Straight from the Heart: Government Policies Influenced by IMA so far

Straight from the Heart: Government Policies Influenced by IMA so far

Dr KK Aggarwal

National President

·         NABH has recognized IMA as facilitator for its pre-entry level NABH accreditation certification.

·         IMA has been able to halt the PM’s announcement to write drugs without brand names.

·         IMA has been able to halt the government move to allow pharmacist to substitute drugs.

·         IMA has opposed online pharmacies.

·         IMA has been able to halt the MTP Bill allowing AYUSH doctors to perform MTPs.

·         IMA has been able to halt, so far, the government’s alleged efforts in allowing technicians to run diagnostic labs and sign the reports.

·         IMA drug policy of ‘one drug- one company-one price’ has been accepted by government in principle.

·         IMA persuaded the government to raise the age of retirement to 65 years for EHS doctors and later extend it to other categories of doctors.

·         Kerala state has included ‘Noise & Health’ as a chapter in the 8th standard syllabus on the initiative of IMA NISS.

·         Delhi can now avail free MRI, CT scan, PET scan tests at 21 private laboratories. The residents are required to show referral letter from the selected 30 government hospitals or 23 state run polyclinics to avail the free service.

·         IMA, has time and again demanded to disperse fund for treatment of trauma victims during the golden hour rather than giving compensation after 5 or 6 years. IMA also suggested ways and means of mobilization of the fund for this purpose, besides asking the insurance companies to make the payment. One suggestion for fund mobilization was as follows: CSR funds should be made to pool to a central corpus fund and not be allowed to get fragmented by giving responsibility to the companies itself. For example, Govt. may plan a corpus for trauma care and companies may be asked to contribute half of their CSR contributions to the same. The Road Transport and Safety Bill 2015 and Road Traffic Accident Act 2016 were passed in the Parliament, 2017.  The following clause in the Road Transport and Safety Bill 2015 is a great victory to IMA’s demand on trauma care.

THE ROAD TRANSPORT AND SAFETY BILL, 2015:  Scheme for Golden Hour ‘141. (1) Notwithstanding anything contained in the General Insurance Companies (Nationalisation) Act, 1972 or any other law for the time being in force or any instrument having the force of law, the insurance companies for the time being carrying on general insurance business in India shall provide in accordance with the provisions of this Act and the scheme made under sub-section (2), for treatment of road crash victims during the Golden Hour”. “(2) The Central Government shall make a scheme for the cashless treatment of victims of the road crash during the Golden Hour and such scheme may contain provisions for creation of a fund for such treatment. Refund in certain cases of compensation paid under section140”. 

·         May 06, 2017: Allahabad: Concerned over the acute shortage of doctors, the state government has decided to rope in private doctors, including specialists, to treat patients at government-run district hospitals as well as community and primary health centres across Uttar Pradesh. Select states like Karnataka have in the past managed to introduce such a system effectively.  “Indian Medical Association will act as our facilitators for the initiative and it would be in coordination with its office-bearers that we plan to work out a duty roster for these doctors who volunteer for the task,”

·         Jaipur: Facing acute shortage of specialists, the state health department has selected 273 MBBS doctors for second batch of one-year certificate course of specialization in 10 different specialties: orthopedics, emergency medicine, ENT, obstetrics & gynecology, pediatrics, pathology, radio diagnosis, anesthesia, ophthalmology and general surgery. The first batch of 233 MBBS doctors have already completed their certificate course of specialization and got postings in trauma centers, maternal and child care units, community health centers and district hospitals as specialist doctors. Existing government medical colleges offered the courses.  MBBS doctors with certificate courses have signed a bond of Rs. 25 lakh. (MBBS doctors can practice as specialists)

·         E-mail received from Principal Secretary for Health & F.W. Dept: Govt. of Karnataka has strongly suggested that if IMA Karnataka can give the list of Doctors, who are willing to work in PHC’s then AYUSH doctors shall not be appointed in these PHCs

·         Medical Wellness Board meeting: Focus on domestic medical tourism and IMA recognized centres where patients can undergo treatment at fixed charges including complications, would be set up.

·         Both President India and Prime Minister of India condemned violence against doctors

·         Government of Gujarat announced new health policy 2016 inviting involvement of private sector in health care

·         Bombay High Court 77 of 2015: Adequate security at hospitals, not more than two attendants of a patient will be allowed to enter the hospital through the main gate.

·         IMA has been able to implement introduction of stents and ortho devices in NLEM

·         IMA has been able to get a white paper made on Indian Medical Services with MCI

·         IMA has been able to get IMA- WHO workshop on AMR and making of an IMA AMR policy

·         IMA has been able to pursue the Dept. of Pharmacovigilance Programme of India (PvPi) to make IMA as nodal centre of IMA pharmacovigilance department.

·         IMA was able to pursue Delhi Government in closing the schools during pollution epidemic

·         IMA was able to get Delhi High Court to take up the matter regarding Delhi pollution and organization of Delhi Marathon.

·         IMA challenged the WHO and Lancet report on pollution causing premature deaths.

·         Delhi High Court suo moto involved IMA on the issue of violence against doctors.

·         IMA made NCERT change its chapter on health service where they had made derogatory writings on private health care.

·         IMA was able to influence timely release of payments for oxygen after the Gorakhpur tragedy.

·         IMA was able to have CGHS release part payments due to various CGHS empanelled hospitals.

·         IMA was able to get a clarification from IRDA that post breast cancer mastectomy is not a plastic surgery and that Crohn’s disease is not an autoimmune disorder.

·         IMA was being able to halt the start of NEXT so far.

·         IMA was able to halt the conversion of MCI to non-democratic NMC.

·         IMA was able to get the MCI revert to its earlier decision of age bar for NEET exam.

·         IMA was able to pursue MCI for making a centralizing number of IMR.

·         IMA was able to reinitiate Dr BC Roy National Awards.

·         Under the new health policy, the health budget will increase from 1% to 2.5% of GDP

·         IMA was able to get health care services out of GST.

·         NACO started test and treat HIV policy.

·         IMA GTN Policy: GeneXpert in every TB case, trace all contacts and notify all TBG patients

·         IMA was able to introduce Depen and Pentids after their shortage in the market.

·         IMA was able to roll back the suspension of AIIMS residents after a strike following the death of a nursing student at AIIMS.

·         ICMR has set up a registry of rare diseases. A disease is defined as rare when it affects less than one in 2,500 individuals. Over 70mn Indians suffer from such disorders and live with them throughout their lives. There are only 500 FDA-approved drugs for over 7,000 rare diseases globally. The health ministry is currently discussing a draft policy for treatment of rare diseases.  This is what I spoke in my Presidential address.

·         In my presidential address at central council meet, I had said, “We also want the Ministry of Health to declare an Epidemic or Disaster Fund aimed at providing free services to all affected. The government announces ex-gratia grant to the families in case of any flood, fire, or train mishap; the same should be announced for any death during the epidemic or for any calamity in the family.” Now NCDRC has held that a malaria death caused by mosquito bite is an accident, and directed the insurer to honor its policy to a widow. (The same will be applicable to dengue deaths also). The commission also cited Black's Law dictionary that describes an accident as "an unanticipated and untoward event that causes harm". 

Pradhan Mantri Suraksha Bima Yojana covers accidental death and disability cover of Rs 2 lakh at a premium of Rs 12 per year.  The benefit of accidental insurance cover of Rs 1 lakh is also extended to all with accounts under the Pradhan Mantri Jan Dhan Yojana (PMJDY) launched on August 28, 2014 by Prime Minister Narendra Modi. The premium for the insurance cover is borne by the National Payments Corp of India.

·         Death due to negligence is an accident: NCDRC, LIC vs Shri Narender Singh on 2 July, 2012: Revision Petition No.  2056 of 2012: Justice J. M. Malik: The word accident is derived from the Latin verb “accidere” signifying fall upon, befall, happen, chance, in its most commonly accepted meaning. According to Webster’s dictionary, accident means (1) an unfortunate incident that happens in unexpectedly and unintentionally, typically resulting in damage or injury (2) A crash involving road or other vehicles, typically one that causes serious damage or injury. According to free online dictionary, accident means an unexpected and undesirable event, especially one resulting in damage or harm car accidents on icy roads. According to business dictionary, accident means in general, an unplanned, unexpected, and undesigned (not purposely caused) event which occurs suddenly and causes (1) injury or…

According to Oxford dictionary, accident means a thing that happens, an event, an event that is without apparent cause or unexpected; an unfortunate event, esp. one causing injury or damage, Chance, fortune, an unfavourable symptom, a casual appearance or effect, an irregularity in the landscape.

Admittedly, the life assured died during an operation by the treating doctors for the treatment of her tubes. Thus, the injury to the life assured was an accident caused by outward, violent and visible means and therefore, the Life Insurance Corporation of India cannot be absolved from its liability to pay the accidental benefits to the complainant.

Last but not the least, some distinction has to be drawn between the accidental death and natural or normal death. Learned counsel for the petitioner did not pick up the conflict with para 7 of the complaint noted above. The absence of anaesthetist before the operation puts the case of the complainant in an impregnable position. Without calling the anaesthetist the above said two doctors should not have treated the patient at all. This itself speaks deficiency in service on the part of the doctors as well as negligence and rashness. The revision petition is lame of strength and therefore, the same is dismissed.

·         IMA was able to get the Inter-Ministerial meeting recommendations finalized.

·         IMA was able to change the perception that mobile towers are linked to cancer.

·         Dr RK Gupta IMA Member form Bilaspur CG State got relief by High Court. He was accused of 13 deaths in the female Sterilization camp organised by Chhattisgarh health department in year 2014.  He was arrested during initial phase as accused. IMA CG State helped him in legal battle. The high court pointed out substandard drugs (spurious drugs) used during the operative course as cause of deaths and not the operative procedure.

·         IMA met the West Bengal Chief Minister and was able to have her order to get all medical negligence cases to WB State Medical council first and to have a redressal mechanism within the hospital first.

·         IMA Karnataka was able to pursue the government in modifying the Karnataka CEA.

·         IMA was able to get all the PCR van police personal get trained in CPR in Delhi.

·         Now under-five child deaths in India will be examined through minimally invasive autopsies to ascertain the exact cause of death, which will benefit in districts like Gorakhpur where child deaths are high. The under-five mortality rate in India stands at 50 per 1000 live births. The pilot project that will begin in January, 2018, at New Delhi’s Safdarjung hospital, is a part of the global CHAMPS— Child Health and Mortality Prevention Surveillance, project, wherein tissue biopsies of the brain, liver, spleen and other tissues are taken in a minimally invasive way.

Smartphones can cause depression and other health hazards

Smartphones can cause depression and other health hazards

The blue light emitted from screens can affect a person’s sleep cycle

New Delhi, 05 December 2017: Prolonged use of smartphones may significantly increase the risk of depression, anxiety and insomnia among teenagers, as per recent findings. The findings indicate that there may be an imbalance in the brain chemistry of young people addicted to devices and the internet.[1] The motivation for going online is an important factor in relating technology usage to depression and anxiety.

While people are concerned about cancer, which remains a controversial issue, there are other future health problems caused by use of smart phones. Prolonged use of mobile phone can also cause neck pain, dry eyes, computer vision syndrome, and insomnia. About 60% of youth between 20 and 30 years of age fear losing their mobile phone, a condition called nomophobia.

Speaking about this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, "Prolonged use of smartphones can cause multiple health issues, not just depression and anxiety. Smartphones and tablets give off a blue light, which can affect a person’s sleep-wake cycle. This blue light reduces the amount of melatonin secreted in our brains, which is a hormone required for good sleep. People who use smartphones in bed have a delayed REM sleep and wake up less alert in the morning. Cell phone elbow happens when one talks on the phone a lot. Holding the phone up to the ear causes the ulnar nerve to get compressed over time, which can lead to problems with motility and sensation. These are just some of the issues. Behaviors can be as addictive as substances, and many of us have the tendency to pull out and check our phones much more often than is necessary.”

Having access to so many different streams of information through gadgets has been found to decrease the brain’s grey matter density, which is responsible for cognition and emotional control.

Adding further, Dr Aggarwal, said, “In this digital era, the key to good health should be moderation – moderate use of technology. A lot of us have become slaves to devices that were really meant to free us and give us more time to experience life and be with people. Unless precautionary measures are taken at the earliest, this addiction can prove detrimental to one’s health in the longer term.” 

Some tips for preventing problems caused due to overuse of mobile phones are as follows.

·         Electronic curfew means not using any electronic gadgets 30 minutes before sleep.

·         Facebook holiday: Take a Facebook holiday for 7 days every three months.

·         Social media fast: Avoid use of social media once in a week for the entire day.

·         Use your mobile phone only when mobile.

·         Do not use computer for more than three hours in a day.

·         Limit your mobile talk time to more than two hours in a day.

·         Do not recharge your mobile battery more than once in a day.

Mobile can also be a source of infection in the hospital setup; therefore, it is disinfected every day.

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[1] Research conducted at Korea University

Straight from the Heart: Ethics, trademarks and tie ups

Straight from the Heart: Ethics, trademarks and tie ups

IMA has done the following in the field of ethics, trademarks and tie ups.

Trade Marks

·         IMA now has a Registered Copyright for ‘Doctor Emblem’ for MBBS doctors (No 12769/2017-CO/A).

·         IMA now has a Registered Trademark for ‘IMA’ Name in Class 44 (Number 3329977)

·         IMA got Registered Trade Mark for IMA Logo in Class 35 (Number 3329979)

·         IMA got Registered Copyright for IMA Logo (No 12770/2017-CO/A)

·         IMA has got ISO Certification (ISO 9001:2015 QMS J1701311)

·         IMA has standardised IMA e-Flag and IMA Flag (at head-quarters premises)

·         IMA Anthem: https://www.youtube.com/watch?v=02XYcITzwiU&feature=youtu.be

·         https://youtu.be/n7t7pMaxb0Q

·         IMA is now ISO 9001 2015 certified organisation

Ethics

·         IMA has standardized new updated “IMA Prayer”.

·         IMA has also participated in updation of “WMA Declaration of Geneva”

·         IMA has standardized IMA Code of Ethics

·         IMA has also signed agreements with ‘IMA AHPI Code of conduct’ and ‘IMA NATHEALTH Code of Conduct.

·         IMA has established National and State UNESCO Chairs on Bioethics.

·         IMA CME policy mandates a slide on bioethics, pharmacovigilance, AMR and pharmacovigilance

·         IMA has certified IMA clinic, IMA professors and IMA credit hours

·         IMA has come out with MCI guidelines for deciding medical negligence under section 8.6 of code of ethics.

·         e-Varsity will be a part of IMA HQs.

·         IMA constitution with resolutions have been updated.

·         IMA No Incentive policy launched in Tamil Nadu, West Bengal.

·         IMA has zero tolerance for cuts, commission, unethical acts, those indulging in child sexual abuse and female foeticide.

·         IMA also has zero tolerance against IMA members who indulge in mud-slinging against each other, against the association or the medical profession in public. 

Investments

·         IMA has finalized IMA Insurance website and IMA SBI credit card

·         IMA has signed an agreement with Ms Anthrix for property investments

IMA Prayer.

IMA has also finalized IMA Prayer.

“May everybody be happy

May everybody be healthy

May everybody be free from pain

May everybody be free from sorrow

May we be the healing cure

Beyond every greed & lure” 

People with Darier’s disease can go into depression

People with Darier’s disease can go into depression

It is a rare disorder, inherited in an autosomal dominant pattern

New Delhi, 04 December 2017: Recently, a case of Darier’s disease was reported from a city in North India. So far, about 15 cases have occurred in India, with this being the first in Uttar Pradesh. The disease is so rare that it affects only one out of one lakh people. Although the disease does not kill, it can be potentially debilitating for the person in question and put them on lifelong precautionary treatment.

Darier disease is a skin condition characterized by wart-like blemishes on the body. The blemishes are usually yellowish in color, hard to the touch, mildly greasy, and can emit a strong odor. The most common sites for blemishes are the scalp, forehead, upper arms, chest, back, knees, elbows, and behind the ear. The mucous membranes can also be affected, with blemishes on the roof of the mouth (palate), tongue, inside of the cheek, gums, and throat.

Speaking about this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, "The wart-like blemishes in this disease usually appear in late childhood to early adulthood. Without precautionary measures, it can become more severe over time with the affected people experiencing flare-ups alternating with periods when they have fewer blemishes. The appearance of the blemishes is influenced by environmental factors such as heat and humidity; UV light; minor injury or friction; and ingestion of certain medications. At times, people with Darier disease may have neurological disorders; and issues with learning and behavior as well. This condition is inherited in an autosomal dominant pattern, which means one copy of the altered gene in each cell is sufficient to cause the disorder.”

Itching is very common in those with this condition.  The affected skin may smell unpleasant, particularly in moist areas. This is probably caused by increased numbers of ordinary skin bacteria growing in the affected skin.

Adding further, Dr Aggarwal, said, “The diagnosis of Darier’s disease can often be made on the appearance of the rash and the fact that it runs in families.  To confirm it, a small sample of skin (a biopsy) can be removed under a local anesthetic and examined under the microscope in the laboratory. Genetic testing to identify a mutation in the ATP2A2 gene can be used to confirm the diagnosis as well.”

Some precautions to be taken for those with this disease include the following.

• Avoid stress, excessive humidity, heat and tight clothes and use moisturizers, sun block and wear the right type of clothes which absorb sweat and keep the body cool.
• For localized lesions, dermabrasion can be done. Topical retinoids are also prescribed and are beneficial.
• If the patient has secondary bacterial infection, then antibiotics are prescribed. Antiviral medications are prescribed if the patient has herpes simplex.
• For severe symptoms, oral retinoids  can be prescribed, but these medications have serious side effects and need to be used with caution. Topical or oral antibiotics can be prescribed during flare ups.
• Using sunscreen and taking vitamin C tablets helps in preventing flare ups in some patients.

Patients should also maintain good hygiene to prevent flare ups. 

Straight from the Heart: IMA Issues

Straight from the Heart: IMA Issues 

An Inter-Ministerial (Health, Consumer, Law and Home) committee was formed at the insistence of IMA; practically met every month during the last one year to take IMA issues forward. MOH recommendations for various issues of IMA so far are as follows:

Clinical Establishment Act

·         To take the police out of appropriate CEA authorities

·         To exempt entry level NABH Accreditations Centre from CEA registration formalities

·         To facilitate single window registration of medical establishments

·         To redefine the word to stabilize in the CEA Act means to “to provide first aid/ basic life support”

·         Standard treatment guidelines are advisory in nature

·         Establishment charges only in consultation with state and IMA

PCPNDT ACT

·         To take penal provisions out for clerical errors in PCPNDT Act. The matter is in the Supreme Court.

Violence against doctors

·         MoH also released series of advertisements in National dailies on the subject of violence against doctors

·         MOH wrote to all the Chief Secretaries of States regarding enacting and /or implementing Laws against violence on doctors

·         MOH wrote to the Law Ministry for initiation of Central Law against violence

Capping of compensation

·         MOH wrote to Consumer ministry regarding amendment in CPA to modify the compensation clause

Crosspathy

·         MoH has given in writing that doctors of non-modern system of medicine cannot prescribe modern drugs. IMA won the crosspathy case in Delhi High Court. The matter is in Supreme Court. ​

NMC and NEXT

·         One of the main Agenda of IMA was “Say No to NMC” and IMA could convenience the Govt. to bring proposed NMC in its present state which is 60:40 ratio of Nominated Vs. Elected Body, out of 29 (25) members – 9 will be elected, 5 Selected and out of 15 nominated, 10 will be medical doctors.

Urgent need to clear misconceptions and taboo about organ donation

Urgent need to clear misconceptions and taboo about organ donation

Number of organ donors is abysmally low in India

New Delhi, 03 December 2017: According to statistics, every single person can save up to 7 lives by donating organs. Apart from this, at any given point, there are about 8 to 10 potential donors in the ICUs of any major city. Despite this, the number of organ donors in India is abysmally low at about 0.34 persons per million of population. As per the IMA, these statistics indicate the urgent need for people to step in and start donating their organs.

Organ donation is the process of Retrieving or Procuring an organ from a live or deceased person known as a donor. The process of recovering organs is called harvesting. This organ is transplanted into the recipient who needs that organ. There are two types of organ donation: Live Donation and Deceased or Cadaver Donation.

Speaking about this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, “Organ donation is still an unsolved problem in our country. However, there has been a recent amendment to the Organ Transplant Act 2014, according to which it is now compulsory for every doctor to follow mandatory required request for organ donation. Live Donation is from a healthy and living person. This can only be done in the case of a liver or a kidney. When we talk about pledging one’s organs or about organ donation, we talk about deceased organ donation or cadaver organ donation. This is organ donation from a person who has been declared brain dead by a team of authorized doctors at a hospital. A person is said to be brain dead when there is an irreversible loss of consciousness, absence of brain stem reflexes and no spontaneous respiration. Organ donation can even provide someone with a second chance at life. For many, this process is a way to go back to a normal lifestyle, ability to see, freedom from pain, or even the ability to become mobile again.”

The absence of brain stem function is documented by conducting the following five tests: absence of Pupillary reflex response to light; absence of Corneal reflexes; absence of vestibulo-ocular reflex; absence of cranial nerve response to pain; and absence of gag and cough reflexes.

Adding further, Dr Aggarwal, said, “We need to communicate to people that they can live even after death through organ donation. There is also a need to remove myths and misconceptions about organ donation and spread the message around. As per IMA’s policies, 100% IMA members should pledge their organs / tissues after cardiac or brain death.”

Here are some myths about organ donation, demystified.

·         Age is not a barrier for organ donation. Even people above the age of 80 have become organ and tissue donors.

·         There is no requirement to be in perfect health for donation. Even those who smoke, drink or don’t have a healthy diet can donate.

·         Organ and tissue donation do not disfigure the body in any way.

In case of an accident, the doctor will always try to save the life of the victim first. Organ donation is considered as an option only when the person dies due to certain circumstances.