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Docs faced with critical question

mumbai Updated: Aug 29, 2012 01:40 IST
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Dr Himanshu Mehta, an ophthalmologist, is used to handling emergencies such as eye injuries sustained in an accident, at his nursing home in Juhu.

However, once the Clinical Establishment Act (Registration and Regulation) Rules are enforced in the state, his ophthalmic nursing home will also have to 'stablise' any patient who needs emergency care.

The Act makes it mandatory for all clinical establishments to stabilise patients - or provide medical treatment necessary to ensure (within reasonable medical probability) that the patient's condition does not deteriorate during transfer to a hospital - in case of an emergency.

"We help patients as good Samaritans, but the law makes us responsible for all emergency cases. If a cardiac patient is brought to me, I am not competent to stabilise him. It would not be fair to the patient either," said Dr Mehta, who has been running Vision Eye Centre for the past 15 years.

The Clinical Establishment (CE) Act, passed by the Centre, is likely to be adopted by the Maharashtra government in the winter session. Once it is enforced, it will override the existing Bombay Nursing Homes Amendment Act, 2005. The new law seeks to bring all health-related establishments - clinics, nursing homes, wellness and fitness centers -under its ambit.

However, many medical practitioners have opposed the mandatory stabilisation clause under the Act, saying that smaller establishments do not have the wherewithal to handle all emergencies. "We agree that there needs to be some registration of all establishments. Currently, there is no system to count or record the different kinds of clinics in the state. This will help identify quacks. However, we are opposed to the mandatory stabilisation clause," said Dr Shivkumar Utture, finance secretary, Indian Medical Association.

"Stabilising a patient is different from providing first aid to trauma patients. Legally, it could be interpreted differently and used against doctors who turn away a patient if they cannot treat him," said Dr Utture, who runs a nursing home at Matunga. He said 90% of clinical establishments including family physicians' clinics and are run by a single doctor with minimum infrastructure. They often do not have ambulances or paramedical staff to accompany an emergency patient to a hospital.

A 2011 study by Centre for Enquiry into Health and Allied Themes (CEHAT), found that only 62% of the hospitals surveyed in Mumbai provided emergency care. "Accident cases are usually medico-legal cases and the overall reluctance to register them and get involved could be one reason why hospitals may be reluctant to provide care in accident cases," the study said.

However, government officials said that the fears of doctors were unsubstantiated. "The state will provide free ambulance service by next year. Doctors need not worry about providing ambulance services. Besides that I think patients are not so ignorant that they will take an accident patient to a skin specialist. I think their fears are unfounded," said state health minister, Suresh Shetty.

The health care industry in the city is also grappling shortage of nursing staff (see box) and maintenance and quarterly submission of patients' records.

Different associations have made representations to the health ministry and discussions are on. It is likely that the law may come into force with modifications as done by other state government such as Andhra Pradesh.