Deepika Padukone Launches Nationwide Mental Health Program

Deepika Padukone Launches Nationwide Mental Health Program The setting-Kamal Mahal, Maurya Hotel Delhi, an epitome of luxury. The occasion- the launch of the first Mental Health Campaign in India by Deepika Padukone's NGO The Live Love Laugh Foundation. There is an air of subdued excitement as invited guests and members of the press walk in and mingle over a cup of tea. The buzz and hush is very palpable as all eyes keep looking at the door just waiting for the founder of Live Love Laugh foundation, Deepika Padukone to walk in. One might ask- what relation does depression have with this beautiful, ethereal, stunning, talented and famous goddess of the Bollywood industry? She has everything- beauty, money, fame - what more does she want? This is just a fad of the rich and famous most would say. And that's where they are wrong in their perception of depression. It is thought of as being all in the mind, a by-product of our emotions and stress and possibly a weakness and not as something that is a disease like an authentic diabetes or a heart attack. The numbers are staggering and the resources scarce. And hence the need for an initiative like the Live Love Laugh Foundation founded by Deepika . To educate, empower and prevent , to remove the stigma associated with the word depression and to bring mental health to the fore as a disease entity which can strike anyone, anytime and needs to be treated like any other chronic non communicable disease. While explaining how important it is to take the step of talking to the one suffering from depression, Deepika launched a social campaign through her Live Love Laugh foundation, #DOBARAPOOCHO. “In the times we are living today, we have become so competitive, which is a good thing, but we have become extremely insensitive too. Through this campaign, I dedicate this to people who have survived depression, people suffering through it even now and urge the society to become more sensitive.” According to Indian Medical Association President-Elect Dr K K Aggarwal, "The government estimates that 6-7 per cent of the country's population lives with major to minor mental health concerns. But we have only 6,500 trained psychiatrists and even fewer psychologists. What is worse is that the stigma and discrimination faced by these people and their families prevent them from seeking guidance." Rajya Sabha has already passed the Mental Health Care Bill 2013 which once cleared by the Lok Sabha would replace the Mental Health Act, 1987. The first ever National Mental Health Policy was launched on October 10, 2014 which seeks to provide universal psychiatric care to the population, 20 per cent of which is likely to suffer some form of mental illness by 2020. The campaign has been jointly launched by the IMA, the Indian Psychiatric Society and Bollywood actress Deepika Padukone's Bengaluru-based Live Love Laugh Foundation (TLLLF). IMA, IPS & TLLLF will be conducting CME Programs across the country to train General Practitioners on Mental Health. Dr Veena Aggarwal Executive Editor eMedinews and IJCP Group

“Dobara Poocho” says TLLLF, urging Indians to reach out to those with mental health challenges

“Dobara Poocho” says TLLLF, urging Indians to reach out to those with mental health challenges - India’s First Nationwide Public Awareness Campaign on Mental Health Launched on World Mental Health Day New Delhi, October 10, 2016: The Live Love Laugh Foundation (TLLLF) today unveiled the country’s first nationwide public awareness campaign on mental health aiming to bring conversations around mental health into the mainstream, and inspire people to reach out to those who could be suffering from mental disorders. The campaign has been designed by McCann Worldgroup and uses the tag-line Dobara Poocho (Ask Again). It was launched as part of World Mental Health Day celebrations in the nation’s capital, in the presence of Smt. Anupriya Patel, Minister of State for Health and Family Welfare, Government of India. Dobara Poocho will run across television, print, digital and radio and comes even as India prepares to cope with the severe economic and societal burden brought on by the epidemic of mental illness in the country. WHO (World Health Organization) estimates that 10% of India’s population suffers from mental health disorders; 80% of those affected are depressed and / or suffering from anxiety, while the remaining 20% battle with severe mental health issues such psychosis, bipolar disorder, schizophrenia etc. In 2013, India lost 31 million years of healthy life due to mental illness of its citizens according to Lancet. By 2025, it is estimated that 38.1 million years of healthy life in India will be lost (23% increase in 12 years). Lancet data also shows that India accounts for a massive 15% of the global mental, neurological and substance-use disorder burden with depressive disorders and anxiety disorders being the most common. According to a 2014 report by the World Economic Forum and Harvard School of Public Health, mental health was expected to cause a loss of US$1.03 trillion in economic output in the country between 2012 and 2030. “Those facing mental health challenges need love and support. TLLLF’s sincere hope is that Dobara Poocho will inspire all of us to become a little more sensitive to the people around us, look out for those who might have mental health issues and guide them to take the right action on the road to good mental health. We believe the campaign will be an important marker in the long and challenging journey to build more awareness and address the social stigma around mental health,” said Deepika Padukone, Founder, TLLLF. “Not only is it imperative to be aware of depression and other mental disorders, it is also important to spread awareness and sensitise society that all individuals who have some form of mental illness have the right and should be provided the resources to deal with these challenges. Caring and supporting such a person through the journey is the need of the hour; we need to build a nation that promotes social inclusion across every dimension” noted Anna Chandy, Chair of TLLLF’s Board of Trustees. Elaborating on the campaign concept, Prasoon Joshi, Chairman Asia Pacific, CEO & Chief Creative Officer India, McCann Worldgroup, said “Questions like “How are you”?, “How was your day?”, “What’s up?,” are asked as a form of greeting. Very often they are empty tokens of communication – asked and then immediately forgotten. Wedo not wait for an open, heartfelt response and we’d be taken aback if the person actually responded honestly on her or his state of mind at that moment! The truth is that behind that mask, one out of every ten Indians are afflicted with depression and anxiety. Dobara Poocho was born out of this very need to look at someone again, to observe that someone closely again, to be aware of his or her nuances again, to hold the person close again, to ask again.” The campaign film for Dobara Poocho has been shot by Nirvana and features simple stories of regular people courageously facing and fighting depression. It is a testament to the strength and courage of the human spirit. The print campaign showcases real people who have gone through or are going through depression, and fought the illness to become stronger and whole. The Dobara Poocho launch in New Delhi was preceded by a panel discussion featuring an eclectic mix of speakers including Dr. Sadhana Bhagwat - National Professional Officer, Non-Communicable Diseases, WHO-India; Dr. KK Agarwal – National President Elect, Indian Medical Association; Dr. G Prasad Rao - President, Indian Psychiatric Society and Dr. Vikram Patel - Founder and Member of the Management Committee, Sangath. The discussion was moderated by Dr. Shyam Bhat, Trustee of TLLLF. Jio is the Campaign Partner for Dobara Poocho. Other partners include DNA Networks (Event Partner), ITC (Hospitality Partner), Tissot (Initiative Partner) and Vistara (Airline Partner). Background: Mental Health in India has assumed crisis propositions and is being viewed as India’s next biggest health and societal crisis. It is estimated that ~ 15% of the country’s population lives with major to minor mental health concerns. That’s more than 100 million Indians, with the number increasing every year. Despite the large number of people who require mental health attention, India has only ~ 6,500 trained psychiatrists and ~ 22,000- 25,000 mental health workers including social workers, psychologists and counsellors. What’s worse is that stigma and discrimination faced by those suffering and their family members prevent them from seeking guidance. Only about one in 10 people with mental health disorders are thought to receive evidence-based treatment. The Live Love Laugh Foundation (TLLLF) was set up in 2015 as a Charitable Trust to champion the cause of mental health in India and focus on depression in particular. The main aim of TLLLF is to reduce social stigma and create awareness around mental health. TLLLF has spread awareness on mental health via its English / Hindi website (www.thelivelovelaughfoundation.org / www.thelivelovelaughfoundation.org/hi), through extensive engagement on social media, outreach to various print, TV, radio and digital media outlets, and by undertaking several on-ground activities such as mental health awareness programs for school students and teachers which has been already conducted in 27 schools, reaching 4804 students and 1332 teachers around the country. TLLLF has also commenced a sensitization program on mental health for doctors in collaboration with the Indian Medical Association (IMA) as well as the Indian Psychiatric Society (IPS) reaching more than 2,000 doctors so far, with a target of an additional 5,000 doctors during 20016-17. The launch of Doobara Poocho is an important complement to TLLLF’s activities.

The Allopathic Modern Medicine Ramayana

The Allopathic Ramayana

Dr KK Aggarwal Navratras to Diwali is the season of revisiting the messages from Ramayana, the largest epic of our country once classified as one of the Puranas. One can understand the story of Ramayana as the story of mind, body and soul and the story of causation and prevention of a disease. In the mind, body, soul concept, the soul is represented as Rama and the physical body as Sita. Body is made up of five elements with earth being the predominant. Sita was the daughter of earth (prithvi). Soul and body can only unite in presence of a determined mind holding them together. Determination means “aim” and in Hindi it is called “lakshya”. The mind with a defined aim, therefore, represents “Lakshmana”. Rama, Lakshmana and Sita, therefore, represent the union of mind, body and soul. The three will stay together as long as one has his or her ten 10 senses (five motor and five sensory) under control. Senses are Chanchal like horses. Chariot of two horses is called Rath and chariot of ten (das) horses is called “Dasharatha”. Therefore, mind, body and soul will be together with the resultant health only if the body is ruled by “Dasharatha” by controlling all the ten senses. The next part of Ramayana talks about the causation of disease and worries. The causative factors are “kama, lobha and ahankaara”. In Ramayana kama is depicted by Kaikeyi, lobha by Mareech and ahankaara by Ravana. If any one of them was not there Ramayana would not have happened. The sum total of the three is responsible for any disease or miseries in life. When Kama (Kaikeyi) predominate senses (Dasharatha) has to die. When moha (Mareech) dominates the mind (Lakshman) gets diverted and when Ahankar (Ravana) takes over, it controls the body (Sita) and makes the mind (Lakshman) and soul (Rama) wander. The next part of Ramayana is how to win over ego or Ravana. The first step is to win over the mind by controlling the prana Vayu component of the body by indulging in Pranayama. In the context of Ramayana, this means winning over Hanumana, the son of Vayu. Once he is controlled, all the thoughts representing as the Vanar Sena (Chanchal natures) are controlled. The next step is to control the intellect (King Sugriva). He can only be influenced by killing lust (Bali), who is living with Sugriv’s wife. Lust cannot be killed from front and has to be killed from behind and that is what Rama does to Bali. Killing of the lust from behind is depicted as Pratyahara in Yoga and means living a disciplined satvik lifestyle. The next step is to follow “one point contemplation” or living in the present. In Ramayana context it represents one point determination or “the war over Lanka”. Once that happens firstly the tamas (Kumbhkaran), than the rajas (Meghnad) and finally the ego (Ravana) dies. Both tamas and ego die automatically by the consciousness (Rama) but to kill the rajas, one has to conquer it with the mind (Lakshmana). Once this happens, the Satwa or Vibhishana takes over and the mind, body and soul are reunited leading to inner happiness again. Lastly, when Rama, Lakshman and Sita go back to their journey of life, back to Ayodhya, Hanuman goes with them as in Ayodhya, Dasharatha is no more. If you cannot control your 10 senses by yourself, you need to continue Pranayama or carry Hanuman with you for life. These the spiritual messages from Ramayana.

Heart Care Foundation of India to create health awareness this festive season through its annual flagship event – the MTNL Perfect Health Mela

Heart Care Foundation of India to create health awareness this festive season through its annual flagship event – the MTNL Perfect Health Mela Delhites will get their health dose the fun way by participating in various cultural events and health activities, which will be hosted during the five-day celebrations Delhi Health Minister Satyendar Jain to inaugurate the event New Delhi, 07th October 2016: Heart Care Foundation of India, a leading national non-profit organization committed to making India a healthier and disease-free nation is all set to open the doors to its annual flagship event – the MTNL Perfect Health Mela. A confluence of tradition and modernity, the main aim of the Mela is to create mass awareness about all aspects of health; using a consumer-driven model as the medium. Celebrating 25 years of its inception, the Perfect Health Mela 2016 will be inaugurated by none other than Delhi Health Minister – Shri Satyendar Jain. The event is being co-organized in association with the IMA, MTNL, Coke, LIC, NDMC& MCD and is scheduled to take place from October 25-29, 2016 at the Talkatora Indoor Stadium, New Delhi. The theme of this year’s event is “One Health”.The event will aim at raising mass level preventive health awareness about lifestyle diseases such as heart disease, hypertension, diabetes as well as addressing the current vector-borne disease menace in the country with special reference to chikungunya, dengue, malaria and Zika. A special focus will be laid on anti-natal health. Addressing a press conference, Padma Shri Awardee Dr. KK Aggarwal, President HCFI &President Elect IMA said,“Our main motive behind organizing the MTNL Perfect Health Mela is to educate people about numerous easy ways by which they can prevent themselves from contracting common lifestyle and environmental diseases using entertainment as a medium. We will be focusing our messaging around common lifestyle and mosquito borne diseases this year. For the first time ever we will also be organizing an event called IMAGodhbharai at the Perfect Health Mela year to raise awareness about the importance of pre-natal health and well-being. We thank all our partners for supporting us for 25 years now.” The Perfect Health Mela is designed to cater to people from all age groups and walks of life. It incorporates activities across categories such as health check up camps, entertainment programs, lifestyle exhibitions, workshops, and competitions. For the first time ever, key activities and discussions of the Perfect Health Mela will be webcasted live for those to see who were unable to attend the event. The aim being to raise preventive health awareness amongst the maximum number of people. Speaking about the event, Padma Vibhushan Awardee Dr Sonal Mansingh said, “I congratulate Heart Care Foundation of India for keeping up the healthy legacy. I am proud to be associated with the event, and as they say, nothing is better than saving lives of the individuals and being at the service for the betterment of the society. This event approaches society as a whole and this is what makes it such a huge success.” Adding to this, Dr P K Sharma, Medical Health Officer, NDMC “We wholeheartedly support Heart Care Foundation of India’s out-of-the-box initiative to reinstate the value of preventive health measures. We encourage everyone to come and attend the event for all the health related queries solved in an easy way. The Perfect Health Mela is in line with our aim of making India a healthy and a disease-free country”. For more information about the event, please visit www.perfecthealthmela.com. Entry to the Mela is free for all. The other dignitaries present on the dies Dr R N Tandon, Hony Finance Secretary IMA & Dr V K Monga, Deen IMACGP

Where is the equity and equality? Why only we, the medical professionals, have to follow it?

Where is the equity and equality? Why only we, the medical professionals, have to follow it? Hon’ble Prime Minister of India, Shri Narendra Modi, in his public address on 26th May, 2016 at Saharanpur, announced extension of retirement age of Government Doctors from 60 years to 65 years to meet the shortfall of doctors in Government Hospitals. Subsequently, Government of India, Ministry of Health & Family Welfare, Nirman Bhawan, New Delhi issued an Office Order No.A.12034/1/2014-CHS-V dated 31st May, 2016, stating that the President is pleased to enhance the age of superannuation of the specialists of Non-Teaching and Public Health sub-cadres of Central Health Service (CHS) and General Duty Medical Officers of CHS to 65 years with immediate effect. In consequent of the above, Railways, CAPF (Central Armed Police Force) as well as Provincial Medical & Health Services in Assam and Delhi also issued similar orders. From the intent of Prime Minister’s address, it is clear that the spirit behind the address and the decision was that the step has been taken to cover the shortage of the doctors in the country. Today, India needs twice the number of doctors, three times the number of nurses and four times the number of paramedics. The Medical Council of India (MCI) has also taken a decision to allow opening of a medical college linked to every district hospitals in the country. Unfortunately, in India everything is decided by full stop or comma in the bureaucratic system. It was expected that the extension of the retirement age of doctors from 60 to 65 years would be automatic but the same is not true. For example, doctors working in Central Public Sector Enterprises (CPSEs), in spite of their representation for clarification are still out of the ambit of Prime Minister’s decision. Over 150 CPSEs are directly under the administrative control of Government of India through their respective ministries. Therefore, it was expected that this decision of the Prime Minister would automatically be implementable on them also. Their exclusion from this decision of the Prime Minister will affect approximately 3,000 doctors of CPSEs who manage over 10,000 beds spread all over the country. We, at Indian Medical Association (IMA) feel that this announcement by Hon’ble Prime Minister of India should automatically be applicable pan India to doctors working in Centre, State, CPSEs, Private Hospitals or any other area. Shortage of doctors is universal and not segment wise. It is important that equity, equality and justice should prevail in any health care decision. In fact, there is no retirement age for doctors. All doctors after retirement from government sector enter into private practice and carry on their active work till they are physically or mentally incapable of doing the same. The retirement age can only be for the purpose of administration but not clinical practice. One may be allowed to retire from an administrative post but allowed to continue to serve in clinical areas. Will someone from amongst us take up this cause in the interest of the medical profession?

Social media mesage on soft drinks

I receive one mail query every day " That a message is being circulated on social media about the pesticide percentage in cold drinks and it is being claimed that the information is being released by IMA (Indian Medical Association).  Thums Up 7.2%, Coke 9.4%,  7up 12.5%, Mirinda 20.7%, Pepsi 10.9%,  Fanta 29.1%, Sprite 5.3%, Frooti 24.5% and Mazza 19.3%."

IMA is not aware of any such study. No such study has been conducted by IMA Head quarters. All be informed about it.

Dr KK Aggarwal

Honorary Secretary General

Indian Medical Association (IMA), The Live Love Laugh Foundation (TLLLF) and Indian Psychiatric Society (IPS) to educate the medical community on depression

Indian Medical Association (IMA), The Live Love Laugh Foundation (TLLLF) and Indian Psychiatric Society (IPS) to educate the medical community on depression

To organize a Continuing Medical Education seminar in Delhi on Sunday to mark the upcoming World Mental Health Awareness Day on October 10

New Delhi, October 8, 2016: Addressing the need to reduce the increasing burden of mental health disorders such as depression on the Indian healthcare system, IMA, IPS and TLLLF will organize a one-of-its-kind Continuing Medical Education seminar for doctors on Sunday, (Oct 9, 2016) in Delhi.
This CME is a part of the ‘Together Against Depression’ program launched by The Live Love Laugh Foundation (TLLLF), a not-for-profit organization started by actress Deepika Padukone with an aim to raise awareness about mental health in India. The purpose of the seminar is to sensitize and assist doctors in working more effectively with their patients who may be going through depression or anxiety.

The Indian government estimates that 6-7% of the country’s population lives with major to minor mental health concerns. This amounts to approximately 70 million Indians, with the number increasing every year. Despite the large number of people who require mental health attention, India has only 3,500 trained psychiatrists and even fewer psychologists. What’s worse is that the stigma and discrimination faced by these people and their families prevent them from seeking guidance.
"A General Practitioner (GP) is the first point of contact for a patient and must be sensitized on ways in which they can diagnose signs of depression amongst patients and help them seek appropriate care.  This program is in line with the MCI’s (Medical Council of India) new guidelines that state that 10% of all medical education programs should focus on mental health. We hope that through this initiative, we can help raise mass awareness about important health issues impacting the overall population and the criticality of prevention, timely diagnosis and treatment”, said Padma Shri Awardee Dr KK Aggarwal – President Elect IMA & President HCFI.

“There is a need to increase resources — human and financial — for mental health in our country. Owing to the associated stigma as well as the shortage of trained medical practitioners in our country, a majority of patients continue to suffer in silence. Since its inception last year, The Live Love Laugh Foundation has been committed to developing outreach programs to highlight the urgent and massive mental health challenges that India faces. We are happy to be hosting this seminar with the support of the Indian Medical Association and the Indian Psychiatric Society. We believe that sensitizing medical practitioners constitutes a major part of the multi-pronged battle that’s needed to fight depression," said Dr. Shyam Bhat, Member of the Board of Trustees, TLLLF.

“In our country, depression is underdiagnosed and not recognized even by our doctors. However, it should be known that depression is a treatable disease and more and more people must be encouraged to seek help in time. Given the shortage of psychiatrists and counselors in our country, GP sensitization is essential. We are hopeful that through these CMEs being organized in partnership with IMA & TLLLF, we will be able to better equip practicing doctors with the awareness and resources needed to be able to help their patients. The IPS is focused on positive mental health and in stigma reduction not only for depression but also across the spectrum for all psychiatric disorders” said Dr. G Prasad Rao, President, Indian Psychiatric Society.

Our country is home to one of the smallest per capita base of mental health professionals globally. This becomes apparent through the following WHO statistics: For every 100,000 people in India, the base of resources for mental health is abysmally small – just 0.3 psychiatrists, 0.07 psychologists, 0.07 social workers, 0.12 nurses. Moreover, there are only 2.1 hospital beds for every 1,00,000 population. This adds up to a huge burden of mental disorders — 2,443 disability-adjusted life years per 1,00,000 population[i]. These statistics are shocking and reflect the fact that India is grappling with one of the highest burden for mental health disease in the world.

The need of the hour is to arm doctors with the resources required to help patients receive appropriate medical attention and treatment and the CME in Delhi is a step in this direction.

[i] http://www.firstpost.com/india/india-needs-to-develop-a-strategy-for-training-human-resources-for-mental-healthcare-3001840.html

Denial of justice: Mediclaim does not cover treatment for any mental illness or psychosomatic disorder

Denial of justice: Mediclaim does not cover treatment for any mental illness or psychosomatic  disorder

Dr KK Aggarwal

National President Elect and Honorary Secretary General IMA

On 10^th October we are observing World Mental Health day.  We have been propagating that there is a paradigm shift the way we need to tackle mental illnesses. That depression is no more a stigma or a social issue, that depression is treatable, that depression is a manageable disease and that depression needs to be diagnosed early.

If it is a disease then why still it is not covered under mediclaim?  Why would people disclose ‘depression’ when getting admitted when their whole claim can get cancelled?

We say suicidal ideation is a medical emergency and such patients needs admission. If it is not covered in mediclaim nobody will disclose or one will get admitted under the disguise of some other illness.

On one hand we want special act for mental health and on the other hand we deny their right to get treated.

Some facts

1.      “I have carefully looked into this. As of now there are no specific government guidelines or legislative provisions about insurance coverage of psychiatric disorders. Hence the insurance providers are not providing coverage for Depression. This is denial of justice and we must fight against it. Prof Roy Abraham Kallivayalil. Secretary General, World Psychiatric Association”

2.       Travel Medical Insurance Policy Exclusions: No claim will be paid arising from suicide, attempted suicide or wilfully self-inflicted injury or illness, mental disorder, anxiety, stress of depression, alcoholism, drunkenness or the abuse of drugs.

3.      The World Health Organisation has recently estimated that 1 in 4 persons will be affected by some form of mental illness once in their lifetime.

4.      In 2005, it was estimated that 6-7% of the population suffered from mental disorders, and about 1-2% suffered from severe mental disorders such as schizophrenia and bipolar disorder.

5.      Nearly 5% of the population suffer from common mental disorders such as depression and anxiety. This number is much higher as mental illness often goes underreported due to the associated stigma and non-coverage in mediclaim like policies.

Good News

As passed by Rajya Sabha on 8th August 2016, the new mental care health bill clause (4) every insurer shall make provision for medical insurance for treatment of mental illness on the same basis as is available for treatment of physical illness. Also under the new bill suicide has been treated as a form of severe stress which will not be punishable under 309 of IPC. But as on day the act is not applicable and depression patients are not under the coverage of mediclaim or other reimbursements.

Even nurses can be booked under 304A

Even nurses can be booked under 304A In The High Court at Calcutta: (Criminal Revisional Jurisdiction): C.R.R No. 1027 of 2013: Dr. Sudhir Kumar Thakur -Vs. The State of West Bengal & Ors. The Hon’ble Mr. Justice Siddhartha Chattopadhyay Heard On: 01.03.2016, 02.03.2016, 14.03.2016, 16.03.2016, 29.03.2016, 02.05.2016. C.A.V. On : 02.05.2016. Judgment Delivered On : 20.07.2016: Siddhartha Chattopadhyay, J. 1. Challenging the legal pregnability of the Order dated 30.07.2012 passed by the Judicial Magistrate, 2nd Court Sealdah, South 24 Parganas, the petitioner-complainant has filed this revisional application under Section 401/482 of the Cr.P.C. read with Article 227 of the Constitution of India. 2. Grievance as ventilated by the applicant in this application is such that his brother S.N.Thakur died in Apollo Gleneagles Hospital due to medical negligence. In the interest of effective adjudication factual aspects needs to be revisited. The case of the de facto complainant in a capsulated form is such that his brother S.N. Thakur since deceased was admitted in Apollo Gleneagles Hospital on 07.04.2012 at 11:15 p.m. with complaints of multiple black patches on skin and bleeding from mouth. The victim patient was immediately taken to the emergency ward, where the doctor in-charge-of emergency department being assisted by a supervising nurse made an initial observation which revealed that the patient was suffering from ecchymotic patches and bleeding from oral cavity. That deceased was accompanied by one Dr. Abhijit Sarkar, who is the doctor of Employer Company. At the time of his admission in Apollo Gleneagles Hospital, the deceased was having a blood report which speaks:- 1. Platelet count – 17000/cmm 2. Neutrophil – 6% 3. Blast cell – 34% 4. RBC Morphology – Normocytic & Hypochromic 3. Condition of deceased patient was highly alarming and the doctor on duty had made a diagnosis that he was suffering from Chronic Myeloid Leukaemia and for immediate management they have administered injection Raciper and Zofar as the patient complained of nausea and vomiting. 4. The consultant Dr. Soumya Bhattacharya over telephone advised the doctor on duty to admit the patient and also advised a series of tests. No immediate treatment was given to the patient nor any such advice was given except certain clinical tests. He specifically averred that such type of patient ought to have given platelets infusion as per accepted medical procedure in a case where there as subcutaneous bleeding and low platelet count can lead to intra cranial bleeding. The progress report maintained by Dr. Nabanita Ghosh speaks the patient complained of pain in the right side of the brain to which he was given only paracetamol. Neither the consultant doctor was informed nor CT scan and admission to ICU was advised. On the next morning when the patient was found unconscious, consultant Dr. Soumya Bhattacharya was informed and he advised for infusion of four units of platelets and also for shifting the patient to ICU. Accordingly the patient was shifted to ICU after significant delay of 1 hour 45 minutes and platelet infusion was given at 12.20 p.m. Although the patient was admitted at 11:15 p.m. of previous day, but the consultant doctor for the first time examined the patient at 10:00 a.m. i.e. almost after lapse of 11 hours. It is specifically complained of that if instant platelet infusion and CT scan were made, there were chance of his survival. Dr. Sanjoy Bhowmik, Dr. Harsh Jain, Dr. Suresh Rama Subba visited the patient at 10:30 a.m. and made observation of decerebrate rigidity which indicates cerebral haemorrhage. CT scan report also speaks that. At 5:30 p.m. when the de facto complainant visited the patient at that time the patient was already having brain dead. Biological death of the patient was declared on 09.04.2012 at 3:40 p.m. It is also alleged that there is some tampering in the progress report of the patient and it was tampered by the hospital authority. 5. After lodging the F.I.R. police took up the investigation and submitted charge-sheet. Case diary reveals that Investigating Officer has taken statement of available witnesses and sent some documents to questioned document examination bureau, who opined that the said report was tampered and a medical board was constituted on the basis of a complaint and the said medical report speaks that there was some sort of negligence on the part of the hospital authority. These are the sum and substance of the prosecution case. 6. At the time of hearing learned Counsel appearing on behalf of the petitioners contended that there is serious medical negligence on the part of the doctors as well as the hospital authority and for their such rashness and negligent act caused untimely departure of his kith. He has referred to the certain points as appeared in the case diary and the history sheet along with bed head ticket. According to him, the impugned order by which the learned Court below stopped the proceeding is unheard of and bad in law. 7. Learned Counsel appearing on behalf of the accused respondent has submitted that there is no iota of evidence by which the present accused petitioner can be brought to book and the impugned order passed by the learned Court below does not suffer from any infirmity and it does not require any interference. 8. After hearing rival submission of the parties and on perusal of the case diary, it appears to me that there is no significant incriminating material appearing against the present opposite party No. 2 namely Dr. Sanjoy Bhowmik, Dr. Suresh Rama Subba, Dr. Harsh Jain. But the case diary speaks that Rossy M. Joseph who was nurse in charge of that ICU is not above board. When she was in ICU, she was supposed to look after the deceased patient but in spite of that the patient had fallen from the bed to the floor. So therefore, prima facie allegation regarding her negligent act can well be deciphered. 9. In fact, there is no evidence collected by the Investigating Officer that Dr. Suresh Rama Subba and Dr. Harsh Jain had given any effective medical treatment to the victim patient. Dr. Sanjoy Bhowmik had given a direction for his surgery. Medical board was constituted by the Government of West Bengal to ascertain the actual cause of death of Sambhu Nath Thakur and the said board opined “the patient presented with history of bleeding manifestation with blood report suggestive of Acute Leukaemia and this type of case always runs the risk of intra cranial of any other fatal haemorrhage at any time. He should be given platelet support as early as possible to save the life of the patient. There was delay in 1st visit of the consultant after admission and also delay in part of investigation specially CT scan brain and blood transfusion also. There might be certain kind of deficiencies in services given on the part of the hospital along with the attending physician and the staff should take more precaution while treating such kind of patient but unfortunately some degree of negligence (which were mentioned in discussion) was there during the time of treatment.” From the said report it reveals that there was certain kind of deficiencies in services given on the part of the hospital along with the attending physician and the staff and they should take more precaution while treating such kind of patient. The medical board concluded that there is some degree of negligence during the time of treatment. 10. The said medical board did not label any accusation against the Dr. Sanjoy Bhowmik, Dr. Harsh Jain and Dr. Suresh Rama Subba. Platelet transfusion was not done promptly which was very much required for imparting better treatment. Certain tests were prescribed but those were not done in time. The specialist doctor namely Dr. Harsh Jain and Dr. Suresh Rama Subba had advised for surgery too. But before the said surgery takes place the victim patient breathed his last. But role of Soumya Bhattacharya speaks prima facie that there was some sort of negligent act on his part which resulted in the death of the victim. From the case diary it appears particularly from the statement of Dr. Joy Basu, that Dr. Nabanita Ghosh has tampered the history sheet of the patient. It appears from the case diary that Dr. Suresh Rama Subba had attended the patient. On a close scrutiny of the case diary it appears to me that Dr. Suresh Rama Subba and Dr. Harsh Jain, after seeing the condition of the patient, advised for surgery and this surgical operation was supposed to be done by Dr. Sanjoy Bhowmik. But before the said surgery takes place the victim expired. Therefore, there is no lapse on the part of Dr. Harsh Jain, Dr. Suresh Rama Subba and Dr. Sanjoy Bhowmik. Case diary also reveals that Rossy M. Joseph nurse of that hospital had been attending the patient in the night shift. In spite of that the patient fell down from the bed to the floor, which goes to suggest that there is negligence on the part of the attending nurse i.e. Rossy M. Joseph. 11. Learned Counsel appearing on behalf of the petitioner has referred to a decision reported in AIR 1985 SCC 1285 (Bhagaban Singh –Vs.- Commissioner of Police) and submitted that before hearing the application under Section 258 of Cr.P.C., he should have been informed. This judgment relates to provision of under Section 173 (2) of Cr.P.C. Hon’ble Apex Court held that the Investigating Officer is under an obligation under Section 2 (ii) of Section 173 to communicate the action taken by him to the informant and the report forwarded by him to the Magistrate under the said section. Obviously the reason is that the informant, who sets machinery of investigation into motion by filing the F.I.R. must know the result of the investigation initiated on the basis of his F.I.R. In this instant case, charge-sheet has been submitted and so the same analogy cannot be applied in this particular case. Yes, state has appeared on behalf of the prosecution before the learned Trial Court but the de facto complainant was unaware of the fact of filing application under Section 258 of Cr.P.C. In 173 (2) of Cr.P.C. it is mandatory to inform the defacto complainant. But there is no such mandate under Section 258 of Cr.P.C. that the complainant has to be informed. Therefore, the de facto complainant cannot claim the benefit of 173 (2) of Cr.P.C. when the petition was heard under Section 258 of Cr.P.C. as of right. He has also cited another unreported decision in connection with Aruna Ramchandra Shanbaug –Vs.- Union of India & Ors., which was in connection with ‘euthanasia’. In that judgment Hon’ble Apex Court held that a decision has to be taken to discontinue life support either by the parents or the spouse or other close relatives, or in the absence of any of them, such a decision can be taken even by a person or a body of persons acting as a next friend. It can also be taken by the doctors attending the patient. However, the decision should be taken bona fide in the best interest of the patient. That judgment is squarely applicable in this case because the patient came with a serious condition and clinical tests were not done within the shortest possible time and when he was having ‘brain dead’, there was no option left with by the doctor concerned to withdraw the life support. So it cannot be said that the act of the doctors were not bona fide. Learned Counsel appearing on behalf of the petitioner also relied on the decision reported in (2009) 9 SCC 221 (Malay Kumar Ganguly –Vs.- Dr. Sukumar Mukherjee & Ors.) In the said judgment Hon’ble Apex Court dismissed the criminal appeal but allowed the civil appeal. In this case we have to consider the criminal negligence act and nothing more. Civil wrong, if any done by the doctors, that may be decided by the consumer forum court, if such application has been filed before that authority. In the said judgment Hon’ble Apex Court held that the doctor concerned not having requisite expertise and did not follow medical treatments protocols laid down by expert. Here the picture is completely different. Nobody raised his eyebrows regarding the qualification and expertise of the doctors concerned. The de facto complainant’s main case is that the deceased was not attended by doctor at the crucial point of time. It is true that consultant doctor Mr. Bhattacharya, without seeing the patient, over telephone had directed for certain pathological tests. But the said pathological tests were not done instantly and next morning the said consultant doctor came to see the patient and till then no laboratory test was done. Dr. Harsh Jain, Dr. Suresh Rama Subba were the visiting physicians and they have contacted with Dr. Sanjoy Bhowmik for the surgical operation of the victim patient. But before the surgical operation is done, the patient expired. Due to non-availability of the clinical test reports doctors cannot be blamed. It prima facie appears that the hospital authority did not respond to the grave situation, which they were supposed to do. 12. Learned Counsel appearing on behalf of the state has referred to a decision reported in 2003 Cr.L.J. 3327 (Neela Lohitha Dasan Nadar –Vs.- State of Kerala). Spirit of the said judgment speaks that it should not be forgotten that the normal rule is that both parties do get the opportunity to adduce evidence and the Court gives its verdict on the guilt or innocence of the accused based on the evidence in the case. The Court may invoke under Section 258 of Cr.P.C. in a case where the allegations against the accused even accepting them as true, do not constitute offence or on being satisfied that there exists serious defects in the prosecution case which go to the root the matter, thereby rendering further proceedings rather impossible or futile. The power to stop proceedings at any stage has to be sparingly used that too in an extremely exceptional cases. That judgment of the Hon’ble Apex Court has been accepted in many other cases i.e. guideline which has to be adhered to by all the Courts in the country. 13. Learned Public Prosecutor has also referred to a decision reported in AIR 2004 SCC 4674 (Adalat Prasad –Vs.- Rooplal Jindal). Here the case of Jacob Mathew was considered. So, I am of the view, that the decision of Jacob Mathew is also to be considered along with this judgment so far as Section 258 of Cr.P.C. is concerned. Reason for passing the judgment in regard to Jacob Mathew’s was as such: - (1) Jurisdiction of the Magistrate to issue process arises only if the complaint contents allegation involving the accused in the commission of a crime. (2) It is open to the summoned accused to approach the Court issuing summon and convince the Court that there is no such allegation in the complaint which requires his summoning. (3) No specific provision of law is required. (4) Since it is an interim order it can be varied. Finding of that case was examined by Hon’ble Apex Court in Adalat Prasad –Vs.- Rooplal Jindal case. Views expressed that once under Section 204 of Cr.P.C. is applied then the Court cannot come back to under Section 203 of Cr.P.C. and his only remedy is under Section 482 of Cr.P.C. Mainly Hon’ble Apex Court dealt with the provisions under Section 200, 202, 203 and 204 of Cr.P.C., Hon’ble Apex Court mainly focused on Chapters XV, XVI of the Code. But scope of Section 258 of Cr.P.C. was not examined by the Hon’ble Apex Court because that was not placed before their Lordships for consideration i.e. in any summons case instituted otherwise than upon complaint i.e. police case but summons triable. Therefore, in this instant case ratio of Adalat Prasad’s case is not relevant. On the other hand Neela Lohitha’s case under Section 258 of Cr.P.C. was specifically considered and it was a police case instituted on the basis of F.I.R. The decision reported in Subramanium Sethuraman –Vs.- State of Maharashtra & Anr. reported in 2004 AIR Supreme Court 4711, is not applicable here because it was also in respect of a complaint case but the principles of Jacob Mathew’s case can be dealt with here in respect of other matters i.e. when Section 304A of Indian Penal Code can be invoked against a doctor. In that case Hon’ble Apex Court held to prosecute a medical professional for negligence under a criminal law it must be shown that the accused doctor did something or failed to do something which in the given facts and circumstances of this case no medical professional in his ordinary sense and prudence would have done or failed to do so. The hazard taken by the accused doctor should be of such a nature that injury which resulted was most likely eminent. 14. Doctor who administers a medicine known to or used in a particular branch of medical professional impliedly declares that he has knowledge of that branch of science and if he does not in fact possess that knowledge, he is prima facie acting with rashness and negligence. 15. After going through all the decisions referred to by the rival parties, I am of the view that it is perhaps needless to say that indiscriminate prosecution of medical professional of medical negligence is counter- productive to the object and scheme. If during a surgical operation hands of a surgeon begins to tremoring due to apprehension of medical negligence and that ‘Sword of Damocles’ is on his neck, he cannot render his best to carry on life saving scalpel to perform an essential surgery. In case of administering treatment with medicine, if two views are accepted by medical science, and if he applies one of them instead of using other drug and due to his such choice if the patient dies, should the doctor be penalized? In my humble view, Section 304A of Indian Penal Code although does not bear the word ‘Gross’, but while dealing with such case Court must consider it, as ‘Gross’. It must be the causa causans otherwise doctor concerned would always be under the dangling fair of facing a prosecution and to refuse to treat the patient by referring the patient to some other hospital/nursing home, clinic, which eventually would lead to disservice to the society. Court should not encourage this approach. 16. Therefore, in my humble consideration there is no merit in this application under Section 401, 482 of the Cr. P. C. read with Article 227 of the Constitution of India so far as opposite party No. 2 Dr Sanjoy Bhowmik, opposite party No. 3 Dr Suresh Rama Subba, opposite party No. 4 Dr Harsh Jain are concerned. But there is apparent gross negligence on the part of the attending nurse Rossy M. Joseph and she cannot be discharged at this stage. Accordingly, this revisional application is allowed in part in respect of Rossy M. Joseph who was attending nurse of the victim. So far as proceeding against Dr. Sanjoy Bhowmik, Dr. Suresh Rama Subba and Dr. Harsh Jain are concerned, that be stopped. 17. Let a copy of this judgment and LCR be sent to the learned Court below for information and taking necessary action and to proceed with the case in accordance with law. 18. Urgent certified photocopy of this order, if applied for, be supplied to the parties upon compliance with all requisite formalities. (Siddhartha Chattopadhyay, J.)/ A.F.R/N.A.F.R. www.livelaw.in

Indian Medical Association (IMA), The Live Love Laugh Foundation (TLLLF) and Indian Psychiatric Society (IPS) to educate the medical community on depression

Indian Medical Association (IMA), The Live Love Laugh Foundation (TLLLF) and Indian Psychiatric Society (IPS) to educate the medical community on depression To organize a Continuing Medical Education seminar in Delhi on Sunday to mark the upcoming World Mental Health Awareness Day on October 10 New Delhi, October 8, 2016: Addressing the need to reduce the increasing burden of mental health disorders such as depression on the Indian healthcare system, IMA, IPS and TLLLF will organize a one-of-its-kind Continuing Medical Education seminar for doctors on Sunday, (Oct 9, 2016) in Delhi. This CME is a part of the ‘Together Against Depression’ program launched by The Live Love Laugh Foundation (TLLLF), a not-for-profit organization started by actress Deepika Padukone with an aim to raise awareness about mental health in India. The purpose of the seminar is to sensitize and assist doctors in working more effectively with their patients who may be going through depression or anxiety. The Indian government estimates that 6-7% of the country’s population lives with major to minor mental health concerns. This amounts to approximately 70 million Indians, with the number increasing every year. Despite the large number of people who require mental health attention, India has only 3,500 trained psychiatrists and even fewer psychologists. What’s worse is that the stigma and discrimination faced by these people and their families prevent them from seeking guidance. "A General Practitioner (GP) is the first point of contact for a patient and must be sensitized on ways in which they can diagnose signs of depression amongst patients and help them seek appropriate care. This program is in line with the MCI’s (Medical Council of India) new guidelines that state that 10% of all medical education programs should focus on mental health. We hope that through this initiative, we can help raise mass awareness about important health issues impacting the overall population and the criticality of prevention, timely diagnosis and treatment”, said Padma Shri Awardee Dr KK Aggarwal – President Elect IMA & President HCFI. “There is a need to increase resources — human and financial — for mental health in our country. Owing to the associated stigma as well as the shortage of trained medical practitioners in our country, a majority of patients continue to suffer in silence. Since its inception last year, The Live Love Laugh Foundation has been committed to developing outreach programs to highlight the urgent and massive mental health challenges that India faces. We are happy to be hosting this seminar with the support of the Indian Medical Association and the Indian Psychiatric Society. We believe that sensitizing medical practitioners constitutes a major part of the multi-pronged battle that’s needed to fight depression," said Dr. Shyam Bhat, Member of the Board of Trustees, TLLLF. “In our country, depression is underdiagnosed and not recognized even by our doctors. However, it should be known that depression is a treatable disease and more and more people must be encouraged to seek help in time. Given the shortage of psychiatrists and counselors in our country, GP sensitization is essential. We are hopeful that through these CMEs being organized in partnership with IMA & TLLLF, we will be able to better equip practicing doctors with the awareness and resources needed to be able to help their patients. The IPS is focused on positive mental health and in stigma reduction not only for depression but also across the spectrum for all psychiatric disorders” said Dr. G Prasad Rao, President, Indian Psychiatric Society. Our country is home to one of the smallest per capita base of mental health professionals globally. This becomes apparent through the following WHO statistics: For every 100,000 people in India, the base of resources for mental health is abysmally small – just 0.3 psychiatrists, 0.07 psychologists, 0.07 social workers, 0.12 nurses. Moreover, there are only 2.1 hospital beds for every 1,00,000 population. This adds up to a huge burden of mental disorders — 2,443 disability-adjusted life years per 1,00,000 population[i]. These statistics are shocking and reflect the fact that India is grappling with one of the highest burden for mental health disease in the world. The need of the hour is to arm doctors with the resources required to help patients receive appropriate medical attention and treatment and the CME in Delhi is a step in this direction. Ends- [i] http://www.firstpost.com/india/india-needs-to-develop-a-strategy-for-training-human-resources-for-mental-healthcare-3001840.html

Timely action is of key essence while dealing with patients who have suffered a heart attack, sudden cardiac arrest or stroke

Timely action is of key essence while dealing with patients who have suffered a heart attack, sudden cardiac arrest or stroke New Delhi, 06th October 2016: In India, around a third of the population suffers from degenerative diseases like ischemic heart issues, chronic obstructive pulmonary problems and stroke. These diseases also known as the leading killers were also accountable for 30 percent of all deaths in 2013. Stroke and heart disease are leading causes of death and disability in India. The estimated prevalence rate of stroke in the country ranges from 84-262 per 100,000 population in rural and 334-424 per 100,000 populations in urban areas. Approximately 40% of patients with stroke succumb to their illness. Both heart attack and stroke are caused by interruptions in the normal flow of blood to the heart or brain, the organs that are the most essential to life. This happens when the cells present in the heart and brain don’t get enough access to the oxygen-rich blood and other nutrients. In such a case, these heart and brain cells begin to malfunction and die. This cell death can set off a series of harmful effects throughout the body resulting in familiar symptoms of a heart or brain emergency. However, one must remember is that heart attacks and strokes are not the same. While one affects the heart, the other damages the brain. Speaking about the issue, Padma Shree Awardee Dr KK Aggarwal, President Heart Care Foundation of India and President Elect IMA said, “Stroke-like heart disease is a lifestyle induced ailment aggravated due to obesity, physical inactivity, regular heavy or binge drinking, smoking, hypertension, high cholesterol levels, diabetes, sleep apnea, family history and heart disease. Timely recognition of symptoms and seeking emergency help is key to saving lives. Just like in sudden cardiac arrest deaths every minute lost in performing hands-only CPR decreases the chances of a person's revival by 10%, every minute lost in getting medical attention increases chances of death and disability. India is facing a stroke and heart disease epidemic, and we must work towards amending our high-stress lifestyle to reverse this trend and save lives. ” The most common symptoms of heart attack include crushing chest pain and difficulty breathing. A heart attack might also cause cold sweats, racing heart, pain in the left arm, jaw stiffness, or shoulder pain. Additionally, many don't know that women often have different heart attack symptoms than men. For instance, instead of having chest pain during a heart attack, women may feel exhausted and fatigued or have indigestion and nausea. The symptoms of stroke include sudden difficulty seeing, speaking, or walking, and feelings of weakness, numbness, dizziness, and confusion. Some people get a severe headache that’s immediate and strong, different from any kind they’ve ever had. It is important to differentiate the conditions and seek immediate help when faced with such situations. One should never neglect the even the smallest symptoms. In the case of stroke, the F.A.S.T technique should be used to detect the conditions and save lives. • Face Drooping – Does one side of the face droop or is it numb? Ask the person to smile. Is the person's smile uneven? • Arm Weakness – Is one arm weak or numb? Ask the person to raise both arms. Does one arm drift downward? • Speech Difficulty – Is speech slurred? Is the person unable to speak or hard to understand? Ask the person to repeat a simple sentence, like "The sky is blue." Is the sentence repeated correctly? • If the answers to these questions are yes, then it is Time to call your doctor immediately. Lifestyle changes are also a must. People often remain unaware of the consequences of their choices on their health. The risk of a stroke and heart disease in a smoker is double when compared to a non-smoker. Smoking increases clot formation, thickens the blood, and increases the amount of plaque build-up in the arteries of both he heart and brain. In addition to this, obesity puts a strain on the entire circulatory system. It can also make people more likely to have high cholesterol, high blood pressure and diabetes, all of which can increase stroke and heart disease risk. Alcohol use is also very dangerous. A healthy diet comprising of fruits, vegetables, and low trans fats is a must for the prevention of lifestyle diseases.

IMA 1 Voice: Stop NMC

IMA 1 Voice: Stop NMC Team IMA 2016 Niti Aayog has recently put the proposed National Medical Commission Bill – 2016 on the public domain and had invited observations and comments from the stake holders. Over 9000 stake holders sent their comments and observations on the said Bill. In a stake holder’s meeting, IMA has come out with the following points and IMA feels that if the said bill is passed by the government in the forthcoming winter session, it will not be in the interest of the society. 1. There is nothing new in the proposed bill, instead the Niti Aaygo should have asked for suggestions to amend the existing IMC act 1956 and its subsequent amendments. 2. In the present bill the representative character, which is a must for any regulatory body, a fine balance between the elected and nominated members, has been completely given go by. In fact in the proposed bill, there is total exclusion of elected members. It will have 100% nominated members. 3. The present MCI under the IMC act has representations from all State Medical Councils, health science universities and registered medical practitioners. The same will be lost with the new bill. 4. Health is a state subject and the state doctors are regulated by the state medical councils. How can one justify no representation of state medical councils in NMC? Also the state Medical Councils are autonomous independent bodies but under Sec. 14(5) NMC can take action against state medical councils to ensure for compliance. 5. Also it is likely that the autonomy vested with the State Medical Councils which are independent creation of respective state legislation will go in the next phase. All State Medical councils are likely to be replaced by nominated councils in future. 6. The bill stipulates the denial of legitimate right of the medical education conferring universities in terms of their representation in the composition of the regulatory body in spite of they being the exclusive key player. 7. It is possible that in near future Niti Aayog may suggest similar bills to replace Dental Council of India, Nursing Council of India, Pharmacy Council of India etc. and it is possible to take similar steps even to non-medicals like Bar Council of India or Chartered Accountants of India. 8. The Bill in its present format will also do injustice to people of Jammu and Kashmir as the present bill does not talk about its applicability to Jammu and Kashmir when the existing IMC Act specifically mentions about it. 9. All the powers in NMC are vested with the Chairperson who will also be the ex-officio chairperson of medical advisory council. The Chairperson will be appointed or nominated by the Central Government. Loop holes have been kept in the criteria for selection: any one with over 20 years of experience in profession out of which 10 years shall be in a leadership role. The word leadership role has not been defined and probably kept to suit the nominators. The term of the chairperson also has been limited for maximum 2 terms of 4 years each and retirement age also has been kept at 70 years. 10. There are further ambiguities in the bill also. Sec. 12 (3) prohibits Chairperson after retirement for accepting employment in private medical college for 1 year but Sec. 12(5) allows central government to permit Chairperson to accept such appointments. 11. The Chairperson will always be on the mercy of the government as the government can remove the Chairperson on flimsy grounds such as physical, mentally incapable of performing duties, abusing position, making persistent defaults, not performing or not complying with actions of the Government. 12. The medical assessment and rating boards like the under graduate and post graduate education boards, although are designated to be autonomous yet they would be seeking directions from the Government through the commission in regard to its tasks dispensation. 13. Under Section 19(4) NMC may allow and sanction locally designed courses by individual institutions which will open the medical education beyond standards. 14. Under Sec. 20(1) and 23(1) President of the under graduate or the post graduate board is empowered to take all decisions on behalf of the board that means that all the powers are vested with the President and not with the board. 15. The said Boards under Section 25(2) would be entitled to hire 3rd party agencies for accreditation including empanelling the same which would be opening flood gates for the various private rating agencies. 16. Under Section 23 (3) the said Board would be evaluating the scheme for opening new medical colleges and make recommendation in regard to approval or disapproval without any necessity on onsite inspection and on the basis of paper assurances. Further by a provision to Sec 27(4), the Board is entitled to make relaxation for opening of a medical college in unserved area without defining the same and therefore opening an avenue for discretionary authority. As such the entire process would end up in dilution of the desired standards and resultant production of comprised graduates. 17. The Sec. 28(3) provides for a board of medical registration that would have a President and 2-Part time members which is different from the other boards namely, under graduate and post graduate rating board respectively. 18. There is no clarity proposed in the Bill pertaining to who will be the primary registering authority. 19. Under Sec. 29(2) (ii), all the professional organisations and associations of doctors have been brought under the Disciplinary jurisdiction of NMC without realising that the Association / organisations of doctors are not registered under the State Medical Register or the National Medical Register, as the case may be. 20. Under Sec. 29(2) (v) it is contemplated that the States or Union Territories where there is no State Councils, the same has to be put into place within 3 years from the date of the said Bill coming into force which is a direction contrary to the spirit of federalism. It has also been provided that during the transitory period the board of medical registration would have the trial jurisdiction for registered medical practitioners of the State/UT where there is no State Medical Council without bringing out as to what authority would have appellate jurisdiction. 21. The said Board under Sec. 30(2) would be administered by the President or a Part Time member in singular or a combination of both which is different from the other boards without indicating who would be assigning the said onus to the part time member. 22. Under Sec. 31(1) the Board has the requisite of the licentiate examination which in reality puts a question mark on the credibility of the universities conferring MBBS qualification. 23. NMC has proposed an Exit Exam but has simultaneously proposed that if the person does not clear the exam, he can be allowed to practice on the basis of mercy appeal. Under Sec. 31 (3) (d), exemption can be granted by the Commission to practice without clearing the national licentiate examination. This negates what is provided for under Sec. 31(1) read with Sec 17 of the proposed Bill. This discretionary power is open for misuse resulting in manipulation and corruption. 24. Under Sec. 32, governing recognition of qualifications no provision is made for renewal of the same. 25. Sec. 33(3) provides an opportunity to appeal to central government in respect of medical institutions outside India trying to set up institutions in India but no such provision is made for medical institutions in the country which brings out the grossest medical discrimination. 26. Sec. 35 makes the provision for “other medical qualifications granted by any other bodies which is opening Pandora’s Box in this regard. This would provide a back door entry for non MBBS doctors to enter in the register. The said provision gives absolute authority to the central government to include said other qualifications in schedule 4 which has not been defined. 27. Under Sec. 42(3) merger of National Board of Examinations is brought out with the PG Education Board which is solely aimed at a back door validation of qualifications granted by DNB and upon merger they would be included in schedule 1 of the IMC act. 28. Under Sec. 44, rules can be made by the central government but no modality is providing as to how regulations would be made and what will be the matters on which they would be made. 29. Sec. 45 provides central government with an overriding authority to not only direct the commission to amend the regulations but also direct them to make or revoke regulations amounting to usurpation of the authority of making even subordinate legislation which is un heard of. 30. Further in case the said direction is not implemented by the Commission the Government will Sue-motu can dispense the same on its own. That cannot be a more vulgar way of trampling upon the autonomy in such a high handed manner. The net result would be that the NMC powers which stands centralized in the hands of handpicked President would ultimately will be under the total dictates of the Government resulting in the Commission getting transformed into an extended Babudom of the government of India. IMA RESOLUTIONS For State Councils: Resolved that the National Medical Commission Bill 2016 explicitly takes away the total autonomy vested with State Medical Councils which are independent creation of the respective State legislation and makes them subordinate including sub servient, hence, the State Medical Councils need to oppose the same tooth and nail in their own interest in conformity with the subtle principles of Federalism. For General Public: Resolved that the National Medical Bill 2016 talks of prescribing of the chargeable tuition claimable by the private medical colleges for a % of seats there at from 0 up to 40% and leaving the rest outside the ambit of prescription resulting in fleecing of the poor and meritorious students in a brazen manner at the hands of exploitative private/ corporate sector and resultantly opening free vista for the open ended exploitation, and thereby adding to the cost of the medical education beyond the reach of the ordinary and poor. Hence the Bill needs to be abrogated forthwith in larger public interest. For Media: Resolved that the National Medical Commission Bill 2016, Intends to centralize the power and authority of prescribing the public good in a manner which operationally turns out to be ‘anti poor’ and exclusively catering to rich and thereby adds to the ever widening social divide needs to be opposed by the society at large. For Universities and Health Sciences Universities: Resolved that the National Medical Commission Bill 2016, stipulates denial of legitimate right of the medical education conferring universities in terms of their representation in the composition of the regulatory body in spite of they being the exclusive key player, hence the universities & health sciences universities need to oppose the same tooth & nail. For Professionals : Resolved that the National Medical Bill 2016 in its present form liberally, calculatedly and explicitly provides for the entry of persons without valid modern medicine registering qualification to be included in the State Medical Register and National Medical Register respectively, thereby getting them entitlement and legitimacy to practice modern medicine, negates the statutory purport of the modern medicine and tramples upon the same. Hence, this gross liberalization of indiscriminate in permissible broadening ending up in free flowing licensing to practice modern medicine by the undeserving at the cost of professional sanctity mandates abrogation of the said Bill. For Member of Parliamentarians: Resolved that the National Medical Commission Bill 2016, in view of the intrinsic anomalies, contradiction, inconsistencies, poor syntaxing and being inconsistent with inclusive dispensation of the desired public good and standardizing quality based medical education, thereby generating effectively trained health man power for an effective medical health care delivery system catering to the mandate of ushering in Welfare State needs to be abrogated. For Youth: Resolved that the National Medical Bill 2016 ultimately would add not only to the ever increasing cost of medical education, but also would end up in dilution of desired standard of the medical education which would not be commensurate with rightful and legitimate expectations of young generation of the country, hence for their insulation of the interests, the youth in general should insist of abrogation of the said ill intended Bill. For the Congress Party in Opposition : Resolved that the National Medical Bill 2016 which has been piloted by the present Govt. is exclusively intended to cater to and provide the coziest cushion to private and corporate players in enhancing their own capital interests and gains at the cost of sacrificing the legitimate right and interest of deserving young and meritorious generation of the country. Hence, the same needs to be abrogated unconditionally.. Proposed line of action: Resolved that the National Medical Bill 2016 which intends to replace IMC Act 1956 with amendments from time to time in reality is expected to cater to the very objectives which existingly are dealt with by the said Act , could be achieved better by updating the same in terms of vesting the MCI with the authority for accreditation of medical institutions, prescribing the national perspective development plan for establishment and geographical location of medical colleges, to tide over the mal distribution, being vested with the authority for prescribing service conditions and pay scales for medical teachers and invoking developmental grants vide 5 years planed period for medical education, hence the proposed bill needs to be abrogated. For State Governments: Resolved that the National Medical Commission Bill 2016, is a gross attempt towards usurping the legitimate authority of the State Government vested with it on the matter included in the concurrent list appended to the Constitution of India, therefore needs to pick up the emanating signals there from in the interest of upholding their rightful authority should insist on abrogation of the same, For Professional & Specialty Associations: Resolved that the National Medical Bill 2016 in its present form brings explicitly professional & specialty association under its ambit of disciplinary and ethical jurisdiction in spite of the fact that they are not registered under the State Medical Register or the National Medical Register, as the case may be, as an association, the same therefore amounts to annihilation of their statutory authority . As such the said Bill is required to be abrogated in order the uphold the honor, dignity and authority of the specialty / professions respectively. For State Governments : Resolved that the National Medical Bill 2016 in its present form is trampling upon principle of federalism , equity, equitability and explicit single meaning of the specific inclusion under it leaving open the area of ambiguity providing for lenient scope for wide varied & convenient interpretation which does not fit in to construing the same as an ideal peace of legislation in larger public good, hence, needs to be abrogated. For other Professional Councils: Resolved that the National Medical Bill 2016 at the cost of annihilation of even the vestiges of autonomy of a regulatory council with reference to MCI as of now would widen the same to devour the health professional councils created wider appropriate parliamentary enactments and also other professional councils need to get alarmed vide the said signal to nip the generated evil in bud by seeking its abrogation. For Society at large: Resolved that the National Medical Bill 2016 in spite of making laudable claim to achieve public good in reality is ending up in centralizing in the entire power and authority in the hands of the handpicked nominees nominated by the government in an autocratic manner and imposing the un required condition of the licentiate examination which defy the set out the democratic and constitutional norms ending up in catering to the cause of the rich and corporate at the cost of negating the claims and expectations of the deserving and the meritorious poor, and thereby bring out its ugly human face needs to be abrogated forthwith.

Excessive alcohol consumption continues to damage the society, economy and the health of the individuals

Excessive alcohol consumption continues to damage the society, economy and the health of the individuals It is the cause of death of over 2.5 million individuals every year (almost 4% of all deaths worldwide), and the third leading risk factor for poor health globally, accounting for 5.5% of disability-adjusted life years lost New Delhi, 04th October 2016: Excessive alcohol consumption and under-age drinking are common issues, which all countries globally continue to struggle with. The urgent need to raise awareness about the evils of alcohol consumption has been brought up by most National and International bodies during their annual meetings. However, till now, no strict action has been taken to curb the menace of alcohol. In a developing country like India, there’s an immediate need for framing a new set of policies, which will focus on reducing excessive alcohol consumption and framing new policies for harm reduction. Speaking on the issue, Padma Shree Awardee Dr KK Aggarwal, President Heart Care Foundation of India and President Elect IMA said, “The government should start with formulating new policies, which will focus on reducing the harm caused by excessive alcohol consumption. They should also impose some staunch legal and regulatory measures to limit the access to alcohol in cases of individuals who are below the certain age. The focus should be laid on creating new healthy and social policy interventions regarding alcohol, consumption by targeting vulnerable groups like high-risk drinkers. At present, the country already has some existing policies but they are not being properly implemented in the required areas. Bringing in international public health advocacy and partnerships to educate individuals about the ills can definitely help to free society from the shackles of alcohol consumption.” As far as our health is concerned, alcohol weakens the communication pathways of the brain, which causes sudden mood shifts, changes behavior and weakens the ability to coordinate. Excessive drinking can aggravate severe cardiovascular issues like cardiomyopathy – stretching and drooping of heart muscle, arrhythmias – irregular heartbeat, heart stroke and high blood pressure. Not only this, excessive consumption can cause liver inflammation problems like steatosis, or fatty liver, alcoholic hepatitis, fibrosis and cirrhosis. It is also a leading cause of obesity. A few measures that can be considered to reduce health burden of alcohol consumption • Increase alcohol prices, through taxation • Regulate access and availability of alcohol by limiting the hours and days of sale, the number and location of alcohol outlets and licensed premises, and the imposition of a minimum legal drinking age • Public authorities must strengthen the prohibition of selling to minors • Practicing alcohol marketing in a restricted way • Increase public awareness of harmful alcohol consumption

First Treat-to-Target recommendations for gout

First Treat-to-Target recommendations for gout The first treat-to-target recommendations for gout based on the available scientific evidence have been published online September 22, 2016 in the Annals of the Rheumatic Diseases. The main treatment goal is to reduce levels of serum uric acid to a target of lower than 6 mg/dL and to maintain that level. While the target serum uric acid level in patients with severe gout, such as tophi or frequent attacks should be below 5 mg/dL. Decrease in pain, presence/absence of attacks and the amount/reduction/absence of tophi are other three treatment targets. The recommended outcome measures have been grouped into three: • Clinical: Pain, number of joints involved, number of attacks/year • Lab: Serum uric acid, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), serum creatinine • Patient-reported outcomes: Quality of life, short form 36, work status, productivity, work days off and absenteeism. The Expert Group recommends prompt treatment of acute attacks with appropriate anti-inflammatory drugs taking into consideration the presence of comorbidities. Educating patients about the disease, lifestyle changes and the need to adhere to treatment even in absence of acute flare-up of disease to reduce risk of hypertension, heart disease, and kidney disease is also highlighted in these guidelines. These recommendations were developed by an international Expert Group that included 11 rheumatologists, one cardiologist, one nephrologist, one general practitioner and one patient with gout.

Beware: CDC reports rise of polio-like illness that causes acute flaccid myelitis with paralysis

Beware: CDC reports rise of polio-like illness that causes acute flaccid myelitis with paralysis Cases of acute flaccid myelitis, a polio-like illness, which is causing paralysis are being reported from the United States. According to the Centers for Disease Control and Prevention (CDC), such cases have shown an increasing trend and there has been an increase in reports of confirmed AFM cases this year compared with last year. This year, 50 people in 24 states in the country had been diagnosed with acute flaccid myelitis (AFM) between January 1 and August 31, 2016, compared with only 21 people in 2015 in 16 states. While 120 people, mostly patients 21 and younger, in 34 states, were diagnosed with the condition from August to December 2014. Acute flaccid myelitis affects the nervous system, the spinal cord in particular. The etiology still remains unknown, but viral infections such as polio and non-polio enteroviruses, adenoviruses, and the mosquito-borne West Nile virus have been implicated. Enteroviruses can cause neurologic illness such as meningitis, but more serious disease like encephalitis and AFM are less common. Symptoms include sudden onset of weakness in the limbs and loss of muscle tone. Some patients have pain in their arms or legs though numbness or tingling is rare in these patients. Other symptoms include difficulty in swallowing, slurring of speech, facial weakness. In very severe cases, respiratory failure may occur due to the weakening of the muscles of respiration, which may necessitate urgent ventilator support. There is no specific treatment. The outbreak of acute flaccid myelitis in the year 2014 coincided with an outbreak of enterovirus D68. The CDC is encouraging healthcare providers to be vigilant for AFM among their patients, and to report suspected cases to their health departments. CDC has also cautioned people to: • Wash their hands with soap and water • Avoid close contact with sick people • Clean surfaces with a disinfectant, especially those that a sick person has touched.

IMA and AHPI appeal government to clear payments of CGHS empanelled hospitals

IMA and AHPI appeal government to clear payments of CGHS empanelled hospitals

It is an irony that CGHS fixes the rates by calling tenders and then makes L1 as the industry standard, a practice unheard anywhere in the world; said Dr KK Aggarwal, President Elect, IMA and Dr Girdhar Gyani, Director General of association of Health Care Providers of India.

Addressing a press conference, the doctors said that most rates fixed by CGHS are illogical and unviable. They said that none of the hospitals that follow standard protocols should accept to be empanelled under these conditions.

Today hospitals are forced to accept these rates as most PSUs and even other central government schemes empanel hospitals, if they are empanelled with CGHS.  In a way hospitals get exploited by the CGHS.

World over quality and patient safety are driven by regulator and/or payers. It is ironical that CGHS does exactly the opposite. It shows the least respect for patient safety and purchases health services for its valued employees as if it was procuring POTATOs or ONIONs.

In the process, patient safety is bound to get jeopardized. The government should realize that it was duty bound to ensure that population get safe (first) and affordable (later) health services.

CGHS should adopt rates of medical procedures on a scientific basis.

The government should invite rates from NABH accredited hospitals, which are certified on highest possible standards of patient safety and after verifying their scope of services in terms of systems, processes, equipment, manpower etc. CGHS can later take the average and apply it across the country.

In spite of accepting unviable rates, least CGHS could do is to make payment to hospitals in time. It is ironical that CGHS as a government agency is not respecting/adhering to the written agreement to pay 70% of fee within 5-days.

Till date not a single bill has ever been paid in this stipulated time. On the contrary, it takes months and years before hospitals are paid their dues. The situation is so grim that hospitals have begun to bleed due to huge outstanding amounts. The system is so bad that at any point of time the total outstanding due to hospitals remain between 200-300 crores for months. One group of hospitals in NCR has an outstanding of 75 crores since the past 3 months. Similarly, one super specialist hospital has an outstanding of 25 crores. Outstanding of the hospital also includes the payments to be given to the treating doctors.  

How will a doctor or a medical establishment work if the payments are not given to them in time.  The doctors have provided all services without any delay and that too when the services are being provided for peanut worthy amounts.

The CGHS charges for Septoplasty are only Rs 6613, for tonsillectomy are 5750, for appendectomy are 9324, for Coronary Care with Cardiac Monitoring are 863 and Ventilator Charges per day are 611. In routine, one cannot cover this cost, so then how can one absorb the cost of interest and delayed payment.

Many hospitals are being pushed to the limit of unsustainability on account of huge outstandings from CGHS.

Similar schemes are being run by state governments like TN, AP, TELANGANA etc. These schemes are fully digitized and payments are made within 2-4 weeks. In case of CGHS, officers in the rank of Additional Secretary are running the scheme and yet we have not been able to make it objective, transparent or dynamic.

As per MCI Ethics Regulations, doctors are supposed to uphold the dignity and honor of the profession.  Their main object and the very purpose of their practice are to render services to humanity and any reward of financial gain has to be a subordinate consideration. They are supposed to give priority to the interest of the patient.  Their personal financial interest should not conflict with the medical interest of the patient.  I am supposed to announce my fee before rendering service and not after the operation or treatment. They cannot enter with a no-cure no-payment agreement with my patients.  They are supposed to provide my services without expecting any considerations. They have an obligation to the sick and I have to see to it that the patient is not neglected. 

They are not supposed to insist for any advance money for providing treatment to a road traffic accident in emergency and are supposed to provide free treatment to all patients with acid burn, rape and child sexual abuse. 

Their charges, as per Clinical Establishment Act, have to be reasonable and can be controlled by the state Govt.

The doctors all these years have been accepting and adhering to all this with humility, but they deserve to get their legal dues in time.

If they are required to be punctual while giving services to patients they are also entitled to get my reimbursements in time.  How can one survive if CGHS, ESI, PSUs or insurance companies do not clear my dues in time?

If they have some doubts and clarifications due, they can withhold that part of payment and clear the rest. Many hospitals pay the consultants all their dues if they agree to get 5% deducted from their payment. 

All payments given after the due agreed date should be reimbursed with the market interest rate.  When a Consumer Court awards compensation against a doctor and in favor of a patient, the doctors are required to pay the compensation along with the interest rate.  In the famous Anuradha Saha Case the Supreme Court decided a compensation of Rs 12 Crores and out of this 50% was the interest amount.