The amended KPME Act – a sterile gauze for a festering wound

With 20,000+ doctors going on indefinite strike against the state Government’s proposed amendment of the Karnataka Private Medical Establishments (KPME) Act, 2007, the Government gave in to their concerns and diluted the amendment bill. Prajwala Hegde (Twitter: @PrajwalaH) has more.

The Karnataka government's initiative to regulate the private healthcare sector resulted in a massive strike by doctors last month, with the backlash eventually forcing the government to go soft.

More than 20,000 doctors in the state went on a strike early November as the government was about to table its amendment (2017) to the Karnataka Private Medical Establishments (KPME) Act, 2007to regulate the functioning of the private medical sector and fix a cap on how much they can charge the patients. The proposed amendment came forth with 14 amendments, some of which got the doctor’s goat. The proposed controversial changes to the Act included longer jail terms and higher monetary fines in case of alleged negligence or malpractice.

Proposed changes

Among other things, the bill proposed the cost of health services be fixed and private hospitals be barred from charging any amount in excess of these set prices. The bill said establishments would be required to display a patient’s charter, which talks about the rights of patients, as well as a Private Medical Establishment's Charter prominently and that in the event of death, the body of the deceased should be handed over to the kin immediately without insisting on payment of dues.

Further, the bill said private hospitals would need to display brochures that give complete information to the patient, including full cost, risks and benefits before the treatment begins. The bill also had provisions for redressal of patients’ grievances. It said any patient or healthcare provider could approach the district grievance redressal committees with its plaint. The amendment would have made it mandatory to provide life-saving or stabilizing emergency measures without insisting on advance payment.

The bill also clearly spelt out penalties for doctors and medical establishments that fail to comply with the new norms. For example, the fine for running a non-registered private medical establishment has been increased from Rs. 10,000 to Rs. 5 lakh. Similarly, the fine and term of imprisonment for non-adherence to the rules regarding maintenance of clinical records and payments has been increased from six months and Rs. 2,000 to three years and Rs.1 lakh.

Also, the bill stated that complaints pertaining to negligence, non-adherence to standard protocols for treatment, procedures and prescription audit shall be referred to the Karnataka Medical Council for inquiry.

The bill was first tabled in the assembly in June and later sent to the joint select committee after doctors and medical professionals opposed it.

Ridiculous suggestions

Dr. Alexander Thomas, President, Association of Healthcare Providers India (AHPI), said, “I have also worked extensively with the government and I was part of the original bill [recommendations made by the committee headed by the then Chief Justice of Karnataka High Court Vikramajit Sen], which was patient-centric. Even that didn’t have the ridiculous jail terms, which have been removed now post our fruitful discussion with the CM. Even the price capping wasn’t there in the earlier bill. That’s how the common man in Karnataka has access to state-of-art healthcare and we need to understand that hospitals need to be financially viable. Regulation of private healthcare is alright, but it needs to be logical.”

He referred to a study titled ‘Karnataka Public Health Policy’ prepared by the Karnataka Jnana Aayoga Task Force, of which he is the member secretary and said public healthcare can be improved when the government and the private sector work together.

Public support

In a letter addressed to the Chief Minister, Health Minister and members of the Legislative Assembly, more than 16 civic organisations (Karnataka Janaarogya Chaluvali, Alternative Law Forum, Slum Janadolana Karnataka, Mahila Munnade, Karnataka Rajya Raitha Sangha, among others) expressed their support for the bill. These organisations urged the government “to stand with the vulnerable citizens of the state and demand that legislators and ministers not give in to the private hospital lobby.”

Health activists who were in favour of the bill’s punitive measures believe that there is a lack of transparency in the way private hospitals function. Dr. Sylvia Karpagam, public health doctor and researcher, said, “I do support regulation of the private healthcare establishments. The original bill by the joint panel was progressive and had evolved out of a need. A lot of funding goes to private hospitals via government schemes but still there is no restriction on what they can charge the patients. This is not even a bill that is against the doctors. In fact, there should be a whistle-blower clause wherein doctors in private hospitals can report against unethical practices. The private hospitals do thrive on illness and that is not a good thing.”

Bill defanged

The government and the protesting doctors reached an “amicable settlement” that led to the withdrawal of the indefinite strike on November 17. The agitating doctors withdrew the strike after meeting Chief Minister Siddaramaiah and an interim order passed by the Karnataka High Court, directing them to restore their medical services.

A diluted version of the bill was passed by a voice vote in the Assembly on November 22 after dropping a jail-term clause for the doctors. Ajay Seth, Additional Chief Secretary, Health and Family Welfare Department, said that this bill seeks to enhance the issue of transparency in a significant manner. “We have started work and we will be drafting the rules within a month. We are applying our minds to frame the rules, which will be, in turn, reviewed by the expert committee. Later, there will be a 15-day period wherein we will invite recommendations from the general public.”

When asked about the public perception of how policy decisions are taken mostly by the private players, who in turn dictate terms to the government, he said, “It was a wrong perception since framing of policy follows a due process. It doesn’t happen in secrecy.”

Plaint against IMA

During the doctors’ strike, which went on for four days, 51 deaths were said to have occurred due to non-availability of medical help.

A Bangalore-based advocate lodged a complaint against the president of Indian Medical Association (IMA) Dr HN Ravindra and its secretary Dr B Veeranna for "instigating doctors to go on strike, leading to disruption of the services."

Refuting these allegations, Dr Ravindra said, “IMA did not call for the protests. We only called for ‘Belgaum Chalo’ and the protest on November 13, based on the working committee decision. I only threatened to go on fast unto death if government passed the act.”

He believes that the proposed KPME Bill will be “miserable for the public in future and the government is trying to show that they are pro-public through this populist Act.” He also alleged that the government has failed to pay private hospitals to the tune of Rs660 crore in the last two-three years for subsiding schemes under Yeshasvini scheme.

He added that there is a lot of ambiguity surrounding several provisions and they already have the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002, to regulate the private healthcare sector. On the amendment regarding releasing dead body to relatives without insisting for payment, he said that there is also a 2005 Supreme Court verdict on this for medico-legal establishments.

Even as the private sector says the bill was being unduly harsh on them, the government’s act of withdrawing the controversial amendments has left the citizens underwhelmed. They say the government flattered to deceive, buckling under the pressure of the private sector.

Ever wondered why a doctor referred you for a lab test or a scan – either an MRI, CT or ultrasound, when you thought you didn’t need one? Or referred you to a particular laboratory for medical tests? The reason is not surprising – there’s a nexus between the doctors and the labs.

On December 1, the Income Tax department raided a few Bengaluru-based doctors and diagnostic centres and the raids revealed a deep seated nexus between the two. Media reports after the raids revealed that documents obtained during the raids indicate that doctors receive commissions for referrals for laboratory tests and scans ranging from 20% to 35% of the cost of the test.

IT sleuths seized about Rs 1.4 crore in cash and about 3.5 kg of jewellery and bullion during its three-day action against two in-vitro fertilisation (IVF) centres and five diagnostic centres.

Officials said, in some cases, the referral fees were paid to doctors in cheque and was shown in books as professional fees. The investigation found that cuts for doctors were found to be around 35% for MRI tests,20% for CT scan while Labs admitted to previously undisclosed income which exceeds Rs. 100 crore.

IMA Karnataka Chapter busts myths related to KPME bill

Bengaluru: The face-off between the government and private hospitals over the Karnataka Private Medical Establishments Act, 2007 traumatized several people, patients in particular with doctors unitedly opposing what they called the ‘draconian’ bill. Over 22,000 doctors and more than 6,000 hospitals and clinics across the state kept off their OPD services indefinitely from November 16th morning. The strike was subsequently called off after a sit down with the state Government and a diluted bill was tabled and passed in the Karnataka Assembly.

The media latched on to the face-off between the striking doctors and the government, while the ailing public were caught in between. Several versions of the reasons as to why the doctors opposed what many patients viewed as a transformative welfare measure executed by the Government on their behalf floated around in the media.

According to the IMA Karnataka Chapter, these reports are not in sync with the actual reasons as to why the doctors opposed the bill tooth and nail. The doctors had their own valid reasons for opposing the bill, which they set out in a rebuttal to these reports. We reproduce here below the text of that rebuttal so that our readers can judge the merits of the (original) bill for themselves. (The rebuttal was on the original amendment proposed)

KPME Facts and Myths

1. Media report- KPME Act is for registration of private hospitals which doctors are against.

Fact: Doctors already register their clinics, and renew it once every 5 years. This amendment makes it once every 3 years.

Why we oppose: At present, there is already a ‘LICENSE RAJ’, where we are forced to run from one office to another, often dealing with bribes and corruption to register our clinics. This amendment will only increase corruption and harassment of doctors.

2. Media report: This amendment helps patients get justice against doctors which is opposed by doctors.

Fact: This amendment establishes a district redressal body, made of 6 members, headed by the Panchayat head, with only 1 member as a doctor, and others by non-professionals. A doctor has to represent himself in case of a complaint, without a lawyer.

Why we oppose:
A) It is not possible for a non medical professional to make judgement on a doctor's decisions. This body will harass doctors and increase corruption.
B) If a doctor has to represent himself for any complaint, who will look after his patients?
C) There are already several bodies for patients to complain, including consumer court, civil court, medical body. Another body is unnecessary and only serves to increase fear in a doctor’s mind.

3. Media report: This amendment is to control corporate hospitals, not small clinics.

Fact: the amendment applies to all private establishments.

Why we oppose: Small clinics and nursing homes are run by 1 or 2 doctors, without any management staff. They form the backbone of healthcare in most rural areas. They will be worst hit by this amendment, and might be forced to shut down, which will be disastrous for the general public.

4. Media report: The government is already providing Healthcare at affordable rates. The private sector needs to be regulated.

Fact: The government spending on healthcare is abysmally low. WHO advises spending 10% of GDP whereas in India it is 1 per cent? Karnataka has fewer dispensaries per 1000 population than any neighbouring state.

Why we oppose: The government has failed in its responsibility to provide good public healthcare. Instead of improving their facilities they are seeking to curb private establishments. This will only lower private establishments to government level.

5. Media report: Private hospitals are looting patients and earning huge profits.

Fact: Most private establishments do not break even for 5-10 years. After that their profits are in single digits. This is in large corporate hospitals. In smaller nursing homes, doctors aim to earn. Enough to pay their staff and give a good future for their children.

Why we oppose: The government offers ZERO subsidies to private medical establishments. We buy land at commercial rates, pay commercial tax, GST, water all at commercial rates. Industries pay Rs 5 per unit for electricity. We pay Rs 8 per unit. When the government is not subsidizing us in any manner, what right do they have to set our prices.

Moreover there is a wide variety of services available for the same condition. One Company laser machine is available for Rs 2 lakh, another for Rs 45 lakh. How can both be charged the same? What is the incentive for any hospital to invest in new technology or improve service if the rate charged is the same no matter what. Why should a doctor spend money and go abroad to train, if he has to charge the same as someone doing an inferior procedure? This amounts to communism and cannot be sustained. It will lead to a collapse of the Healthcare industry and that is not an exaggeration.

At the end, the protest is in everyone's interest and not just the doctors.

(Prajwala Hegde is a Bangalorebased freelance writer and a member of 101Reporters.com, a pan-India network of grassroots reporters.)


Disclaimer: The opinions expressed within this article are the personal opinions of the author. The facts and opinions appearing in the article do not reflect the views of Karnatakatoday.com and Karnatakatoday.com does not assume any responsibility or liability for the same.