Doctors up in arms against assault

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The recent attack on a doctor in Dhule has brought to fore the aspect of security for medical professionals and the rising incidents of doctor-patient friction.

Two days after an orthopaedic doctor of Dhule civil hospital was thrashed by a patient’s relatives after a quarrel over alleged medical negligence, medical students have declared a mass boycott of classes on Friday in protest. The youth wing of Indian Medical Association (IMA), Maharashtra and the Maharashtra Association of Resident Doctors (MARD) have organised the protest.

Terrified resident doctors have demanded more security on campus. “The CCTV footage shows how brutally the doctor was assaulted. The visuals are terrifying and the degree of the attack has scared many of us,” said Swapnil Meshram, a third-year resident doctor from JJ Hospital.

Students on medical campuses are raising the issue of lack of ‘well-trained’ security personnel. “Most medical campuses lack well-trained security guards. How can doctors concentrate on treating patients when they are concerned about self-defence?,” asked Meshram.

Yashovardhan Kabra from KEM Hospital agreed with Meshram. “Medical education is a long and tiring process. Doctors are overwhelmed with work. Attacks on doctors only add to their pressure,” said Kabra.

Aniket Gaikwad from Sion Hospital said that most colleges didn’t have a Rapid Action Force. “The forces should be in place to ensure quick intervention in cases of attack,” said Gaikwad.

Another concern for the doctors is the poor implementation of the Doctors Protection Act. Offenders are booked under the Maharashtra Medicare Service Persons and Medicare Service Institutions (Prevention of Violence and Damage of Property) Act, 2010, commonly referred to as the Doctor’s Protection Act (DPA). “There have been 45 cases registered under the Act so far but none of the accused have been brought to book,” said Meshram.

Dhule doctor in ICU

The orthopaedic doctor who was assaulted by a mob in Dhule Civil Hospital was transferred to the intensive care unit of Jupiter Hospital in Thane Wednesday. According to doctors, Dr Rohan Mhamunkar has suffered an orbital fracture and an undisplaced fracture in the skull and may require a surgery. Mhamunkar had suffered several blows of rods wielded by a mob of over 20 people in the Dhule Civil Hospital on March 12, leading to multiple contusions. Dr Niharika Mehta, who checked Mhamunkar in Dhule, said in her report that his soft brain tissues were swollen in the right frontal region. A CT scan showed the sphenoid bone, situated in the middle of the skull, was also fractured.

“He was brought to the hospital late last night (Tuesday). Doctors have examined him and he continues to remain under observation in ICU,” said Dr Ajay Thakkar, CEO at Jupiter Hospital. Mhamunkar’s colleagues, however, said he was slated for a “craniotomy surgery”. The Dhule police had arrested nine persons in the case. They were all relatives of a 25-year-old accident victim who had been brought to the hospital but was referred to another hospital for want of a neurosurgeon.

 

Police say more offenders identified, arrests soon

The Dhule police Thursday claimed to have identified several people who vandalised the Dhule civil hospital and thrashed an orthopaedic doctor. Search for those identified is on and arrests are likely, officers said.

According to the Dhule police superintendent, the nine persons already arrested have been booked under various sections of the Indian Penal Code for attempt to murder and for assaulting a public servant, along with sections of the Maharashtra Medical Act. Chief minister Devendra Fadnavis has also instructed the police to take strict action in the case and propose ways of ensuring security of doctors.

Common Counselling At State Level Compulsory Now For UG And PG Courses

NEET 2017: For Medical Admission, Common Counselling At State Level Compulsory Now For UG And PG Courses

In a landmark decision, following the introduction of single medical entrance exam (NEET) in the country, the Ministry of Health and Family Welfare has now made provision for common counselling at the State level for admission to medical courses at the under graduate (UG) and post graduate (PG) levels. As per the amendments made in the relevant regulations of MCI, the designated authority at the State/UT level shall conduct common counselling for all medical education institutions in the State whether established by the Central Government, State Government, University, Deemed University, Trust, Society, Company, Minority Institutions or Corporation.

According to the ministry, the move would bring in transparency in the admission process and curb the practice of capitation fee charged by private colleges. Further, a statement from the ministry also said that the students would not have to apply to multiple agencies for admission in the same State.

After NEET UG 2016 was conducted by CBSE, the Ministry had issued an advisory on 9 August 2016 in consultation with States and other stakeholders to the States to preferably conduct combined counselling for admission to MBBS courses for session 2016-17. At the instance of the Ministry, UGC had also directed all Deemed Universities that they shall also be part of common counselling for admission in common courses organized either by State Government / Central Government or through its agencies based on the marks obtained in NEET.

The advisory for common counselling at the State level was repeated December 2016 for admission to PG courses for the session 2017-18. The advisories were issued since counselling was not covered under any regulations and the entire admission process had evolved as an administrative mechanism. But now with the amendment notifications in Graduate Medical Education Regulations, 1997 and the Post Graduate Medical Education Regulation, 2000, enabling legal provisions have been made for common counseling, said the ministry statement.

The counselling for All India Quota seats at under graduate and post graduate level will continue to be conducted by the Directorate General of Health Services, Ministry of Health and Family Welfare, the statement clarified.

Dhule resident doctor in ICU after patient’s family thrashes him

An orthopaedic senior resident doctor, Dr. Rohan Mamunkar​, was beaten black and blue after he asked family members of a patient to take him to another centre since there was no neurosurgeon on duty. The incident took place on Sunday night at the Goverment Medical College (GMC) in Dhule, Maharashtra when a patient was brought in with a head injury.

When the orthopaedic resident doctor informed the family members that he would have to be taken to another tertiary care centre, a mob of over 20 relatives attacked him. The CCTV footage shows them hitting the resident doc with rods, among other things.

The doctor has sustained injuries on his abdomen, chest and head. He has also suffered an injury to the orbital bone that is present in the socket of the eye. The doctor who is now admitted in the ICU, has suffered loss of vision in one eye.

The Maharashtra Association of Resident Doctors (MARD) has decided that they will protest by wearing black ribbons to work on Tuesday and also conduct candle light marches.

Dr Yashvardhan Kabra, president of the Maharashtra Association of Resident Doctors and third-year PG student at KEM Hospital, Mumbai, said, “As of now, Dhule doctors are going to go on a mass bunk. Central MARD will be protesting today by wearing black ribbons and organising a candle march. We will plan further action soon.”

Probe ordered into harass charge of PG medical students in Odisha

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The State Government on Thursday directed chiefs of three Government medical colleges and hospitals to inquire into allegations of harassment of post graduate (PG) students by head of departments and professors.

Additional Secretary of Health and Family Welfare Department Surajit Das has asked the Director of VIMSAR at Burla, Deans and Principals of SCB Medical College and Hospital at Cuttack and MKCG Medical College at Berhampur to take appropriate action against the erring officials.

‘’The medical college authorities have been directed to submit an action taken report within seven days and ensure that such incident does not occur in future,’’ Das said.

It was alleged that the heads of departments and professors are encouraging PG students for their own personal and domestic work, thereby neglecting treatment of patients and education of students which is essential for their on job training.

Five days back, the Director of Medical Education and Training (DMET) had shot off letters to authorities of the three medical institutions along with Director of Acharya Harihar Regional Cancer Centre and Superintendent of Sardar Vallabhbhai Patel Post Graduate Institute of Paediatrics at Cuttack.

In his letter, DMET PC Mohapatra stated that as per the allegations, PG students are forced to do personal works by their respective department heads. The works include shopping grocery, cooking, taking children to schools, teaching their children, bringing breakfast, lunch and dinner free of cost, arranging drinks, helping them in private practice, managing celebrations like marriages and birthday ceremonies.

Apart from personal work, the students are also forced to pay hospitality cost including hotel expenses, food, site seeing and gifts for examiners during exams. Students had alleged that the activities were more than ragging since they are harassed physically and mentally.

‘’Since such allegations are grievous, we would review and conduct surprise checking by a squad periodically if the authorities fail to take any action,’’ Mohapatra stated.

Protocol on heart attack

Health agency recommends nationwide adoption of hub-and-spoke network

India’s health research agency has recommended the nationwide adoption of a heart attack treatment protocol that doctors say is intended to benefit tens of thousands of patients across the country currently unable to access timely care.

The Indian Council of Medical Research (ICMR) has urged states with existing ambulance networks to implement the protocol that relies on a hub-and-spoke network of large and small hospitals and ambulances equipped to exchange electrocardiograph (ECG) readings via mobile devices.

Cardiologists who developed the so-called ST-elevation myocardial infarction (STEMI) protocol and tested it in Tamil Nadu over a period of 32 weeks have observed a sharp increase in the proportion of patients who receive appropriate care and a reduction in mortality. The ST-elevation refers to a signature change in ECG and is the commonest type of heart attack that occurs when a blocked artery obstructs blood flow to the heart.

“Timely, appropriate treatment reduces the risk of heart failure and helps patients return to normal productive lives – this has huge economic implications,” said Thomas Alexander, a senior cardiologist at the Kovai Medical Centre Hospital, Coimbatore, and director of the STEMI protocol project.

India has about 800 hospitals with cath labs, or facilities that can provide angiography and angioplasty services – the standard treatment for heart attacks – and an estimated two million patients who suffer heart attacks every year.

But most cath labs are located in cities and large towns and, medical studies have suggested that less than 10 per cent of patients in small towns and rural areas with ST-elevation heart attacks currently receive the ideal treatment in time.

The STEMI protocol, developed by Kovai and collaborating institutions, uses ambulances with trained paramedics, ECG monitors, and mobile devices to transmit patients’ ECG readings to hub hospitals where cardiologists will screen the ECG and guide ambulances to spoke centres. There, patients will receive drugs such as clot-dissolvers before they are moved to the nearest hub hospitals for angiography and angioplasty, if required.

“The shorter the time from onset of symptoms to treatment, the better is the outcome for patients,” said Ajit Mullasari, a senior cardiologist at the Madras Medical Mission, Chennai, and a member of the STEMI protocol study team. “The thrombolytic (clot-dissolving) therapy clears the blood clot in the artery and extends the window of time available for angioplasty, if required, which is used to treat the blockage itself,” Mullasari said.

While similar protocols may already be in place in some locations, senior ICMR officials say, standardised implementation across the country will increase the number of patients who receive timely treatment.

“States may need to tailor the protocol to suit their own needs, depending on where their cath labs are located and on their ambulance and road networks,” Meenakshi Sharma, a scientist in the ICMR’s division of non-communicable diseases.

The ICMR, which funded the development evaluation of the STEMI protocol, had called a meeting of health officials from 18 states in January to urge them to adopt the protocol. “States will need a strong ambulance network to be able to implement this,” Sharma said.

The Tamil Nadu study compared the outcomes of implementing the protocol for a period of 32 weeks on 2,420 patients with those of standard treatment received by 898 patients for a period of 12 weeks.

The cardiologists observed a nearly 10-fold increase (3.7 per cent to 33.5 per cent) in the proportion of patients transferred from spoke centres to hub hospitals, higher rates of coronary angiography (35 per cent to 60 per cent), and higher rates of primary angioplasty (46 per cent to 70 per cent).

At the end of a year, doctors observed three per cent lower mortality among patients who received the STEMI protocol compared to patients who received standard treatment.

The findings of the STEMI protocol study appear today in the Journal of the American Medical Association (JAMA) Cardiology.

“These results are impressive,” Amitava Banerjee, a preventive cardiologist at the Fair Institute of Health Informatics Reserarch, London, said in a commentary on the study published in the same issue of the journal. “Importantly, 48.4

per cent of patients were living below poverty level, showing that not only is this program feasible and deliverable in India, but also population coverage is possible across socio-economic boundaries.”

An analysis of the impact of the protocol also indicates economic gains. “For every rupee spent on establishing the STEMI network, there is a gain of four rupees through averted economic loss caused by long-term health consequences suffered by heart attack survivors who do not receive timely treatment,” Alexander said.

However, a senior cardiologist in India cautioned that the programme may be easier to implement in states with a strong healthcare network such as Tamil Nadu or Kerala than in states with weaker infrastructure.

“We’ll have to see how well this can be implemented in the northern states,” said Rajeev Gupta, a senior consultant in Jaipur who is trying to implement the protocol through a private hospital.

Cardiologists and ICMR officials also point out that the success of the protocol will also require states to pull down the financial barriers that prevent patients from accessing angioplasty. “Many states now have government-funded health insurance schemes which may help facilitate the easy implementation of the protocol,” Gupta said.

“This is a protocol conceived and designed by Indian cardiologists, a creative solution to address uniquely Indian challenges,” Brahmajee Nallomothu, professor of cardiovascular diseases at the University of Michigan, Ann Arbor, and co-author of the JAMA Cardiology study said. “This is something other low and middle income countries could learn from for themselves.”

AIIMS-Patna to be ready by Dec; health secy reviews project

AIIMS

Union health secretary CK Mishra (centre) is flanked by director Dr PK Singh (left) and medical superintendent Dr Umesh Bhadani (right) at AIIMS-Patna.

After three missed deadlines, the Centre has given agencies engaged in the construction of AIIMS-Patna an ultimatum to complete the project by December, this year.

Union health secretary CK Mishra asked construction firms to complete all work by December. He was here to review the progress of hospital construction on Wednesday. The project had to be completed by October 2012.

Mishra also passed explicit instructions to the superintending engineer to camp here, sort out issues with the agencies, and submit him a report within a week.

The construction firms — BL Kashyap & Sons Ltd., Nagarjuna Construction Company Ltd and the Ahluwalia Contracts (India) Ltd — had complained that their bills were pending in absence of a regular superintending engineer. The superintending engineer of AIIMS Jodhpur has been given additional charge of Patna after the previous incumbent left in October 2014.

“Our bills worth Rs 14-15 crore are pending with the AIIMS,” said PN Pandey of the BL Kashyap & Sons Ltd. The firm has to construct the 960-bed hospital and infrastructure, besides estate services, like internal roads, etc. It is this package, which has been inordinately delayed, as nearly 30-40% work still remains.

BL Kashyap & Sons was given the Rs 351-crore hospital package in October 2010, with a completion deadline of two years. However, the firm claimed that it got the project drawings and maps a year after it was handed the project.

The Nagarjuna construction firm has completed the construction of the medical college building and is now engaged in auditorium work. Ahluwalia Contracts is undertaking electrical work, even as basic hospital services have been initiated with 200-odd beds.

The AIIMS-Patna project has four packages, all of which are running behind schedule. Since December 2012, the deadline has been revised thrice – January 2014, December 2014 and now December 2017.

Disclosure of FMGE answer keys will affect doctors’ quality

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Answer keys to the qualifying test for allowing foreign medical graduates to practice in India cannot be disclosed as it would “dilute the standards” of healthcare, the CIC has held.

Information Commissioner Yashovardhan Azad gave this order on the plea of an RTI applicant R Seshadri who had sought from the Medical Council of India (MCI) the question papers along with the solutions, together commonly referred to as answer keys, for the Foreign Medical Graduates Examination (FMGE).

AIIMS nurse death: Doctor says Kaur was operated upon without anaesthesia

AIIMS nurse death: Doctor says Kaur was operated upon without anaesthesia

Shocking details emerged about the tragic death of the 28-year-old AIIMS staffer, Rajbir Kaur who died during childbirth at the institute, when a doctor who was part of the medical team revealed on Wednesday that the deceased was operated without anaesthesia.

“Despite refusal by Senior Resident doctor of Anaesthesia Department N Nisa to allow Kaur to be operated on the back table in the maternity Operation Theatre, it was the doctors from Gynaecology Department who shifted her to the back table for the caesarian section,” the doctor said on the condition of anonymity.

Kaur, who died on February 4 after caesarean delivery, had suffered a cardiac arrest during the surgery, leading to more complications. During treatment, she also lost her baby.

Doctors from the Gynaecology and Anaesthesia Departments committed a series of procedural lapses that led to the nursing officer’s death, said the doctor.

Doctors should use the front table for surgeries related to pregnancy as the back table in the maternity OT is meant for normal procedures such as examining patients with gynaecology-related difficulties.

The doctor said that after Kaur was shifted to the back table, the team of gynaecologists had told Manish, a Junior Resident doctor from Anaesthesia Department present on duty, that they will perform the caeserian section with local anaesthesia if he did not administer any anaesthetic.

The doctor said both depended on each other for administering anaesthetic to the patient, but none actually did.

“As the team started performing the surgery, Kaur jumped up due to extreme pain after the first incision. After that when Manish went to check on her, the team realised that the patient was not given anaesthesia,” the doctor said.

Later, Manish, during the caeserian section, gave Kaur an anaesthetic agent to calm her down.

The gynaecology team was led by Seema Singhal, a senior doctor and a faculty at the All India Institute of Medical Sciences.

Among other procedural lapses, the doctor said that the medical team had not secured an airway before starting the surgery, which led to difficulties in breathing for the patient.

“It was only N Nisa who later arrived and ensured the tracheal intubation. Had the team followed the instructions of N Nisa, things would have been under control,” the doctor said.

Tracheal intubation is the placement of a flexible plastic tube into the windpipe to maintain an open airway.

The medical team had also not prepared the patient well for the surgery due to which the patient witnessed pulmonary aspiration during the surgery.

“When the entire chaos was unfolding in the OT, the suction apparatus was not working either,” the doctor added.

Although, the nursing officer was revived and shifted to the ICU, she remained in coma for three weeks before being declared dead on February 4.

“The morbidity was due to a cardiac arrest, however, later her other organs also got damaged leading to her death,” the doctor said.

Later, a probe committee, constituted to investigate the alleged procedural lapses, had terminated N Nisa on February 21.

4000 medical PG seats added to streamline medical education: PM Narendra Modi

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Prime Minister Narendra Modi today said the government has streamlined the medical education field and created 4,000 new post-graduate seats in medical colleges which would resolve the problem of lack of doctors.

“In our country, in the field of health there has always been a complaint that we do not have enough doctors. This is because we do not have a robust system to produce doctors,” Modi told a gathering which included medical students at the Surat airport after his arrival.

“If we go to the base of the problem, less number of students can get admission into post-graduate (courses in medical field) due to lack of seats, so only few become professors,” he said.

“As there are less (number of) professors, it has become difficult to open new medical colleges. The entire system is entangled in these circles,” Modi said.

“But we have streamlined it. We have increased 4,000 post graduate seats in one year. This is a big step in the country,” he said.

“Every year 4,000 new post-graduate students (apart from the number of seats already existing) will pass out now who can also become professors. This means they can impart medical education to thousands of students across the country which will solve the issue of shortage of doctors,” he said.

“With this we are confident that medical services will be available at village level as well,” he said.

The Prime Minister also praised the work being done to make cities and villages free from open defecation.

“A big work is being done in the urban development field in the entire country. I would like to congratulate the Gujarat government for making the cities open defecation free,” he said.

“Now, in the entire country 500 cities have been declared open defecation free. These cities created infrastructure to make it possible,” he said, adding that in the villages also the programme is going on in full swing.

Modi is on a two-day visit to the state during which he will attend a number of events and meetings.

He will inaugurate a national convention of women sarpanch in Gandhinagar, address an industry meet of OPAL project of ONGC in Dahej and inaugurate a four-lane bridge over Narmada river in Bharuch.

The PM will also visit the Somnath temple and attend a meeting of the temple trust.

Govt adds over 4,000 PG seats in medical colleges

Medical seats

Centre has approved the addition of more than 4,000 seats in post-graduate courses in medical colleges this year to meet the rising demand for higher education in the healthcare sector.

The 4,193 seats approved on Thursday by the health ministry will come up in 71 government medical colleges across the country, taking the total number of post graduate seats available in the country to 35,117.

“It is an all-time record number of PG medical seats that have been approved by the government in various medical colleges and hospitals for the academic session 2017-18,” claimed a health ministry statement.

“This will further boost our resolve to strengthen tertiary care and improve medical education in the country,” health minister JP Nadda said.

The additions include in DNB seats, which are equivalent to MD/MS, which have been increased by 2,147 in the last one year.

At least 1,000 more seats are likely to be added this month, Nadda said, in reference to finance minister Arun Jaitley’s budget announcement to add 5,000 seats in PG medical courses.

“We are likely to achieve the target soon,” said Nadda, adding that several colleges have sent proposals to add more seats, and these are being studied.

Government approves record 4000 PG medical seats for 2017-18 session

The government has approved a record number of over 4,000 PG medical seats in various medical colleges and hospitals for the academic session 2017-18. Of the total, 2,046 seats will be added to medical colleges.

With this, the total number of available PG medical seats has increased to 35,117.

Looking at the need to increase PG seats in clinical subjects, the government had decided to amend the teacher-student ratio for these subjects in government medical colleges.

This change alone has resulted in the creation of 1,137 extra seats in 71 colleges.

Many other government colleges, out of the total of 212, are still in the process of sending their proposals and it is expected that at least 1000 more seats will be added during the month of March 2017.

Diplomate National Board (DNB) seats, which are equivalent to MD/MS, have increased by 2,147 in the last one year.

Thus, there has been a total addition of 4,193 PG seats in the country so far, and a further addition of more than 1000 seats is likely during March 2017.

Once that happens, the Budget announcement of adding 5,000 PG medical seats in the country is likely to be achieved soon.