The Purpose of licensing / registration in healthcare
Sometimes I wonder what is the purpose of registration of doctors under the Indian Medical Council Act or State Medical Council Acts ? By the same token the question also arises what is the purpose of registration of establishments under Clinical Establishment Act , PCPNDT Act, Transplantation of Human Organs and Tissues Act, or a blood bank under Drugs and Cosmetics Act. The sole purpose to my mind is to have the power to cancel the registration in case of a misdeed , professional negligence , clerical error, or procedural lapse done by those registered under these Acts. However the question arises that should cancellation of such registration matter ? To the law abiding it causes severe distress and financial loss but only because they are law abiding and have invested time, money, effort , and sacrificed their youth to attain these registrations.
However when we look around ourselves we find that the rights and privileges of those who are registered legally under these acts are not defended by the very authorities who register them. You do not need to be registered in a state medical council under the Indian Medical Council Act to be appointed to office of physician in Government or to be entitled to sign or authenticate a medical or fitness certificate or any other certificate required by any law to be signed or authenticated by a duly qualified medical practitioner. To be an Authorized medical attendant empanelled with various public sector enterprises you also do not need to be registered under IMC Act.
Though a clause in IMC Act mentions some mild punishment (slap on the wrist) for those who practice modern scientific medicine without registration but to an application by MLAG, Medical Council of India under RTI replied that it does not have any data regarding those punished for violation of this law. It does however have voluminous data on doctors who have been prosecuted by it on its website and same is the situation with State Medical Councils. Given the soft approach towards those who blatantly break the law should it matter that those qualified get themselves registered. Look around you once to find innumerable quacks, RMPs, Bengali doctors , pharmacists and Crosspaths who are rampant and proliferating with each passing day. If you do not need an MBBS degree to practice Modern Scientific Medicine, let the regulators and the judiciary stand up and say so.
Another aspect is that with the current law of cumbersome re registration in place , the Punjab Medical Council which has 49395 doctors registered under it has listed only 16662 as eligible to vote. The corollary being the rest of 32733 doctors are either dead, or living abroad or practicing without valid registration. Even IMA has given reply in parliament that about 80% doctors registered with it are currently practicing (with or without valid registration). The thrust of the power used by medical councils is against private doctors nearly all of whom have wilted under the whip of the state medical council and complied with the law by re registering. Most doctors working in institutes or in Government services once registered do not opt for re registrations. If a doctor continuing to practice medicine without mandatory 5 yearly registration is an illegality then it cannot be selectively enforced only on a special group.
Those who wish to do illegal sex determination in mobile ultrasound clinics obviously do not register themselves under PCPNDT Act. Dr Amit Kumar did close to 600 (that are known) odd illegal paid kidney transplants in different states not by getting registered under TOHOA. The “nursing homes” where illegal second trimester MTPs or amputations for begging are conducted are obviously not registered under any MTP Act or Nursing Home Registration Act. But what action is taken by those in authority to check these illegal establishments; None. Dr Amit Kumar was arrested number of times and granted bail or released by police all with help of money. It actually makes financial sense to run a clinical establishment illegally and pay the inspectors and the regulators the bribes rather than try to follow the innumerable standards and fulfill the criterion for various registrations and the 27 licenses needed to run a small nursing home.
Let registration of qualified doctors not be a tool to harass them only. Let it also give them the privileges of being registered. If there is no deterrent for those who practice without registration then the incentive to get registered goes. To those who practice illegally with impunity the authorities like State Medical Councils, Appropriate Authorities under special Acts are toothless paper tigers. Unless strong action is taken by the regulators against those who are not registered with it, they lose the moral right to police those who are. Government, judiciary and administrative machinery has often used the stick to make Doctors fall in line without first giving them their rights and privileges due to them. Till that time law of natural justice demands that the "License-permit Raj" in healthcare be dismantled ASAP.
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
09316517176 , 9814013735
Forwarded as received
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