KPME Act: A Medical Discourse.
A perspective of the accused.
An article by: Manasvi Nag, Deeksha D’sa, Keshav Jhawar and Anushree S.
The Karnataka Private Medical Establishments Act was passed in 2007, to bring a comprehensive legislation which was considered necessary in place of the Karnataka Private Nursing Home (Regulation) Act, 1976. It was done to have an effective control over Private Medical Establishments (PMEs) in the State. The main purpose of the bill was to regulate the PMEs by making their registration a compulsion and laid down the standards and guidelines that they are supposed to follow in order to efficiently manage and control their quality of services. The Act also constituted of providing a prescription of the charges payable for the medical treatment and other services received in advance, in the form of brochures or booklets and mentioning the legal and statutory obligations that these PMEs are bound to follow. It required all PMEs to maintain and report crucial data pertaining to the National healthcare programmes and facilities. It also allowed members of the family of a patient to avail a copy of the observations, treatment, investigation and diagnosis belonging to the particular patient. The bill also clearly stated that if the provisions of the act were to be violated, it could lead to serious consequences such as a suspension, suffering penalties or even cancellation of the registration.
But recently, in the year 2017, the government suggested a few amendments in the law, in order to provide affordable and quality healthcare facilities for the welfare of the people. It aimed to strengthen the law by making the bill more people centric. This amendment intended to increase the transparency between the private sector and the people by making them more accountable to the government. It gave the government a stronger sense of authority over the private medical associations as they would now oversee all their actions in a detailed manner. It also suggested fixing uniform package rates for various treatments under the health assurance schemes of the state government.
Although, as expected, the private doctors were unhappy with the proposed amendments and they displayed their unhappiness in a full-fledged strike and a rally. On the 17th of November, 2017, more than 35,000 private doctors got together on the streets of Belgavi and protested against the amendment brought about by the health minister of Karnataka, K. R. Ramesh Kumar. Following the day of the strike, there was a bandh in the state of Karnataka and all private doctors, along with their clinics closed shops. This attracted the attention of everyone in the state and awareness was created amongst the people about what exactly had happened. According to our sources, the health activists and the localites who were unable to pay the ‘overpriced’ bills of the private doctors, were in favour of the bill whereas, the private doctors, on whom the impact was to be made, were against it. The rally resulted in the death of 22 people; however, we do not know the actual reason behind their death.
Our team interviewed some private doctors who were present at the time of the rally to know their perspectives on the issue. The private doctors, who were, obviously, disrupted by the proposed bill, believe that even though the government was bringing about the bill for the betterment of the public, it was ultimately going to harm them. A lot of changes, according to these doctors, must be brought in the bill so that the benefit of the doctors is also kept intact. According to the new bill, the doctors, when accused of any misconduct, cannot be represented by any legal entity and can directly be imprisoned. Although, initially, the doctors could be imprisoned for life, but now the tenure has been reduced.
“There were two entities; they wanted to put the charges as well as imprisonment on doctors who would quote a body dead or unduly charge the patients with really high prices; and, if the patient has the evidences of the same, then they can sue the doctor [sic]”, according to Dr Puneet.
When further questioned, Dr Puneet stated his personal opinions regarding the issue and also mentioned that it was highly possible that this amendment was brought about right now; in order to gain the public’s support, keeping in mind the upcoming elections. According to him, a lot of people have a negative notion for the doctors and do not understand the doctors’ stance. He later emphasised on the fact that even doctors have to pay their debts which they might’ve taken in order to buy the expensive equipment and to set up their clinics and hospitals, and, putting a cap on their prices will just result in people losing interest in the profession and moreover, them losing faith in their abilities.
When another private doctor, Dr Vidya T. S. was questioned, about the same issue, she said “The end decision is made by a lawyer or a politician, who would decide whether your procedure was done rightfully or not. They are people who have no knowledge about medicine and fail to understand our point of view.”
Having attended the rally and being a part of the strike, Dr Vidya expressed that the concerns of the private doctors were genuine and that the government was the only one who could help them out. When asked about the details of the rally, since both Dr Vidya and Dr Puneet had first-hand experience, they mentioned that antagonistic attitude towards the government was questioning the means of their livelihood.
Another point was brought up was the concern against the fixed bracket of price which said that the doctors who have their own clinics are at a greater loss than the ones who work in a private medical institution as, the prices, with regards to the bill, are fixed and cannot be changed from disease to disease, or according to the doctor’s consultation, and thus the private small-scale doctors lose on their income. The private doctors are found to be strongly opposing this fixed bracket of price as they believe that every patient and his case is unique in its own way, and so is the way of treatment.
The political perspective is, as mentioned before, very questionable. According to our research, the proposed amendment was just a tactic to gain public support for the upcoming elections in the month of April, as it was brought about by the ruling Congress party. At the same time, the BJP state president, B S Yeddyurappa, stated that these amendments are in an “undue haste”, and has also probed the Congress government to withdraw the bill immediately; he further claimed that if his party was voted into power in the coming state elections, the proposed bill would be scraped within the next 24 hours.
Apart from the private doctors’ view, there were some other countering points found as well. “The regulation is not a violation of doctor’s rights. In fact, it protects the patient’s rights. It is a tragedy that this has become a doctor-versus-patient issue”, said Sylvia Karpagam, doctor and researcher. A group of citizens have formed a support group to counter the narrative of private doctors as “victims”. (Read the full article by The Hindu here)
Our team also questioned some aspiring doctors in medical schools to know their perspectives. Their reply to our question, “Should the government be allowed to regulate the prices of the medical procedures?” was that the government has very less knowledge when compared to the medical professionals and they should be allowed to regulate their procedures. Although, it doesn’t mean that the private doctors should overcharge their patients for the treatment that they provide.
When our reporters asked for some solutions for this problem, the private doctors suggested that it is not the government that is supposed to rule, it is the people. Although, the people who are not aware about the act are tend to blindly follow their leaders. For this to be rectified, the private doctors will have to go from door to door explaining their perspectives, and medical stalls can be put up, creating awareness, especially in rural areas , where there’s absolutely no knowledge about process or the act. The only possible solution is for the people to become aware of all the perspectives, including that of the private doctors.