amc-noah “gates open”dr. gupta mukesh co-editors dr. baliga pradeep dr. rao nitin dr. sushmita...

For Private Circulation Only

Vol. 41 │ Issue No. 4 │ February 2013Official Journal of the Association of Medical Consultants, Mumbai Published Quarterly in May, August, November, February

IN THIS ISSUE• Amc NoAH• Do’S & DoNT’S• Amc INDIA• mEDIcAl ETHIcS• AmcoN 2013 mEmorIES• rApE lAw• From THE prESS

AMC-NoAh “GAtes opeN”

Vol. 41 l Issue No. 4 l February 2013 1

EDITORIAL BOARD

EDITORDr. Gupta Mukesh

CO-EDITORS Dr. Baliga Pradeep

Dr. Rao NitinDr. Sushmita Bhatnagar

Dr. Baid Deepak

ADVISORY BOARDDr. Kapoor Lalit M.

Dr. Rao P. N. Dr. Oza Umesh

BOARD OF TRUSTEES MANAGING TRUSTEE

Dr. Shah Bipin V.

TRUSTEESDr. Badwe ShrikantDr. Kate SuhasDr. Nayak AchyutDr. Oza UmeshDr. Pandit Bipin Dr. Rao Suresh S.

WEBSITEwww.amcmumbai.com

WEB EDITORSDr. Checker Vipin

WEB CO-EDITORS Dr. Arshad G. Moh’d.

Dr. Rao Sujata Dr. Dani Saurabh

DISCLAIMERUnless otherwise stated, the opinions expressed by the writers are their personal opinions. The AMC reserves the right to use material published in ‘The Grasp’ for its Website or for any other purpose deemed necessary.The appearance of advertisement in ‘The Grasp’ is not guarantee or endorsement of the product or the claims made by the manufacturer/ advertiser.

ASSOCIATION OF MEDICAL CONSULTANTS, MUMBAI4, Ganpati Niwas, Old Police Lines, Opp. Andheri Station,

Andheri (East), Mumbai - 400 069.Tel.: 2684 4639 / 2683 6019 (10 a.m. to 6 p.m.)

Telefax : 2682 1109e-mail: [email protected]

MANAGING COMMITTEE (2012 - 2013)President Dr. Adyanthaya Kishore Imm. Past President Dr. Ajay HarianiImm. Past President Dr. Niranjan AgrawalVice President Dr. Naik Sudhir Vice President Dr. Sabh KhambayPresident Elect Dr. Rao Sujata Hon. Secretary Dr. Pandit Veena Hon.Treasurer Dr. Pikale SangeetaHon. Jt. Treasurer Dr. Baliga Pradeep Hon. Jt. Secretary Dr. Chawhan Rajendra Hon. Jt. Secretary Dr. Sharma Smita Prog. Committee Chairperson Dr. Parikh Hitesh Office Secretary Dr. Vazzifdar Khurshed Editor- The Grasp Dr. Gupta Mukesh

ZONAL DIRECTORS

Dr. Agarwal Shivbhagwan N. Dr. Badwe Shrikant Dr. Dave Rajesh Dr. Desai Ajit K. Dr. Kulkarni Gurudas B. Dr. Naik Dilip S. Dr. Oza Umesh Dr. Shah Bipin V.

COMMITTEE MEMBERSDr. Badwe Rohini Dr. Pradhan Sunay Dr. Bahekar Pramod Dr. Rao NitinDr. Baid Deepak Dr. Shah JayeshDr. Bhatnagar Sushmita Dr. Shah SuhasDr. Bhatt Hitesh Dr. Shetty RathnakaraDr. Checker Vipin Dr. Shukla Ashokkumar Dr. Dani Saurabh Dr. Sundaram Natarajan Dr. Khambay Sabh Dr. Suradkar ShekharDr. Lokras Girish Dr. Vaidya DeepakDr. Patel Manoj Dr. Vora AgamDr. Pattiwar Sanjay Dr. Worlikar Umesh

CHAIRPERSON OF CELLSConsultants Benevolent Scheme Dr. Shah Bipin V.H & A Cell Dr. Rao Suresh S. MMC Cell Dr. Pandit BipinInfrastructure Cell Dr. Naik SudhirMedico Legal Cell Dr. Datar NikhilSocial Service Cell Dr. Agarwal Shivbhagwan N. Public Relations Cell Dr. Pikale SangeetaAffiliate Unit Cell Dr. Agarwal NiranjanDirector AMC India Dr. Kapoor Lalit M.

Edited by : Dr. GUPTA MUKESHCo-ordinated at MAGNA GRAPHICS, 101 C-D Govt. Indl. Estate,

Kandivli (West), Mumbai – 400 067For Association of Medical Consultants, Mumbai. (For Private Circulation Only)

Contents

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Edit Speak - Dr. Mukesh Gupta

President Precept - Dr. Kishore Adyanthaya

Secretary’s Report - Dr. Veena Pandit

Do’s and Dont’s - Dr. Lalit Kapoor

AMc India---An Idea Whose Time Has come!

End of the Road for Small Nursing homes?

AMc Professional Indemnity Scheme an Update

Medical Ethics and Law-Complement or Conflict

Ghost Faculties, Rogue Institutions And The Medical council Of India

AMcON 2013

I am not God... (Poem)

Do we need to have any amendments in existing law regarding rape victim?

From the Press

NoAH - Preamble

Vol. 41 l Issue No. 4 l February 2013


Dear Friends,

The last Grasp of this volume comes to you with an interesting threshold of events. Besides the yearly change over this also marks the flurry of expansion and focused activities by the AMC. Pan India presence of AMC is becoming more and more of a reality. To sail through the rough waters of the travails of running a small nursing Home AMC has successfully launched the true to its name NOAH- Network of AMC Hospitals. There is no doubt that the power lies in the Unity. This has to be realized to its full potential.

With the election time in various associations what comes to mind is that why do we need these elections every year? Can we not have longer tenure? It’s mostly the same set of people who keep working in the organizations. To understand this we can draw eg from the sports. In sporting teams, in spite of being in the winning side, players always face the problems of monotony, lack of opportunity of family time, loss of focus, distractions, falling prey to the ‘nasha’ of power. By regular change of guard complacency is removed. Some fresh people always join in and bring freshness to the stagnating direction of thoughts. It gives appropriate time to groom newer leaders and

also make them do various positions in the organizations to understand the true essence of the organization better. People just tagging in the organization without contribution are given exit route. The only downside is repeated exercise of request for votes and disturbance for some in form of smses etc. Well also it is an opportunity to connect with the whole association to understand their perspective.

The latest salvo in the insensitivity of authorities comes in the form of changing definition of Hospital as a service provider for the insurance sector- mediclaim .Only hospitals more than 15 beds are considered eligible and rest not. How can a simple point not register in relevant minds that the cost of claims will only skyrocket if the insurance is providing reimbursement only to bigger hospitals. This is in direct conflict to the national policy of making health care affordable, easily accessible, acceptable and near the doorstep of the population. Some times we just cannot fathom the inexistence of common sense.

Life is full of these situations. Just when we think the problem is almost over a new dimension of issues crop up. Classic example of this is the Fire NOC issue. There is a sense of hopelessness

Dr. Mukesh Gupta

edit Speak Edit Speak - Dr. Mukesh Gupta

President Precept - Dr. Kishore Adyanthaya

Secretary’s Report - Dr. Veena Pandit

Do’s and Dont’s - Dr. Lalit Kapoor

AMc India---An Idea Whose Time Has come!


AMc Professional Indemnity Scheme an Update

Medical Ethics and Law-Complement or Conflict

Ghost Faculties, Rogue Institutions And The Medical council Of India

AMcON 2013

I am not God... (Poem)


From the Press

NoAH - PreambleVol. 41 l Issue No. 4 l February 2013 3


which comes in the mind. There is many a times lack of inclination of authorities to create clear solutions to the problems and rather push it further…sometimes awaiting their tenure to get over or sheer not wanting to take responsibility for the radical correct decisions. This is the time when we start thinking of concepts like…unity , faith , perseverance, focus, hunt for newer perspective etc.

With all these stress and sufferings in our mind we fail to perceive the existence of fulfilling happiness. Recently at a workshop of AFG, Nitya Shanti a corporate trainer with a past history of being a Buddhist Monk had beautifully enchanted the audience on various facets of being Happy. Some of the important aspects he said was that Happiness is an inside job. The most important part is to learn to live in our own skin. We need to differentiate between our business, other’s business and God’s business. We keep worrying about other’s business…activities,other’s wrong doings and get worked up. Similarly we look at natural calamities, and get stressed. This does not mean we become a recluse. Lets follow the three principles interestingly put forth by

Vulcan Nick—Be Thankful, Dream Big and Never Give up.In tough times remember even the arrow is needed to be pulled back before its onward journey forwards.So if we get slow don’t bother as the fast growing trees are chopped earlier whereas slow growing tree are not used hence survive longer. ”The Fastest way is infinite patience”Reality is much easier than the stories we tell about what bad happened .thus reliving the bad past is worse than actually experiencing it. Also worrying about what can go wrong next is only going to add to our suffering. What is expected of us is to look at the present and focus on inner peace. But do not stop- Keep moving ahead, even if slowly….but surelyWith these words I take leave as the Editor of Grasp , which I felt gave me a fulfilling experience of life in this journey. I take pride in the feeling that I was in this position when the Grasp took the new avatar of colored version from its robust black and white foundation.

- Dr Mukesh GuptaEmail : [email protected]

Mrs. Pushpa Eswar (Manager), Pramila, Rupali, Rabiya, Sagar, Kamlesh, Vandana & Vasanti

AMC OffiCe StAff:



President’sPrecept Dr. Kishore Adyanthaya

President, Association of Medical Consultants, Mumbai

It was an interesting year indeed and a real education to me. Running a large

organisation as ours with varied activities, without preparing for it in advance - imagine my plight! It is a daunting task. I wouldn't have been able to fulfill it except for office bearers help, who bore most of the burden.I am indebted to Dr. Niranjan Agarwal, Dr. Sudhir Naik, Dr. Sujata Rao, Dr. Pradeep Baliga, Dr. Sangita Pikale and my Hon. Secretary Dr. Veena Pandit, who were with me every step along the way. I am also thankful to the advice given by Dr. Lalit Kapoor, Dr. Bipin Shah, Dr. Bipin Pandit & Dr. Suresh Rao.AMCON was a success with a great line up of speakers in their specialised fields. Justice N. Santosh Hegde was the most suitable person to deliver the Dr. Jhaveri oration. Mr. Vithal Kamat, Radhanath Swami Maharaj, Mr. Prahalad Kakkar and Ms. Shabana Azmi – excellent speakers – held the delegates spellbound.The newly formed fledgling NoAH is now 202 strong. Following a series of negotiations with Bajaj Allianz insurance company we have finally signed an MOU with them where in they have promised to empanel all our members and at rates which the members are already charging for their non-insured patients. This was a significant achievement. Few more insurance companies will follow. The next step is to negotiate with public sector GIPSA companies, whose PPN network we have boycotted since last two years. In

spite of many meetings we have not come to a settlement. Hope with formation of NoAH we have more bargaining power.We joined a PIL on the TPA issue filed by a consumer inthe Bombay High Court as an intervenor. At the last hearing the court has asked us to givepossible package rates for 44 procedures which could then be incorporated in the policies sothat the patient is aware of what he is entitled to before he makes the choice of his hospital. Wehave engaged the services of HOSMAC to do a costing exercise and also conducting our ownstudy before we decide to submit the packages. All the pros and cons will be examined beforewe take a final decision on this matter.This has been a year of robust growth. Not only in Mumbai and Maharashtra, the home state, but also in the neighbouring states. We have vibrant Affiliate bodies in Mangalore and Bangalore. Who have already started rendering medico legal help and conducting BLS workshops.Hubli- Dharwad will be an affiliate by March. Ajmer, Aurangabad, Jalna and Kolkata all have shown interest and we have conducted seminars on Medico legal issues there. The "Change of User" issue is almost over and the members who have paid have received their COU Certificates. About the registration of nursing homes pending NOC from fire dept AMC has done lots of running around from meeting Fire chief and drafting the norms for a nursing home to



meeting the Addl. Municipal commissioner, Chief Secretary and Secretary of Urban development ministry several times. We have been promised that the conditional NOC issued by Fire Dept if accompanied by a self certification that the conditions have been fulfilled will be accepted for registration.AMC was invited by the Chief Secretary, Maharashtra state, for a meeting with Several NGOs to formulate the health for the state for coming years. It was attended by Officers from the MCGM, Maharashtra State health department, Dean of MUHS and NGOs like Mumbai First, UNICEF, UN population Fund, Armaan etc and several topics were discussed. We informed there that work done by various NGOs have been already undertaken by our association

and are successfully conducting the First Aid Responder Workshop, Blood Donation drive& organ donation awareness, Accreditation of small Nursing Home, Nurses Training Programme, Fighting for the Noise Pollution and Railway accident victims etc. I think we need more PR to see we get credit for the work done by us.

I had a fruitful year and I am thankful to all my committee members, colleagues and friends, well wishers and office staff in fulfilling my responsibilities. I am confident that the new team under Dr. Sujata Rao will take our Association to greater glory.

Long live AMC

E-mail: [email protected]

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Secretary’S reportDr. Veena Pandit

"Hello" to you all in this the last Secretary's Report from me!As usual the Managing Committee has been busy managing the various affairs of our Association with great success in most and limited success in some.AMCON was great success as usual. All the talks and the panel discussion gave very good take home messages. Shabana Azmi's talk on Empowerment for Women was on an apt topic in view of the Nirbhaya tragedy. Our debaters with their oratorial skills kept the crowd glued to their seats.AMC has filed an intervention in the PIL lodged by Gaurang Damani. The High Court has requested us to give packages for 44 procedures. A big "Thank you" to those of you who sent in their suggested charges.After consulting Adv A. Kumbhakoni, it was decided to give the packages mentioning a wide range and for a planned surgery on a ASA Grade 1 adult patient in AC single occupancy room with attached toilet. Charges to vary for all other grades patients. Do remember that the Supreme Court has said that a professional's charges cannot be fixed by others.BMW collection charges:SMS Envoclean has agreed to charge Rs 275/- for one consulting room in a nursing home upto 25 beds; and for two consulting rooms in nursing homes upto 50 beds. In larger hospitals, it will be Rs 275/- per consulting room as per actuals. If there is a dental chair or a pathology laboratory in the nursing home, it will be charged separately.AMC-NOAH is gaining popularity and already has 202 nursing homes as members. AMC-NOAH has

signed an agreement with Bajaj Alliance and negotiations are on with Star Health. We have appointed a facilitator to help our members with all TPA related work. Do join AMC-NOAH and avail of all facilities. Do enroll with Bajaj Alliance.Several committee members met MLAs from their areas and also the Minister for Parliamentary Affairs to sensitise them about the Clinical Establishment Act. This act is expected to be tabled in the budget session.The Fire NOC matter is still not settled. We had a meeting with Chief Secretary Mr. Jayant Kumar Banthia as I pen this. Meeting with the Chief Minister is also on the anvil, to sensitive the CM about the problems of small Nursing Homes.there is still no clarity on the fDA rules.Some nursing homes in Goregaon have received notices asking to install green filters in the drainage from their places. We are following up on this.The Metrology department seized the weighing machine of one of our members, he has complained to us and asked for our support. We are also following up on this matter.The AMC Conference Tour of Japan-Cambodia is planned for May 2013. One bus is already full and registrations are still coming in. Do join and experience a conference tour organized by us. The AGM of AMC is scheduled for 24th Mar 2013. We have a interesting Quiz organized for you. Do check your emails and start participating online to be selected. Our own doctors will entertain you with rocking music too. Mark this date in your calendars. See you all for the AGM and elections!


Intensive Care Units are high pressure areas in any hospital and Critical care is a highly complex specialty of Medicine. It has been estimated that approximately 30 % patients in ICU are expected to die. In the USA, one out of 5 Americans will die in an ICU. As usual, because of poor documentation and poor data-gathering, we do not have specific figures for India. But it is certain that, increasingly, more Indians will be dying in an ICU.In fact there is a shortage of ICU beds in India, though the number of ICU beds is increasing, what with healthcare now being designated as an industry—presently supposedly a US 40 billion dollar industry, expected to double over the next few years. As a result, there is an awesome mushrooming of fancy, hi-tech hospitals all over the country, with the inevitable ICUs and ICCUs being the key areas in the hospital.Obviously, in view of the more than average potential of morbidity and mortality in critical care areas, a higher incidence of medico-legal problems can be expected. ICU care-givers, whether doctors or nurses, experience heightened stress levels, part of it due to a profusion of ethical and legal dilemmas they face on a day-to-day basis.Not in the least, this is on account of the fact the law in India has no clear stand on end-of-life issues.The law in India has lagged behind the advances in Medical technology

and the latest concepts of Medicine. This lack of clarity and decisiveness is responsible for inability to formulate protocols for the various situations presenting themselves in the critical care setting. Undoubtedly, the unresolved legalities and ethical dilemmas, are fertile ground for medico-legal issues which in turn make the job of those working in the ICU settings more onerous.I would like to mention a few of the issues that are of concern in this regard.DiSCONtiNUiNG tReAtMeNtIt must be the experience of every intensivist when it is very clear that continuing with life-prolonging interventions is not only futile, but may even be cruel. “Dying can be a peaceful event or a great agony when it is inappropriately sustained by life support” –Roger Bone.In a situation like this, can you or should you pull the plug ? Is it legal or even ethical to limit life-prolonging interventions ?Incidentally, limiting life –prolonging interventions can be in 2 categories. Firstly, Withdrawing treatment : means, stopping a treatment.Secondly, Withholding treatment : means, never starting a treatmentThere is an obvious difference between the two. Whereas, the first one is an act of commission, the second one is an act

dos' aNd doN’ts MeDiCO-LeGAL iSSUeS iN CRitiCAL CAReDr. Lalit Kapoor


of omission.Though the final effect is the same, it is believed that it is easier to do an act of omission than to do an act of commission. Hence, the latter is more common in the ICU setting but may amount to passive euthanasia.Whereas physician –assisted suicide is legally permissible in some countries, and Adance directives by patients in the form of DNI (Do not intubate) or DNR (Do not Resuscitate) are statutorily recognized in many countries, in India, they do not find place in any of the statutes. On the contrary, every form of euthanasia has been frowned upon by the Indian Supreme Court and is forbidden legally. Also, in our country,suicide and abetment to suicide is punishable under the Indian Penal Code. Hence, withholding or withdrawing life-prolonging interventions even with the consent of the patient or relatives can find you on the wrong side of the law.BRAiN DeAtHIn our country, brain death is defined only for the purpose of Transplantation of Human Organs Act 1994. Indian law does

not define the state of brain death in contexts other than organ transplantation. This, again, is an area that needs the law in India to catch up with current medical concepts.In Indian scenario, what if family desires, after due counseling and discussions by the treating doctors, to withdraw life-supporting treatment?This is a difficult question, But I was relieved to know that the answer I had been giving in the past is identical to the one given by the Committee for the Development of Guidelines for limiting life-prolonging interventions and providing palliative care towards the end of life constituted by the Indian Society of Critical Care medicine. It provides a much-needed guideline.

“If the patient is discharged from the hospital preterminally, an appropriate discharge process (“discharged on request” “left against medical advice” or “discharged against medical advice”, in keeping with the hospital policy should be followed”

In presence of lacunae in the law, this is the usual practical course of action. The patient, is shifted in a ICU ambulance along with life-support equipment to his/her residence or any other place of choice.

The basis for this action is the fact that you cannot impose treatment on anyone who does not consent for the same. In fact, doing so could constitute, under common law and as per IPC, what is termed as assault and battery.

Other Medico-legal issues in critical care Medicine –preventive aspects

Without going into details, I will only mention the potential areas where we need to exercise caution:


sDocumentation and record-keeping :This should be meticulous given the higher potential of allegations of negligence. Good records are your best defence against allegations. Remember, legally, what is not documented, never happened !sinformed consentThis is even more important in ICU settings and must be recorded at all appropriate stages.sDenied consent or refusal of consentDo not fail to record the fact that patient or relatives have refused consent for a particular procedure or course of action.sHospital Acquired infection issues

This is particularly relevant in Critical care units. There should be documented efforts

to prevent it especially in the form of protocols. HAI can easily alleged in specific situations.

sConfidentiality issues

Do not discuss the condition or medical status with all and sundry. Communicate only with designated relatives.

To summarise, Critical care is a highly complex area of Medicine. ICU care-givers are greatly stressed by lack of clarity or even absence of proper laws. Hence need for greater caution. Statutory guidelines need to be formulated at the earliest. The best way to deal with medico-legal problems is to prevent them.

Dr Lalit KapoorEmail : [email protected]

Condolences

Dr. Yogesh NagarSenior Gynaecologist

ObstetricianDate of Final Journey:

15/12/2012

Dr. Kiran PatelE.N.T. Surgeon

Date of Final Journey: 15/12/2012

mailto:[email protected]


AMC took birth in 1972 in the Western suburbs of Mumbai as Consultants’ Association (CA) with a membership of 120 Presently it has over 7500 members –and growing @ 1 new member per day ! It’s uniqueness lies in the fact that it is not specialty-specific and provides a platform for all specialties of medical consultants . It focuses exclusively on the non-academic aspects affecting Consultants and medical establishments. It is need-based and consultant-centric as a result of which it readily takes up the task of trouble-shooting in all issues affecting doctors. Hence, it is now a vibrant, front-line organization.

It was realized that with minor variations, the problems of Consultants and Nursing homes are similar in all parts of India ---and so are the solutions ! It therefore stands to reason that, if requested, AMC should help consultants from other regions to organize themselves into similar bodies. These consultants need not have to re-invent the wheel but can easily replicate the organizational structure and aims and objectives of AMC in other parts of the country .

Wider networking can only be symbiotic, potentiating and unifying. Many health-

care related legislations originate at the national level and have to be thus addressed nationally. Hence AMC INDIA.

AMC INDIA—THE PLOT SO FAR !

The ideology of the AMC is now being taken to other states of the country to facilitate

AMC INDIA---AN IDEA WHOSE TIME HAS COME!By Dr Niranjan Agarwal and Dr Kishore Adyanthaya


formation of similar bodies outside Mumbai which can eventually form AMC INDIA. Project AMC INDIA team , with Dr. Lalit Kapoor as its Director has visited a number of cities in India on invitation of local groups of interested Consultants . A presentation on the aims and objects of AMC and its various activities is made by the team members . Medico-legal topics are discussed , some of the speakers being locally invited. We had successful programs at Kolhapur, Bangalore, Mangalore, Mysore and Kolkatta last year itself with the help of local organizers . We actually succeeded in launching AMC Kolhapur and Banglore last year itself and successfully launched Manglore this year. We have successfully enrolled more than 140 members from these areas so far and many more applications are pending scrutiny. We

had a highly successful program at AJMER this Nov but the official launching is awaited. At the time you read this report AMC Hubli - Dharwad - Belgaun would have hopefully seen the day as we discuss the same at

program there on 24th feb. There are many more cities like Solhapur Sangli Aurangabad Pune and Nagpur in Maharashtra which are being worked upon as also Bhopal Delhi Jaipur Goa and Srinagar in other states.

The modus operandi of forming an Affiliate unit of AMC (AU) in the particular city is outlined. The minimum requirement for formation of an AMC unit is 25 members. The AU can determine its own Life membership fee but it has to remit and amount equivalent of 40 % of the current AMC Mumbai LM fees, to AMC India corpus. The local Body has to sign an MoU with AMC Mumbai. Our Professional Indemnity , H & A and CBS schemes are available to the AU through AMC Mumbai.

An electronic version of GRASP will be available to the AU members. News and views of AU can be shared in GRASP. After AU enrolls substantial members, the corpus given to AMC Mumbai will be transferred to AMC India

The response in the various cities visited by Team AMC has so far been extremely enthusiastic and encouraging. We hope to visit many more cities in the coming year. AMC members who have links with Consultants in other cities are urged to arrange meetings so as to accelerate and consolidate the dream of AMC INDIA ! Having a larger and a national body will not only serve our fellow beings but also make us more stronger . If the happenings in the country are any indications than there is not need to emphasise that larger and united stronger we are.

I would also like to thank the team of AMC members who visited places in conducting the Medicolegal seminars : Lalit Kapoor, Niranjan Agarwal, Kishore Adyanthaya, Gopinath Shenoy, Bipin & Veena Pandit, umesh Oza, Suresh Rao, S. N. Agarwal , Suhas Kate, Nikhil Datar. Jahangir Gai, N. D. Jaywant, Who have taken time out from the busy schedule to preopogate the idea of AMC-INDIA.


CLASSifieDSAVAiLABLeConsulting AC Rooms available in main Lokhandwala Market, Lokhandwala Complex, Andheri(West). Required MBBS Doctors / Gynaecologist to assist in Gynaeo –Care clinic at Lokhandwala, Andheri (West). t Contact No. 26304312 / 9930305729

Air-conditioned Consulting rooms for consultants and surgeons available at a posh new polyclinic at a prime location in Andheri (W) on J.P. Road near Metro station. Dentists required part time or full time. For details. t Contact 9769943270/9769468073, email: [email protected].

AVAILABLE RUNNING NURSING HOME ON RENT FOR MEDICAL / COMMERCIAL USE 1500 sq.ft.-1st Floor-S.V.Road, Borivali west. Nr. To station. - Air Condition Consulting Room, Side room, operation theatre. All Municipal formalities duly completed. t Contact: 9869285520

For sale Air Conditioned, 300 Sq. Feet at Nusser house 3Rd Floor, 20 Mama Parmanand House, Opera House, Opp. Roxy Cinama, Mumbai – 400004. t Contact- 09869567613 / 9821024519

AIRCONDITIONED CONSULTING ROOMS for consultant, surgeon available on first floor in Kingsway Klinik, 5, Broadway-Kalki Building, Opp. King’s Circle garden, Matunga (C.R.) above Appollo Pharmacy hourly basis, long hours possible, reasonable deposit and terms, Between 9am to 5PM Rs. 5500/- per month for two hours, all inclusive. t PHONE: MOHANDAS P. PAI 24101397/24151644/ 9220428957

Amc Member Invites Correspondence from Parents of a Gujarati Doctor Boy Preferably Post Graduate for his MBBS (Mumbai) Daughter Aiming to Pursue P G. B D 05/09/1984 H T 4’11” 55 Kg t Contact M - 09820051146

Mumbai Based Gujarati Jain Parents Invite Proposal For Their 30 Year Old Daughter, 5’8” Dnb, (Ophthal) Pursuing Fellowship In Paediatric Ophthalmology. Please Forwarded Bio-Data (Preferably With Photograph) to t Email: [email protected]

MUMBAI BASED GUJARATI VAISHNAV DOCTOR FAMILY INVITE PROPOSALS FOR THEIR MEDICO GIRL,PURSUING MD(ANAESTHESIA),BORN 1985; FROM ALLOPATHIC POST GRADUATE BOY. WITH A GOOD FAMILY BACKGROUND.PLEASE FORWARD YOUR CV,PHOTOGRAPH &OTHER DETAILS-t MOB:9819823950 EMAIL: [email protected]

Seeking suitable alliance for 28-year-old, 5’2’’, good-looking Saraswat Brahmin girl. DNB in Ophthalmology, currently working in a BMC hospital. From an educated, well-to-do family from Mumbai. Both parents are dentists and brother works with an investment bank.t Phone: 9820826975, Email: [email protected]

Mumbai based Gujarati Vaishnav doctor family invite proposal for their son (Born 31st December 1984; 5’9”) pursuing 2nd year MDS (Oral Surgery) from Dental/Allopathic Graduate Gujarati Girl. Please forward Biodata, photo and horoscope. Email: [email protected] t Cell: 9930161542,

Inviting an alliance for Jain Marwari girl, pursuing MDS in Paedodentistry & residing at Mumbai.” t Contact no: 09820046386.

MAtRiMONiAL


Our city Mumbai has been called Maximum City, the city which never sleeps, the city which provides opportunities to everyone who is willing to work hard and make a living. It is the most populous city in India, and the sixth most populous city in the world, with a population of approximately 20.5 million. Along with the neighbouring urban areas, including the cities of Navi Mumbai and Thane, it is one of the most populous urban regions in the world. Mumbai is also the richest city in India, and has the highest GDP of any city in South, West or Central Asia.

The healthcare system in Mumbai has long been a model for the rest of the country. The city attracted a large number of patients from all over the country for reliable and affordable healthcare. A three tier system was envisaged and implemented which comprised of the local general practioners and the dispensaries of the municipal corporation as the first tier, the local maternity homes and the nursing homes both of the private sector and the public sector as the second tier and the large tertiary care hospitals attached to the municipal and government medical colleges and the large charitable/private hospitals as the third rung. The entry of a few corporate houses into healthcare in the late nineties and the early 21st century slowly saw this ecosystem being under increasing challenge. The slowly but surely increasing penetration of health insurance also saw increased demand for corporate hospitals where apart from good quality healthcare a

good ambience also mattered. The booming Indian economy also has contributed to rising inequalities among the population. While there was a class which demanded the ambience of a five star hotel in a hospital, there also is a middle class which demanded good quality of healthcare at an affordable cost.

Unfortunately over the last 5 years Nursing home owners in Mumbai have been feeling shortchanged. Increasing Governmental/Municipal regulations have made life difficult for the nursing home owners. As of today the average nursing home owner has to procure a Nursing home registration license, A MTP license, A Family Planning/tubal ligation License, A PcPNDT license, a Shop & Establishment license, MPCB license, a license for Combustible Gases(Oxygen/CO2),a Fire NoC…etc etc the list is almost endless. This involves multiple visits to the concerned departments and needless to say one wonders whether greasing of the palms is needed to get the licenses. In 2009 it was the Separate Staircase issue, in 2010 it was the Change of User issue, in 2011 it was the PPN network issue and in 2012 it was the Fire NOC issue. In 2013 the nursing homes in P North have been issued notices to have a Green Filter installed for their drainage system. In short Nursing homes have been at the receiving end of the long stick of the government for the last 5 years.

The latest salvo fired against Nursing home


- Dr Sudhir NaikVice President & Chairperson AMC-NoAH


owners is the IRDA guidelines published on their website which has altered the definition of a hospital/nursing home where an insured patient can take treatment. This new definition says a hospital is one which is registered and which has at least 15 beds in an area where the population is more than 10 lacs (at least 10 beds in areas where population is less than 10 lacs) and which has a fully functional OT and which is under the supervision of a qualified medical practioners and a qualified nurse round the clock. This new definition essentially threatens to deny access to insured patients to nursing homes not fulfilling the above criteria for either cashless or even for reimbursement claims.

This systematic attempt to target small healthcare providers leaves a nagging suspicion of a sinister plan to push nursing homes towards extinction. The only way to fight back is obviously to stay united and push our case in front of the concerned authorities in a more organized manner.

Against this background, it was felt in AMC that though the Nursing Home Cell (Infrastructure Cell) has been addressing these difficult issues in a dedicated manner , there was a need to carve out within AMC a more focussed and specifically empowered outfit to find innovative solutions to these problems with a greater sense of urgency. Accordingly, AMC Managing Committee considered improvement of the Nursing Home (Health Infrastructure) Cell to AMC-NOAH with the avowed objective of creating a cohesive group of small health providers to focus on Nursing homes problems exclusively, and therefore , more effectively. It would of course function as any of the other Cells of AMC. The AMC-NOAH is designed to be a highly disciplined and motivated unit with adequate checks and balances .It would be empowered to create effective disincentives for non-compliance with directives of the AMC-NoaH issued in the common interests of

its members

The aims and objectives of AMC-NoAH are

To represent and negotiate with the insurance industry ,healthcare supplies industry ,and Customer groups on behalf of the members hospitals for their welfare.

To ensure that the interests of the small and medium healthcare providers is taken note of by the Government while drafting any new law or regulatory mechanism for the health care industry

To liaison with all Government bodies at local state and central levels on all issues concerning the hospitals on behalf of AMC.

To encourage all member institutions to obtain AMC/FEQH accreditation in order to ensure certain optimum standards of healthcare.

To conduct training programmes for enhancing the knowledge and skill of all human resources related to hospitals

To help members to take care of labour/personnel issues.

AMC-NoAH will strive to achieve these objectives & ensure that the members of AMC who run/own these small and medium healthcare establishments have their common interests safeguarded while they are offered a slew of innovative support system initiatives. It is therefore in every nursing home owners interest to immediately apply for the membership of this revamped cell of AMC. As of today we have around 250 nursing homes in our fold and we hope to reach a target of 800 by the end of 2013. Members who join before 31st of March 2013 will be considered as Founder Members and will have a few advantages for riposting their faith in AMC. So we request all members to take note of the same and apply for the membership of AMC-NoAH at the earliest.

Email : [email protected]


AMC’s Group Professional Indemnity Insurance Policy will now be entering its fifth year .The features of this Policy are designed to be doctor-friendly and have more-or-less, stood the test of time. This, despite the fact that the scheme is unparalleled and has benefits which no other existing Policy anywhere in the country can boast of. Even the private medico-legal protection schemes that have mushroomed – are high on promises but low on performance , as has been gathered from a number of members who joined this , having been lured by the tall claims .

-In the event of a legal notice or a notice from a Consumer Forum, members are being provided with legal assistance seamlessly. Members also continue to get tele-guidance on a 24 x 7 basis in case of immediate problems.

Undoubtedly , there are still several shortcomings in the scheme which need to be corrected . It has been decided to have some more value-additions to its working .

To begin with , we plan to have a meeting of all our panel advocates to get valuable feedback and suggestions for improving the quality of legal assistance available to our members . The schedule of the advocates’ professional fees has undergone considerable upward revision and may be further revised , if that is called for. If need be , some more dedicated advocates may be inducted in our panel.

We have been experimenting with out-

AMC PROFESSIONAL INDEMNITY SCHEME AN UPDATEof-court settlements in appropriate cases , especially the ones that may come in the category of “indefensible cases” . A number of such settlements have been made within the terms of our MoU with the Oriental Insurance Co. In the process , we are attempting to device a grievance redressal mechanism by the AMC where aggrieved patients are occasionally heard by a designated committee of our Association. In some cases , it has yielded good results.We need to fine-tune this effort and establish a protocol.

We are also improving the procedural aspects of the methodology of members approaching AMC for medico-legal assistance and for processing their claims.

The revised form for intimation of a claim is being printed herewith for information of members. So also the current schedule of charges of Advocates fees’ is being printed for information of members. Shortly , we will be informing members of our latest list of Advocates.

We expect members to follow the protocols strictly so as to get the optimal assistance from AMC , which may not be forthcoming if the prescribed procedure is not followed. Members’ cooperation for making the scheme more effective will go a long way in strengthening the efforts of AMC to mitigate the hassles of those of us unfortunate enough to have to go through a medico-legal problem.

(With inputs from AMC medico-legal Cell)

By Dr. Ajit Desai, Convenor—Medico-legal Cell ,AMC


MEDICAL ETHICS AND LAW-COMPLEMENT OR CONFLICTDr. Lalit Kapoor

Since the evolution of mankind, efforts have been made to regulate the behavior of individuals and groups of individuals in society by voluntarily enunciating a code of ethics for their respective members. Ethics has been defined as a science of moral principles. In fact, ethics is something that has to do with your conscience. It is a code of conduct, a way of behavior, almost a way of life. For all practical purposes, the words “ethical” and “moral” are interchangeable. At one time, it was like advice from a father to a son. There are some who believe that ethics cannot be taught, it can only be inculcated, especially by example. The oldest code of ethics for medical practitioners was the Hippocrates oath which formed the basis for a self-inflicted code of conduct.We have to understand the relationship between Medical Ethics and Law before we try to answer the question –Are the two complementary or conflicting?The link between Ethics and Law has been very neatly summed up thus:Law cannot reach where enforcement cannot follow. Hence, ethics begins where the law ends or cannot reach.The fact of the matter is that Ethics cannot be considered in isolation of Law or vice versa. Ethics and Law are cognate i.e. “related to or descended from a common ancestor” Hence, there is considerable overlap between Ethics and Law. They cannot be taught separately, and undoubtedly, they are complementary.Historically, as we said earlier, the code of conduct was self-inflicted. However, with the passage of time and evolution of society and with the tremendous scientific progress and rapid industrialization there was a sea change

in the social and cultural behavior of the people. The number of physicians increased greatly and the relations between physicians were wedged by several interacting forces--- politics, government, law, media, etc. It became necessary to frame statutory measures enforcing the principles laid down in the code of ethics and that is how Medical Councils were born.The mind-boggling advances in Medicine and Technology keep aggravating the dilemmas of doctors and Society and the margins between Ethics and Law become more and more hazy and the common lineage between the both becomes more evident. How does one determine where Law ends and Ethics begins.It is true that Law is lagging hopelessly behind, the advances in Medicine---not having kept pace with progress in Medicine.Genetics, Prenatal testing, organ donation, stem cell applications, abortion, end of life issues, surrogacy----are all areas which have thrown up numerous challenges which are unaddressed by law and have created painful predicaments for doctors.It must also be recognized that though Medical Ethics and Law can be considered complementary, there are areas of dissonance and conflict. For example, under the Code of Ethics, a medical practitioner gives a solemn declaration:”I will maintain the utmost respect for human life from the time of conception”. And yet, every day doctors are terminating human life by way of abortions since they have the force of Law with them. Thus, terminating a life-in-the making could be Legal, though unethical. This could of course vary from geographical region to region. The same act


could be both illegal and unethical in a country like, say, Ireland but not so in India.In other words, an act could be illegal but ethical and yet on the other hand, an act could be legal yet unethical. An example of the latter pertains to dichotomy of professional fees. There is no Law or Statute in India, not even an Income Tax law, which is violated in case of fee-splitting. However, what can be invoked is the violation of the Code of Ethics which specifically prohibits such an act. Hence, fee-splitting is not illegal but it is unethical!There is another area of conflict, which is worthy of note. The Medical Code of Ethics states unequivocally : “In an operation which may result in sterility, the consent of both husband and wife is needed.”This is in direct conflict of the Law which emphasizes that, for a sterilization operation, consent of the spouse is not essential! Where does this leave the poor doctor? Does he follow his Code of Ethics or should he follow the Law?And consider this from the Code:“6.6. Human Rights: The Physician shall not aid or abet torture nor shall be a party to either the infliction of mental or physical trauma or concealment of torture inflicted by some person or agency in clear violation of human rights”Where does this leave the jail doctors and the doctors being part of a team executing a capital punishment?It is hence amply clear that though Medical Ethics and Law are supposed to be complementary; there are areas of conflict which need to be resolved. Also, with the rapidly changing healthcare scenario in this country, the relevance and applicability of the Code of Ethics needs to be re-looked into and made modern and more in sync with the times.I am afraid, if this is not done, this Code might soon become anachronistic and a historical document.Apart from the unprecedented advances in Medicine, our Society itself has undergone a tremendous metamorphosis. Materialism, greed and self-centeredness is the order of the day and our sense of right and wrong is totally blurred.

Healthcare is now a multi-billion dollar “industry” and growing by the day. Healthcare is now a marketable commodity.It is also a commodity which is now quoted on the Stock Exchange (Equity of some corporate hospitals) and as a result, Health connotes wealth, at least for the share holders, in the form of dividends.In such a milieu, the elaborate prescribed code of medical ethics is bound to take a back-seat. Whereas in earlier days, medical students were exhorted to master the art and science of Medicine, it is now inevitable that they master the art, science and commerce of Medicine!However, it is precisely in such circumstances that there is heightened need for auto-regulation so that Medical Ethics can truly complement the Law. But this can only happen, if the provisions in the present Code of Ethics are re-visited. We may need to delete, revise, modify, modernize, and even rationalize some of the provisions. The Medical Council Act is a flawed piece of legislation and needs re-

crafting. The Medical Councils need to get greater autonomy and freed from the interference of politicians.When a wealthy philanthropist in the USA made efforts to have endowed in his name a Chair of business ethics at the Harvard Business School, his offer was politely refused by the dean of

the institute on the ground that there was no such thing as ethics in business!This is precisely what happens when there is an awesome mushrooming of the various kinds of peddlers of the medical commodity resulting in unabashed and virulent marketing. In such a scenario, ethics, complementary to Law or otherwise, can easily be relegated to the back –burner.

Dr. Lalit KapoorGeneral and Gi surgeon

Founder, Medico-Legal Cell, Association of Medical Consultants, MumbaiAuthor of Book “Better Safe than Sorry—Medico-Legal Dos and Don’ts”“Reprinted with kind permission of One india One People foundation”Website : www.oneindiaonepeople.com


A case vide RC 25(A)/2010 was registered against (a) Dr. Ketan Desai, alleging that while functioning as the President of the Medical Council of India (MCI) New Delhi, during the period March, 2009 to April, 2010, he committed criminal misconduct by entering into criminal conspiracy with the management of Melmaruvathur Adhi Parasakthi Institute of Medical Sciences, Melmaruvathur, Tamil Nadu (MAPIMS); (b) other officials of MCI and; (c) private persons.The matter was regarding the recommendations issued for renewal of permission for admission of third batch of students for MBBS degree course for the academic session 2010-11.It was alleged that in pursuance of the said conspiracy, Dr. Ketan Desai, President of the MCI by abusing his official position as Chairman of the Executive Committee of MCI, recommended the renewal when the Institute did not possess the requisite infrastructure and facilities as required under the norms laid down by the MCI and the Central Government. He thus committed offences punishable under section 120-B read with section 420 IPC and section 13(2) read with 13(l)(d) of Prevention of Corruption (PC) Act 1988.As required by the MCI’s Establishment of the Medical College Regulations - 1999, inspection of MAPIMS for obtaining, the “Letter of Permission” for admission of first batch of students for the academic year 08-09 was carried out by the MCI team on 11th and 12th April 2008 by Dr. S.B. Agarwal, Dr. P.K. Dasgupta and Dr. Basant Lal Sirohiwal, who pointed out deficiencies in (a) the teaching faculty; (b) staff position and (c) bed occupancy. The college reported compliance in under a month and another inspection was carried out on 06.05.2008 by a team consisting of Dr. S.B. Agarwal, Dr. V.K. Gupta and Dr. Archana Thakur and they recommended that the Letter

GHOST FACULTIES, ROGUE INSTITUTIONS AND THE MEDICAL COUNCIL OF INDIA

Dr. Gopinath N. Shenoy, Email : [email protected]

of Permission be granted and the same was granted by the Govt. of India on 04.07.2008. A Letter of Intent (LoI) was issued by the Ministry of Health and Family Welfare, Govt. of India vide letter dated 20.06.2008.The first renewal inspection for admission of second batch of students for the academic year 2009-10 was carried out by the MCI team consisting of Dr. C.A. Desai, Dr. Sushma Vasisht and Dr. Sheela Sharma on 31.03.2009 and 01.04.2009. The team pointed out certain deficiencies. The college submitted a compliance report again in under a month. Another inspection was carried out on 30.04.2009 by a team consisting of Dr. M.C.R. Desai, Dr. Ram Prakash and Dr. Suresh Kumar. On the basis of their report, the renewal of permission for admission to the second batch of students for the academic year 2009-10 was granted by the ministry vide its letter dated 19.06.2009.For the academic year 2010-11, i.e. the second renewal of permission for admission of third batch of MBBS students, MCI carried out the inspection on 16th and 17th of February 2010 by a team comprising of Dr. S.B. Agarwal, Dr. M.A. Kunjarnma and Dr. S.S. Minnas. The team noted deficiencies in the teaching faculties. The Executive Committee, upon consideration of the Inspection Report, noted the deficiencies and decided to recommend to the Central Government not to renew the permission for admission of the third batch of students for academic year 2010-2011.Following the compliance report submitted by the college, the MCI carried out a compliance verification inspection on 29.03.2010 by a team of inspectors of MCI comprising of Dr. S.B. Agarwal, Dr. S.P. Sharma and Dr. K.V. Malini. Upon consideration of Inspection Report, in the meeting held on 05.04.2010, the members of the Executive Committee decided to recommend to


the Central Government to renew the permission for admission of the third batch of 150 students at the Institute for the academic year 2010-2011. On the basis of the recommendation from the MCI, the Central Government approved the renewal of permission for the admission of the third batch of students for the academic year 2010-11 vide its letter no. U12012/334/2006-ME(P.II) Dt. 23.04.2010.During the course of CBI investigations, it was revealed that, as per MCI requirements, there should be a total of 262 faculty members in the college for the third year of MBBS and that shortage of eligible faculty members would prompt action against the college.Hence in 2009-10, MAPIMS recruited several faculty members who were not permanent, including 32 members, some of whom worked only for one day or a few days in the college only for the purpose of presenting themselves before the compliance inspection team of MCI on 29.03.2010 as regular faculty members. They were actually faculty members who were not only not employed in the college on a regular basis as wrongly declared by them in the Declaration Form, whereas in fact, they were working at other hospitals at the same time which they were not supposed to do.In short they were “Ghost Faculties”.The 32 ghost faculty members who had attended MCI inspection on 29th March 2010 were not required by the college authorities to sign any attendance register or to attend the college regularly. They were paid salary in cash either lump-sum or on case to case basis and not as per the UGC Rules. Their acknowledgment of payment of salary in cash was taken on vouchers even after the date of compliance inspection on 29.01.2010 and in some cases even after the registration of the case by the CBI.The ghost faculty was not shown as faculty members in the lists provided to the chartered accountant of the hospital trust for the purpose of income tax computation nor did their names appear in the lists provided by the hospital for payment of professional tax and in the banks through which regular faculty members were paid their salaries.Medical Institutions who engage in such

nefarious activities are known as “Rogue Institutions”.It was also revealed during the investigation that the ghost faculty was recruited temporarily by MAPIMS for showing them as regular faculty for the purpose of MCI inspection. MAPIMS could get away with all this because the inspection team members of MCI also adopted a casual approach in their job, by not verifying whether the ghost faculty produced before them were regular faculty or not. Had they made diligent enquiries during inspection, the irregularities would have come to light.It was surprising that when MAPIMS was not able to produce the required number of staff members for the regular inspection, how was it possible to rectify the shortage in a short span of time during the compliance inspection? It was further alleged that this escaped the attention of the MCI inspectors due to their careless attitude.Rogue Institutions resort to multiple misrepresentations like (a) showing a paying bed as a free / diet paying bed; (b) not disclosing that consideration is paid for by the patients for the investigations / treatment rendered; (c) showing the same bed as a bed for the DNB student, MD student and a student for a diploma; (d) clubbing the beds of different hospital as their own to attain the required bed strength; (e) falsifying the age of the teaching faculty such that they can be retained longer; (f) showing the same person as a teacher for MD, DNB and Diplomas; (g) fabricating bed occupancy; (h) falsify norm of five in-patients per student; etc., etc.In such cases, criminal charges can be filed against (a) the ghost faculty; (b) the appointing authority of the Institution; (c) the MCI inspectors.GHOST FACULTY: They can be charged under the following sections of the Indian Penal Code.Giving False Evidence – Section 191 IPC. The ghost faculty being legally bound to state the truth gives a declaration on the Declaration Form which is false and which they know to be false.Fabricating False Evidence – Section 192 IPC. By making false entries in the attendance register,


the ghost faculty fabricates false evidence.Cheating by Personation – Section 416 IPC. The ghost faculty fraudulently and dishonestly presents themselves as full time faculty and induces the inspectors to believe that they are full time faculty and thereby wrongly grant recognition to the Institution.Criminal Conspiracy – Section 120A IPC. The ghost faculty agrees with the rogue Institution to do an illegal act.Act done with Common Intention – Section 34 IPC. The ghost faculty and the rogue Institution does a criminal act in furtherance of a common intention i.e. to illegally get the rogue Institution recognized.Two authorities can take action against such ghost faculties (a) the MCI or the State Medical Council; (b) the criminal authority.In the MAPIMS case, the MCI has cancelled the registration of 32 erring doctors for a period of 3-5 years. The CBI can criminally prosecute them.If by chance some doctors are still functioning as ghost faculties in other institutions, it is high time they resign. Unfortunately, their resignation will not make them immune to action as they have already committed criminal offences and action can be taken against them up to a period of three years (limitation) from the last cause of action.THE ROGUE INSTITUTIONS: Ghost faculties are appointed by some ‘appointing authority’. Appointing authority can be the Dean / Medical Superintendent / CEO / Medical Director of the health care Institution. All persons who are aware of the ghost faculty such as the HR department, finance department, the Head of the respective clinical departments, the administrative staff who handles the attendance muster, salaries, accountants, etc can also be hauled up as accessories / abettors to the crime. Finally the Trustees, Board of Directors can also be made accountable as they are supposed to be aware of what happens in their Institutions and thus cannot escape responsibility.The appointing authorities can be prosecuted under the sections mentioned above or for the abetment of the same as they are fully aware of the acts and they willingly permit the same.

There is abetment by conspiracy and abetment by aid.Abetment by Conspiracy – Section 107 cl. 2 IPC. The appointing authority of the rogue Institution engages with the ghost faculty in a conspiracy for doing an illegal act in pursuance of that conspiracy.Abetment by Aid – Section 107 cl. 3 IPC. The appointing authority of the rogue Institution intentionally aids the ghost faculty to commit an illegal act.If the appointing authorities are registered medical practitioners, the MCI and the State Medical Councils also get the jurisdiction to conduct an inquiry and if found guilty of misconduct, the Council can suspend them. If the criminal authority convicts and imprisons the appointing authority even for one day, the Medical Council may deregister them temporarily or permanently.THE MCI INSPECTORS: The criminal authorities will always try to make out a case that the inspectors are hand in glove with the rogue institutions. Collecting circumstantial evidence in this regard is very easy. It does not require great intelligence to understand the motive behind absent attendance registers / unsigned registers / fabricated registers; salaries paid in cash or paid lump-sum; absence of the ghost faculty’s remuneration in the computation of income tax / professional tax records, absence of TDS payments and the absence of their names in the salary credit statements.All the inspectors are usually registered medical practitioners and so they not only come under the jurisdiction of the CBI but also the MCI. In the MAPIMS case, the CBI has recommended ‘Major Penalty’ against four MCI inspectors.Going for inspections of medical colleges thus can be very dangerous and clearing of a medical college should only be done after a thorough scrutiny.So ghost faculties, rogue institutions and the inspectors beware. MCI is now very serious about clearing all the irregularities in medical education. Medical colleges will have to do justice to the student community that they undertake to train failing which they might face criminal prosecution.


AMCON 2013Dr. Hitesh Parikh

Prog. Committee ChairmanAMCON 2013 was held in Birla Matushri Sabhagar under the leadership of Dr Kishore Adyanthaya and Dr Niranjan Agarwal as the convener. It was a unique program in terms of the topics which were selected and discussed. His Holiness Radanath Swami Maharaj gave a in depth lecture on Know God Know Peace. This was followed by a very practical but informative talk by Mr Vithal Kamat and he aptly called it Zero to Hero. He gave a detailed explanation about the pitfalls in business and how to overcome them with a resounding success. Mr Prahlad Kakar the icon of advertising world gave a lucid presentation on how to extract more than 100% from your life. He showed some of is evergreen adv and received a very loud applause for it. Mrs Shabana Azmi the glamorous and ever young but dynamic lady gave a heart rendering talk upon the insults faced by the females and she showed the

way of how the women can be empowered. Justice Santosh Hedge the chief guest gave head to heart talk on the functioning of the legal system. He explained the lacunae in the legal system and how in spite of the best efforts nothing can be done.

In the latter half of the program a panel discussion on the intricacies of the new proposed laws and regulations affecting the health care industry was held. It was very informative and cleared some of the misconceptions one had.

The Debate on how modern means of transportation have distanced people reminded us that modernization comes with a price. All in all AMCON 2013 was a success and I hope more consultants take the advantage of such programs.

24 Vol. 41 l Issue No. 4 l February 2013

Vol. 41 l Issue No. 4 l February 2013 252525Vol. 41 l Issue No. 4 l February 2013


I am not God... but neither am I the Devil

-Dr Pranav H. Kodial, Dahanu

Welcome my dear patient, confide in me your suffering,My decades of long study, and my hard, exhaustive training,Is always at your service, but understand this, my friend,I am not God...but neither am I the Devil.

My sleep at night, I give up, and my time with my family too,I sacrifice my own health sometimes, in order to heal you,These sacrifices I don’t regret, but understand this, my friend,That I am not God...but neither am I the Devil.

I shall treat your illness, every night and day,But will you get well by it? I confess, I cannot say,“What do you mean?” You ask, and my answer is, my friend,That I am not God...but neither am I the Devil.

You may get better, your health, vigour renewed,Your eyes will then be filled...with tears of gratitude.I do not deserve those tears; please offer them to God,For I am not God...but neither am I the Devil.

I merely give you medicine, as my Teaching would tell me to,But God is really the One who restores health back to you.He deserves the credit, please understand this, my friend,That I am not God...but neither am I the Devil.

The same medicine that healed you, may also sadly however,Unexpectedly, without warning, cause the death of another,It’s all Destiny and God’s will, and that’s the truth, my friend,That I am not God...but neither am I the Devil.

Illness, health, life and death, are decided by Fate, you see,They cannot be guaranteed, neither by you, nor me.As your well-wishing doctor, I can only try my best,For I am not God...but neither am I the Devil.

So shower me, my dear patient, neither with praise nor hatred,Try to understand and remember, this cardinal truth instead,I am a human being like you, imperfect and mortal,I am not God...but neither am I the Devil.

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je$eerÛeer PeesHe ceer lÙeeielees, kegâšgbyeeÛÙee menJeemeeuee cegkeâlees,let yeje JneJeeme cnCetve, ceer ceePes mJeemLÙener IeeueJeJelees.¢eeÛee HeMÛeeleeHe veener ceuee, HeCe FlekeâÛe mecepetve Ies js,ceer lees osJener veener... HeCe ceer mewleevener veener...

je$ebefoJeme ceer ßece keâjerve, legPÙee GHeÛeejemee"er,HeCe lÙeeves let yeje nesMeerue keâe? cee$e ns ceer meebiet Mekeâle veener.cnCepes?! let ceuee efJeÛeejMeerue, ¢eeÛes Gòej Deens,efkeâ ceer lees osJener veener... HeCe ceer mewleevener veener

Meem$eeøeceeCes DeeceÛÙee, ceer Heâkeäle legPÙeeJej GHeÛeej keâjlees,HeCe osJeeÛÙee ke=âHesvesÛe efce$ee, let Deepeejeletve yeje neslees.osJeÛe legPÙee DeeYeejeÛee ueeÙekeâ Deens, ns mecepetve Ies js,DeeefCe ceer lees osJener veener... HeCe ceer mewleevener veener...

pÙee GHeÛeejeves let yeje Peeueeme, lees keâOeer ogmeNÙeeuee efJe<e "¤ Mekeâlees,Dekeâmceele, DeveHesef#ele HeefjCeece neslees, lees DeYeeieer keâeUeÛÙee Dee[ peelees.¢eeueeÛe osJeeÛeer FÛÚe cnCeleele, ns melÙe veekeâejlee Ùesle veener,keâejCe ceer lees osJener veener... HeCe ceer mewleevener veener...

Deepeej-DeejesiÙe, peieCes-cejCes, ns veMeeryeeÛes KesU, nes efkeâ veener?lÙeebÛeer `ie@jsbšer' keâesCe osT Mekeâlees, ve letner, Je ve ceerner.legPee efnleefÛeblekeâ [e@keäšj cnCetve ceer kesâJeU øeÙelve keâ¤ Mekeâlees,keâejCe ceer lees osJener veener... HeCe ceer mewleevener veener...

cnCetve vekeâes ceuee legPee DeefYeMeeHe, DeeefCe vekeâes legPeer mlegleer,Heâkeäle mecepetve Ies DeeefCe ue#eele "sJe, Kejer JemleefgmLeleer.ceer HeCe ceeCetmeÛe Deens, DeHeefjHetCe& Je veMJej,ceer lees osJener veener... HeCe ceer mewleevener veener...ceer lees osJener veener... HeCe ceer mewleevener veener...

ceer lees osJener veener...HeCe ceer mewleevener veener...-[e@. øeCeJe n. keâesef[Ùeeue, [neCet=


Delhi gang rape case and consequent media attention created uproar in our country regarding deficiencies in our justice delivery system. It is said that JUSTICE DELAYED IS JUSTICE DENIED. Most of the accused get released on bail and eventually don’t get convicted also.The judicial trial takes years or sometimes decades together. We will first go through existing law regarding rape.

Current Law —

The code of criminal procedure, 1973 (CrPc): 1(164A. Medical examination of the victim of rape

1) Where, during the stage when an offence of committing rape or attempt to commit rape is under investigation, it is proposed to get the women with whom rape have been committed or attempted, examined by medical expert, such examination conducted by a registered medical practitioner employed in a hospital run by the government or local authority and in the absence of such a practitioner, by any other registered medical practitioner with the consent of the women or of a person competent to consent on her behalf and such women shall be sent such registered medical practitioner within twenty four hours of receiving the information relating to commission of such offence.

2) The registered medical practitioner, to


- DR RAJENDRA TIWARI

whom such women is sent shall without delay examine her and prepare a report of his examination giving the following particulars, namely:

(1) The name and address of the women and the person by whom she was brought.

(2) The age of the women

(3) The description of material taken from the person of the women for dna profiling

(4) Marks of injury,if any, on the person of the women.

(5) General mental condition of the women; and

(6) Other material particulars in reasonable details

3) The report shall state precisely the reason for such conclusion arrived at.

4) The report shall specifically record that the consent of the women or of the person competent to give such consent on her behalf to such examination had been obtained.

5) The exact time of commencement and completion of the examination shall also be noted in the report.

6) The registered medical practitioner shall, without delay forward the report to officer who shall forward it to the Magistrate reered to in section 173 as part of referred to in clause (a) of


subsection (5) of that section.

7) Nothing in this section shall be construed as rendering lawful any examination of the women or of any person competent to give such consent on her behalf.

Explanation –For the purpose of this section,”examination” and “registered medical practitioner” shall have the same meaning as in section 53

CrPC (Amendment) Act, 2005 (Notes on Clauses)

Section 164 A has been added to provide for medical examination of victim of rape by registered medical practitioner employed in a hospital run by the government or local authority or in the absence of absence of such a practitioner by any other registered medical practitioner.

Deficiencies in the law and some amendments suggested

1) The urgency should be to make victim reach nearest medical facility without delay. Therefore all registered medical practitioners should be sensitized in rape examinations. Emergency set ups must have rape kit.

2) The government may involve associations of registered medical practitioners(AMC,IMA, FOGSI …etc) and train all registered medical practitioner through its branches all over the country)

3) MCI in consultation with doctors associations may come out with short refresher course for the same.

4) There must be a standard Performa for examination of a sexually assaulted victim.

A lot of people are only living another “yesterday”. Their life today is exactly the same as it was yesterday. To have a more meaningful life on a daily basis, one has to add that meaning, that vision, that adventure into every day. Sometimes all it takes is a question to make a better today: What do I want to achieve today? What contribution do I want to make? Which area do I need to grow in? How can I do more? How can I be more?

A Better Today

Ethical ValuesPeople who have abundant materialistic success in their outer life as well as abundant peace of mind and happiness in their inner life use the highest ethical values as their inner compass or guiding stars. Values are more important than facts. They will make or break a country, a company, a relationship or a home. Life is 10% what happens to us & 90% percent how we react to it with which ethical values as our guiding compass. The remarkable thing is that we have a choice everyday regarding the values, we will embrace for that day. You cannot change the past, you cannot change the fact that people will act in certain ways. You cannot change the inevitable. The only thing you can do is to play on one string and that is your values. It is your values that guide your attitude towards a positive or negative direction. Then only you can use your knowledge skills in the right or wrong way.

Mrs. Pushpa EswarManager-AMC

[email protected]


Nov 01, 2012: Ban on doctors sponsored by pharma companies may ease

New Delhi: The ban on doctors being sponsored by pharma companies to attend conferences could soon get diluted. The department of pharmaceuticals, that is preparing the “Uniform Code of Pharmaceutical Marketing Practices”, has asked the Union health ministry to take a relook at the existing rule of such activities by the Medical Council of India.Nov 08, 2012: Super-specialty doctors get high court relief Mumbai: Doctors who pursue super-specialty courses in Maharashtra will have to serve a one-year bond in public hospitals, the Bombay high court has ruled. The judges said that doctors were a “national asset”, comprise a “national talent pool” and must be given posts “commensurate with their specialization”. More importantly, it directed the state that from next year, super-specialty doctors should be appointed to a post within a month of declaration of their results or they should be released from bond conditionsNov 11, 2012: 10,000 foreign educated doctors jobless, fail to clear MCI test

Chennai: Close to 10,000 Indians across the country who have completed their undergraduate medical education abroad are unemployed or under-employed. This is because they have not been able to clear the screening test mandated by MCI. Since 2002, students who have studied medicine abroad have had to appear for a screening test conducted by MCI. Only those who clear the test, administered by the National Board of Examinations, get certificates from the state medical council permitting them to do a year-long internship in a university or hospital in the state.Nov 16, 2012: Medicos face Rs. 50 Lakh fine for quitting civic hospitals Mumbai: Medical students who pursue their post-graduation at civic hospitals will now have to put in a minimum of five years of service at the hospitals after completing their studies or pay a fine of Rs.50 lakh. The stringent condition - all PG students will have to sign a bond - is part the BMC’s efforts to stem the exodus of trained doctors from the public hospital system to private medical facilities that offer better salaries. It follows a similar rule imposed by the State last year that requires resident doctors to take up

FroM tHe preSSCompiled by: Dr. Pradeep Baliga(Sourced from various Agencies)


postings at government hospitals in rural areas.Dec 07, 2012: Agents Hesitate To Woo Customers in Absence of Commissions Mumbai: Health insurance portability, which has been in force for a year, has not resulted in any major churn among policyholders. Insurers say that one of the reasons could be that agents are reluctant to hand-hold customers as regulations bar commissions on ported policies.Dec 12, 2012: Medical council plans protest to oppose new law. The Maharashtra Medical Council is planning a state-wide protest against a new central law that seeks to regulate the functioning of all medical facilities. The Clinical Establishment Act, which was notified by the Centre earlier this year, is expected to come up before the State Assembly for approval. The MMC says if the “draconian” law is implemented, it will lead to closure of small medical set-ups and significantly increase the cost of treatment.Dec 13, 2012: Get TB drugs at shops free, govt to pay up New Delhi: In a move to curb multi-drug resistant tuberculosis cases caused mostly because of irregular medication, the government has decided that relevant medicines will be available for free at all chemist shops and corporate hospitals. The scheme will be rolled out across the country by next March. A patient, confirmed positive for TB by a qualified doctor, simply needs to register with the Revised National Tuberculosis Control Program.Dec 14, 2012: Don’t involve doctors in insurance claims Mumbai: Doctors should not be involved in settling medical insurance claims, the

Insurance Regulatory and Development Authority told the Bombay High Court on Thursday. Not only is there a shortage of doctors, but it could increase the cost of insurance business, it added.Jan 04, 2013: Insurers gear up for collective bargaining Mumbai: Insurance companies are set do some collective bargaining with hospitals to bring down cost of treatment for surgical packages. The four PSU non-life companies, General Insurance Corporation and Life Insurance Corporation are promoting a third-party administrator, which will kick off in October.Jan 08, 2013: Incentives to TPAs anti-consumer: High CourtMumbai: The Bombay high court on Monday said insurance companies that give incentives to TPAs to reduce claims are working against consumer interest. The insurance regulator IRDA told the court that if it comes across such companies, it shall take them to task.Jan 08, 2013: AMC to give rates for 42 ailments Mumbai: In the Bombay high court, advocate, representing the Association of Medical Consultants with 7,500 members in the city, said it is ready to indicate amounts for 42 standard ailments which may be indicated in the policy. The AMC will submit a draft to IRDA in four weeks. The judges said it could be taken as a reference to implement in 50,000 hospitals nationwide.Jan 09, 2013: MNC body backs MCI guidelines banning all kinds of gifts to doctors in clinical trial Mumbai: In a significant development, the pharma industry has decided to adopt strict guidelines to bring in transparency


in clinical drug trials, and break the nexus between companies and doctors by adopting stringent MCI guidelines which ban all gifts to doctors. The “Code of Pharmaceutical Practices” adopted recently bans all trials conducted for “disguised promotion” of medicines, while laying down that companies need to disclose all trials conducted in the country.Jan 16, 2013: MCI bars varsities from starting PG courses Bangalore: In a blow to lakhs of doctors across the country, MCI has barred all health universities from starting any post-graduate or post-doctoral certificate course this year. These PDCC courses can be done by doctors with an MD to enable them to perform specialized procedures. Doctors are upset by the MCI’s move to control health universities.Jan 21, 2013: No pay, housing for 30 super specialists from civic hospitals Mumbai: Nearly 30 super specialty doctors who recently joined civic-run hospitals have neither received a pay scale nor an accommodation for about two months now. The HC had directed the state to either appoint super-specialty doctors during the bond period on posts commensurate with their specialization or release them from the bond.Jan 26, 2013: Hospitals cold to ‘preferred network’ tag Mumbai: The job is getting tougher for insurers and TPAs to convince hospitals to be on their Preferred Provider Network list. In a bid to lure more customers, both private and public health insurers are trying every trick in the book to get more such hospitals on board. According to insurers, the deliberations are going nowhere as

hospitals seek higher rates than what is on offer.Jan 26, 2013: Health cover set to cost 25% more Mumbai: Public sector nonlife companies are set to revise health insurance rates by 20-25% with the regulator moving fast on approvals of new plans. A proposal to increase premium rates has been pending with the Insurance Regulatory and Development Authority (IRDA) for some time and the current schedule of rates has been in force for nearly five years now.Jan 26, 2013: MCI urges docs to promote use of generic drugs Mumbai: In its directive dated January 21 to the principals of medical colleges, directors of hospitals and presidents of all state medical councils, the MCI has said every physician should, as far as possible, prescribe drugs with generic names and ensure that there is a rational prescription and use of drugs. All doctors registered under the MCI act have been asked to comply with the directive.Jan 29, 2013: Padma award for four doctors Mumbai: Four doctors from Mumbai received the Padma awards on Republic Day. The Padmashri was conferred on Dr. Rajendra Badwe, Dr Amit Maydeo and Dr. Sundaram Natrajan (AMC Committee Member) while Dr. Nandkishore Laud received the Padma Bhushan.Feb 01, 2013: Most attacks on doctors by patients’ kin go unpunished Mumbai: Most attacks on doctors and medical staff by relatives of patients go unpunished. There have not been arrests in most cases of vandalism in hospitals and assaults on doctors. In cases where arrests were made, assailants got bail a day later.(Sourced from various agencies)

email: [email protected]


Association of Medical Consultants has over the years emerged as a true representative body of the Medical Consultants in the city of Mumbai and its extended suburbs. It has extended a helping hand to its members whenever they have faced medico-legal trouble. With a total membership of close to 7500 it has been at the forefront of all efforts to liaison with the government on various issues concerning the welfare of its members. With such a large membership it is only fair to expect that the needs/problems of different groups of members will be different. In the past few years members who are running small and medium healthcare setups have increasingly come under government scrutiny. The issue of separate staircase for Nursing homes was one such issue on which it was AMC which took the lead in first mounting a legal challenge and subsequently even convincing the state government to amend the DC rules to make an exception to this rule for already existing health care institutions. The issue of Change of User and NOC from fire department continue to haunt the members who own/run small and medium health care establishments, and it has been AMC which has taken up cudgels on behalf of its members to try and resolve this issue amicably. This sometimes led to a piquant situation wherein other members at times felt all AMC efforts were directed to help Nursing home owners. This however is an erroneous perception as AMC has also in the past taken up issues concerning members who are attached to larger corporate hospitals. In its earlier Avatar it was the Nursing home cell of AMC which took up the issues of the nursing homes and it was later revamped into a Health infrastructure Cell.

It is now accepted that the small and medium healthcare providers namely the nursing homes are being increasingly pushed to a

corner. Patients are becoming more demanding necessitating the doctor to spend more time with Patient/Relatives to explain to them the medical conditions of patient. The insurance companies are also demanding lower tariffs to cover for their losses which they claim is due to excess billing and malpractices of some of the providers. Their system of Cashless services had inherent problems such as delayed payment and non-payment after preauthorization and increased burden of paperwork. The Local Tax, Business & Labour laws are becoming stringent and the skilled manpower scarce. The subtle pressure from the larger corporate hospitals also has resulted in Government regulations becoming too overbearing and impossible to comply with. In such scenario, the Nursing Home Owners need a representation & support system so that they can focus on their core competence namely Medical Deliverables. In view of the aforesaid, it was felt in AMC that though the Nursing Home Cell (Infrastructure Cell) has been addressing these difficult issues in a dedicated manner, there was a need to carve out within AMC a more focussed and specifically empowered outfit to find innovative solutions to these problems with a greater sense of urgency. Accordingly, AMC Managing Committee considered the re-incornation of the Nursing Home Cell to AMC-NoAH with the avowed objective of creating a cohesive group of small health providers to focus on Nursing homes problems exclusively ,and therefore, more effectively. It would of course function as any of the other Cells of AMC. The AMC-NoAH is designed to be a highly disciplined and motivated unit with adequate checks and balances .It would be empowered to create effective disincentives for non-compliance with directives of the AMC-NoaH issued in the common interests of its members.

NoAH - Preamble


MEMBERSHIP APPLICATION FORM FOR AMC - NoAH

Details of the MemberName : Dr. (Mr./Mrs./Ms.) (Name)

(Middle name) (Surname)Date of Birth : AMC Membership No:Residential Address :

Contact No : (M) (R) Email : Educational Qualification : MMC Reg No :

Details of the Healthcare UnitName of the Healthcare Unit : Residential Address :

Contact No : (M) (R) Email : Website : Nursing Home Reg No : MTP Registraton No : PNDT Reg No :FEQH Accreditation Yes /No Minimum / Optimum / ExcellentNo. of Bed : Carpet Area in sq Feet No. of OTs :

Facilities: Please Tick: Medical Surgical ICU NICU Obstetric / Gynec Laboratory X-ray CT Scan / MRI

Details of the other Members / Partners:

Sr. Name and address Contact noAMC Member

Yes or NoIf Y then AMC No:

I hereby solemnly affirm that all the data provided by me in this form is true to the best of my knowledge.

Name of MemberCurrent Fee structure:a. The Joining fee would be Rs. 2,500 for Nursing Homes & Hospitals having bed capacity of 10 or less.

For Nursing homes & hospitals having bed capacity of 11-25 Rs. 5,000 and 26-50, the joining fee would be Rs. 7,500. More than 50 beds it would be Rs. 10,000.

b. The Annual fee would be Rs. 500 for Nursing Homes & Hospitals having bed capacity of 10 or less. For Nursing homes & hospitals having bed capacity of 11-25 the annual fee will be Rs. 1,000 and for hospitals having beds 26 or more, the annual fee would be Rs.1,500 and Rs. 2,000 for those with more than 50 beds.

Passportsize photo

of themember


DeCLARAtiON (on letterhead of nursing home/hospital)

I,__________________________________________________________ Indian Inhabitant, aged ________ years, residing at ________________________________________________________________________________________________, do hereby solemnly declare and state as under :-

That, I am the Owner/ Proprietor/ Partner of the [name of the Nursing Homes/ Hospitals] and I am the life member of Association of Medical Consultants.

OR

That, I am the Director of the Company that runs the Nursing Home/ Hospital and I have the authority to sign the declaration. A copy of the board resolution dated [insert date] authorising me as the signatory is attached hereto and marked as Annexure A.

That, I have the decision-making powers in running of the Nursing Home/ Hospital.

That, I agree to abide by all the rules and bye- laws of the AMC-NoAH and I will also abide by the decisions of the disciplinary committee of AMC-NoAH. All the owners/trustees/directors/employees/agents/servants of the hospital/nursing home whether or not they are members of the AMC will also abide by the decision of the disciplinary committee of AMC-NoAH.

That, my nursing home/ hospital has less than 75 beds. A copy of the registration certificate of the nursing home/hospital is attached hereto and marked as Annexure B.

That, I accept that the quantum of fees payable will be decided by the incumbent Governing Council of AMC-NoAH and I will pay the admission and annual fee for the membership and I also agree to pay any optional fees for selected ‘value added services’ as may be intimated to me from time to time by the Governing Council of AMC - NoAH.

That, I will abide by the obligations cast upon me by AMC-NoAH which are mentioned in the constitution document of AMC-NoAH in its true letter and spirit.

That, I will not do any such acts which would invite disciplinary action against me and my nursing home/hospital.

That, I accept that there will be a graded disciplinary action grid. The escalating grid will be warning, temporary suspension and finally expulsion. I also accept that all disciplinary action will be the responsibility of the Governing Council of AMC-NoAH and the same shall be final and binding upon me.

Solemnly declared at )

aforesaid this ____ day of 2012 )

Place :

(Sign & Stamp of member with Reg. No)


Proforma for Medico-legal Assistance (Oriental) THROUGH AMC Date:To,Sr. Divisional / Regional Manager,The Oriental Insurance Co. Ltd.Mumbai.Dear Sir,I am a member of group indemnity policy /Errors & omission policy of Association Of Medical Consultants, requesting for claim number & medico legal assistance.Relevant details are as under.1. Name: __________________________ Address:- ______________________________________________________________________a) Tel. No._______________________b) E-mail ID. _______________________2. Life Membership Number ________________ Speciality: ______________________3. a) Indemnity Policy Cert. No.______________b) Errors & Omission Policy Cert. No.______________4. Retroactive date ____________5. Amount Insureda) Indemnity Policy Rs.___________/-b) Errors & Omission Policy Rs.___________/-6. Nature of Problem: (TICK WHAT IS APPLICABLE)a) There has been some occurrence/event which in my opinion may in future lead to medicolegal problem.I have received a letter of allegations from the patients/relatives/advocates.c) I have received a notice from District/State/National Consumer Forum.I have received a notice from MMC.I have received a notice/ summons from magistrate court/ police station.Any Other : _____________________________________________________________________7. I have received above mentioned letter/ notice/ summons on_____________ (Date)8. My agent is___________________________________________________________________I undertake responsibility of informing the Medico – Legal cell on quarterly basis about the status of the case. I also undertake to abide by the terms & conditions of the group professional Indemnity policy / Medical Establishment Policy issued to AMC. I enclose the following:-Copy of insurance certificate for year of incidence, all the years after that & current year insurance certificate.Copy of legal notice received from District/State/national consumer Forum, MMC, National Human Rights Commission or any other authority.Summary of case.Copy of your reply/Advocate reply.Copy of advocate bill if any. Please note advocate bill will be paid as per schedule on receipt of copy of claim petition, reply of advocate or written statement & original bill. Advocate schedule enclosed.PLEASE SUGGEST A SUITABLE ADVOCATE TO REPRESENT ME BEFORE THE AUTHORITIES.Signature of doctorIn case of any query please contact Mr. R.C. SURI (9833415877 / 9869176239) ORAMC OFFICE Tel No. 26836019.


tYPe Of WORK DiStt.CONSUMeR

COURt

StAte COMMiSSiON & MAHARASHtRA

MeDiCAL COUNCiL

NAtiONALCOMMiSSiON(NeW DeLHi)

RS RS RS

1st Stage of study of the case papers, taking instructions from the doctor, filing vakalatnama drafting and filing reply and affidavit. Stage of drafting and filing rejoinder to a say of the complaint including affidavit in lieu of evidence.

50% 50% 50%

2nd stage including cross examination, written arguments and obtaining final order.

50% 50% 50%

tOtAL 30000 40000 50000

N.B.:1. The expenses in preparation of voluminous documents, cost of expert evidence etc. as agreed in the MOU, will be paid on

the basis of actuals supported by vouchers.2. Advocates will prefer bills to the Oriental Insurance at the end of each stage mentioned in the above schedule.3. If the same Advocate is defending more than one doctor, 50% fees will be payable for 2nd case or subsequent cases.4. In case of compromise cases, fee payable will be as per stage of case subject to minimum of 50% and maximum of 75%

depending upon stage.5. Monitoring Committee may relax the above limit in relevant cases.6. Fees for :

a Criminal cases }b Medical Council. } will be decided on case to case basis.c Human Rights Commission etc. cases. }

7 Reply to notice received regarding negligence – Rs.5000/- (if later on this results into a court case, this amount will be adjusted out of total fee. This will be paid within two weeks of submission of Bill.

8 Senior Advocates with 20 years of experience as well as existing Advocates handling AMC cases in the past will be paid at the rate of State Commission schedule even if deputed for District Court / Consumer Court.

9 The cost of consulting senior advocates, medico-legal experts, forensic experts or any other experts whose inputs are required for defending the claim is payable additionally.

10 In case the insured and his/her advocate shall need to travel to a location outside Mumbai, the travel expenses for the same shall be paid for. The reimbursement shall be based on 2nd class AC Railway fare for cases where the distance is less than 500 kms. Policyholders shall be entitled to reimbursement for Economy class airfare if they need to travel to court proceedings to cities beyond 500 kms. The insured and his advocate shall also be provided reasonable lodging expenses, if incurred.

11 PAYMeNt Of ADVOCAteS’ feeSa. Oriental shall pay the fees to the Advocate directly as per Schedule B attached to the MOU. The insured doctor shall

not be asked to pay the Advocate and then claim reimbursementb. The Advocates shall send their bills for professional services and expenses to Oriental as per stages indicated in the

Schedule B.c. Oriental will pay the Advocates bills with reasonable dispatch and any payment delayed beyond 3 months shall be

reported to Dy. General Manager and in case the same is still not paid within one month, it shall attract interest at 10 % p.a. from the date of reporting of complaint to Dy. General Manager.

d. If a case is prolonged beyond 2 years, 10% additional fee will be paid for each block of two years beyond 1st two years.e. For National Commission Cases Rs.4000/- per visit to N.C. Will be paid additionally to the Advocate.f. The total fee will be as per above schedule and nothing extra will be charged from the Doctor/Nursing Home/

Hospital.I hereby agree to the above schedule and

will not claim anything from theDoctor / Medical Establishments.

SCHeDULe fOR LeGAL feeS fOR ADVOCAteS fOR HANDLiNG MeDiCO-LeGAL CASeS Of tHe MeMBeRS Of tHe ASSOCiAtiON Of MeDiCAL CONSULtANtS, MUMBAi (AMC)

Under Professional indemnity Policy (Doctors) error and Omission Policy for Medical establishments

'SCHEDULE B'

amc-noah “gates open”dr. gupta mukesh co-editors dr. baliga pradeep dr. rao nitin dr. sushmita...

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