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Sunday, September 30, 2007

Bill to punish hospitals for turning away emergency patients

Private hospitals and practitioners will not be able to turn away an emergency patient if a bill drafted by the Law Commission takes the shape of a law.

The Commission in a draft bill on accident victims and emergency patients, which includes expecting women, seeks to make it binding on the hospital or the doctors to admit, stabilise or transfer, if required, to another hospital irrespective of whether victim can pay or has medical insurance or not.

The hospital cannot refuse the accident victim even on the ground that it was a medico-legal case and that it can be attended to only by a designated hospital of the jurisdiction, the draft bill says.

Under Indian laws, the case of a person getting an injury, whether by accident or inflicted, must go through the process of court. Thus, he can be examined and treated only by the designated government hospitals, which are usually few and far between.

The private hospitals turn away such patients as the treatment may be viewed by the court as interference in the process of law.

As a result many a patient battling for life lose it out as he is taken from hospital to hospital, without finding any medical help.

But private hospitals are also routinely turning away patients when they find the patients cannot pay, or does not have an insurance cover

The draft bill also requires the state government to frame a scheme of reimbursement of expenses to the hospital, or even an individual, incurred on the treatment or transfer of patient.

The bill also stipulates punishment for refusing to admit, treat or transfer a patient after emergency treatment to other hospital.

The Commission lays down the punishment of six months imprisonment along with fine of Rs 10,000 to the doctor or persons running the hospital if an emergency treatment is denied.

The punishment would be in addition to penalties prescribed by the State Medical Council or any other law in force.

While drafting the bill, the three-member Commission headed by Justice M Jagannadha Rao drew heavily from Emtala (Emergency Medical Treatment and Labour Act) - also known as Patient Anti-Dumping Act in force in the US.

Outlining the process of handling emergency patients, the bill stipulates that when a patient arrives at the hospital doorsteps, the doctor or the management under no circumstances will refuse treatment on the ground that it was a medico-legal case, or that the patient cannot pay for the treatment or does not have a medical insurance cover.

The doctors would immediately examine the patient to determine whether it was an emergency case or not and then as a first step taken in emergency cases, would stabilise the patient. If it is not an emergency case, the proposed law would not apply.

In case transfer is required, the doctor would obtain a "written informed consent" from the patient, in case he or she is in a position to, or from the relatives, as the situation may be.

While obtaining consent, the patient or relatives must be informed of pros and cons of transfer. The doctor or hospital's obligation under the proposed law ceases if patient in his senses refuses to be transfered.

Notably, the Commission in a separate draft bill has held the consent will not be considered an "informed consent" if the patient does not understand or know that refusal to be transfered can lead to death or some permanent damage.

As for the transfer process, the Commission says doctor would ensure sufficient medical support is provided en route for an unharmed transit of patient from one hospital to another. For this, the doctor would seek an in-house ambulance or call an ambulance.
In case ambulance is not available then he will seek the help of police to transfer the patient. If none of these is available, then a private person's vehicle may be sought for the transfer.

From Deccan Herald

Wednesday, September 05, 2007

Extension of Joining Time Illegal - Chennai High Court


High Court directive to Government on Assistant Surgeon vacancies

Special Correspondent

CHENNAI: The Madras High Court has directed the State Government to forward to the Tamil Nadu Public Service Commission, proposals relating to Assistant Surgeon (General) vacancies arising from non-joining of selected candidates.

Justice K. Chandru was passing orders on a batch of petitions filed by 15 doctors, who stated that the Government had granted “unlawful” extension of joining time to 215 candidates, who had failed to join within 30 days, as originally stipulated.

While admitting the petitions, the Judge had restrained the Health Department from allowing any of these 215 candidates to join duty.

Specific clause

Counsel for the petitioners contended there was a specific clause in the notification that selected candidates should join within 30 days, and that no extension of joining time would be granted under “any circumstances.”

They also pointed out that applications of 2,700 candidates were rejected because they had not given a declaration that they would join duty within 30 days from the date of receipt of appointment orders.

They submitted that the extension of joining time was given to the 215 candidates by unlawfully relaxing Rule 21(a) of the Special Rules for Tamil Nadu Medical Service. They said the vacant posts were kept idle contrary to the conditions prescribed in the notification.

Prevailing conditions in the State warranted immediate appointment of doctors, they claimed.


In its counter-affidavit, the TNPSC said it had requested the Director of Public Health and Preventive Medicine to send an elaborate proposal with the details of candidates who had not reported for duty. This was necessary for the Commission to allot candidates from the Reserve List, it said, adding no reply was received from the official.

Joining time

Mr. Justice Chandru said strict implementation of the clause relating to joining time by the Commission and the Government would create more vacancies, and might benefit the petitioners. He then directed the Director of Public Health and Preventive Medicine to forward the proposals, as required by the TNPSC, within four weeks from the date of receipt of the order.

For the latest information, please see High Court paves way for filling vacancies in PHCs