killed. SMHCE owned by doctors all over the country provide a check on these rates by providing a cheap alternative to the glitzy 5 star corporate palaces. Ultimately it is market forces which dictate what service provider can charge. Removing this reasonable competition in one fell stroke through this Act will give way to unbridled profit mongering by the business houses owning corporate hospitals

Seeking quality from the healthcare providers through CEA is not the Government’s intent. If that were so why would successive Governments try to bring in through the backdoor notifications that those who have not even qualified MBBS shall be registered in State Medical Council so that they can use modern scientific medicine. Large hospitals of AYUSH Gynaecologists exist in Maharashtra. MCI has stringent criterion for approval of MBBS colleges and these criterion become in-fructuous if non MBBS are to be given the same rights and privileges. Either the stringent criterion for starting MBBS colleges are superfluous and anyone with 100 crore to spare should be permitted to start MBBS colleges or non MBBS cannot have same rights and privileges as MBBS.

How promoting the corporate culture in a country where less than 1.5 % of the population has health insurance will improve the health of the nation is anybody’s guess. Government spending on healthcare is meagre 1.2 % of the GDP as compared to 16 % in developed nations. The intent of the CEA is pure and simple to close the small nursing homes run by gynaecologists/ surgeons all over the country so that all deliveries / caesareans / hysterectomies/ cholecystectomies are performed (at 3 times the rates) in the nearest corporate hospital. I could understand better if the Government increased its infrastructure and manpower ten times and then gave direct orders to close all nursing homes rather than do it through indirect route of forcing them to follow impossible norms under this draconian Act.

I have said it earlier and I say it again. Register Clinical Establishments, Grade them according to services provided. Encourage them to improve their Grade. But do not force the street vendor to computerise his billing system in conformity to Reliance Hyperstores.

Dr Neeraj Nagpal 
Convenor,Medicos Legal Action Group, Managing Director MLAG Indemnity,
Ex President IMA Chandigarh
Director Hope Gastrointestinal Diagnostic Clinic,
1184, Sector 21 B Chandigarh 
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