Medico Legal and Ethical Issues

One need to be scientifically ethically legally and morally correct

Legal update

1 The Surrogacy Writ Petition titled as Jayashree Wad versus UOI amp Others pending before the Honble Supreme Court was listed for hearing on 27042016 Mr Rahul Gupta Advocate appeared in the said case on behalf of IMA In the said case an impeladment application has been filed on behalf of IMA The Honble Supreme Court of India has held that all the matters relating to surrogacy will be heard once the Assisted Reproductive Technology (Regulation) Bill 2014 is enacted as an act of Parliament with or without modification as may be

2 The matter titled as MCI versus Dr Meenakshi Gautam pending before Delhi High Court was listed for hearing on 28042016 Mr Rahul Gupta Advocate appeared in the said case on behalf of IMA In the said case an impleadment application has been filed on behalf of IMA and notice has been issued on the said impleadment application by the Honble Court The next date of hearing of the said case is 19072016 for arguments

3 The matter titled as Pfizer Limited versus UOI relating to FDC was listed for hearing on 02062016 before the Honble High Court of Delhi Mr Rahul Gupta Advocate appeared in the said case on behalf of IMA In the said case an impeladment application has been filed on behalf of IMA The jugdement in the said case has been reserved

4 The matter titled as Indian Radiological and Imaging Association versus UOI amp Anr SLP (C) 110462016 was listed for hearing on 29042016 The Honble Supreme Court of India has only issued notice to the other party in the said case An impeadment application on behalf of IMA has to be filed in the said case The next date of hearing is 26072016

5 The matter titled as Karnataka Beedi Industry versus UOI was listed for hearing on 04052016 Mr Rahul Gupta Advocate appeared in the said case on behalf of IMA In the said case an impeladment application has been filed on behalf of IMA The Honble Supreme Court of India has been pleased to transfer all the pending petitions relating to 2014 Rules before the Honble Karnataka High Court Also the Honble Supreme Court has not granted any stay on the 2014 rules

6 The matter titled as Baharul Islam amp Others versus IMA Assam Branch amp Others SLP No 32592 - 325932015 pending before Honble Supreme Court was listed for hearing on 06052016 An impleadment application on behalf of IMA Hq has been filed in the said case On last date of hearing ie 08032016 theHonble Supreme Court was pleased to list the impleadment application of IMA Hq alongwith the main case on next date of hearing The next date of hearing is 05072016 for arguments

Inter-Ministerial MeetingCEA The committee so far has agreed

bull Police to be out of District Appropriate Authority

bull Entry level NABH to be considered while registering CEA

bull Rule 7 form to be modified accordingly

bull Standard Treatment Guidelines by IMA on periodic basis

bull Doctor out of penalty only medical establishment owners answerable

bull Single Clinic new guidelines to be made

bull Punishment as per size and circumstances

bull Compensation clause for stability

Capping on Compensation Maximum 50 lacs Clinical trial Formula to be used Not the ones based on Motor Vehicle Accident Formula

PCPNDT Graded Punishment Amendment to be made amp Non Pelvic Ultrasonologist to be out as per Delhi high Court order

MOH Stand is that Crosspathy is not allowed

MOH to send letter to states with the medical protection act for strict implementation Where there is no act MOH to write to the states to make one

Why compensation Capping

bull SCI ldquoDr Balram Prasad vs Dr Kunal Saha amp Ors awarded an amount of 11 Crore as compensation for medical negligence (Rs608 00550 + 6 interest)

bull Formula [70 - age at death x annual income plus 30 inflation minus 13rd as personal expenses] The formula takes earning of the person in the calculation and therefore discriminates between the rich and the poor

bull Itrsquos a violation of MCI ethics regulations under the declaration given at the time of registration (Clause d of the Appendix 1)

bull d I will not permit considerations of religion nationality race party politics or social standing to intervene between my duty and my patient

bull It also violates Clause 18 ldquo Payment of Professional Services The physician engaged in the practice of medicine shall give priority to the interests of patients The personal financial interests of a physician should not conflict with the medical interests of patients A physician should announce his fees before rendering service and not after the operation or treatment is under way Remuneration received for such services should be in the form and amount specifically announced to the patient at the time the service is rendered It is unethical to enter into a contract of no cure no payment Physician rendering service on behalf of the state shall refrain from anticipating or accepting any considerationrdquo

bull It violates Article 14 of the Constitution ie Equality before Law All people have right to equal treatment in similar circumstances

bull It also violates Article 21 of the Constitution The right to life enshrined in Article 21 also includes right to health and fair and timely medical treatment

bull It violates the Directive Principles of State Policy ie Article 38 and Article 39 of the Constitution as per which the State is responsible to promote the welfare of the people and to minimize the inequalities in income

bull In US 26 states have imposed capping on medical negligence compensation varying from state to state in the range of USD 250000 upto USD 500000

bull There is a capping on the compensation given to victims of natural calamity ( 4 lacs)

bull Death following sterilization (inclusive of death during process of sterilization operation) in hospital or within 7 days from the date of discharge from the hospital Rs 2 lakh

bull Death following sterilization within 8 - 30 days from the date of discharge from the hospital Rs 50000-

bull Failure of Sterilization Rs 30000-

bull Cost of treatment in hospital and up to 60 days arising out of complication following sterilization operation (inclusive of complication during process of sterilization operation) from the date of discharge Actual not exceeding Rs 25000-

bull Indemnity per DoctorHealth Facilities but not more than 4 in a year Upto Rs 2 Lakh per claim

bull Article 21 of the Montreal Convention in case of death of passengers the airline is liable to pay up to 113100 Special Drawing Rights for each passenger This works out to approximately $174000 at current rates (In Indian rupees this works out to approximately Rs 104 crore)

Capping Suggestedbull Computing 3 factors a) Age b) Risk and c) base amount

bull Compensation = BX F x R 9937

bull B = Base amount (ie 8 lacs)

bull F = Factor depending on the age of the subject as per Annexure 1 (based on Workmen Compensation Act) ( between 9937 and 22854)

bull R = Risk Factor depending on the seriousness and severity of the disease presence of co-morbidity and duration of disease of the subject at the time of enrolment in the clinical trial between a scale of 05 to 4 as under

bull 050 terminally ill patient (expected survival not more than (NMT) 6 months)

bull 10 Patient with high risk (expected survival between 6 to 24 months)

bull 20 Patient with moderate risk

bull 30 Patient with mild risk

bull 40 Healthy Volunteers or subject of no risk

bull In case of patients whose expected mortality is 90 or more within 30 days a fixed amount of Rs 2 lacs should be given

bull Compensation amount will vary up to 7360 lacs depending on the age of the deceased and the risk factor However in case of patients whose expected mortality is 90 or more within 30 days a fixed amount of Rs 2 lac should be given

Violence against doctorsIf any person commits any of the below mentioned offence one can lodge an FIR under Section 154 of the Criminal Procedure Code

bull Criminal Conspiracy ndash Section 120 A and Section 120B of IPC

bull Offences Against The Public Tranquilitybull Unlawful Assembly ndash Section 141 143 and 144 IPC

bull Rioting - Section 146 IPC Section 147 IPC and Section 148 IPC

bull Affray - Section 159 IPC and Section 160 IPC

bull Offences Affecting The Public Health Safety Convenience Decency And Morals Public Nuisance Section 268 IPC Section 269 IPC and Section 294 IPC

bull Offences Affecting Human Body

bull Hurt Section 319 IPC Section 323 IPC and Section 324 IPC

bull Grievous Hurt Section 320 IPC Section 325 IPC Section 326 IPC and Section 326A IPC

bull Act Endangering Life or Personal Safety of Others Section 336 IPC Section 337 IPC and Section 338 IPC

bull Wrongful Restraint Section 339 IPC and Section 341 IPC

bull Criminal Force and Assault Section 350 IPC Section 351 IPC Section 352 IPC and Section 355 IPC

bull Offences Against Property

bull Theft Section 378 IPC and Section 379 IPC

bull Robbery Section 390 IPC Section 392 IPC Section 393 IPC and Section 394 IPC

bull Dacoity Section 391 IPC and Section 395 IPC

bull Mischief Section 425 IPC and Section 426 IPC

bull Criminal Trespass Section 441 IPC and Section 447 IPC

bull Offence of Defamation Section 499 IPC and Section 500 IPC

bull Offences of Criminal Intimidation Insult and Annoyance Section 503 Section 504 IPC and Section 506 IPC

bull Offences of outraging insulting the modesty of women Section 354 IPC Section 354A IPC Section 354B IPC Section 354C IPC and Section 509 IPC

bull Women can make a complaint against the offence of sexual harassment at workplace as per the provisions of The Sexual Harassment of Women at Workplace (Prevention Prohibition and Redressal) Act 2013

bull Against the aforesaid offences of physical violence assault attack one can also file civil suits like suit for permanent injunction suit for damages suit for defamation

bull Apart 17 States and Union Territories have their respective StateUT legislations on the issue of violence assault on doctors For eg Delhi Medicare Service Personnel and Medicare Service Institutions Act 2008 Bihar Medical Service Institution and Person Protection Act 2011 etc In all these legislations punishment is Imprisonment which may extend to 3 years or with fine up to Rs 10000- or both and Compensation of twice the purchase price of property damaged and loss caused to be recovered as arrears of land revenue on default

VIOLENCE AGAINST DOCTORS (BIHAR)

httpsyoutubeRNVzriB2QREhttpsyoutubeOXZQDmNKhTQhttpsyoutubePdUUW3VOkMEhttpswwwfacebookcomsearchstrviolance+keywords_tophttpsyoutube6jXA-gJ-PpQhttpsyoutubeFqH_lypYF08httpsyoutubehJmHjYwFy5Qhttpsyoutube9PwUG_nrZ8AhttpsyoutubesSwuFJ8fths

करम सखया

नाम पता घटना क तथ घटना का ववरण

1 डा योगदर परसाद सह

पी एच सी नरपतगज अररया

30-09-2015 समय 0930 रातर

परतमाह रगदार दन क लए मारपीट करन क सबध म (01102015) को गरफतार

2 डा आनद कमार सललानया

मील रोड खगड़या 14102015 समय 0630 शाम

गाल गलोज एव मारपीटकरन क सबध म (ऍफ़ आई आर 15102015)

3 डा मो सरफ़राज़ जमा ममोरयल असपताल फलवारशरफ पटना

07112015 समय 0815 रातर

रगदार एव मारपीट करन क सबध म (ऍफ़ आई आर ndash07112015हमलावर म दो पाकसतानी नागरक भी शामल ह

4 डा मनोज समल कटहार 20112016 4 लोग क सकल बस एकसीडट म मतय पराथमक उपचार क बाद रफर करनपर पी एच सी म मारपीट एव ऐ एन एम का कपड़ा फाड़कर मारपीट एव बदसलक तथा जन पतरनध दवारा माइक दवारा भीड़ जता कर घटना को अजाम दयागया

5 डा राज कशोर सह सीवान 24112015 रगदार नह दन क कारण िकलनक म घसकर गोल मार दया गया

6 डा ओ पी लाल पी एस सी कचचआई कोट गोपाल गज

26112015 घर म घस जानलवा हामला

7 डा सनील कमार कयर हॉिसपटलकमहरार पटना

02122015 पतर क दवारा दो करोड़ क रगदार क माग

8 डा दवकात बरोल पी एच सी गोपालगज

----- 10 लाख क फरोती

9 डा अनल कमार कशर 16122015 पतर रोहत कमार कशर क हतया

10 डा सी बी सह मोतहार 01012016 डा सी बी सह क ऊपरजानलवा हमला

11 डा ववकानद झा हाजीपर 08012016 िकलनक पर चल थी गोल

12 पराथमक सवसथय क दर कमारखड मधपरा 25012016 परभार चकतसा परभार स दरवयवहारएव मारपीट (सथानीय दरोगा दवारा)

13 डा शरवण कमार पी एच सी रानीपटटीकमारखड मधपरा

26012016 मारपीट एव तोड़फोड़ अनाधकत रप स राषटरय धवज फ़हरान क समबनध म

14 डा सतयनदर कमार पी एच सी नीमचक बथानी गया

27012016 मारपीट एव तोड़फोड़ (आरजडी एम एल ऐ क पतर रणजीत दवारा)

15 डा गणश कमार सचव आई एम ऐ सहरसाशाखा

19022016 अपहरण का परयास था परनत फ़ल हआ अपहरणकरता (अपराधी) कोगरफतार क माग)

16 डा आई डी सह हदय रोग वशष सहरसा

एक करोड़ रगदार क माग (22022016 स हड़ताल पर

17 डा बरजश कमार सह पथोलोिजसट सहरसा 20 लाख रगदार क माग (26022016 तक डा हड़ताल पर )

18 डा गोरव खमका मगद हॉिसपटल पाटना 09032016रातर

उनक कार पर गोल चलाई गई परनत व बाल बल बच गए

19 डा (कनरल) ऐ क सह रबन इमरजसी हॉिसपटल रबल डायगनोिसटक पटना

21052016 बलट क साथ पतर दवारा 50 लाख रगदार क माग क गई (ऍफ़ आई आर 21052016)

20 डा हरकशोर सह फारबसगज अररया 23052016 फ़ोन पर 2 लाख रगदार क माग (ऍफ़ आई आर 23052016)

21 डा पी क झा ओथपडक सजरन एम एम सी एच पटना

24052016 वकरम पालगज दिलहन बाज़ार म आलटो गाड़ी पर जानलवा बनदक स हमला उनक सटाफ को लगी गोल पी एम सी एच म भरती

22 डा वीरदर कमार सनहा बिखतयारपर पी एच सी मपरभार

24052016 नया टोला राधोपर नवासी दनश गपता उफ़र बननी गपता क 15वषय पतर राहल कमार को बहोशी क हालत म लाया गया उस डा बी क सनहा न मत घोषत कया तो पजरन कहन लग क इसका नसचल रहा ह आप इलाज कर इसक लए पी एच सी म तोड़ फोड़ और डॉकटर क साथ मरपी थाटहगामा

23 डा हमनत कमार वमार शश रोग वशषककरबाग पटना

25052016 एस एम एस क दवारा एक करोर क रगदार क माग (ऍफ़ आई आर25052016)

Nearly 1000 Healthcare Workers Killed Since 2014 WHObull WHO Between January 2014 and December 2015 there were 594 reported attacks on

healthcare that led to 959 deaths and 1561 injuries in 19 countriesbull More than half of the attacks were against healthcare facilities (63) and more than a

quarter were against healthcare providers (26) bull Sixty-two percent of the attacks were reported to have intentionally targeted healthcare

bull The Syrian Arab Republic had the most reported attacks on healthcare each year mdash more than twice as many as any other country or territory in 2014 and nearly four times as many in 2015

bull In the Central African Republic 16 of the 26 deaths attributed to attacks on healthcare in 2014 occurred in a single attack on April 28 during an armed robbery on a Meacutedecins Sans Frontiegraveres hospital in the northern town of Boguila

bull In Iraq 18 of the 71 reported deaths in 2014 occurred when the obstetrics section of the Hawija Hospital was bombed on September 6

bull Thirty-one of the 43 deaths in Iraq in 2015 occurred during a bombing on Fallujahs maternity hospital on August 13

bull In Libya 34 of the 39 deaths in 2015 occurred on August 14 when 12 care providers and 22 patients were executed

bull WHO Report on Attacks on Health Care in Emergencies Published May 26 2016

bull Full text

PNDT ActJudgment dated 170216 passed by Honrsquoble High Court Delhi in the matter of ldquoIndian Medical Association vs Union of India WP (C) NO 27212014

bull ldquoWe are of the opinion that for the purposes of prevention of sex determination through ultrasound machines or other radiological techniques it matters not whether the ultrasound machine is in the hands of an MBBS or an MBBS with six months training or an MBBS with one year experience who has cleared the competency test or in the hands of MD radiologist obstetrics The qualification of MBBS itself is a highly sought after qualification to secure which one has to first appear in a competitive examination for admission to a medical college and thereafter has to undergo the rigours of passing the MBBS examination By no stretch of imagination can it be said that an MBBS qualified person lacks education or understanding to be not able to comprehend the fatal consequence of female foeticide as a result of sex determination or the morality behind the same In our opinion to understand the said aspects the one year experience or passing the competency test or undergoing the six months training or acquiring the post-graduate qualification add no further to the person To make an as educated a person as a ldquoDoctorrdquo understand the ill effects of sex determination and that use thereof for the purposes of female foeticide is a crime there is no need to require him either to undergo post-graduation or a six months training or gain a one year experience or pass a competency test By doing so he will not be less likely to break the said law than he would be without the same It is not as if holding a medical qualification recognised by MCI does not have any concern with the conductbehaviour of the holder thereof The holder thereof is required to abide by the standards of professional conduct and etiquette and code of ethics prescribed by MCI in exercise of power under Section 20A of the MCI Act Moreover when the holder of medical qualification is capable of being sensitised with the code of conductetiquetteethics heshe can certainly be sensitised to the issue of PNDT without being required to undergo any trainingexperiencerdquo

bull (i) that Section 2(p) of the PNDT Act defining a Sonologist or Imaging Specialist is bad to the extent it includes persons possessing a postgraduate qualification in ultrasonography or imaging techniques ndash because there is no such qualification recognised by MCI and the PNDT Act does not empower the statutory bodies constituted thereunder or the Central Government to devise and coin new qualification - Meaning thereby as per the definition Under Section 2(p) of the PNDT Act a MBBS is a sinologist or Imaging Specialists

bull (ii) The PNDT ActRules does not apply to the MBBS doctor who gives a declaration that they will not be using the ultrasound machine for sex determination or pre-natal diagnostic procedure

bull (iii) Rule 3(3)(1)(b) of the PNDT Rules (as it stands after the amendment with effect from 9th January 2014) is ultra vires to the PNDT Act to the extent it requires a person desirous of setting up a Genetic Clinic Ultrasound Clinic Imaging Centre to undergo six months training imparted in the manner prescribed in the Six Months Training Rules

bull ldquo98 We accordingly dispose of these petitions with the following declarations directions

bull (i) that Section 2(p) of the PNDT Act defining a Sonologist or Imaging Specialist is bad to the extent it includes persons possessing a postgraduate qualification in ultrasonography or imaging techniques ndash because there is no such qualification recognized by MCI and the PNDT Act does not empower the statutory bodies constituted thereunder or the Central Government to devise and coin new qualification

bull (ii) We hold that all places including vehicles where ultrasound machine or imaging machine or scanner or other equipment capable of determining sex of the foetus or has the potential of detection of sex during pregnancy or selection of sex before conception require registration under the Act

bull (iii) However if the person seeking registration (a) makes a declaration in the form to be prescribed by the Central Supervisory Board to the effect that the said machine or equipment is not intended for conducting pre-natal diagnostic procedures (b) gives an undertaking to not use or allow the use of the same for pre-natal diagnostic procedures and (c) has a ldquosilent observerrdquo or any other equipment installed on the ultrasound machines as may be prescribed by the Central Supervisory Board capable of storing images of each sonography tests done therewith such person would be exempt from complying with the provisions of the Act and the Rules with respect to Genetic Clinics Genetic Laboratory or Genetic Counseling Centre

bull (iv) If however for any technical reasons the Central Supervisory Board is of the view that such ldquosilent observerrdquo cannot be installed or would not serve the purpose then the Central Supervisory Board would prescribe other conditions which such registrant would require to fulfil to remain exempt as aforesaid

bull (v) however such registrants would otherwise remain bound by the prohibitory and penal provisions of the Act and would further remain liable to give inspection of the ldquosilent observerrdquo or other such equipment and their places from the time to time and in such manner as may be prescribed by the Central Supervisory Board and

bull (vi) Rule 3(3)(1)(b) of the PNDT Rules (as it stands after the amendment with effect from 9th January 2014) is ultra vires the PNDT Act to the extent it requires a person desirous of setting up a Genetic Clinic Ultrasound Clinic Imaging Centre to undergo six months training imparted in the manner prescribed in the Six Months Training Rulesrdquo

The matter titled as Indian Radiological and Imaging Association versus UOI amp Anr SLP (C) 110462016 was listed for hearing on 29042016 The Honble Supreme Court of India has only issued notice to the other party in the said case An impleadment application on behalf of IMA has to be filed in the said case

PNDT UP Judgment bull Court No - 21 Case - WRIT - C No - 30908 of 2016 Petitioner - Dr Jitendra Nath Makkar And 3 Others

Respondent - Union Of India And 4 Others Counsel for Petitioner - Man Mohan Singh Counsel for Respondent -CSCASGI Honble VK ShuklaActing Chief Justice Honble Mahesh Chandra TripathiJ

bull On the matter being taken up today learned counsel for the petitioners has pointed out that requisite order has been passed by this Court in identical set of circumstances on 25032015 in Civil Misc Writ Petition No 1325 (C) of 2015 in view of this as present matter is engaging attention of the order passed by this Court The order passed by this Court on 25032015 is quoted below

bull The petitioner who is a practicing Doctor registered with the Medical Council of India has challenged the constitutional validity of Rule 3 (3) of the Pre-conception and Pre-natal Diagnostic Techniques (Prohibition of Sex Selection) Rules 1996 which reads as follows

bull (3) Each medical practitioner qualified under the Act to conduct ultrasonography in a genetic clinicultrasound clinic imaging centre shall be permitted to be registered with a maximum of two such clinics centres within a district The consulting hours for such medical practitioner shall be clearly specified by each clinic centreldquo

bull The challenge is on the ground that under Rule 3 (3) a restraint is sought to be imposed on the right of a medical practitioner to practise his profession by confining the permission to register to only a maximum of two such clinicscentres within the district

bull The attention of the Court has been drawn to the interim order passed by the Delhi High Court on 23 July 2012 in Indian Radiological and Imaging Association (IRIA) and another WP (C) 4009 of 2012 The interim order of the Delhi High Court also refers to an interim order of the Bombay High Court dated 20 July 2012 in Writ Petition Lodging No1829 of 2012 staying the operation of Rule 3 (3)

bull In fact the Union Ministry of Health and Family Welfare has also issued a circular dated 16 October 2012 in view of the interim orders passed by several High Courts Following the interim orders passed by the Bombay High Court and Delhi High Court noted above we issue notice to the first respondent The learned Standing Counsel accepts service of notice and prays for time to file a counter affidavit The counter affidavit shall be filed within a period of six weeks from today In the meantime and pending further orders there shall be a stay of operation of Rule 3 (3) extracted above insofar as it confines a medical practitioner to registration only to a maximum of two clinicscentres within a district List the matter on 25 May 2015

bull Following the same set of reasoning let response be filed by the each one of the respondents within six weeks

bull Matter be listed after six weeks along with record of Civil Misc Writ petition No 1325 (C) of 2015 (Dr Suresh Kumar Khnduja Vs Union of India and others) In the meantime and pending further orders there shall be a stay of operation of Rule 3 (3) extracted above insofar as it confines a medical practitioner to registration only to a maximum of two clinicscentres within a district

bull Order Date - 1272016 TS

Crosspathy CCIM ResolutionCOUNCIL OF INDIAN MEDICINE NEW DELHI MINUTES OF 158TH MEETING OF EXECUTIVE COMMITTEE HELD ON 2862010 AT NEW DELHI

Present

1 Vaidya Raghunandan Sharma President CCIM Chairman 2 Dr Jayaprakash Narayan Vice-President (Ayurved) Member 3 Prof Hakim Syed Khaleefthullah Vice-President(Unani) Member 4 Dr V Stanley Jones Vice-President (Siddha) Member 5 Dr PK Jain Member 6 Vaidya Ved Prakash Tyagi Member 7 Dr Niranjan Singh TyagiMember 8 Dr D Ramanathan Member 9 Dr V Arunachalam Member 10 Dr Rashidullah Khan Member Dr PR Sharma Secretary CCIM Special Invitee- Prof Banwarilal Gaur Dr Khalid Siddqui could not attend the meeting

Agenda Item No11

Declaration of Resolutionnotification Passedissued by CCIM regarding practice of Modern Medicine by ISM practitioners-as ultra virus

It was noted that Civil Writ Petition No 100332005 was filed by National Integrated Medical Association before High Court of Kerala at Eranakulum The petitioners were holding ISM qualification and were also practicing Modern Medicine on the basis of CCIM notification issued from time to time (especially notification dated 19052004 and 30101996) and wanted protection of the Court The Court vide judgment dated 7022006 dismissed the above petition and observed that Central Council cannot issue notifications enabling ISM practitioners to practice Modern Medicine If the practitioners are having enrolment on State Medical Council of Modern Medicine under the Indian Medical Council Act 1956 only then they are entitled to practice modern medicine Therefore National Integrated Medical Association filed and LPA against above judgment vide W A No 12602006 which has also been dismissed by stating that Medical Advances mentioned in Section 2 (e) of the IMCC Act 1970 can not be interpreted to means Allopath Medicine The SLP was filed by the Central Council of Indian Medicine in Honrsquoble Supreme Court of India The Supreme Court of India has dismissed the same As opinion of the Retainer was obtained regarding the legality of notification issued by CCIM opined as under- ldquo1 I have pursued the case file Ld Single Judge Division Bench of High Court Sr Adv PP Rao of Supreme Court and the Supreme Court itself are all in agreement on this issue ie ISM practitioners can not be permitted to practice lsquomodern scientific medicinersquo which is an altogether separate system of medicine and regulated by altogether different enactment

2 As per law recently settled by the Apex Court once any provision has been declared ultra virus by any High Court it is not only applicable in that State but to the whole country As such our Notification dated 1952004 stands quashed

3 An analysis of the said Notification dated 1952004 also reveals two glaring details a) Firstly it empowers ISM practitioners to practice ldquomodern scientific medicinerdquo which is untenable b) Secondly emphasis has been made on ldquomodern advancesrdquo which gives impression of advances made in modern medicine ie allopathic system of medicine

4 Since CCIM is duty bound to incorporate newer improvements in the field of medicine an accordingly improve our curriculum etc there may be a case to move away from the word ldquomodernrdquo and to issue a fresh notification incorporating ldquotechnological advances of relevancerdquo in the field of Indian Medicine that gets support from the lsquoMukhtiar Chandrsquo Judgment 27Agenda Item 158th EC

5 This issue needs to be deliberated by the Ex-CouncilCCIM before a final decision is arrived atrdquo As per legal opinion on the notification 2004 issued by CCIM regarding practice of modern medicine is referred above the notification and other letters issued in this respect by the CCIM does not sustained in Law

Executive Committee decided to withdraw the notification also decided to obtain the legal opinion from Advocate of Supreme Court and call him for discussion in the ensuing meeting of Executive Committee

Clinical Establishments (Registration and Regulation) Act 2010

IMA in principle support the CEA Act but not in its present form It should have amendments in the following points

1 The district Appropriate Authority must be headed by a medical person

2 At the District Level Committee the Police person should be excluded from this Committee

3 Single Doctor Establishment (Husband amp Wife should be taken as one unitOAE-Own Account Entrepreneur) should be excluded from the registration under the CEA

4 Medical Establishment which has entry level accreditation or above under NABH need only registration under the Act and should be automatically get registered under CEA without any other formalities

5 The provision of action including prosecution against quacks should be included in the Act

6 The standard treatment guidelines require updation on a regular basis amp should not be under the provision of CEA They are laid down by professional bodies (IMA and other speciality organizations) and are periodically updated The Act has no role in fixing the standard protocol

7 The cost of treatment cannot be fixed by the Govt or the State Let it be decided by the market forces but it should be transparent and displayed

8 Allopathic doctors should have proportionate representation in National State and District level committee as they provide gt 70 of health care

9 Stabilization clause should be replaced by First AID

10 The name of the Act include the Promotional word so that the name of the Act is Registration and Regulation and Promotion Act 2010

11 All Emergency Services given by doctors to people should be reimbursed by the State government as per the standard State Charges

12 Provision for Grievance Redressal should be deleted since the facilities are already available in the State Medical Council and other forums

13 CEA should have single Window Registration facility

14 Para Medical staff currently working under qualified doctors for the last five years should be treated as trained health care personnel and be included in the category of qualified staff

15 Penalties due to contravention of the Registration or deficiency are very high this to be made realistic

16 The inspection of Medical Establishment should be done under Chairmanship of medical person only

17 Provisional registration should not be given without verifying relevant documents

18 ldquoFor permanent registration the Clinical Establishment required to put up in public domain for inviting objections if anyrdquo This should be deleted

NEET UpheldIMA Stand

1 April 2009 MCI constituted a two man expert group to look into the entire issue Over 90 entrance examinations conducted annually for admission to MBBS course for over 300 medical colleges in the country Numerous complaints were received of irregularities manipulations cheating etc

2 Recommendation NEET Appropriate amendment to IMC act ( section 33) on an urgent basis including through an appropriate issuance of an ordinance by the Government of India Report approved by Executive Committee in May 2009 and by general body by circulation in June 2009 GB adoption was made known to the GOI amp UGC

3 No action was taken by the Government of India on the said recommendations MCI was superseded by a Notification dated 15th May 2010 by the GOI and replaced by a nominated Board of Governors They also did not venture in pursuing the said issue in any manner

4 In between a PIL came to be filed before the Honble Supreme Court who upon detailed hearing directed the GOI and MCI to act on the said recommendation made by MCI in 2009 promptly As a result of the same the GOI on the recommendations of the BOG notified NEET through issuance of a regulation under section 33 of IMC act without making amendment as suggested earlier in December 2010

5 The said regulation was challenged before SCI by the various private managements The same was quashed in 2013 by the Honble Supreme Court by a majority decision of 21 primarily on the ground that MCI did not have the said authority and jurisdiction as the Indian Medical Council Act does not provide for the same

6 GOI under the now democratically elected MCI filed a review petition Re-constituted MCI in its GBM held on 1st October 2015 reiterated its earlier decision that a unitary single Common Entrance Test should be held by a designated competent authority for admission to MBBS Course through incorporating an appropriate amendment to section 33 of the IMC act whereby MCI with the approval of Government of India would be vested with the appropriate authority to notify lsquoRegulationsrsquo for the purposes of conduct of the said test The said resolution was further broadened by bringing out that admission to postgraduate courses should be made on the basis of merit generated at the Common Entrance Test for postgraduate admissions

7 It was further resolved that in view of the exigencies both the recommendations may be given effect by the Government of India by urging Honble President of India to issue an ordinance towards the same if need be The resolution was not only unanimously adopted but the minutes thereof were confirmed in the meeting itself and the communication to the required effect was sent to the Government of India for the needful in larger public interest

8 SC recalled its earlier quashing order and orders for the NEET applicable from this year Even today amendment to section 33 is not in place IMA wants the amendment as early as possible

9 1st may NEET 1 was held (from 15 all India quota for govt medical colleges made open for all India govt as well as private colleges) Only 2 days preparation tine was given ( 28th April was the exam) Wide difference is state and CBSC course CBSC course is Hindi or English and covers 11 + 12th syllabus While state exams cover only 12th that to in regional vernacular languages and in TN only on 12th merit

10 High merit state students studying in vernacular language may get surpassed by low merit CBSC students

11 SC orders that phase 1 students can re-appear in phase 2 NEET exam

12 Govt passes ordinance exempting government colleges from this years NEET

NEET IMA Stand

bull NEET IMA for Merit with Equitable Access

bull IMA stands for merit based selection for both undergraduate and post graduate medical courses

bull It has been the expectation of aspiring students that the selection process be fair and transparent In this regard the stand taken by the MCI and the honourable Supreme Court of India are steps in the right direction NEET is also perhaps the only way to reign in the private medical colleges to conform to best practices

bull IMA also recognises the constraints of the Union Government in ushering in an ideal solution in a country with diverse socio political reality Therefore the issues raised against NEET should also be considered debated and solved

bull Issue 1 NEET places poor rural students especially girls from socio economically backward background studying in Government schools in regional languages at a disadvantage

bull Tamilnadu model of abolishing entrance exam at the undergraduate level by conducting efficient public exam for plus two has been a great leveller This has done away with an expensive undesirable coaching industry

bull Issue 2 The lists of the SCs STs MBC and backward communities of central and state Governments not matching

bull One way out could be to bring NEET in stages beginning with postgraduate medical courses

bull Issue 3 Will they be able to make uniform CBSC syllabus in one year or we will see another ordinance next year to postpone NEET in state medical colleges

bull Another debatable issue is that with state quota being fixed all state students will be judged out of merit of their own students who all will get the same circumstances to appear

NEET Ordinance

MINISTRY OF LAW AND JUSTICE (Legislative Department) New Delhi the 24th May 201 6Jyaistha 3 1938 (Saka) THE INDIAN MEDICAL COUNCIL (AMENDMENT) ORDINANCE 2016 No 4 OF 2016 Promulgated by the President in the Sixty-seventh Year of the Republic of India An Ordinance further to amend the Indian Medical Council Act 1956

WHEREAS Parliament is not in session and the President is satisfied that circumstances exist which render it necessary for him to take immediate action Now THEREFOR 1 (1) This Ordinance may be called the Indian Medical Council (Amendment) Ordinance 2016 (2) It shall come into force at once 2 In the Indian Medical Council Act 1956 (hereinafter referred to as the principal Act) after section 10C the following section shall be inserted namely----10D) There shall be conducted a uniform entrance examination to all medical educational institutions at the undergraduate level and post-graduate level through such desig Provided that notwithstanding any judgment or order of any court the provisions of this section shall not apply in relation to the uniform entrance examination at the undergra 3 In section 33 of the principal Act after clause (ma) the following clause shall be inserted namelymdash(mb) the designated authority other languages and the manner of conducting of uniform entrance examination to all medical educational institutions at the undergraduate le PRANAB MUKHERJEE President DR G NARAYANA RAJU Secretary to the Govt of India

Exit Exam for Medical Graduates Passing out from Indian Universities

bull The government came up with a proposal to have an exit test for all medical graduates passing out from Indian universities

bull IMA strongly opposed this move

bull The major responsibility of MCI is to ensure uniform standards in medical education by having inspection before recognition is given to any new medical college periodic inspection of standards of education in existing medical colleges fixing uniform syllabi and curriculum for MBBS There should be cope for differences in the standards of medical graduates coming out of our medical colleges

bull If MCI does not fulfil this responsibility answer is an accreditation council similar to the one which is existing with regards to arts and science colleges (NAAC) but not exit exam

bull A medical graduate cannot be penalised in the pre-text of lack of uniform standard and subject him to an exit test

bull If it is for the uniformity in standards of graduates passing out of Indian universities then exit test should be applied for all the graduates eg B Tech LLB BSc etc

bull When the government propose exit test for modern medical graduates in the name of maintaining high standards the government is also contemplating bridge courses for Ayurveda Homeo graduates to practise modern medicine eg the Maharashtra governmentrsquos GO to give 1 year training in pharmacology for homeopathy graduates and allowing them to prescribe modern medicine Government is also contemplating 3-year BRHC course to serve the rural population So there is so much of dilution and disparities in the standards of various streams of practitioners who would practise modern medicine To insist on exit test for MBBS graduates one is not able to find a genuine reason

bull Suppose the medical graduates fail in the exit test then what will be their fate Government accepts that 3 year graduates are enough to practise in rural areas government accepts that a crash course or a bridge course is enough for AYUSH doctors to practise modern medicine At the same time government feels that modern medical graduates (MBBS) are not competent to practise modern medicine without an exit test The logic behind this policy is not understandable

bull IMA is strongly against bridge courses crash courses and three year courses for practising modern medicine

bull If the intention of the government is to have lsquointernational standardrsquo for our medical graduates then our graduates should be allowed to practise in other countries without their compiling tests like PLAB USMLE But in spite of the exit test every medical graduate will have to undergo the competency exams of individual countries

bull MCI can do timely revision of curriculum and syllabi for MBBS course and introduce a system of accreditation for evaluating the standards of medical education apart from the periodic inspection like the NAAC for Art and Science graduates MCI should revise the syllabi and curriculum of MBBS course at least once in 5 years

IMA and Service Tax

1 If any trust society is registered us 12AA of Income tax act its income will be exempt from income tax provided the activities are covered Us 2(15) which is as follows The expression ldquocharitable purposerdquo has been defined under Section 2(15) of the Act to include a) relief of the poor (b) education (c) medical relief and (d) Advancement of any other object of general public utility

bull Under service tax as per notification no252012 if any entity is registered us 12AA of income tax act then the services provided by it will be exempt from services tax

bull The detail of notification is as follows charitable activities means activities relating to -

bull (i) public health by way of - (a) care or counselling of (i) terminally ill persons or persons with severe physical or mental disability (ii) persons afflicted with HIV or AIDS or (iii) persons addicted to a dependence-forming substance such as narcotics drugs or alcohol or (b) public awareness of preventive health family planning or prevention of HIV infection (ii) advancement of religion or spirituality (iii) advancement of educational programmes or skill development relating to- (a) abandoned orphaned or homeless children (b) physically or mentally abused and traumatized persons (c) prisoners or (d) persons over the age of 65 years residing in a rural area (iv) preservation of environment including watershed forests and wildlife or (v) Advancement of any other object of general public utility

2 To get registered Us 12A an entity ( state or local IMA branch) should be separately registered as society and should have their own pan no only then they can have their own registration Us 12A If the branch is operating under main office then they can use centralized pan and 12A registration If the branch is not associated with central body and still using your pan then the tax liability of that branch will be that of the main central office The main office is responsible for any tax violation of the branches who are using your pan service tax no and 12A registration

3 As per the notification no252012 the society need not charge any service tax on membership fees if the activities of the societies are covered as charitable as per the notification detailed mentioned above

4 If delegation fee is charged as simple conference fees then one need to charge service tax But if the fees is accepted as donation and receipt Us 80G is issued then no need to charge service tax

5 For stalls sponsorship of session etc service tax should be charged

6 Any donor can donate and get deduction Us 80G to the tune of 50 of the amount donated as per subject to 10 of total income

7 Penalty for service tax default is 100 of tax evasion apart from amount of interest which is 18 up to 6 months of delay 24 from 6 months to one year 30 for rest

Appeal to the CESTAT for levy of Service tax on IMA The appeal was heard by the bench on 4 April 2016 Our arguments have been admitted and stay has been granted in our favour

Service Tax Not Applicable to IMA IN THE CUSTOMS EXCISE AND SERVICE TAX APPELLATE TRIBUNAL NEW DELHI

PRINCIPAL BENCH COURT NOIV Application NoSTSTAY529872014 Appeal NoST525552014-ST (DB)

Ms Indian medical Association hellip Applicants Vs CCE 7 CST (Adj) New Delhi helliphellipRespondent

Appearance Shri Savagya Sharma Advoicate of the Applicants Ms Suchitra Sharma DR for the Respondent

CORAM Honrsquoble Ms Archana Wadhwa Member (Judicial) Honrsquoble Shri B Ravichandran Membeer (Technical)

Date of Hearing 04042016 STAY ORDER NO503472016-ST(DB)

Per Archana Wadhwa

1 The appellant have been taxed to the extent of Rs116 crores under the category of club or association services even though the appellant stand is that they do not fall under the said category but at this Interim stage we take note of the fact that they have been admittedly taxed under the said category which stands held to be ultravires by the High Court of Gujarat in the case of Sports Club of India vide decision dated 25032013 As also by the Honrsquoble High Court of Jharkhand in the case of Ranchi Club Ltd VsCCE Ranchi Zone-2012 (26) STR 401 (Jha)

2 As such at this stage by taking note of the said decisions we are of the view that the appellant is entitled to unconditional stay

We order accordingly

[Dictated and pronounced in the open Court]

(B Ravichandran) (Archana Wadhwa)

Member (Technical) Member (Judicial)

Income tax relief bull Income Tax Appeal 30th May 2016 (42015-16263) Assessment year 12-13 Income assessed (3 50 73258) tax demanded (1 47 87150-) under section 143

(3) of IT Act 1961

bull APPELLATE ORDER US 250(61 AND GROUNDS OF DECISION)

bull Main grievance is against the denial of exemption us II read with section 2(15) IMA is registered us l2AA on 2761974 and us 80G on 3182009

bull The basic objective of IMA is to promote medical science and improvement of public health and medical education etc

bull AO has denied exemption us II that the assessee is involved in commercial activity as the assessee has received endorsements sponsorships and rental income

bull The assessee has receipts arising out of business or commerce amp accordingly 1st provision to section 2(15) is applicable as the receipts are more than Rs 10 lacs

bull Exemption under Section ll (l) (a) is not with reference to the income but it is with reference to application of the income ldquo income derived from property held under trust wholly for charitable or religious purposes to the extent to which such income is applied to such purposes in India the same will not be-included in the total incomerdquo

bull Under Section 2(24) (ii a) voluntary contribution received by a trust is considered to be its income

bull The requirement of Section ll (l) (a) is the trust should be wholly for charitable or religious purposes

bull Section 2(15) defines charitable purposes relief of the poor education medical relief and the advancement- of any other object of general public utility

bull The proviso has been inserted by the Finance Act 2008 to provide for the last Object ie advancement of any other object of general public utility shall not lie a charitable purpose if it involves the carrying on of any activity in the nature of trade commerce or-business or any activity of rendering any service in relation-to any trade commerce or business for a cess or fee or any other consideration A combined reading of the main provision and the proviso clearly show that firstly there is no restriction so far as the object is relief of the poor education medical relief The proviso does not apply to such activities

bull In IMA the entire expenditure is being incurred in the cause of medical relief only IMA is engaged in the medical relief is evident from the fact that it is being supported by the Ministry of Health and Family Welfare by way of financial support The AO has nowhere put any allegation about the application of the income amp accordingly the IMA is entitled for exemption which was wrongly denied

bull ITAT Delhi in assesses own case on identical ground in assessment order 2009-10 has decided the issue in favour of IMA vide 20022015 [2015]41 ITR (Trib) 222

bull The main objects of the society are to promote and advance medical science and to promote improvement of public health and medical education in India The Income Tax Act 1961 allows exemption of tax in the case of assessee who are involved-in charitable and religious activities as per sections I 1 12 amp 13

bull The case is also covered by the case of ITPO vs DGIT(E) PC No 18722013 dated 22012015 and assessees own case of IMA vs ADIT in ITA No 4291Del20+2 dated 20022015 for the AY 2009-10 in which it was held that the assessee is not involved in any trade commerce or business and is totally involved in charitable activity and falling-within the definition of charitable purpose under section 2 (15) under the head medical relief

bull The assessee has also been granted relief on identical issue for the assessment year 2011-12 vide Appeal no 202014-15311 dated 28082015

bull After considering all the facts and circumstances of the case I am of the view that the mischief of proviso of section 2(15) is not attracted in this case and the appeal of the assessee for the AY c2(19)-10 has also been allowed by the Honble Tribunal and following the principle of precedence and consis1ency the AO is directed to allow the exemption us 11(1) with all the consequential benefits

Indian Medical Academybull Legal notice dated 1572015 was issued against Ms Me N Moms Private

Limited Mumbai for unauthorized and illegal use of the words ldquorecommended by IMA Indian Medical Academyrdquo The said company was using the said words expression in their publicity material and advertisements The notice was duly served upon the company and their reply came on 2472015 followed by detailed reply dated 782015 The company agreed to withdraw and stop using the said words expression with immediate effect Accordingly the matter stood resolved and information sent to IMA vide mail dated 1382015

bull Me N Moms withdraws the name IMA from the campaign

Dear Dr AggarwalSub Legal notice sent on behalf of Indian Medical Association (Regd) IMA House Indraprastha Marg New Delhi to Ms Me N Moms Pvt Ltd against illegal and unauthorized use of the words ldquoRecommended by IMA Indian Medical Academyrdquo

Be kindly informed and updated for your records that after we had sent the aforementioned legal notice dated 1572015 the opposite side had sent a short reply on 2472015 followed by detailed reply dated 782015 (received in our office on 1382015) through their lawyers Cyril Amarchand Mangaldas In the last para of the said reply it has been mentioned that the company has decided to remove the letters ldquoIMArdquo from its productspackaging and further assurance given that all advertisements referring to IMA on their products and business shall also be withdrawn Rahul Gupta (Advocate)

Team IMA Note They were using IMA for Indian Medical Academy

Haemophilia Factor Duty Withdrawnbull There are 15 lac patients of Haemophilia in the country Recently Govt of

India imposed import duties on life saving and anti cancer drugs This included factor concentrates (Factor VIII Factor IX Bypassing agents Recombinant factor Vifa) all required for haemophillacs

bull Indian Pharma Industry can not cover the need and demand as they produce only 10 of the required factor concentrates Govt supply of these factors concentrates is uneven eratic and most of the times not available to the patients

bull In the Private Sector single cost of treatment is Rs 12 ndash 18000- and increase in factor price by 30 to 50 will be an additional burden for these patients

bull IMA and Haemophilia Federation of India wrote to the Govt and finally Govt has revoked its order of imposition of import duties for factor concentrates for haemophilia patients

Surrogacy

bull The Surrogacy Writ Petition titled as JayashreeWad versus UOI amp Others pending before the Honble Supreme Court was listed for hearing on 27042016 An impleadment application has been filed on behalf of IMA The Honble Supreme Court of India has held that all the matters relating to surrogacy will be heard once the Assisted Reproductive Technology (Regulation) Bill 2014 is enacted as an act of Parliament with or without modification as may be

BSC Community Health

bull The matter titled as MCI versus Dr Meenakshi Gautam pending before Delhi High Court was listed for hearing on 28042016 Mr Rahul Gupta Advocate appeared in the said case on behalf of IMA In the said case an impleadment application has been filed on behalf of IMA and notice has been issued on the said impleadment application by the Honble Court on the last date of hearing ie 14032016 The next date of hearing of the said case is 11052016

bull The matter titled as Baharul Islam amp Others versus IMA Assam Branch amp Others SLP No 32592 - 325932015 pending before Honble Supreme Court is listed for hearing on 06052016 An impleadment application on behalf of IMA Hq has been filed in the said case On last date of hearing ie 08032016 the Honble Supreme Court was pleased to list the impleadment application of IMA Hq along with the main case on next date of hearing

bull The matter titled as Pfizer Limited versus UOI relating to FDC was listed for hearing on 28042016 before the Honble High Court of Delhi

bull An impleadment application has been filed on behalf of IMA

AYUSH Can Not Practice Modern Medicine Delhi high Court

bull Delhi high courtbull Mumbai high court No implementation till the case is

decided

Strengthen Family Medicine in India to solve the problem of non availability of doctors in rural areas held on 15th July 2016

bull Academic Committee Dr Ved Prakash Mishra Dr K K Aggarwal Dr Sunil Abraham Dr P K Sasidharan Dr M Rajalakshmi Dr A P Jain regretted their inability to attend the meeting

bull The members discussed the communication from Indian Medical Association regarding the need to prepare time-bound recommendations to strengthen Family Medicine in India to solve the problem of non-availability of doctors in rural areas The following recommendations were made and unanimously adopted by the Expert Group members

1 National Health Policy 2002 - It was recommended that 25 of all PG seats should be for Family Medicine Also no newPG course should be started without one in Family Medicine

2 Ministry of Health amp FW in 2010 sent letters to all medical colleges for starting MD in Family Medicine but only Calicut Medical College responded but the course is yet to be recognized by Medical Council of India

3 That a decade ago before the era of PG-mania most MBBS doctors used to do four house jobs before starting practice in Family Medicine

4 The basic objectives of MBBS as defined by Medical Council of India are as under- (a) Diagnose and manage common disease (b) Use Essential Drugs IV Fluids Blood or its substitutes and use laboratory services (c) Manage all types of emergencies (d) Decision for referral when necessary (e) Implementing and monitoring of the national health programmes and schemes f Provide preventive and promotive health care services to the community (g) Develop leadership qualities for a health team (h) Skills to communicate to patients and community (i) Identify health problems analyse them in Physio-Chemical Biological Behavioral amp Socio-economic terms (j) Capacity for continuing and life long medical education

5 The above ten parametersobjectives clearly defines that the primary role of MCI is to make General PractitionerFamily Doctors The above ten parameters also forms the basic objectives of a Family Medicine department

6 In todays era the above objectives are not met Most of the internship instead of being used for clinical learning is wasted in preparing for PG entrance exam Over one lakh doctors in the country today are preparing for PG exams (non-family medicine courses) ignoring clinical experience and clinical practice leading to shortage of residents in Clinical Department in Govt and Non-Government hospitals and wastage of manpower

The Committee suggests the following-

(i) Every medical college should follow the recommendations of National Health Policy 2002 of starting a Family Medicine department

(ii) It should be mandatory for every medical college old or new to have a separate Family Medicine Department with 30 beds earmarked for the department with one Professor one Associate Professor and One Assistant Professor This requirement will be for two PG seats in Family Medicine

(iii) The curriculum drafted and approved by the Academic Committee should be passed as early as possible by the Competent Authorities of MCI

(iv) The whole process should be time bound and PG should be started in Family Medicine by January 2017 in all the colleges whether Govt or Private

(v) In Phase -2 of the plan to augment Family Medicine in India it is proposed to start community fellowshipcertificatediploma courses in various specialties These one or two years courses can help General practitioners whether in Govt or Private practice to provide better family care of that specialty This will also help increase their skills and knowledge in the subject trained

(vi) Later all District Hospitals may also be allowed to start similar FellowshipCertificateDiploma courses

(vii) All doctors who have done MD in Family Medicine should be given preference in CHC as a General Duty Specialist as they will be able to provide all types of emergency care needed in the CHC They over long run will help fulfilling the shortage of specialist in CHCs

The above minutes and the curriculum may be put on the MCI website as soon as they are cleared by the Competent Authority

85 Pictorial Warning no stay on 2014 rules

Karnataka Beedi Industry versus UOI

bull The Supreme Court of India on 452016 refused to entertain any stay on the implementation of 85 pictorial warnings on tobacco packs and related products

bull As per the judgment passed by Honrsquoble Supreme Court of India (Bench comprising of Honrsquoble Mr Justice Pinaki Chandra Ghose and Honrsquoble Mr Justice Amitava Roy it is ordered that cigarette manufacturers to comply with the new rules

bull The Bidi amp Tobacco Manufacturers Association have been contending to get the stay on the grounds that pictorial warning should not be more than 40

bull In force since April 1 2016 the stringent rules mandate an increase in the size of health pictorial warnings from the current 40 percent of the surface of a cigarette packet to up to 85 percent

bull The Court also transferred all the petitions filed and pending in different High Courts in India to the High Court of Karnataka

bull IMA has been fighting for the implementation of the 85 of the pictorial health warnings It filed an application for impleadment amp emphasized before the court not to grant any stay order in the matter in the interest of public at large

Rule 31 (4e) is a violation of MCI act

Transplantation of Human Organs and Tissues Rules 2014 has now been implemented and the rule 31 (4e) is a violation of MCI act

Rule 31 Manner of establishing National or Regional or State Human Organs and Tissues Removal and Storage Networks and their functionsmdash

(4) The broad principles of organ allocation and sharing shall be as under

(a) The website of the transplantation center shall be linked to State or Regional cum State or National networks through an online system for organ procurement sharing and transplantation

(b) patient or recipient may get registered through any transplant centre but only one centre of a State or region (if there is no centre in the State) and his or her details shall be made available online to the networking organizations who shall allocate the registration number which shall remain same even if patient changes hospital

(c) the allocation of the organ to be shared is to be decided by the State networking organization and by the National networking organization in case of Delhi

(d) all recipients are to be listed for requests of organs from deceased donors however priority is to be given in following order namely

(i) those who do not have any suitable living donor among near relatives

(ii) those who have a suitable living donor available among near relatives but the donor has refused in writing to donate an

(iii) those who have a suitable living donor available and who has also not refused to donate in writing

(e) Sequence of allocation of organs shall be in following order State list Regional List National List Person of Indian Origin Foreigner

Violation of MCI act if doctors follow this- Declaration Appendix 1 mentions At the time of registration each applicant shall be given a copy of the following declaration by the Registrar concerned and the applicant shall read and agree to abide by the same d I will not permit considerations of religion Nationality race party politics or social standing to intervene between my duty and my patientldquo

bull A letter has been issued by the Delhi Government to all registered eye centres in this context The matter is a serious concern to the medical fraternity and needs immediate attention

Repeal section 15 (3) of the IMC act 15 RIGHT OF PERSONS POSSESSING QUALIFICATIONS IN THE SCHEDULES TO BE ENROLLED

1 Subject to the other provisions contained in this Act the medical qualifications included in the Schedules shall be sufficient qualification for enrolment on any State Medical Register

2 Save as provided in section 25 no person other than a medical practitioner enrolled on a State Medical Register-

a shall hold office as physician or surgeon or any other office (by whatever designation called) in Government or in any institution maintained by a local or other authority

b shall practice medicine in any State

c shall 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

d shall be entitled to give evidence at any inquest or in any court of law as an expert under section 45 of the Indian Evidence Act 1872 on any matter relating to medicine

3 Any person who acts in contravention of any provision of sub-section (2) shall be punished with imprisonment for a term which may extend to one year or with fine which may extend to one thousand rupees or with both

Section 15 of the IMC Act 1956 contemplates right of persons possessing qualifications in schedules to be enrolled It very categorically speaks that subject to the other provisions contained in this Act the medical Qualifications included in this Act shall deal with enrolment in any State Medical Register

Subsection 2 of the said section stipulates that

a the person who is possessing the registering medical qualification shall hold office as a Physician or Surgeon or any other office in Government or any other institution local or other authority

b Shall practice medicine in any State

c Shall be entitled to sign or authenticate a Medical fitness certificate or any other certificate required by Law to be signed by a duly qualified medical practitioner and

d Shall be entitled to give evidence at any inquest or any court of law as an expert under section 45 of the Indian Evidences Act

These are therefore the 4 cardinal privileges which are accruable to a person who is registered medical practitioner However Section 3 stipulates that any person (the person who is entitled to be dispensing these roles and responsibilities and in dispensation of the same had deviated that far) who acts in contravention of any provision of subsection 2 is open for being punished with imprisonment for a term of simple imprisonment not exceeding a year or a fine which may extend to Rs1 000 or both

This came to be incorporated in the Act in the year 1956 but till date it could not be given effect The reason being the stipulation which is contemplated as punishment for the contravention is simple imprisonment with imposable fine and these are the arenas which are required to be governed through the procedure of the Criminal procedure code In view of the fact Criminal Procedure Code (CrPC) along with the Indian Penal Code (IPC) do not stipulate anything specific explicitly or implicitly for the purposes of operational execution of Section 15 (3) operationally it has become redundant and therefore it could not be given effect till date

The real material mechanism is that today a doctor is being put across to various trials by various multiple agencies be it the ethical jurisdiction being wrested with the registering councils the civil jurisdiction being wrested with the civil court and the compensatory jurisdiction under the Consumer Protection Act and of course the criminality if any under the rubric of the CrPC read with the Indian Penal Code It is precisely for this reason in spite of the fact that this particular provision is protected by a non obstante clause it has not rendered any help and therefore it is imperative that a serious thought is given to this clause being repealed

Also it should be provided by another clause stipulating creation of a standing mechanism for a single window cell for the purposes of receipt of the complaints in regard to deviations by the registered medical practitioners pertaining to the privileges as incorporated in the Subsection from (a) to (d)

And by virtue of this expert standing mechanism the required referrals if any to the trying jurisdictions can be submitted to Perhaps this will definitely result in avoidance of simultaneous multiple trials and the contradiction generated thereof with a single referral standing mechanism statutory in character This mechanism should further be provided with a non obstante clause stating that this will be mandatory independent of whatever is included or not in enabling provisions of otherwise in any other governing Act or statute at the contemporary point of time

CME credit hours not necessary

Technicians canrsquot run med labs sign test reports

bull The Maharashatra state medical education and drugs department has issued a GR stating that holders of a diploma in medical laboratory technician (DMLT) certificate cannot run independent pathology laboratories or sign reports

bull Any violation of the order could lead to jail term of 10 years and a fine of Rs 10000

bull Henceforth running a pathology lab by DMLT and equivalent diploma holder independently would be an offence

bull DMLT holders however can examine samples record it but cannot sign the final report

bull DMLT degree holders can appoint people with MD pathology or diploma in clinical pathology who must be registered under the Maharashtra Medical Council and Medical Council of India

One can Practice anywhere in the countryIMC Act 1956

15 RIGHT OF PERSONS POSSESSING QUALIFICATIONS IN THE SCHEDULES TO BE ENROLLED

27 PRIVILEGES OF PERSONS WHO ARE ENROLLED ON THE INDIAN MEDICAL REGISTER

Subject to the conditions and restrictions laid down in this Act regarding medical practice by persons possessing certain recognised medical qualifications every person whose name is for the time being borne on the Indian Medical Register shall be entitled according to his qualifications to practice as a medical practitioner in any part of India and to recover in due course of law in respect of such practice any expenses charges in respect of medicaments or other appliances or any fees to which he may be entitled

bull 28 PERSONS ENROLLED ON THE INDIAN MEDICAL REGISTER TO NOTIFY CHANGE OF PLACE OF RESIDENCE OR PRACTICE

Every person registered in the Indian Medical Register shall notify any transfer of the place of his residence or practice to the Council and to the State Medical Council concerned within thirty days of such transfer failing which his right to participate in the election of members to the Council or a State Medical Council shall be liable to be forfeited by order of the Central Government either permanently or for such period as may be specified therein

IMA Stand Pharmacists can not prescribe drugs

Doctor Pharma Relationship Pharma Gifts are a Violation of both MCI and Income Tax Act

A violation under Section 37 (1) of Income tax act

CBDT Circular No 52012 [F No 2251422012-ITAII] dated 1-8-2012

1 It has been brought to the notice of the Board that some pharmaceutical and allied health sector Industries are providing freebees (freebies) to medical practitioners and their professional associations in violation of the regulations issued by Medical Council of India (the lsquoCouncilrsquo) which is a regulatory body constituted under the Medical Council Act 1956

2 The council in exercise of its statutory powers amended the Indian Medical Council (Professional Conduct Etiquette and Ethics) Regulations 2002 (the regulations) on 10-12-2009 imposing a prohibition on the medical practitioner and their professional associations from taking any Gift Travel facility Hospitality Cash or monetary grant from the pharmaceutical and allied health sector Industries

3 Section 37(1) of Income Tax Act provides for deduction of any revenue expenditure (other than those failing under sections 30 to 36) from the business Income if such expense is laid outexpended wholly or exclusively for the purpose of business or profession However the explanation appended to this sub-section denies claim of any such expense if the same has been incurred for a purpose which is either an offence or prohibited by law

Thus the claim of any expense incurred in providing above mentioned or similar freebees in violation of the provisions of Indian Medical Council (Professional Conduct Etiquette and Ethics) Regulations 2002 shall be inadmissible under section 37(1) of the Income Tax Act being an expense prohibited by the law This disallowance shall be made in the hands of such pharmaceutical or allied health sector Industries or other assesse which has provided aforesaid freebees and claimed it as a deductible expense in its accounts against income

4 It is also clarified that the sum equivalent to value of freebees enjoyed by the aforesaid medical practitioner or professional associations is also taxable as business income or income from other sources as the case may be depending on the facts of each case The Assessing Officers of such medical practitioner or professional associations should examine the same and take an appropriate action

This may be brought to the notice of all the officers of the charge for necessary action

The Himachal high court had upheld the income-tax departments decision to tax the amount pharmaceutical and allied health sector industries spend on freebies for medical practitioners and their professional associations (March 2013)

High Courtrsquos Ruling The explanation to Section 37(1) makes it clear that any expenditure incurred by the taxpayer for any purpose which is prohibited by law shall not be deemed to have been incurred for the purpose of business or profession The sum and substance of the circular is also the same

In case the assessing authorities do not properly understand the circular then the remedy lies for each individual taxpayer to file appeal under the Act but the Circular which is totally in line with Section 37(1) cannot be said illegal

The Circular also clarifies that the value of the freebies enjoyed by the medical practitioner is also taxable as business income or income from other sources depending on the facts of each case Therefore if the taxpayer satisfies the assessing authority that the expenditure is not in violation of the regulations framed by the medical council then it may legitimately claim a deduction But it is for the taxpayer to satisfy the assessing authority that the expenditure is not in violation of the Medical Council Regulations Accordingly the High Court rejected the petition

Pharma Gifts Violation of Section 28 in The Income- Tax Act 1995

bull In 2014 the office of the Assistant Director of Income Tax (investigation) Unit-IV (2) Jhandewalan Extn New Delhi procured information from MCI under Section 131 of the Income Tax Act 1961

bull The investigating agency took cognizance of the a news titled ldquoGraft charge puts 300 does under MCI lensrdquo reported in times of India on page no 8 dated 18112014 that the Medical Council of India is in possession of an anonymous complaint in regard to bribes paid by an Ahmedabad based pharma company to Doctors in the form of money as well as gifts in return for prescribing its medicines

bull As per the IT department this prima facie is a case of Income Tax evasion as the Doctors seemed to have received benefits in exercise of their profession As per the IT department the value of any benefit or perquisite whether convertible into money or not arising from business or the exercise of a profession is taxable as per section 28(iv) of the Income Tax Act 1961

bull Section 28 in The Income- Tax Act 1995 Profits and gains of business or profession The following income shall be chargeable to income- tax under the head Profits and gains of business or profession- (iv) the value of any benefit or perquisite whether convertible into money or not arising from business or the exercise of a profession]

Not reporting TB a Violation1 GOI Circular Z-2801522012-TB the Government of India Ministry of Health and Family Welfare on 7th May 2012 declared TB as a notifiable disease As pet the circular TB continues to be a major public health problem accounting for substantial morbidity and mortality in the country Early diagnosis and complete treatment of TB is the corner-stone of TB prevention and control strategy Inappropriate diagnosis and irregularincomplete treatment with anti-TB drugs may contribute to complications disease spread and emergence of Drug Resistant TB

In order to ensure proper TB diagnosis and case management reduce TB transmission and address the problems of emergence and spread of Drug Resistant- TB it is essential to have complete information of all TB cases Therefore the healthcare providers shall notify every TB case to local authorities ie District Health Officer I Chief Medical Officer of a district and Municipal health Officer of a Municipal Corporation Municipality every month in a given format

For the purpose of case notification a TB case is defined as follows A patient diagnosed with at least one sputum specimen positive for acid fast bacilli or Culture-positive for Mycobacterium tuberculosis or RNTCP endorsed Rapid Diagnostic molecular test positive for tuberculosis OR a patient diagnosed clinically as a case of tuberculosis without microbiologic confirmation and initiated on anti-TB drugs

For the purpose of this notification healthcare providers will include clinical establishments run or managed by the Government (including local authorities) private or NGO sectors andor individual practitioners

For more detailed information the concerned State TB Officers District TB Officers whose details are available on wwwtbcindianicin may be contacted (Manoj Sinha) Under Secretary to the Government of India

2 The above circular was not sent to Medical Council of India for reasons only known to them Not reporting a notifiable disease is already a violation of Indian Medical Council (Professional conduct Etiquette and Ethics) Regulations 2002

3 Regulation 714 The registered medical practitioner shall not disclose the secrets of a patient that have been learnt in the exercise of his her profession except ndash 1 in a court of law under orders of the Presiding Judge 2 in circumstances where there is a serious and identified risk to a specific person and or community and 3 notifiable diseases

In case of communicable notifiable diseases concerned public health authorities should be informed immediately

Under the regulation the word used is SHOULD but under the notification the word used is SHALL It means it is mandatory to report but for the violation the MCI may take a lenient view if it is the first violation

4 MCI Ethics Regulation 52 Public and Community Health Physicians especially those engaged in public health work should enlighten the public concerning quarantine regulations and measures for the prevention of epidemic and communicable diseases At all times the physician should notify the constituted public health authorities of every case of communicable disease under his care in accordance with the laws rules and regulations of the health authorities When an epidemic occurs a physician should not abandon his duty for fear of contracting the disease himself

5 In most of the municipal corporation acts for example DMC Act ( Delhi) TB is defined as a dangerous disease under 2 (9) dangerous disease meansmdash (a) Cholera plague chicken-pox small-pox tuberculosis leprosy enteric fever cerebrospinal meningitis and diphtheria and (b) any other epidemic endemic or infectious disease which the Commissioner may by notification in the Official Gazette declare to be a dangerous disease for the purposes of this Act Prevention of dangerous diseases The DMC act also mandates reporting under section 371 Obligation to give information of dangerous disease Any person being in charge of or in attendance whether as a medical practitioner or otherwise upon any person whom he knows or has reason to believe to be suffering from a dangerous disease or being the owner lessee or occupier of any building in which he knows that any such person is so suffering shall forthwith give information respecting the existence of such disease to the Municipal Health Officer

6 Section 269 in The Indian Penal Code 269 Negligent act likely to spread infection of disease dangerous to lifemdashWhoever unlawfully or negligently does any act which is and which he knows or has reason to believe to be likely to spread the infection of any disease dangerous to life shall be punished with imprisonment of either description for a term which may extend to six months or with fine or with both

7 Section 270 in The Indian Penal Code 270 Malignant act likely to spread infection of disease dangerous to lifemdashWhoever malignantly does any act which is and which he knows or has reason to believe to be likely to spread the infection of any disease dangerous to life shall be punished with imprisonment of either description for a term which may extend to two years or with fine or with both

8 Narok ( Nairobi) TB patient gets one year for failing to take medicine Charles Ngeno A Narok Court jailed a TB patient for one year for repeatedly failing to take medication thereby infecting his wife and five children Parkuito ole Sankok was also fined Sh30000 or a further six months imprisonment in default The accused pleaded guilty and asked for leniency but Sitati ruled that he had unlawfully refused to take medication while fully aware that the disease was contagious thereby risking other peoples lives Narok Sub-County TB and Leprosy Co-ordinator Jackline Chepletine told the court that the accused was diagnosed with the disease in 2012 but he interrupted treatment He resurfaced in June last year and was once again put under medication In November it was discovered he had developed a Multi-Drug Resistant (MDR) strain of TB due to his absconding and his treatment changed from regular to multi-drug treatment which is more costly He was advised to remain in isolation to avoid infecting the family an offer he declined but promised to comply with the nine-month mono-drug treatment given to patients with one strain of resistance The court was told the patient took the drugs until April when he started to interrupt medication again and at one point he started using alcohol which is prohibited

No cure no payment is not permitted

bull ldquoNo Cure No Paymentrdquo or ldquoGuarantee any curerdquo both are violations of Medical Council of India (MCI) Code of Ethics Regulations as well as Drugs and Magic Remedies Act

bull Division bench at the Bombay High Court refused to grant interim relief to a doctor couple running an IVF clinic at Colaba whose licenses were suspended by Maharashtra Medical Council for three months following complaints that they made promises of guaranteed pregnancy on their clinic website and even offered refund if the treatment failed The complaint was made by the Advertising Standards Council of India in 2014

bull Regulation 61 Advertising 611 Soliciting of patients directly or indirectly by a physician by a group of physicians or by institutions or organisations is unethicalhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

bull Regulation 18 Payment of Professional Services ldquoThe physician engaged in the practice of medicine shall give priority to the interests of patients helliphelliphelliphelliphellip It is unethical to enter into a contract of ldquono cure no paymentrdquo helliphelliphelliprdquo

bull The Drugs and Magic Remedies (Objectionable Advertisements) Act 1954 3 Prohibition of Advertisement of Certain Drugs for Treatment of Certain Diseases and Disorders Subject to the provisions of this Act no person shall take any part in the publication of any advertisement referring to any drug in terms which suggest or are calculated to lead to the use of that drug for ndash d) The diagnosis cure mitigation treatment or prevention of any disease disorder or condition specified in the Schedulehelliphelliphelliphelliphelliphelliphelliphelliphellip Diseases and Ailments (by whatever Name described) which a Drug may not Purport to Prevent or Cure or Make Claims to Prevent or Cure 48 (Sterility in women)

IMA Position statement on Cuts Commissions and Corrupt Practice

In the last Central Council meeting of IMA held in Ahmedabad it was decided that IMA is against giving any targets whether in government or in private sector to its members

These are violations of MCI Ethics Regulations

bull The concerned doctor should bring it to the knowledge of the state council Regulation 17 of the Indian Medical Council (Professional Conduct Etiquette and Ethics) Regulations 2002 reads as follows ldquo17 Exposure of Unethical Conduct A Physician should expose without fear or favour incompetent or corrupt dishonest or unethical conduct on the part of members of the professionrdquo

bull MCI 312 Consulting pathologistsradiologists or asking for any other diagnostic Lab investigation should be done judiciously and not in a routine manner

bull MCI 23 Prognosis The physician should neither exaggerate nor minimize the gravity of a patientrsquos condition He should ensure himself that the patient his relatives or his responsible friends have such knowledge of the patientrsquos condition as will serve the best interests of the patient and the family

bull MCI 31 Unnecessary consultations Unnecessary consultations should be avoided b 311 However in case of serious illness and in doubtful or difficult conditions the physician should request consultation but under any circumstances such consultation should be justifiable and in the interest of the patient only and not for any other consideration

bull 64 Rebates and Commission 641 A physician shall not give solicit or receive nor shall he offer to give solicit or receive any gift gratuity commission or bonus in consideration of or return for the referring recommending or procuring of any patient for medical surgical or other treatment A physician shall not directly or indirectly participate in or be a party to act of division transference assignment subordination rebating splitting or refunding of any fee for medical surgical or other treatment

bull 642 Provisions of para 641 shall apply with equal force to the referring recommending or procuring by a physician or any person specimen or material for diagnostic purposes or other studywork Nothing in this section however shall prohibit payment of salaries by a qualified physician to other duly qualified person rendering medical care under his supervision

bull Code of conduct for doctors in their relationship with pharmaceutical and allied health sector industry 681 In dealing with Pharmaceutical and allied health sector industry a medical practitioner shall follow and adhere to the stipulations given below

bull Gifts A medical practitioner shall not receive any gift from any pharmaceutical or allied health care industry and their sales people or representatives

bull Travel facilities A medical practitioner shall not accept any travel facility inside the country or outside including rail air ship cruise tickets paid vacations etc from any pharmaceutical or allied healthcare industry or their representatives for self and family members for vacation or for attending conferences seminars workshops CME programme etc as a delegate

bull Hospitality A medical practitioner shall not accept individually any hospitality like hotel accommodation for self and family members under any pretext

bull 61 Advertising 611 Soliciting of patients directly or indirectly by a physician by a group of physicians or by institutions or organisations is unethical

bull 712 allows conditions where one can advertise ldquoAn institution run by a physician for a particular purpose such as a maternity home nursing home private hospital rehabilitation centre or any type of training institution etc may be advertised in the lay press but such advertisements should not contain anything more than the name of the institution type of patients admitted type of training and other facilities offered and the feesrdquo

Unrealistic Targets in a Government Camp

bull IMA will not tolerate unrealistic targets for surgeries in a camp

bull IMA has been informed that at State Level targets are given to doctors by CMOs to conduct a specific number of surgeries in a camp in a day

bull As per documents available with IMA a target of 100-250 had been given to doctors for performing sterilization surgeries in one day

bull As per IMA guidelines which are also consistent with Govt guidelines in one day more than 30 such surgeries should not be done

bull IMA wrote to Health Secretary MOH GOI to ensure that no unrealistic targets are given to member of any Association in any State

Health Care Data Privacy and Security Act 2016bull Any violation by doctors again will lead to jail We already have provisions for privacy secrecy and confidentiality in MCI under

professional misconduct and punishments

bull Then why legal provisions and hefty fine under a new legislation It looks all ethics regulations in MCI are getting converted into individual laws with legal provisions IMA raised its points in the said meeting where IOMNA was an invitee (not a regular member of the committee unfortunately)

bull Patience Delicacy and Secrecy Patience and delicacy should characterize the physician Confidences concerning individual or domestic life entrusted by patients to a physician and defects in the disposition or character of patients observed during medical attendance should never be revealed unless their revelation is required by the laws of the State Sometimes however a physician must determine whether his duty to society requires him to employ knowledge obtained through confidence as a physician to protect a healthy person against a communicable disease to which he is about to be exposed In such instance the physician should act as he would wish another to act toward one of his own family in like circumstances

bull 714 The registered medical practitioner shall not disclose the secrets of a patient that have been learnt in the exercise of his her profession except ndash in a court of law under orders of the Presiding Judge in circumstances where there is a serious and identified risk to a specific person and or community and notifiable diseases In case of communicable notifiable diseases concerned public health authorities should be informed immediately

bull 7 MISCONDUCT The following acts of commission or omission on the part of a physician shall constitute professional misconduct rendering himher liable for disciplinary action

71 Violation of the Regulations If heshe commits any violation of these Regulations

bull Declaration g I will respect the secrets which are confined in me

bull IMA View When provisions of PCPNDT act CEA and health data privacy are there in MCI ethics regulations why bring another act underhealth ministry and bring doctors under penal punishment

bull If cleared and passed by the government following will be the sequences

bull Under 39 and breach of the Act will be punishable The breach may be if the health data stored or transmitted by the doctor is not anonymized or De-identified as per the norms of this Act or if the doctor un-authorizingly use the Health Data for the purposes other than mentioned under this Act or uses the Health Data for the Commercial Purposes Commercial gain or causes any damage destroys or deletes or affects it injuriously by any means or tampers any health data existing in any digital form

bull Serious Health Data Breach means breach pertaining to the same individual for the second or repeated times or number of individuals potentially affected or sensitive information or vulnerable or disadvantaged people or deliberate or reckless conduct

bull Penalty (40) Imprisonment of up to two years and fine which shall be not less than one lakh rupees or both

bull For serious health data breach Imprisonment of 2-4 years and fine of more than 5 lacs

bull Any person or Health Information Exchange which is required under this Act or any rules made thereunder to furnish any information or document or books or returns or reports etc to National eHealth Authority or such other designated Authority by Central Government if does not report shall be liable to a penalty of minimum one lakh of rupees and rupees ten thousand for each day during which such failure continues (41)

MCI Declaration Physicians OathAt the time of registration each applicant shall be given a copy of the following declaration by the Registrar concerned and the applicant shall read and agree to abide by the same

I solemnly pledge myself to consecrate my life to service of humanity

I solemnly pledge myself to consecrate my life to service of humanity and society

Even under threat I will not use my medical knowledge contrary to the laws of Humanity

I will maintain the utmost respect for human life from the time of conception

I will maintain the utmost respect for human life from the time of conception and will not directly or indirectly indulge in any sex selective foeticide

I will not permit considerations of religion nationality race party politics or social standing to intervene between my duty and my patient

I will not permit considerations of age disease or disability religion caste creed nationality ethnic origin gender race political affiliation sexual orientation social standing ability to pay or any other factor to intervene between my duty and my patient

I will practice my profession with conscience and dignity

I will practice my profession with compassion and dignity

The health of my patient will be my first consideration

ldquoTHE HEALTH OF MY PATIENT will be my first consideration while I respect his her personality and autonomyrdquo

I will respect the secrets which are confined in me

I will give to my teachers the respect and gratitude which is their due

I will give to my teachers and students the respect and gratitude which is their due

I will maintain by all means in my power the honour and noble traditions of medical profession

I will treat my colleagues with all respect and dignity

I shall abide by the code of medical ethics as enunciated in the Indian Medical Council (Professional Conduct Etiquette and Ethics) Regulations 2002

I shall abide by the code of medical ethics as enunciated in the Indian Medical Council (Professional Conduct Etiquette and Ethics) Regulations 2002 and all its subsequent amendments

I make these promises solemnly freely and upon my honour

Medical Profession and Strikebull Every citizen has the right to protest and even go on strike in rare situations and this right is ingrained in Article 19 of our constitution

bull Supreme Court refused to ban strike by Doctors and opined that MCI is the body to receive complaints on ethical issues related to Doctors strike

bull Vide circular dated 22-04-2015 MCI has written to all State Councils referring to SC judgement and also to 2002 Regulations to take action against doctors going on strike

bull IMA strongly reacted against the circular There is nothing in the said judgement and Regulations to hold that it is against law on the part of doctors to go on strike Regulations nowhere even contain the word ldquostrikerdquo

bull Article 19 in The Constitution of India 1949 talks about protection of certain rights regarding freedom of speech etc 1) All citizens shall have the right (a) to freedom of speech and expression (b) to assemble peaceably and without arms (c) to form associations or unions (d) to move freely throughout the territory of India

bull Doctors rarely resort to strike Strike is a fundamental right of workers and till today there is no ban on strikes in India

bull The scheme of the Industrial Disputes Act 1947 implies a right to strike (vii) in industries A wide interpretation of the term lsquoindustryrsquo (viii) by the courts includes hospitals

bull SC judgement has drawn a parallel with the Bar Council of India and has suggested that all professionals whether medical or legal should be treated alike and should be judged by the respectiveprofessional council and not by the Honrsquoble SC in a matter concerning strike

bull A 22-day strike was held by all lawyers in all district courts of Delhi paralysing court work and harming the interest of clients but the bar Council has not taken any action

bull Doctors strike are not peculiar to India but have taken place in other countries also including USA and UK

Pertaining Laws of MCI

MCI Ethics regulation 24 The Patient must not be neglected A physician is free to choose whom he will serve He should however respond to any request for his assistance in an emergency Once having undertaken a case the physician should not neglect the patient nor should he withdraw from the case without giving adequate notice to the patient and his family Provisionally or fully registered medical practitioner shall not wilfully commit an act of negligence that may deprive his patient or patients from necessary medical care

21 Obligations to the Sick 211 Though a physician is not bound to treat each and every person asking his services he should not only be ever ready to respond to the calls of the sick and the injured but should be mindful of the high character of his mission and the responsibility he discharges in the course of his professional duties In his treatment he should never forget that the health and the lives of those entrusted to his care depend on his skill and attention

A physician should endeavour to add to the comfort of the sick by making his visits at the hour indicated to the patients A physician advising a patient to seek service of another physician is acceptable however in case of emergency a physician must treat the patient No physician shall arbitrarily refuse treatment to a patient However for good reason when a patient is suffering from an ailment which is not within the range of experience of the treating physician the physician may refuse treatment and refer the patient to another physician

The above regulation again indicates that strike should be the last resort

The Essential Services Maintenance Act (ESMA) 1968 is an act of Parliament of India which was established to ensure the delivery of certain services which if obstructed would affect the normal life of the people

2 (1) (a) ldquoessential servicerdquo does not include health as essential service

In Portfolio Committee on Labour the ANC unanimously rejected the Labour Relations Amendment Bill 2014 which seeks to prevent the high incidence of violent strikes in South Africa

Justice Sudhir Agarwal J Rakesh Srivastava J Moti Lal Yadav vs State of UP Thru Chief Secy13501 of 2016 Date 2062016 Allahabad HC

bull 13 We therefore direct as under

bull(a) State Government shall constitute a High Powered Committee headed by a Judicial Officer not below the rank of Additional Legal Remembrancer from Legal Remembrancer Department to conduct an inquiry and submit its report positively within two months of its constitution finding out whether any patient in State Medical Colleges Hospitals have died since 30th May 2016 till today ie 2nd June 2016 on account of protest abstention from duty strike etc of doctors working therein The aforesaid committee shall be constituted within a week from today If any death has occurred Government shall provide compensation to legal heirs of victims by paying a sum of Rs 25 00000-(Twenty Five Lacs)

bull(b) The amount of compensation paid above shall be recovered from the salariesallowances etc as the case may be of doctorsgoing on protestabstention from duty strike etc

bull(c) The Principals of State Medical Colleges as well as Vice Chancellor King Gorge Medical University Lucknow shall identify doctors who have gone on strike protestabstention from duty etc and they shall be administered a serious recordable warningbesides denial of salary allowances honorarium as the case may be and their period of training etc shall be extended by the aforesaid period of non-working

bull(d) In future if any doctor of State Medical Colleges or Government 4 hospitals or Government Medical Services whatever name or title it is called proceed to observe strikeprotest agitationabstention from duty etc heshe shall immediately be identified and a permanent appraisal record of such doctors shall be created by placing on record his her such conduct and admonition theretoIf such conduct has also resulted in any mortality the same shall also be noted therein The said record of doctor shall also be placed on a website constituted for the purpose for knowledge of people at large It shall also be communicated to Medical Council of India for considering cancellation revocation or suspension of license to practice

bull(e) Besides above criminal and tortious action by appropriate authorityvictim wouldmay be open to be taken against such erring doctors

bull(f) Government shall also take disciplinary action by treating the aforesaid conduct as serious misconduct justifying major penalty

bull(g) This policy decision and guideline shall be formulated and communicated to all the doctors at the time of entering the service and those who are already in service shall be communicated within three months from today

bull(h) A report of compliance of this order shall be submitted to the court under personal affidavit of Principal Secretary Medical Health and Family Welfare as well as Secretary Medical Education by 10th September 2016

bull14 With the aforesaid observations the writ petition is disposed of

bull15 The Registrar is directed to forward a copy of this judgment forthwith to Chief Secretary UP Lucknow Principal Secretary Medical Health and Family Welfare and Secretary Medical Education for information and compliance

MCI Treat all emergencies and bill it to the state Medical Council of India NoMCI-211(2)2014-Ethics100305 Date01042015

Sub Guidelines for protection of Good Samaritans in pursuance of directions of Honrsquoble Supreme Court of India-regarding

ldquo It is to inform you that in pursuance of the directions of the Honrsquoble Supreme Court of India in WP (civil) no 2352012 titled as Save Life Foundation amp ANR Vs Union of India amp ANR the matter was considered by Ethics Committee of the Council at its meeting held on 17th amp 18th Nov 2014 The observation and the decision of the Committee is reproduced as under-

ldquoThe Ethics Committee considered the letter dated 24092014 of Additional Solicitor General Honrdquoble Supreme Court forwarded by Under Secretary Govt of India Ministry of Health amp Family Welfare vide their letter dated 28102014 The Committee noted the Supreme Court direction in WP No 235 of 2012 titled as ldquoSave Life Foundation amp Others Vs Union of India and Orsrdquo pending in the Honrsquoble Court

In this connection the Ethics Committee noted that as per Indian Medical Council Act 1956 the Council does not have any administrative jurisdiction over the hospitals or clinical establishment The Council has the jurisdiction only for purposes of teaching

In view of above the Ethics Committee was of the view that an Advisory be sent to all the State Medical Councils DeanDirectors of Medical Education Vice Chancellors of the Universities Indian Medical Association and all the State Medical Councils that they should issue Advisory and instructions informing all the doctors registered or working in the respective institutions of ensuring that in case of emergency situations pertaining to the road accidents or any other emergent situation doctors should attend the patients and given them emergency treatment

The Ethics Committee was also of the view that Advisory is only for providing the treatment With regard to financial aspect the State should develop a mechanism to reimburse as per rates

The said decision has been approved by the Executive Committee at its meeting held on 13012015

In view of above I am directed to request you to issue an advisory and instructions to all the doctors registered andor working under jurisdiction ensuring that in case of emergency situation pertaining to the road accidents or any other emergent situation doctors should attend the patients and given them emergency treatment immediately failing which the State Medical Council andor Medical Council of India may take appropriate action against the erring doctors under the provisions and Indian Medical Council (Professional Conduct Etiquette and Ethics) Regulations 2002

(Dr Reena Nayyar) Secretary IC

Copy to Sh Amit Biswas Under Secretary to the Government of India Ministry of Health amp F W Nirman Bhawan New Delhi with reference to letter NoV1102512014_MEP-I(Volii) (Pt) dated 20th February2015

PIL is not a pill or a panacea for all wrongs

Delhi High Court WP(C) 95972015 PBT vs MCI Vs IMA CORAM HONBLE THE CHIEF JUSTICE G Rohini amp HONBLE MR USTICE JAYANT NATH O R D E R 03032016

PIL PBT Vs MCI Vs IMA

MCI and MOH to take appropriate measures for immediate removal of Dr Ketan Desai from the office of the President of the WMA

MCI to take disciplinary action and to direct investigation into the allegations of corruption in Medical Council of India

bull WMA is not a statutory body but it is only an organization where a number of private medical associations are members

bull It is also not in dispute that Dr Desai has been duly elected to the post of the President of WMA

bull That being the position the disqualification if any incurred by him has to be examined by the competent authority and it is not an issue which can be determined by this Court under Article 226 of the Constitution of India

bull As observed by the Supreme Court in Balco Employees Union (Regd) v Union of India amp Ors (2002) 2 SCC 333 PIL is not a pill or a panacea for all wrongs It was essentially meant to protect basic human rights of the weak and the disadvantaged and wasa procedure which was innovated where a public spirited person files a petition in effect on behalf of such persons who on account of poverty helplessness or economic and social disabilities could not approach the Court for relief Whenever the Courts have interfered and given directions while entertaining PIL it has always been where there has been an element of violation of Article 21 or of human rights or where the litigation has been initiated for the benefit of the poor and the underprivileged who are unable to come to Court due to some disadvantage No such case is made out in the present case

bull The petitioner is a society run by one Dr Kunal Saha who lives in Ohio

bull He had earlier filed WP(PIL)No152010 titled People for Better Treatment (PBT) Through President Vs Ketan Desai amp 3 Ors in the High Court of Gujarat seeking a direction to the respondents No3 and 4 therein to hold and declare that the Vice Chancellor Gujarat University had no authority in law to declare the respondent No1 therein (Dr Ketan Desaithe respondent No5 in the present petition) as an elected member of the Senate of the Gujarat University The said writ petition was dismissed by a Division Bench of the Gujarat High Court observing that the petitioner had not established his credentials andbona fide for pursuing the petition

bull Even in the present petition nothing has been shown as to how the writ is in the nature of public interest On the basis of theaverments in the petition we are unable to hold that the matter involves any element of public interest and therefore we decline to entertain this petition

bull The petition is accordingly dismissed

Constitutional Amendments Being Followed

1 MCI 86 Professional incompetence shall be judged by peer group as per guidelines prescribed by Medical Council of India

2 Statutory Rules or Executive Instructions incorporating certain guidelines need to be framed and issued by the Government of India andor the State Governments in consultation with the Medical Council of India So long as it is not done we propose to lay down certain guidelines for the future which should govern the prosecution of doctors for offences of which criminal rashness or criminal negligence is an ingredient [SCI Jacob Mathew vs State Of Punjab amp Anr on 5 August 2005]

3 Parmanand Kataria vs Union of India clarification in MCI GBM [ It is submitted that Evidence Act should also be so amended as to provide that the Doctors diary maintained in regular course by him in respect of the accident cases would be accepted by the courts in evidence without insisting the doctors being present to prove the same or subject himself to cross-examinationharassment for long period of timeldquo]

RTI is not applicable to IMARight to Information Act 2005 is enacted to provide for setting out the practical regime of right to information for citizens to secure access to information under the control of public authorities in order to promote transparency and accountability in the working of every public authority the constitution of a Central Information Commission and State Information Commissionsand for matters connected therewith or incidental thereto

According to Section 2(h) of RTI Act public authority means any authority or body or institution of self-government established or constitutedmdash

(a) by or under the Constitution

(b) by any other law made by Parliament

(c) by any other law made by State Legislature

(d) by notification issued or order made by the appropriate Government and includes anymdash

(i) body owned controlled or substantially financed

(ii) non - Government organisation substantially financed directly or indirectly by funds provided by the appropriate Government

According to Section 2(j) of RTI Act right to information means the right to information accessible under this Act which is held by or under the control of any public authority and includes the right to-

inspection of work documents records taking notes extracts or certified copies of documents or records taking certified samples of material obtaining information in the form of diskettes floppies tapes video cassettes or in any other electronic mode or through printouts where such information is stored in a computer or in any other device

According to Section 3 of RTI Act subject to the provisions of this Act all citizens shall have the right to information Thus the citizens of India are entitled to obtain the information as their right only from the public authority as defined in Section 2(h) of the RTI Act

IMA does not falls under any one of the conditions of definition of public authority

IMA is not self-government established

IMA is not constitutedmdash (a) by or under the Constitution (b) by any other law made by Parliament (c) by any other law made by State Legislature (d) by notification issued or order made by the appropriate Government and includes anymdash (i) body owned controlled or substantially financed (ii) non - Government organisation substantially financed directly or indirectly by funds provided by the appropriate Government

Further the Central Information Commission in the matter titled asrdquo Mr Aditya Parolia versus Hony Secretary General IMA Complaint No CICSGC2011001137rdquo has given Decision No CICSGC201100113716884 dated 16012012 whereby it was held that

ldquoThe respondent clearly does not fall under clause (a) to (d) Furhter more it has not been shown to have been substantially financed or controlled or owned by the government Hence the Complainant has no legally enforceable right under the RTI Act as the respondent is not a public authority under the RTI Act and is therefore under no obligation to reply to the ComplainantrsquosRTI Applicationrdquo

Leaking IT Information

Section 72A of the Information Technology Act 2008 ndash any act which discloses information in breach of lawful contract is an offence

ldquoSave as otherwise provided in this Act or any other law for the time being in force any person including an intermediary who while providing services under the terms of lawful contract has secured access to any material containing personal information about another person with the intent to cause or knowing that he is likely to cause wrongful loss or wrongful gain discloses without the consent of the person concerned or in breach of a lawful contract such material to any other person shall be punished with imprisonment for a term which may extend to 3 years or with a fine which may extend to five lakh rupees or with bothrdquo

Non-disclosure of Confidential Information and Trade Secrets The employee is mandated to take reasonable steps to keep all the confidential information in confidence except and to the extent when disclosure is mandatory under any law in force The employee further agrees that he shall not discuss or disclose the confidential information of the company to any person or business unrelated to the company

In Escorts Const Equipment Ltd v Action Const Equipment P Ltd AIR 1999 Delhi 73 the Delhi High Court restrained Escorts from manufacturing selling or offering for sale the Pick-N-Carry Mobile Cranes that were a substantial imitation or reproduction of the industrial drawings of the Plaintiffs or from using in any other manner whatsoever the technical know-how

In Burlington Home Shopping Pvt Ltd v Rajnish Chibber MANUDE07181995 61(1995) DLT6 the Delhi High Court again restrained carrying on of any business including mail order business by utilising the list of clientelecustomers included in the database of the petitioner

In Diljeet Titus v Mr Alfred A Adebare and Others 2006 (32) PTC 609 (Del) the defendant an advocate was working at the plaintiffrsquos law firm On termination of employment the defendant took away important confidential business data such as client lists and proprietary drafts belonging to the plaintiff The defendants contended that they were the owners of the copyright work as it was done by them during their employment since the relation between parties was not that of an employer and employee The Delhi High Court rejected this contention and ruled that the plaintiff had a clear right in the material taken away by the defendant Accordingly the Delhi High Court restrained the defendant from using the information taken away illegally It should be noted that the Delhi High Court did not prohibit the defendants from carrying on a similar service The defendants were only restrained from using the information they took as this was necessary to protect the interests of the plaintiffrdquo The relationship between the parties was in the nature of a contract of service

In American Express Bank Ltd v Ms Priya Puri 2006 (110) FLR 1061 the defendant was working as the Head of Wealth Management for the plaintiff bank for the North India region Upon the defendant serving her notice for termination of employment the plaintiff bank instituted allegations of sharing trade secrets confidential information and possessing intellectual property of the plaintiff The plaintiff consequently filed a plea for injunction against the defendant The Delhi High Court rejected this plea on the grounds that ldquoThe inconvenience caused to the defendant shall be much more in case the injunction as prayed by the plaintiff is granted in his favourrdquo The Delhi High Court further observed that in order to claim copyrights the plaintiff should have abridged arranged andor done something ldquowhich would show that they have done something with the material which is available in public domain so as to claim exclusive rights in thatrdquo In addition to restraining employees from using such confidential information post termination by way of seeking injunction or claiming damages the criminal legislation also comes to the aid of employers and provides them with an opportunity to take criminal action against the employees in addition to seeking civil remedies

Provisions of the Indian Penal Code

bull Section 381 (Theft by clerk or servant which is punishable with imprisonment which may extend to 7 years and fine)

bull Section 403 (Dishonest misappropriation of property which is punishable with imprisonment which may extend to 2 years or fine or both)

bull Section 405- (Criminal breach of trust which is punishable with imprisonment which may extend to 3 years or fine or both)

bull Section 408 (Criminal breach of trust by a clerk or servant which is punishable with imprisonment which may extend to 7 years and fine

bull Section 415 (Cheating which is punishable with imprisonment which may extend to 1 year or fine or both) can also be resorted to by the employers in case of breach of confidentiality on part of the employees post-employment period)

bull Provisions Information Technology Act 2000 are also attracted in case of breach of confidentiality and disclosure provisions and allow criminal prosecution and imprisonment or fine or both as required with increasing dependence on technology remedies have been provided under the Information Technology Act 2000 to deal with hacking (Section 66) causing damage to computer system (Section 43) tampering with computer source document (Section 65) punishment for violation of privacy policy (Section 66E) etc may also be considered by the employer as remedies against the employee in case of breach of confidentiality and disclosure provisions

bull Bombay Dyeing and Manufacturing Co Ltd Vs Mehar Karan Singh MANUMH09552010 From Case Notes - Held an employer can protect the trade secrets without preventing the use of the employees own knowledge skill and experience even if this is acquired during the course of employment Therefore whatever information can be carried by the employee in his head it may be used by him after his contract expires or in his business thereafter but all the confidential information including list of customers which cannot be verbatim copied by the employee cannot be used by him to the detriment of his employer In the present case though the Defendant who attended the Board meetings of the Company would have amassed the information and knowledge with regard to the Plaintiffs plans of operation the Defendant cannot be injuncted from disclosing those plans except for what would cause injury or damage to the Plaintiff by such disclosure

bull Ratio An information to be confidential apart from contract must have the necessary quality of confidence about it and must not be something which is public property and public knowledge

Modern medicine is not without risk One year bridge course

1 One year bridge course by AYUSH to practice modern medicine is injurious to the health of the society

2 Both JCI NABH require quality and safety of treatment

3 Modern Medicine learning curve starts at 5 amp require additional 5 years under supervision to practice safe medicine

4 In US each year 56000 ER visits 26000 hospitalizations and 458 deaths are related to paracetamol overdoses

5 Among people 25- 64 yrs drug overdose causes more deaths than motor vehicle traffic crashes

6 In 1999 the Institute of Medicine published ldquoTo Err is Humanrdquo and estimated that as many as 98000 die in hospitals each year as results of medical errors (equivalent to 10 jumbo jets crashing each week)

7 A follow-up study published in 2013 medical errors contribute to 21 to 44 lac deaths each year

8 7-10 gets at least one HAI [ 45 in US (93 1000 patient-days) 71 ( Europe 17 1000 patient-days) 5-19 in India

9 In 2008 MDR TB caused an estimated 150000 deaths as per a 2010 WHO report

10 WHO 7M globally suffer from preventable surgical injuries every year a million of them dye during or after surgery

11 In developing countries the death rate is nearly 10 for a major surgery

12 Mortality from GA affect 1150 patients while infections occur in 3 of surgeries with 05 mortality

13 India record 52 million injuries each year due to medical errors and adverse events (drugs HAI PE)

14 3 million years of healthy life are lost in India each year due to these injuries (Harvard School of Public Health )

14 For every 100 hospitalizations there are up to 14 adverse events

15 Incidence of serious adverse drug reaction is 67 per cent and of fatal adverse drug reaction is 032 per cent

16 Incidence of adverse events is 4 per cent and of deaths due to adverse events is 14 per cent of adverse events

17 Adverse drug events prolong hospital stay by 2 days

18 In India of all visits to the medical emergency department 6 per cent are drug-related

19 Adverse drug reactions account for 45 per cent of all adverse events

Clarification Regarding Procedures to be followed in Case of Short term DemonstrationDisplay of UltrasoundImaging Machines in the WorkshopsCMEndashReg

No V11011052013 -PNDT GOI MOH (PNDT Division) Nirman Bhawan New Delhi Dated the 14th May 2015

To The Principal Secretaries (Health amp FW) All StatesUTs

Subject Clarification regarding procedures to be followed in case of short-term demonstrationdisplay of UltrasoundImaging Machines in the workshopsCME-reg

Sir I am directed to say that an Expert Committee was constituted to re-examine the provisions of the PC amp PNDT Act 1994 and rules framed thereunder The expert committee had given clarifications regarding the powers of State Appropriate authorities and the closure of unusedidlesurrendered Ultrasound machines The recommendations were placed in the 22nd Meeting of the Central Supervisory Board (CSB) [constituted under the Pre-conception and Pre-natal Diagnostics Techniques Act (PC amp PNDT Act) 1994] held on 13th October 2014 under the Chairmanship of Honrsquoble HFM The CSB has endorsed the following recommendations made by the Expert Committee

District Appropriate Authority may grant permission for educationtraining or display of diagnostic technologies as prescribed below For display at scientific exhibition the organizing body should take permission from the District Appropriate Authority for the display of diagnostic technologiesequipment specifying their details DAA should ensure that these diagnostic technologies are not used for live demonstration and the organizing body has to take all responsibilities for the violations under the PC amp PNDT Act 1994 if any

For live demonstration at workshops and conferences permission should be granted only when these diagnostic technologies are demonstrated in registered facilities under the PC amp PNDT Act 1994 with transmission facility for viewing by the delegates Along with the request by the organizing body the details of the diagnostic technologiesequipment used in the workshopsconferences and list of expertsprofessional demonstrating technologies along with qualifications must be submitted The registered facility that provides its premises for same should also intimate to their respective District Appropriate Authority with all information pertaining to the equipment used and expertsprofessional demonstrating technologies In all live demonstration and conferences Appropriate Authority should ensure that all the record under the provision of the PC amp PNDT Act are maintained and preserved

In view of above recommendations of CSB you are requested to take further action and disseminate the same among all stakeholders

Yours Faithfully (Subhash Chandra) Deputy Secretary to the Government of India Tel 23061540

Supreme Court Guidelines to Protect Good Samaritans

1 The Supreme Court has approved the Centres guidelines to protect Good Samaritans who help road accident victims from being unnecessarily harassed by police or any other authority

2 Also they (good Samaritans) will be exempted from any criminal and civil liability

3 A bench comprising justices V Gopala Gowda and Arun Mishra asked the Central government to give wide publicity to these guidelines

4 The bench also took on record the guidelines placed by the Ministry of Road Transport and Highways which were based on the recommendations of the three-member committee headed by former judge KS Radhakrishnan The 2014 committee had given 12 major recommendations including setting up of State Road Safety Councils evolving a protocol for identification of black spots their removal and monitoring to see the effectiveness of the action taken and strengthening of enforcement relating to drunken driving over-speeding red light jumping and helmet or seat belt laws

5 With the courtrsquos approval the government guidelines are law of the land today and a binding to all states

6 A bystander including an eyewitness to a road mishap shall be allowed to leave immediately after taking the injured to the nearest hospital without furnishing his address Police cannot compel people to reveal their identity even if they are the informers or complainants in the case The person can give his or her name voluntarily

7 All registered public and private hospitals will not detain a Good Samaritan or demand payment for registration and admission costs

8 No police official shall ask him any questions and he would be later given a choice to record his statement before the court through video conferencing Departmental or disciplinary action shall be initiated against the officer who coerces or intimidates the informer

9 If the witness volunteers to go before the court to depose in the case the trial judge shall complete his examination in one sitting

10 More than 4 lakh road accidents took place in 2014 The number of deaths also increased from 137 lakh in 2013 to 139 lakh in 2014

11 As per National Crime Records Bureau report in the last decade over 12 lakh people have lost their lives and 55 lakh seriously injured or permanently disabled

12 India stood first with highest number of road fatalities as compares to China Brazil USA Indonesia Russia Iran Mexico South Africa and Thailand

13 50 percent of the fatalities can be averted if victims are admitted to a hospital within the first 1 hour post accident

14 A study by the Indian Journal of Surgery in 2012 says 80 percent of road accident victims in India do not receive emergency medical care within the lsquogolden hourrsquo

Handling of Children with Disabilities and Referral

No9-3CCD2007 15th May 2008

Dr P C Kesavankutty Nayar Acting President Medical Council of India Pocket-14 Sector-8 Dwarka Phase- I New Delhi - 110 077

Dr M Abbas National President Indian Medical Association IMA House Indraprastha Marg New Delhi - 110 002

It has been brought to the notice of Chief Commissioner for Persons with Disabilities that though most of the doctors are not trained for rehabilitation of persons with disabilities they often try to treat their disabilities even when medical or surgical interventions are not required

In the process most critical period of first six years of life is lost which is most important period to train amp rehabilitate the child with disability to utilize the residual capacity of the impaired organs Consequently it is too late for such children to respond to the rehabilitation therapies even by most qualified amp skilled rehabilitation professionals like physiotherapist speech therapist audiologist prosthetic amp orthotic engineer special educator etc

Chief Commissioner has taken notice of the complaints from parents rehabilitation professionals NGOrsquos etc and has directed that appropriate instructions may be issued by Medical Council of India and Indian Medical Association through print and electronic media to the effect that the doctors not trained on rehabilitation should restrict their treatment of children with disabilities to their medical illnessdisease or else action be initiated against such practices under relevant section of MCI

They should refer such children to the qualified rehabilitation professionals to ensure that they get appropriate rehabilitationtherapeutic assistance well in time

The Court of the Chief Commissioner for Persons with Disabilities shall be constrained to initiate action under Section 59 of the persons with disabilities Act 1995 against the doctors who may persist with such practicesIt is requested that action taken in the matter along with the copies of the directions issued may please be sent to this office within 30 days of receipt of this communication

Yours faithfully

( T D Dhariyal ) Dy Chief Commissioner Sarojini House 6 Bhagwan Dass Road New Delhi - 110001 E-mail ccpdhubnicin Telephone 23386054 23386154 Telefax 23386006 Website wwwccdisabilitiesnicin

Uniform Retirement Age 65

Shri Narendra Modi Honrsquoble Prime Minister of India South Block Raisina Hill New Delhi-110 001 pmofficegovin

Respected Sir

Greetings from Indian Medical Association

Indian Medical Association welcomes the announcement of extending the age of superannuation of all the doctors in Central and StateGovts to 65 years IMA also appreciates the prompt action taken by the Govt in notifying this on 31st May for the benefit of thedoctors retiring on 31st May

The Ministry of Railways also responded with similar promptness by notifying it on 31st May 2016 to extend the benefits to the doctorsworking in Railways

However Employees State Insurance Corporation (ESIC) under Ministry of Labour Govt of India where the doctors are working onequivalent terms and conditions as that of CHS have not yet extended the benefit to the doctors working under them

Since the Notification dated 31st May 2016 (copy attached) by MoHFW Govt of India mentions about Central Health Services only it isnot clear whether the doctors working under different Central Govt Departments and PSUs like ISRO NTPC NPCIL SAIL etc are alsocovered under this notification

In the past it has happened when DACP Scheme of Promotion of Medical Officers of Central Govt 2008 (copy attached) wasannounced and the same has not been implemented till date for medical officers of ISRO NTPC NPCIL SAIL etc

Indian Medical Association is of the opinion that medical profession has to be treated differently from other professions and thereforethe service conditions pay and other benefits should be uniform across the country

It is understandable that the health is a State subject however the privileges of doctors at a national level should be uniform andsimilar benefits to be extended to the medical officers working in different States

It is therefore requested that necessary instructions may kindly be issued so that

1 The announcement of Honrsquoble Prime Minster on extension of age of superannuation of doctors to 65 years is to be honoured by allGovt Departments CentralState

2 Uniformity of Service Conditions and Pay Parity for doctors in all CentralState Govt Deptt which should cover the pay tointerns residents amp service doctors

With regards Yours sincerely Dr K K Aggarwal Padma Shri amp Dr B C Roy National Awardee Honorary Secretary General

June 1991 Ministry of Finance

Shortage of doctors in the country

bull Legal and constitutional rights Equality Justice Health fundamental right

bull Relaxation in the norms for setting up of a medical college in terms of requirement for land faculty staff bed bed strength and other infrastructure

bull Relaxation in teacher-student ratio to increase the seats at Postgraduate level

bull Enhancement of maximum intake capacity at MBBS level from 150 to 250

bull Enhancement of age limit for appointmentextensionre-employment against posts of teachersdeanprincipal director in medical colleges from 65 to 70 years

bull Retirement age of central and state government doctors to 65

bull Financial support to State medical colleges under the scheme of ldquoStrengthening and Upgradation of State Government Medical Collegesrdquo to increase postgraduate seats in various disciplines or to start new postgraduate medical courses

bull Financial support under National Rural Health Mission for engagement of staff on contractual basis

bull Approval for establishment of eight AIIMS-like institutions (six in first phase and two in second phase) in the country under Pradhan Mantri Swasthya Suraksha Yozana (PMSSY)

bull IMA should open medical colleges in every state All district hospitals should be converted into a medical college under a PPP model To allow selected state of the art private colleges to open PG seats

bull Like aided schools aided medical establishments to be promoted by the government To provide subsidy tax holidays incentives interest free loans free education for children to doctors for opening small doctorrsquos owned medical establishments

bull The consider the concept of nurse practitioners in the country

bull To allow Para Medical Council and allow para medics to deliver emergency care in ambulances

bull To outsource Govt inpatient and outpatient work to the private sector

bull To have a parallel DGHS DHS Multipurpose Workers Community Health Volunteers Auxiliary Nurse Midwives Lady Health Visitors ASHA workers and Anganwadi Workers in private sector under private establishments in association with IMA

bull Schedule K drugs to be allowed to multipurpose health workers attached to private doctors of private institutions also

bull To recognize skill development courses like compounder dresser injection givers ward boys etc and define their role in the private sector

bull To double the salary of doctors in rural areas and make it income tax free Provide them free residence and good connectivity And award diploma in rural medicine to every doctor who is posted in rural areas for 2 years

bull To make drugsvaccine and other devices available to private practitioners on the Govt bulk rates

bull To provide immunity to doctors for violence against doctors

bull To start universal insurance at national level

bull Promote diploma holders with ten years of experience as Assistant Professors

Subject WhatsApp Groups using the name and logo of IMA without any approval from IMA Headquarters

SirRecently it has come to IMArsquos knowledge that some members are using the name logo of IMA and creating WhatsApp groups by the name of IMA creating a confusion that they are representing the IMA HQs The list of a few such WhatsApp groups are- ldquoWE THE IMArdquo ldquoIMA HQRSrdquo ldquoIMA Officialsrdquo ldquoIMA 2016rdquo ldquoIMA HQTRrdquo ldquoNational IMArdquo ldquoIMA State Presi amp Secrdquo ldquoIMA NATIONAL HQSrdquo ldquoJOIN IMArdquo ldquoIMA HQrdquo ldquoChange IMA 2016rdquo etc etcAs per Bye-Law 39(B) of the Memorandum Rules and Bye-Laws of Indian Medical Association ldquoHonorary Secretary General of IMA shall conduct all correspondencesrdquoKindly note that IMA Headquarters has never authorized any person(s) to create any WhatsApp group and to use the name or logo of IMA Also IMA Headquarters has never itself created any such WhatsApp group using the name logo of IMACreating such unauthorised groups and using the name and logo of IMA in any social Media platforms may amount to an offence under Information Technology Act and also under the Indian Penal CodeThe aforesaid group administrators are requested to stop using the name logo of IMA with immediate effect so as to avoid any inconvenience

Also all members are requested not to use the name logo of IMA in any social Medial or non IMA communications without the written approval or consent from IMA HeadquartersAll office bearers of IMA should also refrain from commenting about IMA in any social on Non IMA Media There are appropriate platforms within IMA to raise any points They are further requested not to participate in any social networking groups in IMA capacityPlease note that social Media platforms are in public domains and any information posted in them can malign the image of the medical profession in general and IMA in particular

We request all the IMA leaders to help maintain the image of the medical profession and neither allow nor involve in any loose talks in the social MediaDr SS Agarwal Dr K K Aggarwal

NCDRC orders Indore Hospital to pay 15 lacs for missing ultrasound findings

bull As per PTI NCDRC has directed a private hospital at Indore and two of its doctors to pay Rs 15 lakh as compensation to a years old child who was born with one hand and one kidney due to negligent and casual approach of the medical practitioners in analysing the growth of the foetus through ultrasonography

bull As per the defence because of tucked position of the foetus the limbs were not seen The foetus was lying on its side with upper limbs tucked underneath it was impossible to see that any limb was missing nor was there any reason to assume or suspect so

bull According to the father of the child the USG which is conducted to examine the well-being of a foetus was not done properly and alleged that the medical practitioners gave report saying no abnormal findings that to on two occasions

bull The bench said the foetal USG is the most important tool to provide prenatal diagnosis of foetal anomalies and had the anomaly been detected the parents would have been referred to a tertiary foetal medicine unit for further investigations which would have revealed the presence of other anomalies in addition to the abnormalities of foetal limbs The existence of two serious anomalies would have resulted in the pregnancy being terminated

bull The doctor is bound by ethical obligations to examine patient thoroughly with all his competence

IMA Stand

1 In 70 cases major heart defects go unnoticed until birth

2 Three-quarters of all babies with missing limbs come as a surprise to both doctors and patients

3 More than 50 cases of Down syndrome are overlooked The number of skilled ultrasonologist who can pick up many Fetal defects is very small

4 1993 NEJM RADIUS study (thatrsquos ldquoRoutine Antenatal Diagnostic Imaging with Ultrasoundrdquo) blanket use of such ultrasounds ldquoclearly indicaterdquo no impact on a babyrsquos outcome

5 No ultrasound without informed consent with riders about missing findings

6 The report should only write what is seen and not use such blanket terminologies like no abnormal findings

7 All reports must state the limitations of the radiologist doctor

8 The consent must have that the scan is limited to gross abnormalities and major life threatening problems primarily

9 1 kidney or even 1 limb is not a cause for performing an abortion medically

10 Medical malpractice insurance should be made compulsory

Caesarean Guidelinesbull Delhi High Court CJ G rohini amp Jayant Nath Centres and MCI

response by September 7 on a plea seeking direction to frame appropriate guidelines for cesarean sections to safeguard the reproductive health rights of women and children

bull Advocate Vikram Srivastava appearing for NGO Independent Thought

bull ldquoconstitute commission of inquiry on the circumstances in which the average birth by caesarean section in private hospitals of Delhi is as high as 6554 per cent against 2065 per cent in the government hospitals of Delhi and where the WHO norm allowed for birth by caesarean section is between 10 to 15 per cent of the total deliveriesrdquo

bull Compare apple to apple indices total Caesarean section primary Caesarean section rate and repeat Caesarean section [ Nulliparous women at 37 weeks of gestation or greater with singleton foetuses with vertex presentation The rate in this group should be between 15 and 17 per cent]

One Can Write off Label use Drugs but with a Rider

bull Off label use of drugs is prohibited by law Unless there is an approved indication by DCGI one can not use the drug for any other indication Using an off label drugs becomes a clinical trial IMA also took up the issue and talked to DCGI when the matter of the eye drug Avastin came up

bull It was decided that any off label use of drug use of which has some scientific evidence requires a separate consent and approval from ethics committee from the patient IMA now has its own independent ethics committee and can take care of such applications

bull Notice F No12-522004-DC(Part I)

bull Directorate General of Health Services Office of Drugs Controller General (India) (Biological Division)

bull FDA Bhawan Kotla Road New Delhi 110002Dated 0903201611-03-16

bull This is in continuation to alert notice issued vide letter no 12-522004-DC (Part-I) dated 21012016 regarding use of Bevacizumab Injection in Ophthalmologic condition The matter has been examined by the Ministry of Health and Family Welfare based on recommendation of Expert Committee meeting held on 08022016 on this subject The Committee examined and deliberated on the use of Bevacizumab Injection in Ophthalmologic conditions as an off-label indication and following observations were made by the Committee

bull Bevacizumab Injection is not approved by global regulatory Authorities for intravitreal use due to non-application by the Innovator for this purpose However WHO (April 2015) has recommended Bevacizumab Injection by including in the list of essential medicines prepared as anti-vascular endothelial growth factor in ophthalmic section based on recommendation of International Council of Ophthalmology (ICO) Further regulatory agencies of France and Italy have allowed its off-label use as a Temporary Recommended Use (TRU)

bull The safety and efficacy of Bevacizumab injection in intravitreal use is stated to be proven by various independent studies (over 2500 studies published) conducted globally It was discussed that rate of endophthalmitis is significantly lower after the injection of Bevacizumab Injection as compared to standard cataract surgery

bull The Bevacizumab Injection is 40 times cheaper than other available drug (Ranibizumab Injection) for same use and equally effective in India This would put less financial burden on patients and prevent blindness of many

bull Based on the above facts following recommendations were made by the Committee

bull The office of DCG (I) was requested to take necessary measures to withdraw the Alert Notice issued on 21012016 which was primarily issued as a precautionary measure in the light of the incidences of blindness reported in Gujarat Further it was proposed that All India Ophthalmology Society (AIOS) and Vitreo Retinal Society of India (VRSI) will formulate guidelines for safe and effective use of Bevacizumab Injection for Ophthalmic purpose based on the written-informed consent as practised globally for off-label use under appropriate environmental conditions by skilled ophthalmic surgeons based on risk-benefit analysis They will further ensure that appropriate training and awareness may be imparted to its members The Ministry of Health and Family Welfare Government of India s accepted recommendations of the Committee Accordingly this notice is issued

bull (Dr GN Singh) Drugs Controller General (India)

Online advertisementsbull Online advertisementsbull The Tamil Nadu Medical Council has resolved warning doctors against

advertising onlinebull It unethical to pay online registries to ensure that their names

appeared among the firstbull TNMC has an online registry of its own on June 1 he said ldquoFor

instance if a patient is looking for a dermatologist in Arumbakkam they can search for it and the names of registered doctors with their address will appear in an alphabetical orderrdquo

bull The Code of Ethics Regulations 2002 states that ldquoa physician shall not make use of him her (or his her name) as subject of any form or manner of advertising or publicity through any mode either alone or in conjunction with others which is of such a character as to invite attention to him or to his professional position skill qualification achievementshelliprdquo

bull In cases of change of address or changing the type of practices or resumption of another practice and in a few other cases a medical practitioner is allowed to make a formal announcement in press

Follow standard treatment guidelines protocol and recommendations

Screen all infants with a birth weight less than 15 kg or gestational age less than 32 weeks for ROP between 2 to 4 weeks after birth

A premature infant is not born with Retinopathy of Prematurity (ROP) the retina though immature is normal for this age The ROP usually starts developing 2-4 weeks after birth when it is mandatory to do the first screening of the child

The current guidelines are to examine and screen all babies with birth weight lt 15 kg or lt 32 weeks of gestation starting at 31 weeks post-conceptional age (PAC) or 4 weeks after birth whichever is later Around a decade ago the guidelines in general were the same and the premature babies were first examined at 31-33 weeks post-conceptional age or 2-6 weeks after birthJuly 2015 Supreme Court ordered State Government of Tamil Nadu to pay a sum of Rs 18 crto an 18-year-old girl who lost her vision at birth The 125 kg baby girl was born prematurely (29 weeks) and was placed in an incubator in ICU for 25 days and was administered 90-100 oxygen at the time of birth and underwent blood exchange transfusion a week after birth The baby and the mother came for a follow-up at the chronological age of 9 weeks The preventable ROP was not screened May 2016 NCDRC ordered Rs 64L compensation against Maharaja Agrasen Hospital and three of its doctors for not screening ROP in a baby who was in the hospital for nearly five weeks

no record means it was not done NCDRCThe nurses daily record does not show any ROP examination was done NCDRCThe patient visited hospital for follow up but nothing is in record about ROP testing NCDRC

IMA Code of Conduct

Preamble As member of Indian Medical Association and as qualified physician the conduct of a registered Medical Graduate is governed by the Ethics and the regulations pronounced by Indian Medical Council Act 1956

As very important part of society and nation building

bull I have read amp agreed to abide by regulations under Indian Medical Council act especially Professional Etiquette amp Ethics) Regulations 2002 amp its subsequent amendments

bull I solemnly pledge myself to consecrate my life to the service of humanity amp maintain utmost respect for human life from the time of its conception

bull I shall practice my profession with utmost conscience amp dignity

bull I shall extend my teachers amp fellow colleagues respect and gratitude legitimately due to them

bull I shall respect the privacy amp secrets of my patients that are confided in me for professional reasons

bull I shall honour the autonomy of my patients to make decisions

bull I shall uphold both beneficence amp non-malfeasance in treating my patients

bull I shall respect human dignity esteem prestige rights amp fundamental freedom of all my patients

bull I shall take both informed consent amp inform refusal from my patient towards any medical or surgical treatment

bull I shall hold diligent regards to cultural diversity and pluralism

bull I shall protect individual amp groups of special vulnerability amp respect the personal integrity of such individual and groups as the case may be

bull I am committed to ensure that the selective sex selection is stopped at all levels and by all means

bull I shall faithfully comply with all the Regulatory and Statutory stipulations

bull I shall not accept any gifts pecuniary benefits or gratification from the pharmaceutical companies equipment suppliers and diagnostic centers or similar agencies

bull I shall not indulge in any activities that are immoral unethical or illegal in the eyes of the applicable governing laws andalso the prudence

IMA Position Statement Doctor Nurse Relationship

Good relationships with nurses and other health care professionals strengthen the doctorndash patient relationship and enhance patient care

bull Doctors to follow MCI Ethics regulations in general and the following in particular

53 Under DUTIES OF PHYSICIAN TO THE PUBLIC AND TO THE PARAMEDICAL PROFESSION ldquo53 Pharmacists Nurses Physicians should recognize and promote the practice of different paramedical services such as pharmacy and nursing as professions and should seek their cooperation wherever requiredrdquo

718 ldquo In the case of running of a nursing home by a physician and employing assistants to help him her the ultimate responsibility rests on the physicianrdquo

And nurses to adheres to code of ethics and code of professional conduct for nurses in India developed by Indian Nursing Council

bull The primary bond between the doctor and the nurse should be a mutual ethical concern for the patients

bull The goal of this partnerships should be based on shared responsibility and accountability for increasing quality and patient safety to improve the patientrsquos care experience and outcomes

bull The primary job of the nurse is to carry out the orders of the attending doctor However where orders appear to the nurse to be in error or contrary to customary medical and nursing practice the doctor has an ethical obligation to hear the nursersquos concern and explain those orders to the concerned nurse An ethical doctor should neither expect nor insist that nurses blindly follow his orders contrary to set standards of good ethical medical and nursing practice

bull In emergencies when prompt action is necessary and the treating doctor is not immediately available a nurse may be justified in acting of her own for the safety of the patient in his interest This protection and insulation is every ones right under Section 92 of the Indian Penal Code ldquoAct done in good faith for benefit of a person without consenthelliprdquo

bull The ultimate goal of this desired relationship should be to create a congenial friendly environment where nurses and doctors are able to question each otherrsquos decision-making without fearing an angry or defensive response or it becoming a victim of lsquostatus blockade syndromersquo

bull Realistically speaking what is mandated is that both strictly follow their respective code of ethics which do not contradict each other on the contrary are totally overlapping hence ending up in a lsquono conflict of any typersquo situation

IMA Position Statement IMA Pharmacist Relationship

bull 53 Physicians should recognize and promote the practice of pharmacy as profession and should seek their cooperation wherever required

bull 371 A doctorrsquos prescription should also make clear if heshe has himself or herself dispensed any medicine to the patient

bull 710 A registered medical practitioner shall not issue certificates of efficiency in modern medicine to any unqualified or non-medical person but heshe can issue such certificates to dispensers after proper training

bull 63 No physician can run an open shop for sale of medicine for dispensing prescriptions prescribed by other doctors or for sale of medical or surgical appliances Drugs prescribed by a physician or brought from the market for a patient should explicitly state the proprietary formulae as well as generic name of the drug

bull 15 As far as possible drugs should be prescribed with generic names Every doctor should make sure that there is a rational prescription and use of drugs

bull 713 It is improper for a doctor to affix hisher signboard at a pharmacistrsquos shop

bull 719 does not allow doctors to use touts or agents for procuring patients So a pharmacist should not indulge in such activities

bull 113 No person other than a doctor who holds qualifications that are duly recognized by MCI and is registered with MCI or State Medical Council can practice allopathic medicine A practitioner of other systems of medicine cannot practice allopathic medicine A pharmacist cannot practice and prescribe drugs

bull 141 Every prescription should carry the registration number of the prescribing doctor The pharmacist should check every prescription he comes across while dispensing medicines

bull 142 Doctors can add as suffixes only those degrees certificatesdiplomas that are recognized by the regulatory bodies or those membershipshonours which confer professional knowledge or recognizes any exemplary qualificationachievements

bull 19 All doctors to abide by the laws of country that regulate the practice of medicine and also follow the provisions of State Acts like Drugs and Cosmetics Act 1940 Pharmacy Act 1948 Narcotic Drugs and Psychotropic substances Act 1985 Drugs and Magic Remedies (Objectionable Advertisement) Act 1954 Neither the doctor nor the pharmacist should be a party to helping others evade these laws

bull 65 A pharmacist should check that all the drugs prescribed by a physician are carrying a proprietary formula and clear name The regulation prohibits dispensing of secret remedial agents by doctors whose composition they do not know This regulation also considers their manufacture or promotion of their use as unethical

bull 67 Practicing euthanasia is regarded as unethical conduct for the doctor The pharmacist has a responsibility to check that every prescription is ethical

bull 720 A Physician shall not claim to be specialist unless he has a special qualification in that branch

bull 73 Not displaying the registration number accorded to a physician by the State Medical Council or the Medical Council of India in his or her prescriptions violates the provisions of MCI regulation 142

bull 78 A registered medical practitioner shall not contravene the provisions of the Drugs and Cosmetics Act and regulations made there under Accordingly Prescribing steroids psychotropic drugs when there is no absolute medical indication and or selling Schedule lsquoHrsquo amp lsquoLrsquo drugs and poisons to the public except to his patient shall constitute gross professional misconduct on the part of the physician

IMA AHPISelf Declaration by Hospitals and Clinical Establishments

( Draft codes by Indian Medical Association and Association of Health Care Providers of India)

We strictly comply with all the laws of the land applicable to any establishment or to the doctors or other staff working in the hospital

We respect and uphold the Rights of Patients in letter and spirit

All our doctors at the joining of the establishment give an undertaking that they have read the MCI code of ethics and that they abide by it

We provide equal opportunity to all without any consideration for cast religion creed race sex or handicapped status

We ensure non-indulgence in any activities that are unethical or illegal such as

Unjustified admissions Wrong or manipulated reporting or manipulated billing to the patient Sheltering any criminal from the law Pre natal sex determination or selective sex abortion Giving cuts and commissions to any one for soliciting patients Wrong entries in insurance forms or over billing in claim cases Accepting expensive gifts cash benefits or gratification from the drug equipment suppliers diagnostic centres or similar health care agencies

And our administration continuously monitors and ensures that no staff indulges in any such activities

IMA NAT HEALTH DeclarationWe the members of IMA and NATHEALTH and signatories to the Code of Ethics for Healthcare do hereby solemnly declare that we have read and understood the Code of Ethics and shall abide by it to maintain ethical and transparent professional conduct and practices to ensure improved access to and better quality of the healthcare ecosystem in India

(i) A voluntary and collective commitment to follow ethical practices to ensure that patients are provided access to high quality cost effective safe and efficient technologies products and services

(ii) Comply with all applicable laws and membersrsquo internal policies on the subject and create a mechanism to address violations appropriately

(iii) Recognize and champion the sanctity of patient confidentiality

(iv) Maintain accurate and complete records and ensure their safety and access

(v) Refrain from offering or accepting any paymentsgifts with the objective of influencing a decision making process within the healthcare community

(vi) Desist from engaging in any activity practice or act which conflicts with or appears to conflict with the interests of the healthcarecommunity end users or patients

(vii) Maintain a safe and healthy work environment

(viii) Provide donations only for charitable purposes and not with the intent to influence the healthcare community to purchase lease or recommend the use of specific products and services or treatment modalities

(ix) Meet all applicable quality standards and accreditations as may be required to provide the appropriate delivery of healthcare services

(x) Undertake appropriate dissemination of the Code for full applicability and accountability

IMA Position statement Values and Ethics of Inter-professional Collaboration

Preamble Work with individuals of other professions to maintain a climate of mutual respect and shared values

bull Place the interests of patients at the center of inter-professional healthcare delivery

bull Respect the dignity and privacy of patients while maintaining confidentiality in the delivery of team-based care

bull Embrace the cultural diversity and individual differences that characterize patients populations and the healthcare team

bull Respect the unique cultures values rolesresponsibilities and expertise of other health professions

bull Work in cooperation with those who receive care those who provide care and others who contribute to or support the delivery of prevention and health services

bull Develop a trusting relationship with patients families and other team members

bull Demonstrate high standards of ethical conduct and quality of care in onersquos contributions to team-based care

bull Manage ethical dilemmas specific to inter-professional patient-population-centered care situations

bull Act with honesty and integrity in relationships with patients families and other team members

bull Maintain competence in onersquos own profession appropriate to scope of practice

bull Communicate ones roles and responsibilities clearly to patients families and other professionals

bull Recognize ones limitations in skills knowledge and abilities

bull Engage diverse healthcare professionals who complement ones own professional expertise as well as associated resources to developstrategies to meet specific patient care needs

bull Explain the roles and responsibilities of other care providers and how the team works together to provide care

bull Use the full scope of knowledge skills and abilities of available health professionals and healthcare workers to provide care that is safe timely efficient effective and equitable

bull Communicate with team members to clarify each members responsibility in executing components of a treatment plan or public health intervention

bull Forge interdependent relationships with other professions to improve care and advance learning

bull Engage in continuous professional and inter-professional development to enhance team performance

bull Use unique and complementary abilities of all members of the team to optimize patient care

Single window registration License Needed by 10 BED Establishment

bull Registration under Nursing Home Act Medical Establishment Act

bull Bio-medical Waste Management Licenses Authorization of HCO by PCB MOU with Vendor

bull AERB Licenses

bull NOC from Fire Department

bull Ambulance Commercial Vehicle Permit Commercial Driver License Pollution Control Licenses

bull Building Completion Licenses

bull Lift license

bull DG Set Approval

bull Diesel Storage Licenses

bull Retail and bulk drug license (pharmacy)

bull Food Safety Licenses

bull Narcotic Drug Licenses

bull Medical Gases Licenses Explosives Act

bull Clinical Establishments and Registration (if applicable)

bull Blood Bank Licenses

bull Boilers Licensesbull MoU agreement with outsourced human

resource agencies as per labour lawsbull Spirit Licencebull Weight and Measuresbull Electricity rulesbull Provident fundbull ESI Actbull MTP Actbull PC PNDT Actbull Sales Tax registrationbull PANbull No objection certificate under Pollution

Control Act (AirWater)bull Arms Act 1950 (if guards)bull Service Tax ( Plastic Surgeons)

IMA reacts on various reports in media about medicine in IndiaOf late there is unfavourable reports in the International media about the status of medicine education and healthcare in India

bull A HT story April 21 2016 said lsquoJust 4 institutes account for a third of Indiarsquos research outputrsquo The story said that India has the best and the worst medical education in the world Four medical colleges in India are among the top 10 global institutions that published the most research between 2004 and 2014 while around 60 of the countryrsquos 579 medical institutions have published no research in a decade Only 25 (43) institutions published more than 100 papers a year and among them accounted for 403 of Indiarsquos total research output of a little over 100000 papers in the decade The story also mentioned that annual research output of the Massachusetts General Hospital was more than 4600 and the Mayo Clinic was 3700 The AIIMS with more than 1100 annual publications ranked third The report was based on other study article by Dr Samiran Nundy Dean Ganga Ram Hospital who wrote ldquoWhatrsquos most shocking is that 332 (573) medical colleges had not a single publication during this period The states with the largest number of private medical colleges did the worst with more than 90 of the medical colleges in Karnataka and Kerala having no publication at allrdquo GRIPMER was ranked 11th in the list of institutions that published the most research The journal quoted was journal Current Medicine Research amp Practice ( a Ganga Ram Hospital Journal) The MCIrsquos 2015 guidelines require at least four research publications for the post of an associate professor and eight for the post of a professor

bull Max Bearak reported in The Washington Post on April 21 2016 ldquoHow bad are most of Indiarsquos medical schools He said that most medical colleges in India are ldquovery badrdquo More than half of those 579 did not publish even a single peer-reviewed research paper in more than a decade (2005-2014) and that almost half of all papers were from just 25 of those institutions

bull Dr Samiran Nundy told The Telegraph that these findings support long-standing suspicions that for many private colleges in the country medical education is just a business AIIMS was the most productive medical college in India In the 10-year period that Samiran Nundy and his colleagues examined AIIMS published 11300 research papers

bull A Reuters four-month-long probe found that since 2010 at least 69 Indian medical colleges and teaching hospitals have been accused of such transgressions or other significant failings including rigging entrance exams or accepting bribes to admit students and that one out of every six of the countryrsquos 398 medical schools has been accused of cheating according to Indian government records and court filings

bull Last January an article by Jeetha DSilva in the British Medical Journal reported that many private medical colleges charged capitation fees which are essentially compulsory donations required for admission

bull The original article titled ldquoThe research output from Indian medical institutions between 2005 and 2014rdquo by Samrat Ray Ishan Shah Samiran Nundy was published online April 18 2016 in the journal Current Medical Research amp Practice The study was done using the SCOPUS database which is owned by the publisher of the journal where the article has been sighted

bull DR S Nundy Current Medicine Research and Practice (CMRP formerly The Ganga Ram Journal) is a peer-reviewed publication of Sir Ganga Ram Hospital The journal is published bi-monthly and is circulated to all major medical institutions in India

IMA Reactsbull There has been a systemic attack on the quality of Indian doctors for more than a decade

bull Our doctors are best in the world there is no doubt about it

bull We are aware of quacks and IMA is fighting against it Witch doctors exist all over the world

bull Private medical colleges do not mean that medical education is inferior Most colleges in the US are private Fee in US private colleges is far more than any standards of Indian education

bull Every PG whether DNB or MCI based education cannot clear hisher exam without a thesis This means that more than 25000 theses are cleared every year Is this not research Unlike in the US most of these theses stay in the library of the university in print form and do not get translated in Indian Medlar or US Medline databases

bull There are over 3000 medical associations in the country where doctors present their data and work done These never gets published Each conference has orations key note addresses guest lectures and award papers Again they never get published

bull There is no central registry except for Indian Medlar but the same has not been promoted in the private sector

bull Itrsquos not easy to get the papers published in International Journals

bull In some third world countries people pay to get their research published to many small International journals with impact factor

bull Not getting published does not mean that doctors are not compiling their data

bull Not getting published in Medline Pubmed or any other international database does not mean Indian researches are inferior or bad

bull West only analyses researches published in international databases

bull For example way back in 1983 my research on leprosy and immunology got never published

bull Remember in India you cannot get promotion without research papers only these research papers may get noted during compilation

bull About 80 of research in the private sector does not get published Their research gets limited to presenting in conferences And these presentations do not get included when compiling these reports

bull We should all react to such International reporting which degrade our doctors

bull To augment quality research in postgraduate medical education the MCI has made it mandatory since 2010 that every postgraduate student registered for the Degree in a medical college under the ambit of MCI permitted approved recognized for the said postgraduate course in his her three years period of study has to present a scientific poster in first year scientific presentation in second year and research publication out of thesis for the said degree which is a condition precedence for appearance at the theory practical viva-voce examination

bull That means over 25000 thesis and 25000 researches gets created every year only from the medical colleges If one adds to DNB and private sector the number will surpass the US figure This does not take into account local society and non-society journals present in the country For example Indian Journal of Clinical Practice in not in the Pubmed but publishes 10 research articles every month

bull Further in the year 2015 the medical council has made it mandatory for every medical college to have a lsquoResearch Cellrsquo for the purposes of promotion of quality research in the said institution (Dr Vedprakash Mishra Chairman Academic Committee Medical Council of India)

bull The above story is based on SCOPUS database again which will not accept most of the Indian studies

bull A national medical research library should be started where copies of all Indian research papers published in different journals and also PG thesis should be available

British Media on Indian Health Systembull Indias medical education system hit by scandals Lancet Volume 386 No 9993 p517ndash

518 8 August 2015 Dinesh C Sharma

bull Doctors and medical students in India should stop wearing white coats BMJ 2015 351 h3855 Edmond Fernandes postgraduate Department of Community Medicine YenepoyaMedical College Yenepoya University Mangalore Karnataka India

bull Corruption ruins the doctor-patient relationship in India BMJ 2014 348 g3169

bull Tackling corruption in Indian medicine Lancet Volume 382 No 9905 e23ndashe24 16 November 2013 Dinsa Sachan

bull India probes corruption in flagship health programme Lancet Volume 379 No 9817 p698 25 February 2012 Shubhalakshmi Shukla

bull Indias health sector responds to new corruption charges Lancet Volume 371 No 9611 p464 9 February 2008 Kristen Elisabeth Solberg

bull Corruption in healthcare httpwwwbmjcomcampaigncorruption-healthcare

bull Good governance in health care the Karnataka experience Hanumappa Sudarshan NS Prashanthemail Lancet Volume 377 No 9768 p790ndash792 5 March 2011

bull Health ministry gives point-by-point rebuttal to Lancet editor TNN | Oct 25 2015 0308 AM IST

Hospitals cannot force patients to buy medicines from their own pharmacy

NCDRC Fortis Health Management (North) Ltd VS Meenu Jain amp Anr passed on 22072014 with case number RP No 2448 of 2013 Per Dr SM Kantikar Member On 25052009

Meenu Jain was admitted to Fortis Escort Hospital Jaipur Rajasthan (OP) for treatment of Guillain Barre Syndrome The Complainant signed a general consent for admission On 25062009 the patient was on ventilator and administered lifesaving drug injection Iviglob-Ex five doses daily for five days The cost of each injection-MRP was Rs18990- Those injections were provided by hospital pharmacy and the Complainant was successfully treated and discharged on 13062009 The total sum of Rs682965- as hospitalisation charges were paid by the Complainant without any protest

The Complainant alleges that he was told that the cost per injection was Rs9000-The Complainant-2 requested the hospital authorities that the injection Iviglob-Ex was available at Rs30 - 40 discount in the other medical shops in the market and he may be permitted to purchase the injections from outside but his request was not considered and he was forced to purchase the injections from the hospital itself

We find that the complainant signed the consent and the counselling form but it is also important to understand the state of mind of the complainant-2 as his wife Meenu Jain was in a critical condition in OP hospital The OP was in a dominating position over the Complainants Thus the hospital authorities indirectly imposed unjustified and unreasonable conditions on the Complainant to purchase the injections from the hospital for the treatment of the patient

The counsel for OP argued that to ensure quality and genuineness of the drugs the OP did not permit the patients to buy the drugs from outside which is not at all convincing and reasonable

The OP sold the injections at the maximum retail price (MRP) and not charged any excess amount ldquoThe corporate hospitals should not be a commercialbusiness centres for profiteering from the exploitation of such critical patients who have to pay sky rocketing hospital billsrdquo ldquoRegarding contention of OP about spurious drugs the OP was at liberty to explain the pros and cons of drugs brought from outside market and after due consent from the complainants they could have administered the injectionsrdquoldquoTherefore considering the facts and circumstances we are of the opinion that the hospital authorities exercised undue influence and compelled the Complainants to pay excess price This amounts to unfair trade practice The right of the Complainantpatient cannot be curtailed by preventing the Complainants to exercise their option to purchase the medicines or injections from the market Also the complainants approach was opportunistic Thus in context of maintaining good Doctor-Patient relationship we feel that the OP should have allowed discount on the purchase of 25 doses of expensive injections Iviglob-Ex by the Complainantrdquo

ldquoThe complainant calculated the excess amount of Rs156167- Also we cannot totally ignore the services which OP had rendered to the patient in critical condition The OP has every right to earn profits from its pharmacy but it should be reasonable or acceptable one Therefore we feel it is just and proper to allow refund of 50 of the calculated excess amounthelliprdquo

Can someone talk loose about the medical profession in social media or media

MCI code of ethics 17 talks about exposure of unethical conduct about a member ldquo17 Exposure of Unethical Conduct A Physician should expose without fear or favour incompetent or corrupt dishonest or unethical conduct on the part of members of the professionrdquo But the same has to be specific and with evidences and that to a complaint in the MCI ethics committee of the state medical council

One cannot talk loose about the medical profession and lower its dignity and honour The same is as per the law

MCI Code of Ethics 111 A physician shall uphold the dignity and honour of his profession

It will be violation of ethics regulation 71 ldquo ldquo71 Violation of the Regulations If heshe commits any violation of these Regulationsrdquo

It will also be violation of MCI DECLARATION At the time of registration each applicant shall be given a copy of the following declaration by the Registrar concerned and the applicant shall read and agree to abide by the same (a) I solemnly pledge myself to consecrate my life to service of humanity (e) I will practice my profession with conscience and dignity (i) I will maintain by all means in my power the honour and noble traditions of medical profession (j) I will treat my colleagues with all respect and dignity (k) I shall abide by the code of medical ethics as enunciated in the Indian Medical Council (Professional Conduct Etiquette and Ethics) Regulations 2002

It will also be violation of regulation 12 Maintaining good medical practice ldquo121 The Principal objective of the medical profession is to render service to humanity with full respect for the dignity of profession and man Physicians should merit the confidence of patients entrusted to their care rendering to each a full measure of service and devotion Physicians should try continuously to improve medical knowledge and skills and should make available to their patients and colleagues the benefits of their professional attainments The physician should practice methods of healing founded on scientific basis and should not associate professionally with anyone who violates this principle The honoured ideals of the medical profession imply that the responsibilities of the physician extend not only to individuals but also to society

Regulation 12 differentiates the dignity of the profession separately from that of a person

IPC 354 defines the word modesty as a crime IPC 354 Assault or criminal force to woman with intent to outrage her modestymdashWhoever assaults or uses criminal force to any woman intending to outrage or knowing it to be likely that he will thereby outrage her modesty shall be punished with imprisonment of either description for a term which may extend to two years or with fine or with both

IPC 355 defines dishonouring a person ldquo 355 Assault or criminal force with intent to dishonour person otherwise than on grave provocationmdashWhoever assaults or uses criminal force to any person intending thereby to dishonour that person otherwise than on grave and sudden provocation given by that person shall be punished with imprisonment of either description for a term which may extend to two years or with fine or with both

IPC 509 defines the ways to insult any modesty ldquo 509 Word gesture or act intended to insult the modesty of a womanmdashWhoever intending to insult the modesty of any woman utters any word makes any sound or gesture or exhibits any object intending that such word or sound shall be heard or that such gesture or object shall be seen by such woman or intrudes upon the privacy of such woman shall be punished with simple imprisonment for a term which may extend to one year or with fine or with bothrdquo

IPC 298 defines assault by way of speech ldquo 298 Uttering words etc with deliberate intent to wound the religious feelings of any personmdashWhoever with the deliberate intention of wounding the religious feelings of any person utters any word or makes any sound in the hearing of that person or makes any gesture in the sight of that person or places any object in the sight of that person shall be punished with imprisonment of either description for a term which may extend to one year or with fine or with bothrdquo

IPC 499 defines the defamation applicable to individual as well as a society ldquo 499 DefamationmdashWhoever by words either spoken or intended to be read or by signs or by visible representations makes or publishes any imputation concerning any person intending to harm or knowing or having reason to believe that such imputation will harm the reputation of such person is said except in the cases hereinafter expected to defame that person helliphelliphelliphellip Explanation 2mdashit may amount to defamation to make an imputation concerning a company or an association or collection of persons as such helliphelliphellip

IPC 500 defines the punishment ldquo500 Punishment for defamationmdashwhoever defames another shall be punished with simple imprisonment for a term which may extend to two years or with fine or with bothrdquo

Indian Penal code 501 defines defamatory print materialrdquo ldquo 501 Printing or engraving matter known to be defamatorymdashWhoever prints or engraves any matter knowing or having good reason to believe that such matter is defamatory of any person shall be punished with simple imprisonment for a term which may extend to two years or with fine or with bothrdquo

Dear Sir

This letter we are writing to sincerely thank our Honorable Minister of AYUSH forhis unambiguous and crystal clear reply in Parliament to a written question ie whetherAYUSH vaidyas are permitted to prescribe modern medicine

Sir the answer is clear and free from all forms of confusion possible distortions andinterpretations

The Honorable Minister of AYUSH has clearly stated that as per the IMC professionalconduct etiquette and ethics regulations 2002 no institutionally qualified AYUSHvaidyas are permitted to practice allopathic drugs For the practice of allopathic drugs(Modern Medicine) the doctors should be qualified in modern medicine and must haveregistered with MCI

Further the intent of the Ministry of AYUSH and NHM in promoting AYUSH also gotsufficient clarity Annexure 1

The reply states that the Ministry of AYUSH envisages only co-location of AYUSH atprimary health service level

It means AYUSH will be strictly dealt by AYUSH vaidyas and modern medicine by MBBSdoctors and there will be no legal approval for cross pathy by AYUSH vaidyas

Annexure 1

National Health Mission envisages co-location of AYUSH Services in facilitiesIndian Bureaucracy August 1 2016 As per Indian Medical Council (Professional Conduct Etiquette andEthics) Regulations 2002 under clause 113 ldquoNo person other than a doctor having qualification recognisedby Medical Council of India and registered with Medical Council of IndiaState Medical Council(s) is allowed topractice Modern System of Medicine or Surgery A person obtaining qualification in any other system ofMedicine is not allowed to practice Modern system of Medicine in any formrdquo

Under National Health Mission (NHM) the principle of lsquoMainstreaming of AYUSHrsquo was adopted to enhancechoice of services for beneficiaries of public health facilities including Primary Health Centres and also torevitalize local health care traditions Accordingly NHM Implementation Framework envisages co-location ofAYUSH services in health facilitiesThe measures to check fake AYUSH practices is responsibility of the respective State Government

The cabinet note for lsquoThe Indian Medicine and Homeopathy Pharmacy Central Council Bill-2016rsquo afterapproval of MOS (IC) for AYUSH was circulated for inter-departmental consultation Comments receivedfrom Law Ministry have been incorporated

Government has established two new institutes iei All India Institute of Ayurveda in New Delhi with 200 bedded referral hospital for Post Graduate and

PhD level education in the field of Ayurveda

ii North Eastern Institute of Ayurveda and Homeopathy (NEIAH) at Shillong Meghalaya with 100 beddedAyurvedic hospital and 50 bedded Homeopathy hospital to provide Under Graduate Post Graduate doctoraland Post doctoral teaching in Ayurveda and Homoepathy

This information was given by the Minister of State (Independent Charge) for AYUSH Shri Shripad Yesso Naikin written reply to a question in LokSabh

MEDICAL COUNCIL OF INDIA

NoMCI-Computer4012016122857 Date01082016

ToThe DeanPrincipalAll Medical Colleges of India

Sub Digital Mission Mode project by Medical Council of India

Dear SirMadamThis is to bring to your notice Medical Council of India(MCI) has initiatedthe process of implementing e governance through Digital Mission Modeproject by Medical Council of IndiaAs Part of the DMMP MCI through open tender process selected a Systemintegrator Ms Bodhtree Consulting Ltd amp Ms Technify Solutions PvtLtd To design procuredevelop supply implement operate andmaintain MCI-DMPP solution for e governance purposeMCI e governance Project thereby achieving majority the followingamongst othersProvide an online channel for application to avail the services of MCIProvide application progress status available online to the applicantProvide a repository certificates etc For future reference on MCIrsquoswebsiteReduced cost to avail service by the applicant due to reduction inphysical travel availability of e-payment etcMonitoring of attendance of faculty of medical collegesUnique ID for each doctors across IndiaUnified database-ldquosingle version of the truthImproved complaint and grievance redressalWorkflow based processingEnhanced and user friendly document managementAvailability of MIS and dashboard for management

During the integration process awe shall also be interacting with all themedical colleges in India time amp again for quick and full proof egovernance system We are also in process of creating details ofmandatory amp desirable requirements with time lines form the MedicalColleges As the project will be driven under strict time lines ampcontinuous monitoring of MCI-e Governance Team by the office of the

DIRECTORATE FAMILY WELFARE GOVTOF NCT OF DELHIBamp C Wing level-7 Vikas Bhawan-II

Near metacalf House Civil Lines Delhi-110054Ph23813477 amp Email Id pndtdelhigovin

F9(24)1 PNDTDFWA20164517-23Date 2772016

ToThe Director PNDTMinistry of Health amp Family WelfareNirman BhawanNew Delhi

Sub Order of Honrsquoble High Court of Delhi at New Delhi dated 170216 WP (c) 6968(2011 IRIA VsUOI amp Anr copy 212014 vs Indian Medical Association Vs Union of India and WP(c) 31842014 sonological Socity of India Vs UOI amp Anr

SirMadam

With reference of the subject as mentioned above you are requested to inform status of implantation of Court judgment for case No WP69682011 IRIA Vs UOI amp Anr WP(C) 27212014 Vs Indian Medical Association Vs Union of India and WP(C) 31842014 Sonologial Society of India Vs UOI amp Anr The State of Delhi is constantly receiving emailsRepresentations from Court in the above mentioned case State of Delhi has received a communication from Govt of India that GOI is filing a SLP in this matter whereas Department of Law amp Justice GNCT of Delhi has advised Directorate of Family Welfare that any judgment of the Honrsquoble High Court if not stayed by the higher court should be implemented in letter and spiritYour are hereby requested to please provide us the current status of SLP filed and further direction about implementation of the order of Honrsquoble High Court

F9(24)1 PNDTDFWA20164517-23(Dr

JP Kapoor)Director of Family

Welfare

Copy toPs to Honrsquoble Chief MinisterOSD to Honrsquoble Minister of HealthPs To Honble Minister of Health

Ayush public notice on imprint for ASU drugs and industryWednesday August 3 2016 PharmaBiz

bull Drugs and Cosmetic Act 1940 is an act to regulate the import manufacture distribution and sale of drugs and cosmetics Ayurveda Siddha or Unani drugs includes all medicines intended for internal or external use for or in the diagnosis treatment mitigation or prevention of disease or disorder in human beings or animals and manufactured exclusively in accordance with the formulate described in the authoritative books of Ayurveda Siddha and Unani Tibb system of medicine specified in the first Schedule

Provisions of DampC Act 1940 applicable to ASU drugs

bull33C Ayurveda Siddha and Unani Drugs Technical Advisory Board 33D Ayurveda Siddha and Unani Drugs Consultative Committee 33E Misbranded drugs 33EE Adulterated drugs 33EEA Spurious drugs 33EEB Regulation of manufacture for sale of ASU drugs 33EEC Prohibition of manufacture and sale of certain ASU drugs 33EED Power of Central government to prohibit manufacture etc of ASU drugs in the public interest 33F Government Analysts 33G Inspectors 33H Application of provisions of sections 22 23 24 and 25 33-I Penalty for manufacture sale etc of ASU drugs in contravention of this Chapter 33J Penalty for subsequent offenses 33K Confiscation 33L Application of provisions to Government departments 33M Cognizance of offenses 33N Power of Central Government to make rules and 33O The power to amend the first Schedule

bull Schedule E of DampC Rule 1945

bull Schedule E of Drugs amp Cosmetics Rule 1945 contains a list of poisonous substances under the Ayurveda (including Siddha) and Unani Systems of medicine Such Ayurveda Unani amp Siddha drugs containing any of the potentially hazardous ingredients of plant animal and mineral origin as specified in the Schedule E (1) Rule 161(2) of the Drugs and Cosmetic Rules 1945 are required to be taken under medical supervision As per legal provisions caution is to be printed on the label of the container of such medicines

Revision of Schedule E (I)

bull In the list of Schedule E of Drugs amp Cosmetics Rule 1945 only some parts of the plants are found poisonous whereas the rest of the plant is not poisonous and some of the names were found incorrect The matter was examined in detail and finally as per recommendations of ASU Drug Technical Advisory Board (ASUDTAB) Schedule E (I) has been revised and necessary amendments in the list of plants and names etc for Ayurveda Unani amp Siddha poisonous drugs have been carried out Draft Notification in this regard was issued on 13th April 2010

bullPublic Notice from Ayush

bull Department of Ayush (formerly Dept of ISMampH) has issued a public notice on 15th January 2016 The notice clearly has advised the public to purchase and consume Ayurveda Unani amp Siddha drugs only on the prescription of the institutionally qualified and registered practitioner of the respective system Further the notice also warns to avoid purchasing the Ayurveda Unani amp Siddha drugs online and using them without medical consultation

Schedule E drugsbull Manufactures of Ayurveda Unani amp Siddha drugs must ensure to imprint lsquoCaution to be taken under medical supervisionrsquo both in English and Hindi on the labels of all such Ayurveda

Unani amp Siddha drugs which contain potentially hazardous ingredients of plant animal or mineral origin as specified in the 2nd Schedule E(1) of the of the Drugs and Cosmetic Rules 1945 Cases of the contravention of these provisions as and when found may be immediately brought to the notice of the concerned State Licensing Authority for appropriate action

bullList of poisonous substances under Ayurveda

bull A Drugs of vegetable origin

bull Abrus precatorius Linn (Seed) Aconitum chasmanthum Stapfex Holmes Aconitum ferox Wall ex Ser Baliospermum montanum Mull ArgCalotropis procera (Ait) R Br Cannabis sativa Linn (Except seeds) Croton tiglium Linn Datura metal Linn Gloriosa superba Linn Hyoscyamus niger Linn Nerium indicum Mill Papaver somniferum Linn (except seeds) Semecarpus anacardium Linn f and Stychnos nux vomica Linn

B Drugs of animal origin

bull Snake poison

bull C Drugs of mineral origin

bull Arsenic Arsenic trisulphide Arsenic disulphide Mercury Hydrargyri subchloridum Copper sulphate and Cinnabar

If more than the Schedule E is required

bull The steps taken by the Department of Ayush in the revision of Schedule E (I) in 2010 and issuing a public notice in 2015 are welcome from the quality assurance point of view Office order by the Department of Ayush in 2005 regarding imprint on heavy metals within permissible limits provided much needed support to the Ayurvedic drug industry particularly at the international level

bull The steps taken by the Department of Ayush in the revision of Schedule E (I) in 2010 and issuing a public notice in 2015 are welcome for the consumer buying products manufactured by pharmaceutical companies Some vaidyas and Hakims use poisonous substances in preparation of medicines and prescribe in clinical practice The Schedule E need to be amended in this respect also as several case reports about Ayush drug poisoning at clinical level have been published

bullImpact on Ayurvedic drug industry Herbal extracts and proprietary ayurvedic medicines are in high demand Traditional Ayurvedic formulations are in also in demand and prescribed by Ayurvedic practitioners They are being sold through the internet also as e-commerce business After publication of article regarding heavy metals in Ayurvedic formulations in Journal of American Medical Association (JAMA) the sales of ayurvedic formulations containing heavy metals was hit The US FDA also issued a public notice regarding permissible limits of heavy metals in Ayurvedic formulations

bullThe public notice issued by Department of Ayush is also on the same lines and consumers should know about poisonous constituents which are used in ayurvedic formulations As an instance Aconitum ferox Wall ex Ser (Ranunculaceae) is part of herbo-mineral preparations like Tribhuvanakirti Rasa Higuleshwara Rasa Anandabharirava Rasa Sutashekhar Rasa Ramban Rasa Mrityunjaya Rasa Arshakuthara Rasa Agnikumar Rasa Prataplankeshwara Rasa and Ashwakanchuki Rasa Tribhuvanakirti Rasa is commonly used in the treatment of common cold and is highly efficacious also As per ayurvedic methodology Aconitum feroxis purified by the methods mentioned in ancient texts and after purification only it is used in formulations ayurvedic physicians claim that after purification Aconitum ferox becomes non-poisonous We need to verify ancient claims by modern research methods so that claims are not missed out as far as public benefit is concerned

Legal update

Inter-Ministerial Meeting

Capping Suggested

Violence against doctors

Slide Number 8

Slide Number 9

Slide Number 10

Slide Number 11

Nearly 1000 Healthcare Workers Killed Since 2014 WHO

PNDT Act

PNDT UP Judgment

Crosspathy CCIM Resolution

NEET Upheld

NEET IMA Stand

NEET Ordinance

IMA and Service Tax

Service Tax Not Applicable to IMA

Income tax relief

Indian Medical Academy

Haemophilia Factor Duty Withdrawn

Surrogacy

Repeal section 15 (3) of the IMC act

One can Practice anywhere in the country

Not reporting TB a Violation

Health Care Data Privacy and Security Act 2016

MCI Declaration Physicians Oath

Medical Profession and Strike

Justice Sudhir Agarwal J Rakesh Srivastava J Moti Lal Yadav vs State of UP Thru Chief Secy 13501 of 2016 Date 2062016 Allahabad HC

MCI Treat all emergencies and bill it to the state

RTI is not applicable to IMA

Slide Number 58

Caesarean Guidelines

Online advertisements

IMA Code of Conduct

IMA AHPI

IMA NAT HEALTH Declaration

IMA reacts on various reports in media about medicine in India

IMA Reacts

British Media on Indian Health System

Slide Number 79

Slide Number 80

Slide Number 81

Slide Number 82

Schedule E drugs

Legal update

1 The Surrogacy Writ Petition titled as Jayashree Wad versus UOI amp Others pending before the Honble Supreme Court was listed for hearing on 27042016 Mr Rahul Gupta Advocate appeared in the said case on behalf of IMA In the said case an impeladment application has been filed on behalf of IMA The Honble Supreme Court of India has held that all the matters relating to surrogacy will be heard once the Assisted Reproductive Technology (Regulation) Bill 2014 is enacted as an act of Parliament with or without modification as may be

2 The matter titled as MCI versus Dr Meenakshi Gautam pending before Delhi High Court was listed for hearing on 28042016 Mr Rahul Gupta Advocate appeared in the said case on behalf of IMA In the said case an impleadment application has been filed on behalf of IMA and notice has been issued on the said impleadment application by the Honble Court The next date of hearing of the said case is 19072016 for arguments

3 The matter titled as Pfizer Limited versus UOI relating to FDC was listed for hearing on 02062016 before the Honble High Court of Delhi Mr Rahul Gupta Advocate appeared in the said case on behalf of IMA In the said case an impeladment application has been filed on behalf of IMA The jugdement in the said case has been reserved

4 The matter titled as Indian Radiological and Imaging Association versus UOI amp Anr SLP (C) 110462016 was listed for hearing on 29042016 The Honble Supreme Court of India has only issued notice to the other party in the said case An impeadment application on behalf of IMA has to be filed in the said case The next date of hearing is 26072016

5 The matter titled as Karnataka Beedi Industry versus UOI was listed for hearing on 04052016 Mr Rahul Gupta Advocate appeared in the said case on behalf of IMA In the said case an impeladment application has been filed on behalf of IMA The Honble Supreme Court of India has been pleased to transfer all the pending petitions relating to 2014 Rules before the Honble Karnataka High Court Also the Honble Supreme Court has not granted any stay on the 2014 rules

6 The matter titled as Baharul Islam amp Others versus IMA Assam Branch amp Others SLP No 32592 - 325932015 pending before Honble Supreme Court was listed for hearing on 06052016 An impleadment application on behalf of IMA Hq has been filed in the said case On last date of hearing ie 08032016 theHonble Supreme Court was pleased to list the impleadment application of IMA Hq alongwith the main case on next date of hearing The next date of hearing is 05072016 for arguments

30-09-2015 समय 0930 रातर

07112015 समय 0815 रातर

bull Full text

Present

Agenda Item No11

NEET IMA Stand

NEET Ordinance

IMA and Service Tax

Per Archana Wadhwa

(3) of IT Act 1961

Surrogacy

decided

No9-3CCD2007 15th May 2008

Yours faithfully

Respected Sir

IMA Stand

IMA Code of Conduct

bull AERB Licenses

bull Lift license

Dear Sir

Annexure 1

F9(24)1 PNDTDFWA20164517-23Date 2772016

SirMadam

F9(24)1 PNDTDFWA20164517-23(Dr

Welfare

bull Snake poison

Legal update

Capping Suggested

Slide Number 8

Slide Number 9

Slide Number 10

Slide Number 11

PNDT Act

PNDT UP Judgment

NEET Upheld

NEET IMA Stand

NEET Ordinance

IMA and Service Tax

Income tax relief

Surrogacy

Slide Number 58

IMA Code of Conduct

IMA AHPI

IMA Reacts

Slide Number 79

Slide Number 80

Slide Number 81

Slide Number 82

Schedule E drugs

30-09-2015 समय 0930 रातर

07112015 समय 0815 रातर

bull Full text

Present

Agenda Item No11

NEET IMA Stand

NEET Ordinance

IMA and Service Tax

Per Archana Wadhwa

(3) of IT Act 1961

Surrogacy

decided

No9-3CCD2007 15th May 2008

Yours faithfully

Respected Sir

IMA Stand

IMA Code of Conduct

bull AERB Licenses

bull Lift license

Dear Sir

Annexure 1

F9(24)1 PNDTDFWA20164517-23Date 2772016

SirMadam

F9(24)1 PNDTDFWA20164517-23(Dr

Welfare

bull Snake poison

Legal update

Capping Suggested

Slide Number 8

Slide Number 9

Slide Number 10

Slide Number 11

PNDT Act

PNDT UP Judgment

NEET Upheld

NEET IMA Stand

NEET Ordinance

IMA and Service Tax

Income tax relief

Surrogacy

Slide Number 58

IMA Code of Conduct

IMA AHPI

IMA Reacts

Slide Number 79

Slide Number 80

Slide Number 81

Slide Number 82

Schedule E drugs

30-09-2015 समय 0930 रातर

07112015 समय 0815 रातर

bull Full text

Present

Agenda Item No11

NEET IMA Stand

NEET Ordinance

IMA and Service Tax

Per Archana Wadhwa

(3) of IT Act 1961

Surrogacy

decided

No9-3CCD2007 15th May 2008

Yours faithfully

Respected Sir

IMA Stand

IMA Code of Conduct

bull AERB Licenses

bull Lift license

Dear Sir

Annexure 1

F9(24)1 PNDTDFWA20164517-23Date 2772016

SirMadam

F9(24)1 PNDTDFWA20164517-23(Dr

Welfare

bull Snake poison

Legal update

Capping Suggested

Slide Number 8

Slide Number 9

Slide Number 10

Slide Number 11

PNDT Act

PNDT UP Judgment

NEET Upheld

NEET IMA Stand

NEET Ordinance

IMA and Service Tax

Income tax relief

Surrogacy

Slide Number 58

IMA Code of Conduct

IMA AHPI

IMA Reacts

Slide Number 79

Slide Number 80

Slide Number 81

Slide Number 82

Schedule E drugs

30-09-2015 समय 0930 रातर

07112015 समय 0815 रातर

bull Full text

Present

Agenda Item No11

NEET IMA Stand

NEET Ordinance

IMA and Service Tax

Per Archana Wadhwa

(3) of IT Act 1961

Surrogacy

decided

No9-3CCD2007 15th May 2008

Yours faithfully

Respected Sir

IMA Stand

IMA Code of Conduct

bull AERB Licenses

bull Lift license

Dear Sir

Annexure 1

F9(24)1 PNDTDFWA20164517-23Date 2772016

SirMadam

F9(24)1 PNDTDFWA20164517-23(Dr

Welfare

bull Snake poison

Legal update

Capping Suggested

Slide Number 8

Slide Number 9

Slide Number 10

Slide Number 11

PNDT Act

PNDT UP Judgment

NEET Upheld

NEET IMA Stand

NEET Ordinance

IMA and Service Tax

Income tax relief

Surrogacy

Slide Number 58

IMA Code of Conduct

IMA AHPI

IMA Reacts

Slide Number 79

Slide Number 80

Slide Number 81

Slide Number 82

Schedule E drugs

30-09-2015 समय 0930 रातर

07112015 समय 0815 रातर

bull Full text

Present

Agenda Item No11

NEET IMA Stand

NEET Ordinance

IMA and Service Tax

Per Archana Wadhwa

(3) of IT Act 1961

Surrogacy

decided

No9-3CCD2007 15th May 2008

Yours faithfully

Respected Sir

IMA Stand

IMA Code of Conduct

bull AERB Licenses

bull Lift license

Dear Sir

Annexure 1

F9(24)1 PNDTDFWA20164517-23Date 2772016

SirMadam

F9(24)1 PNDTDFWA20164517-23(Dr

Welfare

bull Snake poison

Legal update

Capping Suggested

Slide Number 8

Slide Number 9

Slide Number 10

Slide Number 11

PNDT Act

PNDT UP Judgment

NEET Upheld

NEET IMA Stand

NEET Ordinance

IMA and Service Tax

Income tax relief

Surrogacy

Slide Number 58

IMA Code of Conduct

IMA AHPI

IMA Reacts

Slide Number 79

Slide Number 80

Slide Number 81

Slide Number 82

Schedule E drugs

30-09-2015 समय 0930 रातर

07112015 समय 0815 रातर

bull Full text

Present

Agenda Item No11

NEET IMA Stand

NEET Ordinance

IMA and Service Tax

Per Archana Wadhwa

(3) of IT Act 1961

Surrogacy

decided

No9-3CCD2007 15th May 2008

Yours faithfully

Respected Sir

IMA Stand

IMA Code of Conduct

bull AERB Licenses

bull Lift license

Dear Sir

Annexure 1

F9(24)1 PNDTDFWA20164517-23Date 2772016

SirMadam

F9(24)1 PNDTDFWA20164517-23(Dr

Welfare

bull Snake poison

Legal update

Capping Suggested

Slide Number 8

Slide Number 9

Slide Number 10

Slide Number 11

PNDT Act

PNDT UP Judgment

NEET Upheld

NEET IMA Stand

NEET Ordinance

IMA and Service Tax

Income tax relief

Surrogacy

Slide Number 58

IMA Code of Conduct

IMA AHPI

IMA Reacts

Slide Number 79

Slide Number 80

Slide Number 81

Slide Number 82

Schedule E drugs

30-09-2015 समय 0930 रातर

07112015 समय 0815 रातर

bull Full text

Present

Agenda Item No11

NEET IMA Stand

NEET Ordinance

IMA and Service Tax

Per Archana Wadhwa

(3) of IT Act 1961

Surrogacy

decided

No9-3CCD2007 15th May 2008

Yours faithfully

Respected Sir

IMA Stand

IMA Code of Conduct

bull AERB Licenses

bull Lift license

Dear Sir

Annexure 1

F9(24)1 PNDTDFWA20164517-23Date 2772016

SirMadam

F9(24)1 PNDTDFWA20164517-23(Dr

Welfare

bull Snake poison

Legal update

Capping Suggested

Slide Number 8

Slide Number 9

Slide Number 10

Slide Number 11

PNDT Act

PNDT UP Judgment

NEET Upheld

NEET IMA Stand

NEET Ordinance

IMA and Service Tax

Income tax relief

Surrogacy

Slide Number 58

IMA Code of Conduct

IMA AHPI

IMA Reacts

Slide Number 79

Slide Number 80

Slide Number 81

Slide Number 82

Schedule E drugs

bull Full text

Present

Agenda Item No11

NEET IMA Stand

NEET Ordinance

IMA and Service Tax

Per Archana Wadhwa

(3) of IT Act 1961

Surrogacy

decided

No9-3CCD2007 15th May 2008

Yours faithfully

Respected Sir

IMA Stand

IMA Code of Conduct

bull AERB Licenses

bull Lift license

Dear Sir

Annexure 1

F9(24)1 PNDTDFWA20164517-23Date 2772016

SirMadam

F9(24)1 PNDTDFWA20164517-23(Dr

Welfare

bull Snake poison

Legal update

Capping Suggested

Slide Number 8

Slide Number 9

Slide Number 10

Slide Number 11

PNDT Act

PNDT UP Judgment

NEET Upheld

NEET IMA Stand

NEET Ordinance

IMA and Service Tax

Income tax relief

Surrogacy

Slide Number 58

IMA Code of Conduct

IMA AHPI

IMA Reacts

Slide Number 79

Slide Number 80

Slide Number 81

Slide Number 82

Schedule E drugs

bull Full text

Present

Agenda Item No11

NEET IMA Stand

NEET Ordinance

IMA and Service Tax

Per Archana Wadhwa

(3) of IT Act 1961

Surrogacy

decided

No9-3CCD2007 15th May 2008

Yours faithfully

Respected Sir

IMA Stand

IMA Code of Conduct

bull AERB Licenses

bull Lift license

Dear Sir

Annexure 1

F9(24)1 PNDTDFWA20164517-23Date 2772016

SirMadam

F9(24)1 PNDTDFWA20164517-23(Dr

Welfare

bull Snake poison

Legal update

Capping Suggested

Slide Number 8

Slide Number 9

Slide Number 10

Slide Number 11

PNDT Act

PNDT UP Judgment

NEET Upheld

NEET IMA Stand

NEET Ordinance

IMA and Service Tax

Income tax relief

Surrogacy

Slide Number 58

IMA Code of Conduct

IMA AHPI

IMA Reacts

Slide Number 79

Slide Number 80

Slide Number 81

Slide Number 82

Schedule E drugs

bull Full text

Present

Agenda Item No11

NEET IMA Stand

NEET Ordinance

IMA and Service Tax

Per Archana Wadhwa

(3) of IT Act 1961

Surrogacy

decided

No9-3CCD2007 15th May 2008

Yours faithfully

Respected Sir

IMA Stand

IMA Code of Conduct

bull AERB Licenses

bull Lift license

Dear Sir

Annexure 1

F9(24)1 PNDTDFWA20164517-23Date 2772016

SirMadam

F9(24)1 PNDTDFWA20164517-23(Dr

Welfare

bull Snake poison

Legal update

Capping Suggested

Slide Number 8

Slide Number 9

Slide Number 10

Slide Number 11

PNDT Act

PNDT UP Judgment

NEET Upheld

NEET IMA Stand

NEET Ordinance

IMA and Service Tax

Income tax relief

Surrogacy

Slide Number 58

IMA Code of Conduct

IMA AHPI

IMA Reacts

Slide Number 79

Slide Number 80

Slide Number 81

Slide Number 82

Schedule E drugs

Documents

Medico Legal and Ethical Issues