The aim of amendments to the Karnataka Private Medical Establishment (KPME) Act was to ensure protection of patient rights/citizens’ interests and bring in much needed transparency and accountability in private medical establishments. We welcome the government’s move to table the KPME amendments in the assembly.

The Bill includes certain key pro-patient provisions but certain others have also been watered down to placate the private hospital owners. These changes to the Bill are proof of how the private hospital lobby was able to hold the government to ransom. We take strong objection to a closed door meeting between the private hospital lobby and the Chief Minister even as the Bill was being tabled. This is undemocratic and has excluded a large section of those who are at the mercy of the very same lobby who have privileged access to the CM.

Regulation of the private health sector is a necessary first step to check uncontrolled commercialisation of health care and ensure strengthening of the public health system. In this context several citizens’ groups had been demanding citizen-centric amendments to the KPME Act that included a state level authority to ensure effective implementation of the Act, protection of patient rights in PMEs, an independent grievance redressal forum, with full-time members to address violations of patient rights, cost regulation, banning cut and commission practices in PMEs as also the practice of giving targets to employee-doctors /staff in private medical establishments.

Citizens’ struggle and KPME amendments

In this context it is important to foreground the relentless efforts of various mass-based organisations and citizens’ groups who have led a relentless struggle against the powerful private hospital lobby. In fact it is due to these relentless efforts that the Bill continues to contain some crucial pro-patient provisions. Pro-citizen provisions such as patient rights charger, PME charter, cost capping and others were viciously opposed by the private hospital lobby even when citizens groups made representations in various committees including the Joint Select Committee of the House. As expected this has been a battle of the unequals which the private hospital lobby demonstrated through its misinformation campaign and the subsequent unethical protest.

Citizen-centric provisions in the Bill

We welcome the introduction of an enforceable patients rights charter for the first time, in this amendment. Similarly, the creation of a charter for private medical establishments detailing its responsibilities has also been introduced. Several important rights like the right to care, right to prior and informed consent, right to dignity and privacy, right to information about the treatment and the right to a second opinion have been introduced. These two charters have to be prominently displayed at every hospital and a complaint can be filed with the District Registration and Grievance Redressal authority.

This authority, entrusted with powers of a civil court shall be a platform for patients to take their grievances.  Similarly, the right of patients to receive emergency treatment without having to pay an advance amount and the right to have the body of deceased patients released before making the full payment are two important aspects which this amendment has introduced.

No State-level oversight Authority

But the Bill does not provide for a state level authority to ensure effective, stringent implementation of the Act. Therefore implementation of the amended Act will continue to be poor. The Appellate authority as envisaged by the Bill has two clinicians and there is no clarity what will be the nature of oversight by this body.

District level Registration and Grievance Redressal Committee

The Bill has combined the DRA and GRC into one body the District Registration and Grievance Redressal Authority headed by the DC with powers to look into both registration and grievances.  The composition of the DRGRA includes a representative of the very same IMA which has demonstrated complete lack of accountability, responsibility and concern for patients.

The Bill also does not specify who the woman representative in the Authority will be. Therefore the composition of the DRGRA does not ensure a fair hearing for patients. Secondly the Bill does not define what a “frivolous” complaint is and does not lay out the due process to be followed by the Authority to determine what is “frivolous” and what is not. These elements along with Rs. 10000 fine for “frivolous” complaints will deter patients from filing complaints.

Therefore the Bill, while providing a redressal forum has created several deterrants where the odds are stacked against the patients.  Given the unequal nature of power between the PME and patient, the threat of a fine for ‘false’ complaints will not only deter patients from filing complaints but is also likely to be abused by the well-connected private hospital lobby. Referring doctors to KMC will again make the patient vulnerable to an ‘expert’ driven forum. It is unclear if the patient will also have to approach KMC in this instance. If yes, the purpose of having a district redressal forum is diluted and will require patients and attenders from districts to travel to Bengaluru to testify before an ‘expert’ private doctor heavy committee – another deterrent.

It is also of concern that the Amendments have been modified to state that patients cannot approach the courts directly and will be able to only after exhausting all mechanisms through the grievance redressal forum.

No cost regulation of PMEs

We also have been demanding price regulation in PMEs in order to put an end to the arbitrary and exorbitant cost of services as witnessed in Fortis hospital in the last few days. What happened in Fortis is a textbook case of irrational, unscientific, highly exploitative costing in private hospitals. The present Bill does not address this primary issue and therefore does not prevent exploitation of patients. The government has abdicated its role as a regulator. Failure to regulate costs of care in private hospitals only demonstrates that neither the ruling party nor the opposition have the integrity required to take such steps.

The government’s current move to fix the costs of procedures under various government schemes is an existing practice where government pays private hospitals empanelled under various schemes to provide a certain restricted number of services at pre-determined rates. In the event that such schemes are cancelled by the government this provision will become void.

No provisions to prevent malpractice in PMEs

Apart from stating that no private diagnostic facility will be set within a radius of 200 m of a government hospital, the Bill is silent about the rampant malpractices like cuts and commissions and criminal negligence in private diagnostic centres, clinics and hospitals.

Profiteering private hospital lobby and its direct threat to patients

The IMA’s deliberate misinformation campaign shifted focus from hospitals to doctors and raised non-existent issues such as jail term to create mob panic that prevented discussions of any genuine concerns. For instance there was a section of doctors working in private hospitals who wanted provisions protecting whistleblowers from within the hospitals. Similarly provisions banning cuts and commissions, concerns of small clinic and hospital owners were completely drowned out in the deliberate cacophony of lies and distortions.

The events of the past week have only further eroded the trust between doctors and patients, when in fact the Bill had the potential to reduce the trust deficit. We urge the doctors’ associations and their members to deeply reflect on their role in this entire episode.

Why was an amendment aimed at ensuring accountability of establishments needlessly painted as one that attacked doctors? What does the future hold for patient-doctor relationship after this episode? What kinds of accountability mechanisms they plan to bring in within their organizations such as IMA, PHANA to ensure responsible, mature conduct of its office bearers? The IMA and PHANA, instead of being voluntary associations have used ‘draconian’ measures to ensure that all doctors participate in protests without any room for personal choice. Is this the same when it comes to performing procedures and tests with the interest of the PMEs being foregrounded over those of patients?

Opposition parties’ support for the private hospital lobby

These events also revealed how Leaders of the opposition parties made statements in support of private hospital owners but none in support of protection of patient rights. The BJP members who were in the Joint Select Committee of the House, issued a dissent note which mirrored the demands of the private hospital lobby. BJP leader Yeddyurappa has even threatened to repeal the Bill if voted to power. The central government’s health care policies have opened the floodgates of corporatisation.

Therefore the state BJP’s support of private hospitals is not surprising and sends out a dangerous message to citizens. The JD(S) too helped propel the misinformation campaign by harping on the non-existent jail term and speculating about one-size-fits-all charges for all establishments. Both the opposition parties failed to show any concern to patients rights and have exposed their affinity for the private health lobby.

Government needs to reverse its pro-private health care policies and reduce dependency on private health sector which it is not able to regulate

The private health sector has repeatedly demonstrated its profiteering nature and through last week’s protest has sent a clear message that it will stop at nothing to protect “business interests”. But the state government on its part has continued to pursue health care policies that push citizens to seek care in private sector thus increasing their dependency on the latter. The government must immediately demonstrate its commitment to strengthening the public health system by:

• Tripling its health care budget in the coming financial year and investing in public health facilities at all levels.
• Stop empanelling private /corporate hospitals under various government insurance schemes so that tax payers money is not siphoned off to the private sector
• Roll back its policies that hand over government hospitals/health centres to private entities

Inclusiveness and Participation in law making

We urge the government to bring in greater inclusiveness and participation in law making. We had demanded that the government hold public consultations in every district with citizens during the KPME amendments process. This would have ensured a just and fair law and also ensured that there was little scope for misinformation. At least in the drafting of the rules for the act now, this must be followed.

Way forward

The KPME Bill has opened the discourse on health care issues in the public domain for the first time. We will take this critical discourse forward to the people of Karnataka and continue our struggle to strengthen the public health system, for demanding citizen-centric health care policies and legal instruments anchored in our Constitutional values of social justice, equality, transparency and democratic accountability. In the context of this Bill, we will continue to work with patients and their caregivers suffering violations in private/corporate hospitals to seek justice. We will fight for a healthcare system that is accessible to all.

Karnataka Janaarogya Chaluvali
Alternative Law Forum
Slum Janadolana Karnataka                                                
Karnataka Janashakti
Swaraj Abhiyan
Samaana Shikshanakkagi Janandolana
Manthan Law
Mahila Munnade
Safai Karmachari Kavalu Samiti
Karnataka Sex Workers’ Union
Swaraj Sanghatane
Sangama
Karnataka Rajya Raitha Sangha
Janandolanagala Maha Maitri
Lancha Mukta Karnataka Nirmana Vedike
Garment and Textile Workers’ Union
Jana Sangram Parishad

This is a pressnote forwarded by Karnataka Janaarogya Chaluvali and Alternative Law Forum, published under our ‘Message Forward’ section. The opinions expressed here are of the organisations and do not represent that of Citizen Matters.