Chief Minister Siddaramaiah doing North Korea's Kim Jong Un proud with his KPME amendment act.

Let me start this article by posing this question:

Do we need to regulate Private Medical Establishments & Private Practicing Doctors?

The simple answer is a resounding “Yes”.

Private Medical establishments have not covered themselves with glory; we have witnessed how unscrupulous the system has become with eye only on Return on Investments,profits and economics of scale, treating patients as just a number on their balance sheets, especially among the big corporate hospitals. Do you really think the big corporate who run hospitals can substantiate their present ICU costs of Rupees 75000/- to 150000/- per day? The answer is “No”.

Smaller Hospitals are not far behind, Karnataka State Government received “suo motto” notice from National Human Rights Commission in the year 2015 for deliberate misconduct by private hospitals in Kalburgi. The situation was similar to what had happened in erstwhile Andra Pradesh, unsuspecting poor villagers & tribals were instilled with fear of Cancer of Uterus & medically untenable Hysterectomies performed. In some cases they were done on women as young as 20 & typically all these were done after harvest season. Amongst medical circles it got the moniker “Uterus Harvesting”. Now that is a criminal act and those doctors/PMEs have been rightly punished.

Above are 2 examples where private healthcare establishments have failed the society, we will find more if we go by many anecdotal instances that are brought to our notice regularly & also if we pick up the grievances pending in Consumer courts and regular courts.

Not withstanding the above; on a day to day basis we will also find numerous examples of yeoman service that private establishments are doing and continue to do; being a doctor and a key team member of many lifesaving missions, I shall take the liberty of discounting all those good jobs done by my fraternity till now, in the clause “Part of the job”.

Yet, when self-regulation becomes inconsequential & unscrupulous behavior of a few begins to affect the quality of life of society, as in this case; it is the job of government & PMEs together as primary stake holders, to intervene and bring in legislation or self-regulation for the benefit of all stake holders. In the case of Health sector it is more important as Private Healthcare caters to nearly 75% of the population & fills the gap, which let us face it, government setup can never fill at this juncture.

All Doctor & private Medical Establishment forums in the state of Karnataka, are willing to work with Government and its agencies to bring in the much needed regulation. The dialogue happened for nearly one & half years and a clear unwritten understanding was reached too; however, for reasons best known to Health Minister & Chief Minister, the Justice Vikramjit Sen Amendment to KPME act has been tabled in winter session of Karnataka Assembly in 2017 unilaterally without including any changes/modifications which Doctors/PMEs wanted.

The Medical Fraternity wants more teeth to self-regulation; it wants government to give more powers to Medical Council Redressal Cell, while the government on its part wants a grievance redressal cell created as part of KPME act where Zilla Panchayat CEO is given the powers of a Civil Judge in every district. This is untenable to Doctors  and PMEs. Medicine is not a perfect science like mathematics & same treatment on similar subset of patients is known to produce variable to different diametrically opposite results. This needs to be judged by a peer group who can understand the clinical situation better than say a Zilla Panchayat CEO who has no medical education. This Grievance Redressal Cell is nothing but a Kangaroo Court put up with unexplained vindictiveness of present Health minister & Chief Minister of Karnataka. This move would suit a country like North Korea with dictators like Kim Jong Un and not in our mature democracy, if we consider ourselves as one.

I would also like to bring to your notice that there are already various grievance redressal mechanisms already available for our patients (now consumers) including consumer courts & regular courts apart from Redressal cell in MCI & states.

1)      District Forum headed by a judge

2)      State Commission headed by a High Court Judge

3)      National Commission headed by a Supreme Court Judge

4)      State Medical Councils

5)      Medical Council of India

6)      Civil Courts

7)      Complaints under various Sections of IPC 1860

8)      Complaints under Monopolies and Restrictive Trade Practices

9)      Public Interest Litigation

All of the above forums have been quite active, especially since the debacle of Kalburgi in 2015 and there is increased civil society activism led by NGOs claiming to be looking after patient interests. Personally, I am very much in favour of strengthening these above forums instead of creating another Grievance Redressal Cell headed by a ‘person-ignoramus’. The question we need to ask is why is Siddaramaiah Government hell bent on creating such a forum, is it to provide alternative routes of income to the political leaders in Zilla-Parishad local bodies? With the formation of this Grievance Redressal Cells these petty political leaders can now create trouble and sit on judgement for the same regarding Doctors/PMEs.

The Consumer Protection Act 1986 was a body blow to medical profession when Supreme Court in its judgement declared that Patients are “Consumers” and brought our profession under the ambit of CPA. This has over nearly 2+ decades led to a culture of litigation by patient and patient attenders (of course the changing times also aided it), led to protective practice and increased investigations by Doctors/MEs and also commercialization with corporate setups.

The Government on its part has made issue complex by charging water, power, pollution board services & all other services at commercial rates. Imported lifesaving medical equipment are in some instances taxed at 200 – 300% of cost to fill its coffers, service taxes are the highest among-st all services. The question that we need to ask is; if India practices free trade – why regulate fees in medical sector after charging everything to the sector at commercial rates? How can service costs be fixed by the government when the burden of running it is on private parties?

Today a Hi-Tech hospital requires minimum of 5 years to start earning money until then it is mostly running on losses and money pumped by entrepreneurs or corporate. Is it right on the part of the government to regulate fees in a sector where survival itself is difficult for new entrants? Are the political masters playing to the will of their old corporate Hospital buddies, so that new entrants find it more difficult or better still not enter at all. So that they can eventually they can play the monopoly game? Whatever be the motive it looks more sinister than the simplistic explanation of “looking for benign interests of patients tone” to me.

The question “why Government Hospitals are not included to be inspected and judged by the newly formed committees & grievance redressal cell?” needs to be answered by the Health Minister and CM. It shows that the motive is to subjugate the hitherto private health sector under the might of all powerful government. It reminds me of Indira Gandhi taking over private banks in a single act, it is to remind us poor Doctors that our life and earnings are subject to approval by politicians who run the government who are as of today beyond any reproach. It is a declaration by those politicians in power that; in our democracy all are equal but we the special ones are more equal. This KPME amendment is actually asking questions on the health of our democracy and informing all people that ‘we the people’ stand exposed and are powerless in front of the tyranny of ruling politicians.

At a time when Chief Minister & Health Minister should be more worried about the crumbling infrastructure of government health apparatus they are involved in destroying a system which is providing the much needed support to public. If he cares, Mr Siddaramaiah should make it compulsory for all Government officials starting from himself to get healthcare from Government hospitals only. He should improve the paper movement of Insurance in government hospitals, does he even know how long it takes for Aroghya Bhagya patients to get effective treatment from the point of their first OPD, Mr Siddaramaiah; if you are truly concerned about poor patient welfare, you should implement patient charter in all government hospitals. Basically you should take up the cudgels for providing clean, affordable, competent medical care to patients in government hospitals or let the government, yourself and the Health Minister be tried for a few culpable Homicides for deaths due to lack of infrastructure in Government hospitals.

On their part, for Doctors and PMEs this is a wake-up call to bring in better self-regulation to improve the perception about them among common people.

I state this today with lot of conviction & responsibility “the healthcare indices of our country and the mean survival age of people has improved largely due the efforts of Doctors  and PMEs” and less due to government driven healthcare.

I request all readers to visit your nearest government health setup it could be a PHC, a Taluk Hospital, a district Hospital or a Center of excellence run by government give suggestions to government to improve the same and follow it up to check if anybody in the government system cares. Now do the same in a private setup – see the difference in approach of both. Now imagine a day when Private hospitals have closed down due to the reckless imprudence on the part of government which you voted.

As your friendly neighborhood Doctor I am telling you at this rate “that day is not far away”.

Finally as a parting shot: A little bird in state Congress corridors of power informs me that a certain Superspecialist Doctor of an important Corporate Hospital who also happens to be son in law of an ex minister in present government is negotiating with power brokers of Congress for Rs 400 crores as settlement to not bring this amendment. Is it true Mr Siddaramaiah?

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The above article is available unedited on my blog

An edited version of this was published by Swarajya Magazine on 17th October 2016