2 year post-PG bond in Odisha

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Students pursuing post-graduate courses in the three government-run medical colleges will have to serve the state for a minimum of two years failing which they could be penalised.

While making the provision mandatory, the government has asked the Directorate of Medical Education and Training (DMET) to ensure execution of the bond that students will have to sign to this effect while taking admission in the state-run medical colleges.

The decision, taken last week by the state’s health department stressed that “all candidates taking admission in government medical colleges, either under state quota or all India quota in post-graduation in medicine (MD), post-graduation in medical master of surgery (MS), master of dental surgery, or doctor medicine (DM) courses” would have to execute the bond. The decision will not be applicable to under-graduate courses such as MBBS, BDS and paramedical courses.

The government will allow the bond to lapse if it cannot provide employment to the candidate within six months of the candidate completing the PG course.

The announcement also said that in the event of a student getting an opportunity to pursue higher studies immediately after completion of the PG course, he or she would be allowed to join the course.

But, after completion of higher studies, they would have to serve the state government for the stipulated two years. Such students would be required to make affidavits before first class judicial magistrates.

Defending the decision, state health secretary Pramod Kumar Meherda said: “The state has an acute shortage of doctors. The government spends a lot in providing medical education in the state. But, most of the students are reluctant to serve the state. The purpose of the bond is to retain graduating doctors and utilise their services.”

About 1,300 of 4,700 posts of doctors are vacant in the state at present.

In November 2015, the state government had dismissed 408 doctors for abandoning duty.

At the specialists’ level (doctors with PG degree holders), the state faces an acute shortage. There are nearly 450 post-graduate seats in the three colleges – SCB Medical College, Cuttack, MKCG Medical College, Berhampur, and VSS Medical College, Burla.

An official said that if a student fails to adhere to the bond and does not serve the state for two years, the government would impose monetary penalties.

“The penalty will be double the amount of stipend/salary received during the study period (post-graduation). We will also not release their pass certificate, college leaving certificate or any other certificate in the custody of the authority.”

The official said candidates leaving the pos-graduation course before completion would be liable to face monetary penalty of Rs 10 lakh, the amount of stipend and the salary received by him or her till that period.

An official said the bonds would be made on non-judicial stamp paper of Rs 21. The bonds would have to be signed by the candidate, two sureties (parents or guardians), the dean and the principal of the institutions concerned. The bonds would be collected centrally at the time of provisional admission by the selection committee, and to be handed over to the respective institutions after final admission.

Choking in womb: 30% preterm births in capital due to pollution

Pregnant women who expose themselves to outdoor pollution too often are putting their babies in danger. City doctors warn that one in every four babies born is preterm. And one out of four preterm deliveries could be due to exposure to automobile and industrial exhaust.

Reacting to an international research study conducted by the Stockholm Environment Institute (SEI) that links outdoor pollution to preterm births and low birthweight babies, city doctors reveal that the rate of preterm births in Hyderabad is between 20 and 24 per cent of live births. They also list outdoor pollution, particularly automobile and industrial exhaust, as one of the major causes for preterm deliveries and birth of underweight babies.

In the absence of official data on preterm deliveries and low birthweight babies, city doctors estimate that at least 20 per cent of the live births fall short of the gestation period. On the higher side it is 24 per cent. Increased incidence of asthma and autism in children of age group 0-5 years is also linked to their mothers being exposed to air pollution during pregnancy .

Dr Roya Rozati, head of the department of obstetrics and gynaecology, Owaisi Hospital and Research Centre, says, “ Alt hough there are no accurate statistics for Hyderabad, the preterm birth rate is around 24.5 per cent. The incidence is increasing.“

“Currently we are working on epidemiological study on pollution and preterm births, low weight babies and infertility in different populations under different conditions of exposure. The consistency of results strengthen the weight of evidence for a true association between exposure and outcome,“ points out Dr Roya Rozati. According to Dr Sharmila Khaja, consultant paediatrician, Apollo Hospitals, Hyderabad is no different from other major cities when it comes to pollution and premature births. “Particulate matter of 2.5 microns is known to cause preterm births. Almost 30 percent of all preterm births is due to pollution,“ she adds.

Dr Vimee Bindra, consultant gynaecologist and infertility specialist, estimates that between 21and 25 per cent of babies born in the city are pre term. “ Antenatal exposure to air pollutants can increase the risk of preterm delivery and low birth weight babies. Severe pollution may lead to stillbirths or sudden infant death syndrome,“ she warns.

According to Dr Harikishan Boorugu, senior consultant physician, vehicular pollution can result in worsening of asthma and lung problems. The morality rate depends on how preterm is the baby just before 37 weeks of pregnancy or much before (28 weeks etc).

Private hospitals reuse disposables, make you pay for them

Disposables like catheters, guide wires and balloons used in every angioplasty are reused and billed repeatedly in many private hospitals.

Adding to the risk of infection, you could be paying for something that has already been paid for. And the hospital may be making a profit of Rs 20,000 to Rs 30,000 on every procedure with simple reuse and rebilling, say industry sources.

The practice is so rampant that the health ministry has issued an office memorandum warning against reuse of disposable surgical items, particularly in cardiology, when they are meant for one-time use.

“The items after one procedure are sterilised and reused and (patients) are charged full amount of these items,” stated the memo dated December 21, 2016. The matter had been “viewed by this ministry seriously”, it said, and clarified that “reuse of disposable items, particularly in cardiology and other specialties, is not permitted in healthcare organisations empanelled under CGHS (Central Government Health Scheme)”.

It goes on to warn of “suitable action including withdrawal of CGHS empanelment” against defaulters. It is silent on action against big corporate hospitals that are not empanelled under CGHS.

“Most private hospitals, especially hospitals chains, insist that cardiologists reuse these items. While reusing these items a couple of times might be justified in some cases where you want to help bring down costs for a patient, in most of these hospitals, not only do they reuse four or five times, patients are also billed afresh for each of these items, helping the hospitals make a profit of Rs 20,000 to Rs 30,000 on each procedure or patient,” explained a cardiologist who has worked in several leading private hospitals.

All disposable items have clear instructions on the packaging saying they should be used only once and cannot be resterilised. Some cardiologists in private hospitals admitted that reuse was common but said it was not a problem if the items were properly resterilised. Companies, they said, insisted on single use to sell more of their products.

Cath lab technicians and dealers who sell disposables and stents to hospitals also confirmed that such reuse was common. Hospitals like AIIMS and PGI hardly ever reuse these items as there is no pressure to cut corners to make profit.

“In the US, solid catheters or catheters without holes can be resterilised and reused but only once or twice. But reuse of catheter with holes like a guide catheter used in angioplasty is not allowed as it is difficult to clean the insides where blood residue might remain. This is to prevent any chance of HIV and Hepatitis B infection. Also, resterilising affects the quality of the item as it hardens the plastic, making it less flexible,” explained a senior AIIMS cardiologist.

Chain hospitals are the worst offenders, according to a cardiologist who has worked in one such institution. “If doctors in one hospital in the chain reuse an item five or six times, that is lauded as a great example of cost saving. It is pushed as standard operating procedure across the entire chain, putting enormous pressure on doctors who try to resist such unethical overuse of a disposable item,” explained the cardiologist.

“Reuse is bad and doing so without the patient’s consent is criminal,” said another cardiologist. “And charging for resued items is fraud of the highest order being done in most elite hospitals to push up profits. It is easy to investigate and expose this. The government can get the number of angioplasties done in a hospital and ask for proof of purchase of the disposables for the last two years. There is a formula for how many disposables are needed for each angioplasty. They will find that far fewer disposables have been purchased than the required number, which will show clear reuse. Such hospitals should be prosecuted,” he said.

However, reusing of items with patients’ consent to reduce costs for the poor should not be treated as criminal acts, he added.

Many drugs using active Viagra ingredient: Govt

Many drugs using active Viagra ingredient: Govt

After registering a case against a pharma company based in Bihar, the health department suspects that there are other ayurveda and homeopathy drugs using sildenafil citrate, an active ingredient in Viagra.

Sildenafil citrate can only be sold on the prescription of an authorised doctor but the action of health department officials against such drugs shows that it was easily available as over-the-counter drug in the form of ayurveda and homeopathy medicine.

The drug is prescribed for erectile dysfunction but it can cause cardiac arrest and other severe complications.

Around four days ago, ayurveda department and health department jointly conducted a raid and collected medicines of ayurveda and homeopathy suspecting them having sildenafil citrate in Jaipur and Bihar.

“We are awaiting the report of seven samples collected. After receiving the report of laboratory test, we will take further action,” Ajay Phatak, drug controller, health department, said.

He said that use of sildenafil is allowed in allopathic medicines only as it is an allopathic content. No other alternative medicine like ayurveda or homeopathy can use it. It makes drugs spurious.

The health department officials had conducted raids in Bihar, where the manufacturer’s unit was situated.

Phatak said that they would take action against ayurveda and homeopathic medicines which are using allopathic contents. “We are taking it as a campaign against spurious drugs,” Phatak said.

After the raids, the drug controller imposed prohibition on sale of seven such drugs which were suspected to be using allopathic content- sildenafil. The cost of the drugs was over Rs 2 lakh.

HRD to rank law, medical colleges from this year

From this year, students will be able to know where a particular medical, dental and law college stands in terms of standard of education as the HRD ministry has included these institutions in its India Rankings 2017 which will be released on April 4.

The HRD ministry had released the first-ever national rankings last year when it had included Technical, Management, University and Pharmacy institutions as categories.

“From this year medical, dental and law colleges will also be ranked,” a source told PTI.

Nearly 49 law colleges and 43 medical or dental institutions have come on board to be ranked this year, the sources added.

In the coming years, however, it is expected the number of medical, dental and law colleges will significantly go up.

President Pranab Mukherjee will release the rankings in the first week of April at an event where HRD Minister Prakash Javadekar would also be present.

Another key aspect of the rankings this year is that institutions will also be given weightage over the number of patents or path-breaking research that is conducted by them, it is learnt.

Unlike last year, when each category had a separate list, the India Rankings 2017, would have a single list where the best institutions from all categories would compete against each other.

However, an additional category wise list may also be released.

“There may be a single list of say the hundred best colleges in the country whether they are varsities, IITs, IIMs, Medical or law colleges. However in addition, category wise lists will also be released,” an official source said.

Officials also said a significant emphasis has been laid on the public and peer perception of the institutes which will participate in these rankings.

The data provided by the institutions was put up and there has been a very enthusiastic response from the public, a senior official added.

Doctors debate stent ethics after price cap

The National Pharmaceutical Pricing Authority (NPPA) decision to put a cap on stent prices has not only dealt a huge blow to hospitals and device manufacturing companies but has also thrown up a question of ethics, with experts locking horns on the appropriateness of stent implants.

Whether one needs a stent implant or not is generally decided by a lone cardiologist. The norm in some developed countries, however, is for a ‘heart team’ to take a collective decision. The team usually comprises a cardiologist, a cardio thoracic surgeon, a cardiac anesthesiologist, general physician and an outsider.

What’s worse in the country is that there is neither a third party watchdog to regulate stent implantation according to established protocol nor is a medical audit done.

“Without a third party watchdog, a medical audit or a heart team to take a collective decision before stent implantation in a patient, as is done in a few developed countries, it will always leave a doubt that stents are being overused,” said Dr RV Kumar, cardiothoracic surgeon and head of department of cardiothoracic surgery at Nizam’s Institute of Medical Sciences (Nims).

In fact, a medical audit of stents is performed on Aarogyasri patients, but not in the case of private patients. In such cases, even private insurance players do not look into the merits of each angioplasty but merely give procedural clearance to the hospitals.

Dr MSS Mukharjee, director, department of cardiology, Maxcure Hospital, Madhapur, said that the concept of stent appropriateness will develop in due course of time.

“Don’t mix stent appropriateness with the stent price capping issue. Now, the problem is stent pricing and how people who can afford to buy the latest fourth generation stents are helpless as device makers have withdrawn them from the market,” he said.

He added that cardiologists in India generally follow the protocol and guidelines issued by the Cardiology Society of India and American College of Cardiology while deciding to implant a stent in a patient.

Meanwhile, patients looking for high-end stents continue to suffer as city-based corporate hospitals find themselves in a spot after price cap. “There is a lot of confusion since patients want high-end stents and companies have started withdrawing stocks from the market,” said Harish Manian, COO of Continental Hospital.