Holding that the rules laid in the Employees State Insurance (ESI) Act do not allow the transfer of any of its assets to any person, including the state government, the Delhi High Court has stopped the transfer of hospitals and medical colleges under the Employees State Insurance Corporation (ESIC) by terming it “legally impermissible” and “contrary to the law.
A bench of Acting Chief Justice Gita Mittal and Justice C Harishankar pointed out that there was no provision in the ESI Act which enables the ESIC to do so. The directions come on a plea which had challenged the transfer of the hospital and medical colleges under it to any state government.
“The scheme of the ESI Act, 1948, especially Sections 59A and 59B of the statute do not enable the ESIC to transfer any of its assets to any other person, including the State Governments. There is no provision in the statute which enables the ESIC to do so,” the court said.
The bench, while delivering the judgment also added, “Given the legislative mandate, we, therefore hold that the action of the respondent no. 2 in transferring the medical colleges and institutions to the state governments is without jurisdiction, contrary to law and illegal”.
In order to effectuate the administration of the purposes of the ESI Act, the Centre had established the ESIC which would provide benefits to the employees in case of sickness, maternity and employment injury.
The court held that there was substance in the petitioner’s contention that instead of addressing the several concerns pointed out by the members in the 164th Meeting, ad hoc decision to transfer even proposed medical colleges were being taken.
“There is strength in the petitioner’s contention that there was nothing on record to show that any case by case evaluation of either the need or the efficacy of such transfer was conducted prior to the same being affected,” adding that the interest of the insured persons would be compromised and that the ESIC is losing all control over the facilities.
The court also said that “ESI Act contains nothing to indicate that funding by the State Government would entail, as necessary and inexorable sequitur, throwing open the hospitals to the general public”.
“…..If, by virtue of their being contributing employees of the ESI, and, per definition therefore, “insured persons”, the petitioner and others like him have a statutorily fossilized right to exclusive enjoyment of the facilities at the ESI hospitals, the court has a duty to zealously protect and preserve that right,” the bench said in a 38 page judgment.
The court’s direction came on pleas filed by Balaraj Jadhav and others who contended that the ESIC was flouting Section 59B of the ESI Act. According to this section, the ESIC took steps for establishment of medical, dental and nursing colleges all over India.
It also said that the source of funds given for this purpose was that of the ESIC and therefore comprised of contributions by the insured persons under the ESI Act. The plea also highlighted the gross mismanagement by quoting a CAG report.
The ESIC, on the other hand, had said that it should exit the field of medical education as it is not the core function and the objective of section 59B of the Act is unlikely to be met. It said that the state governments would contribute to the better functioning of the hospitals and colleges.
MEDICAL GRADUATES of the 2017 batch, who are aspiring to take up post-graduate (PG) courses, have challenged the state government’s decision of making one-year rural service mandatory for PG applicants. An online petition, started by the parent of one such graduate, has received over 1,600 signatures. It is mandatory for students of government medical colleges — pursuing both under-graduate and post-graduate courses — to serve a one-year bond service in a hospital run by the public health department of the state. However, students are known to skip these postings or postpone them till after post-graduation.
The new rule aims at keeping a check on this practice. A Government Resolution (GR) was issued to this effect was issued by the Department of Medical Education and Drugs on October 12. As per the GR, the new rule will be in force for admissions taking place for the 2018-19 academic session. This puts the MBBS graduates of the 2017 batch, who had decided to complete their rural posting after PG, at a disadvantage.
The development comes two months ahead of the National Eligibility-cum-Entrance Test for PG admissions. The petition was started by Muzaffar Khan, whose son graduated from a government medical college in Yavatmal this year. Khan has also filed an online grievance with the department of medical education and drugs.
Khan said, “We have asked the government to reconsider its decision. The announcement came very late and my son had already started preparing for NEET. He will lose a year if the rule is to be applied.”
The Directorate of Medical Education and Research (DMER), meanwhile, also wrote to the department to amend the GR and implement the new rule from the 2019-20 academic year. Since, the bond service does not apply to graduates of private medical colleges, they will be able to apply for PG, he added. He said if the petition does not bear a result, he will resort to a legal recourse.
Pravin Shinghare, director, DMER, said, “It is true that the GR, as it stands today, favours graduates from private institutes. We have already apprised the department of the matter.”
Medical Education Secretary Sanjay Deshmukh said the rules have been decided in principle and the timeline is to be finalised. “By next week, we will come up with a decision on whether to implement it for the academic year 2018-19 or 2019-20,” he said.
Parents oppose bond service for post-graduate medical aspirants
Parents of medical aspirants have floated an online petition against a recent state government resolution requiring the aspirants to complete their bond service before seeking admission to post-graduation medical and dental courses.
Medical and dental graduates, post-graduates and super speciality students from government-run colleges are required to spend a year at a state-run rural health care centre after writing the final exam. The students who don’t do so must pay a fine of Rs15 lakh, Rs50 lakh and Rs2.5 crore, respectively.
The parents said that the decision, which comes two months before National Eligibility-cum-Entrance Test – Post Graduation (NEET-PG), has put the aspirants in a spot. Despite their preparations, the exam has become inconsequential for those who are yet to complete their mandatory one-year service in rural areas.
So far, the petition has garnered over 1,700 signatures.
Many medical students who want to pursue post-graduation and super-speciality courses comply with the rural service for all the courses combined after finishing their academics. However, with the new GR in place, the students can no longer do so.
The change in norms is the latest in the state government’s efforts to enforce the bond, as many medical graduates manage to dodge the rural stint. However, various stakeholders have expressed reservations over these measures.
Muzaffar Khan, the parent who started the online petition, said that the move to make bond requirement mandatory for PG admissions at the eleventh hour is unjust to students. “Enforcing the rule on students facing exams without giving them sufficient notice is an injustice. Now they will have to start their preparations anew after their rural stint and end up losing a year or so,” he said.
Khan also suggested that the rule will result in students graduating from private medical and dental colleges getting most of the PG seats in government-run colleges, as they don’t have to sign the rural bond. “By restricting the government college graduates from PG admissions, the government is indirectly giving an edge to the graduates from private and deemed colleges. The government is also encouraging students to pursue graduation in private colleges and deemed universities which have very high fees, poor infrastructure and very few patients to avail clinical knowledge,” read the petition.
Maharashtra: Medical PG aspirants face bond hurdle
Less than three months before the National Eligibility-cum-Entrance Test (NEET)-PG, the state’s medical education department has issued a government resolution (GR) mandating MBBS graduates from public medical colleges to submit bond-free certificates in order to qualify for a PG seat.
The GR, issued on October 12, has shocked thousands of PG aspirants, who are questioning the decision being taken at the eleventh hour after most have spent months preparing for the entrance test. While MBBS students are expected to complete a one-year bond after their five-and-half-year course, the state allows them a window of six years to pursue higher education. Most avail of that extra time and only a handful proceed to do bond service immediately after MBBS.
The state’s medical education department has proposed to tweak the duration of the MBBS course to 6.5 years from the existing 5.5 in order to leave no room for students to dodge rural postings. The idea is to merge the rural bond service with the course duration so students are awarded degrees only after completion of their one-year stint and before they can go for post-graduation.
Under the current rule, a medical graduate is allowed a window of six additional years after completion of MBBS to pursue post-graduation and super-specialization and is not expected to immediately proceed for the rural posting. But the state has found this clause is being exploited by students, who often skip rural internships in the name of higher education and the absence of a foolproof government mechanism to track their career graphs.
TOI has learnt that medical education secretary Sanjay Deshmukh has sent a proposal to his ministry this month seeking its approval to change the course framework. In an exercise that began in January, the Directorate of Medical Education and Research (DMER) found out around 4,500 doctors may have skipped their rural postings between 2001 and 2011. Maharashtra produces close to 7,000 MBBS graduates every year, of which 2,800-odd pass out of the 19 public medical colleges. A creation of a software application that will make postings and vacancies in the public health department-run hospitals transparent is also in its final stages of trial.
A senior government official confirmed the proposal is under consideration.
“Rules under the Maharashtra University of Health Sciences (MUHS) Act don’t allow us to withhold documents, including mark sheets, for reasons such as non-fulfillment of bonds. If this proposal gets the nod, students will have to go for rural postings before appearing for their PG entrances. This way, once they serve the rural bonds, they are free to do what they want,” the official said.
About two decades ago, this framework was already in use in the state. A GR issued in the late 1990s mandated students to complete their rural stint before going for PG. The system worked smoothly for some time as candidates were placed in rural, district and civil hospitals run by the state’s public health department (PHD). But it had to be scrapped in 1999 after the PHD said it didn’t have vacancies to accommodate all medical pass-outs. The friction between two arms of medical education and public healthcare in Maharashtra—DMER and PHD—has often led to even willing students not finding rural postings of their choice.
Nationally too, the idea of increasing course duration has been discussed time and again. Ex-health minister A Ramadoss was the first to speak in favour of it in 2007. In 2012, it was discussed by then Union health minister Ghulam Nabi Azad and the Medical Council of India (MCI). At that time, amending the MCI Act too was given a thought.
Dr Pravin Shingare, who heads the state’s DMER, said while MCI is the only one that can decide on course duration, MUHS can make “modifications” within the MCI framework. He said most students give the rural stint a slip because there is nothing to hold them back. “While doctors practising in Maharashtra may still be netted at the time of registering with the Maharashtra Medical Council (MMC) as they are required to produce a bond-free certificate, those coming from other states often get away,” Shingare said.
The medical community, however, thinks it would be unfair to increase the duration of medical education. “Why can’t the government break up the one-year internship tenure and incorporate rural posting without increasing the overall course duration,” said Dr Sagar Mundada, who previously led the Maharashtra Association of Resident Doctors (MARD). He added doctors anywhere take around 12 years to complete super-specialization, and any further increase would be exasperating. A senior professor from JJ Hospital concurred the move would be unfair to students of government colleges as those studying in private ones will save a year and have the benefit of appearing for PG before the others.
Aiming to foster competition and nudge government hospitals to improve health services, Niti Aayog, along with the health ministry, has started ranking district hospitals on the basis of their performance on health indicators.
There are around 734 district hospitals across the country which provide secondary healthcare facilities to people. In addition, around 300 other hospitals, such as women’s hospitals at the district level, will also be rated. The decision to track the performance of district hospitals came as the Modi dispensation believed that despite large amounts pf money being allocated to these hospitals which have a critical role in providing healthcare, there was no comprehensive system to assess their performance based on measurable health outcomes.
The rating will create an environment to nudge hospitals towards improvement. The entire exercise will also provide an evidence base and help identify hospitals that need to be incentivised.
The indicators on which performance will be measured include OPD per doctor, number of laboratory tests per technician, stock out rate of essential drugs, bed occupancy rate, C-section rate, blood bank replacement rate and post-surgical infection rate. Number of functional hospital beds per 1,00,000 population, ratio of doctors, nurses and paramedical staff are other factors which will be taken into account while accessing the performance of district hospitals.
The index will also capture, for the first time, feedback from patients as high weightage has been assigned for patient satisfaction score.
Over 4,500 Maharashtra doctors – including close to 2,500 graduates from Mumbai medical colleges – have been declared ‘quacks’ by the Directorate of Medical Education and Research (DMER) following their failure to serve the mandatory one year in rural areas.
The DMER has drawn up a list of 4,500 doctors who received their MBBS degrees between 2005 and 2012 but did not honour their commitment to serve in rural areas. They also did not pay the penalty for their failure to do so.
All serving doctors must renew their registration with the Maharashtra Medical Council (MMC) every five years. However, since these 4,500 doctors violated their rural service bonds, their registrations stand cancelled.
Medical students graduating from government-run colleges sign a bond promising to serve at a primary health center in a village for a year within five years of obtaining their MBBS degree. If they do not serve the bond, they must pay a penalty, which is a steep Rs 10 lakh for a plain vanilla MBBS doctor, Rs 50 lakh for postgraduates, and Rs 2 crore for super-specialty doctors.
According to DMER data, among the doctors declared ‘quacks’ are 780 from Seth Gordhandas Sunderdas Medical College, Parel; 761 from Grant Medical College attached to JJ Hospital; 595 from B J Medical College, Pune; 526 from Government Medical College, Nagpur; and 485 from Topiwala National Medical College attached to BYL Nair Hospital at Mumbai Central.
Doctors, however, are up in arms against DMER’s decision. They say that DMER is just forcing doctors to serve in fringe areas without developing proper health infrastructure there. “The condition of some of the primary health centres and rural hospitals in the state is so bad that they don’t even have adequate stock of basic medicines,” said Dr Sagar Mundada, chairman, youth wing, Indian Medical Association (IMA).
DMER head Dr Pravin Shingare, however, said the decision has been taken after giving these doctors enough time to serve the bond. “We will share details of these doctors with district-level committees, which are authorised to take action against bogus doctors. The committee has members like the civil surgeon and superintendent of police who will now take action against them,” he said.
He added that these doctors may have multiple degrees but without the renewal of their registration with MMC they are as good as quacks. Dr Ajay Chandanwale, Dean, BJ Medical College, Pune, said: “Notices have been issued to students. They must either serve the bond or pay the penalty for not serving it. The government will not allow renewal of their registrations if they don’t do so.”
Dr Sanjay Deshmukh, Deputy Director, Health Services, said the doctors must understand that the one-year rural stint for all new graduates is aimed at meeting a desperate demand for doctors in villages. “There is a huge shortage of doctors in the rural parts of the state. Most of the students after passing the final exam, choose municipal corporations in cities to work in public health departments rather than serving people in rural areas,” he said.
Patients treated by female surgeons are less likely to die in the first few weeks after operation than those treated by their male counterparts, a study claims.
Studies have shown that women and men practise medicine differently, although little researchexists on differences in learning styles, acquisition of skills, or outcomes for female and male surgeons.
Researchers led by Raj Satkunasivam from the University of Toronto in Canada compared outcomes for patients undergoing one of 25 surgical procedures by a female surgeon with patients undergoing the same operation by a male surgeon of the same age in the same hospital in Canada.
To ensure the two groups were well balanced, patients were matched for age, sex, presence of other conditions and income. Surgeons were matched for age, experience, volume and hospital.
The main outcome was a combined measure of death, readmission to hospital and complications 30 days after surgery, researchers said.
A total of 104,630 patients were treated by 3,314 surgeons (774 female and 2,540 male) over the study period (2007-2015).
The study published in The BMJ found that patients treated by female surgeons were slightly less likely to die within 30 days, but there was no significant difference in readmissions or complications.
There was also no difference in outcomes by surgeon sex in patients who had emergency surgery, where patients do not usually choose their surgeon, researchers.
Results remained largely unchanged after accounting for additional factors like case mix (differences in a patient’s condition), researchers said.
Possible reasons underlying better outcomes for patients treated by female surgeons are not clear, although it may be related to delivery of care that is more in line with guidelines, more patient centred, and involves better communication, they said.
“Our findings have important implications for supporting sex equality and diversity in a traditionally male dominated profession,” researchers said.
Union minister Ashwini Kumar Choubey today said there is a shortage of over 6 lakh doctors in the country now but the crisis would end by 2022, as the number of seats in medical colleges has been increased.
As per population, the country requires 14 to 16 lakh doctors but at present merely eight lakh doctors are serving the people, he said.
The health ministry has increased seats in medical colleges to achieve the “health service for all” goal of the prime minister, the Minister of State for Health said here.
The medical colleges would produce 67,972 MBBS doctors and 30,228 post-graduate doctors a year, Choubey said, adding that presently the figure is 32,000 MBBS doctors and 12,000 PG doctors.
The increased seats would gradually bridge the gap by 2022, the minister told reporters.
He said Prime Minister Narendra Modi wants to bring down the infant mortality rate and maternal mortality rate in the country.
The prime minister will launch the intensified Mission Indradhanush in Gujarat tomorrow to accelerate progress towards the goal of full immunisation coverage, Choubey said.
He inspected the Patliputra Medical College and Hospital and reviewed central government sponsored health plans.