Sunday, 21 December 2014

Not reporting TB a violation of MCI ethics regulation 7.14

 Wide letter number Z-28015/2/2012-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 irregular/incomplete 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 i.e. 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 and/or individual practitioners.

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

A copy of this circular was sent to all Principal Secretaries / Secretaries of Health of States / UTs With the request to kindly immediately; All Directors            of Health Services of bring  this  order  to  the  notice  of  all States / UTs                concerned   for          compliance,        in  their respective State / UT; All State TB Officers of States / UTs; PS to Union Minister HFW / Union Minister of HRD & CIT / MOS (HFW); PPS  to  Union  Secretary  HFW  /  DGHS  /  Union  Secretary  AYUSH/ Union Secretary HR (DG-ICMR) / union Secretary — NACO / DG-NIC; All Addl. Secretaries & Joint Secretaries in MOHFW / GOI All Dy. Director General / DteGHS / MOHFW / GOI; Director (Media) MOHFW / Got; All  Regional Directors (HFW/GOI) — with request to facilitate wide dissemination of this Govt. Order, for compliance,  in respective states / UTs; Websites of MOHFW/GOI ( and Central TB           Division (; DDG (NIC) & Sr. Technical Director (NIC) / MOHFW / GOI.
The above circular was not sent to Medical Council of India for reasons only known to them. Not reporting a notifiable disease is a violation of Indian Medical Council (Professional conduct, Etiquette and Ethics) Regulations, 2002 under regulation 7.14 : "The registered medical practitioner shall not disclose the secrets of a patient that have been learnt in the exercise of his / her profession except –

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 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.

In most of the municipal corporation acts for example DMC Act ( Delhi) TB is defined as a dangerous disease under 2 (9) "dangerous disease" means— (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.

[The author Dr K K Aggarwal is Senior National Vice President Indian Medical Association and President Heart Care Foundation of India]


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