By
- Dr. (Prof.) Mahesh Baldwa,
M.D, D.C.H, FIAP, MBA, LL.B, LL.M, PhD (law)
Senior Pediatrician & Medicolegal Advisor
Formerly Assistant Professor of Pediatrics at T.N. Medical College and Nair Hospital, Mumbai-8
Ex. Asst. Professor JJ Hosp, Grant Medical College
Ex. Professor, paper setter & examiner of law to postgraduate students of University Department of Law, University of Mumbai
Baldwa Hospital, Sumer Nagar, S.V. Road, Borivali (West) Mumbai 400 092
- Dr. Sushila Baldwa, MBBS, MD, consultant, Apollo clinic (part of Apollo Hospital), Kandivali West, Mumbai
- Dr Namita Padvi, MBBS, MD, DNB, PGDML, Emirates Hospital Dubai
- Dr Varsha Baldwa, MBBS, MD, PGDML, P.D.Hinduja Hospital, Mumbai
Introduction
At 1.4% of the GDP, India’s public health expenditure is among the lowest in the world. Almost 70% of the health spending is by people bearing their own expenses. Regulations are a must to streamline processes and it must be done by regulators as well as doctors to ensure patients always come first.
The debate starts on ‘cut practice’
The debate on the cut practice triggered after Asian Heart Institute in Bandra Kurla Complex put up a hoarding near the airport that stated ‘Honest Opinion. No Commission to Doctor’. Many doctors took offence and the Indian Medical Association demanded that AHI should pull down the hoarding as it suggested all other doctors are into the unethical practice.
The nine-member committee on ‘cut practice’
The nine-member committee working on the legislation recently submitted the first draft to the state’s medical education department. The committee will be headed by former Director General of Police, Pravin Dixit. The committee consists of Dr Avinash Supe, Director of Medical Education and major BMC hospitals; Dr Sanjay Oak, Director of Prince Aly Khan Hospital, Byculla; Dr Abhay Chowdhary, President of Maharashtra Medical Council; Dr Ramakant Panda, Vice Chairman of Asian Heart Institute, Mumbai; Indian Medical Association (IMA) representative, Dr Yeshwant Amdekar, pediatrician; Dr Amit Karkhanis, dermatologist; and Dr Himmatrao Bawaskar, Mahad.
Tentatively name of ‘cut practice’ law
Tentatively named the “Prevention of Cut Practices in Healthcare Services Act, 2017”, the legislation is being framed to clamp down on unnecessary referral of patients by a doctor, hospital or a diagnostic centre.
Draft law on cut practice
The draft law says the Act aims to prevent and regulate the existing system of commissions, inducements and cuts in the professional fees taken by healthcare service providers of all systems in Maharashtra. The Act also strives to regulate and streamline the existing system of functioning of the healthcare service providers in the State. Cut is a form of commission offered to a doctor by another doctor after a patient is referred for check-ups, diagnostic tests or surgeries.
Ambit of cut practice
A doctor or medical institution will face an inquiry by the anti-corruption bureau (ACB) if a complaint is lodged against them under section 3 of the law that defines the offences of “cut practice”.
The ACB is expected to check the veracity of the complaint and complete the investigation within three months. It can seek additional time of three months. A provision of fining bogus complainants has been made. After a probe, the ACB will file a complaint before the session’s court, which will try the case under the Code of Criminal Procedure, 1973. Till the inquiry is complete, anyone trying to malign the reputation of the doctor or the healthcare service provider shall be liable to one month’s jail.
Highlights of cut practice law
The draft rules also call for simultaneous action from the respective medical council under which the doctor or the hospital is registered. If a medical professional or a hospital is found guilty, the council shall take cognizance of such offence and initiate an inquiry into the case within six months of the receipt of the FIR. It should take appropriate legal action and may also suspend the guilty for at least three months.
Bias in observations
Let me start with the observation that the perception of the government about the doctors in the state who are serving the society is highly biased.
According to chapter 1 on definitions in your proposed act, clause 2(a) authorizes anticorruption bureau as an appropriate authority. Probably medicos are the only professionals belonging to private sector in the state/ country brought directly under the jurisdiction of ACB. Was it really necessary when there are provisions in the state or national medical councils where implementation of existing provisions could have been reinforced?
- Clause 2(b) says that such cases will be conducted in session’s court only and not in smaller courts as if doctors are criminals of highest order!!
- Clause 2 (d) mentions acts of various councils of branches of medicine except acts of councils governing Ayush branches indicating bias of those who are drafting this act towards doctors practicing modern medicine.
- Again clause 2(e) mentions all councils of modern medicine but does not mention any council of Ayush practitioners!
- Chapter 2, clause 3(1) b, discusses referral by one doctor to other. All such referrals are looked at suspiciously but excludes internal referrals in a multi-speciality (corporate) hospitals. This shows the bias against small hospitals which have served the society sincerely for 7 decades since independence and now suddenly look doubtful in character to the law makers.
Suspicion ‘intention’ of cut practice may become source of harassment
Patients can complain on the suspicion of ‘intention’ of the doctor of indulging in cut practice. Unfortunately no scientific method has ever been devised to judge ‘intention’. Thus smell of intention can be a big source of harassment to doctors.
Trial of cut practice cases
“Cut practice in medical services is an offence and would be charged under cognisable offence tried by JMFC, 1st Class.
Repeat offenders
Any person, who indulges in such acts repeatedly, would be treated as repeat offender.”
Other pathy doctors
Veterinary doctors, occupational therapists and even dentists will come under the purview of the law. Interestingly, the rules are silent on alternative medicine practitioners, such as homeopaths.
Punishment for ‘cut practice’
A preliminary draft of the proposed legislation against “cut practice” has recommended a jail term of five years and penalty of up to Rs 50,000 against doctors indulging in unethical means to exploit patients.
Objections on cut practice law and induction in assembly
The proposed legislation will be made available in the public domain before its finalized and tabled in the Maharashtra state Assembly.
Sooner or later law on cut practice will affect you as well
One should remember once draft rules against ‘cut practice’ recommend 5 years in jail for doctors in Maharashtra soon same law will also come to your state also.
