The Karnataka Private Medical Establishments (Amendment) Bill, 2017 and Church based mission hospitals – Some FAQs

 

Background

Most mission hospitals in India have been started with the sole purpose of meeting the healthcare needs of the poorest and most marginalised, especially in areas where healthcare is inaccessible.

Some of the characteristic features of Mission hospitals have been

  1. Holistic approach to healthcare – Mission hospitals have invested in healthcare personnel at all levels. Although doctors are trained. a lot of attention is paid to training paramedical staff – nursing, laboratory, aides, pharmacists etc. The model of healthcare being the responsibility of a team rather than being doctor centric is a striking feature of most mission hospitals. This is a good model to highlight because it focuses on holistic care and also does away with shortage of paramedical staff.
  2. Cross subsidy – The model of waiving off fees for the poor while charging the paying patients at different rates based on facilities offered is another feature of Church based hospitals. However it should be strongly emphasised that mission hospitals do not charge exorbitant rates even for the paying patients so the range of costs is not abnormally high.
  3. Rationale of care – Mission hospitals have followed rationale of care with standard treatment practices. Mentoring and teaching of young post graduates and junior doctors ensures that the same standards are maintained. The nursing and other paramedical staff also have practical experience in the mission hospitals
  4. Innovations and research – Church based mission hospitals have also been active participants in academics and research ensuring that they have been at the cutting edge for newer developments. The hospitals have not stagnated with old and out-dated methods.
  5. Rational salaries – Most Church based institutions have decent payscales for ALL staff. The hospitals are in a huge staff crisis because there is constant poaching from both government and charitable hospitals by corporates that offer exorbitant pay-scales but later put undue pressure on the staff to reclaim the costs. This is one of the reason quoted by doctors for performing unnecessary procedures and irrational tests.

FAQ#1 How do the KPME Amendments affect the Church based mission hospitals?

It is a pity that the Mission hospitals have either been very quiet around the issue of regulation or actively participating in protests with private hospitals. A lot of the apprehension has been due to miscommunication and false propaganda by the IMA and PHANA but that is still not an excuse. Most of the Church based mission hospitals will fall fit into the regulatory guidelines because of their basic principles of rationale of care and cost self-regulation. The regulations will be felt most strongly by those PMEs that are practicing irrational care and charging patients exorbitantly.

FAQ#2 Will doctors be penalised by the CEO of the Zilla Panchayat at the district level?

The members of the RGRA include the Deputy Commissioner of the district (Chairman), the District Health and Family Welfare officer (Member secretary), the district AYUSH officer, one member each from the IMA and one more association and one woman representatives with the authority is dealing with a grievance redressal. Atleast three of these members are allopathic doctors and no more than 1/3 are private medical doctors. This is to ensure that patients receive a fair hearing. The CEO of the ZP are is not part of this committee.

FAQ#3 Can this registration and Grievance redressal body (RGRA) cancel hospital licences?

For registration, the RGRA can set up an Inspection committee and either grant registration or reject within 90 days of the receipt of application. IF they delay beyond 90 days, the registration is deemed to be granted. It cannot reject an application without giving an opportunity for the applicant to be heard and without recording reasons for the rejection.

The RGRA, on its own, or based on any written complaint can inspect or ask Inspection committee to inspect and PME to make sure that it meets the registration standards. If it doesn’t, the authority will ask the establishment to remedy this within a period of time. (Also see FAQ#7)

FAQ#4 – Can the RGRA send a doctor to jail?

If the RGRA receives a complaint about non-compliance with patient’s charter or PME charter, it can investigate. If the complaint pertains to negligence, non-adherence of standard treatment protocols for treatment, procedures and prescription audits it will be referred to the Karnataka Medical Council (KMC). The KMC should enquire and report within 60 days. This time period will ensure that cases are not stuck with the KMC for years leading to unnecessary burden and stress for patients and/or families.

The RGRA has the power of a civil court and can summon and examine any person under oath, can produce documents and witness, can receive evidence on affidavits and ask for any public document. It has to dispose the complaint within 90 days.

FAQ# 5 Will all hospitals have to charge low rates which will make us bankrupt?

The KPME Amendments mention that there will be an expert committee to study (AND CLASSIFY) PMEs, recommend minimum standards of infrastructure, staffing and staff qualifications, recommend standard treatment protocols for treatments and procedures and prescription audit. They will also make recommendations for fixation of uniform package rates for each procedure and treatment covered under the Government insurance schemes. They will however call for objections, put out these recommendations in public domain and fix and notify only after that.

Every PME shall notify and make available schedule of charges for consultations, investigations, medical treatment, procedures, hospital charges and other services. This can be on a public website provided by the government, on the hospital website and/or on the hospital notice board in a  conspicuous place. A schedule of charges in the form of booklets or brochures should also be readily available.

The PME can collect an amount not more than that notified after providing an itemised bill. If the patient is eligible under the BPL scheme then no charges can be collected from the patient. If it is an APL patient, the government will reimburse 30% costs and the other 70% can be claimed as per the notified rates.

If there is an emergency, advance payment should not be insisted upon.

FAQ#6 – If a patient dies without paying, we can’t do anything. We will lose the money.

If a patient is deceased his or her body cannot be held until bills are settled. If it was a patient under the government schemes, then the money can be claimed from the government or legal proceedings can be filed against the representatives of the deceased.

FAQ#7 – If we make a mistake, we will have to pay penalty in lakhs

If PME fails to comply with the RGRA directives a penalty of 50,000 can be imposed and/or registration cancelled after giving the establishment an opportunity to be heard. If it is complaint about over-charging, a penalty of 1.5 times the overcharged amount can be charged after giving an opportunity for the PME to be heard. Of the penalty amount the patient is reimbursed the overcharged amount and the rest is deposited with the Arogya Raksha Samiti for public health activities at the district level. If the same violations take place for a third time in a year by a PME the RGRA can make a written complaint to the court for possible prosecution. If convicted, the PME is liable for a penalty upto 3 times the amount overcharged or 1 lakh, whichever is higher.

If there is a violation of the patients charter or PME charter, RGRA can impose a penalty of Rs. 10,000 for first non-compliance and 20,000 for second during a calendar year after giving the establishment an opportunity to be heard. 50% of this amount is paid to the patient and balance with the ARS. For the third complaint in a calendar year, the RGRA shall make a written complaint to the court. If convicted, the penalty is Rs. 50.000.

FAQ#7 – Everybody and anybody will start filing cases against us and we will have to spend all our time fighting cases instead of seeing patients
Whoever makes a false and frivolous complaint can be punished with a fine of Rs.10,000 by the RGRA. Only after exhausting the RGRA channels, the complainant can approach a court.

Dr. Sylvia Karpagam

Public health doctor and researcher

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