Recently the Government of Indian has constituted a national council for clinical establishments. The object is to determine minimum standards for hospitals and hold periodic reviews. The committee is also going to classify the hospitals into different categories and maintain a national register of hospitals. The Director General of Health Services will be chairperson and members are to be drawn from Dental, Medical, Pharmacy and Nursing Councils.
Apart from the representatives of these four Councils, the committee will have representation from Central Council of Indian Medicine, one each for disciplines like Ayurveda, Siddha, Unani and also from Homoepathy. One representative each from IMA and Bureau of Indian Standards are also to be included. Thus, the Union Health Ministry has started the procedure for regulating and grading the hospital sector, which is the only unregulated sector so far in India. Though there are specification, rules and regulations for hospitals attached to the medical colleges and dental colleges, framed by Medical Council and Dental Council respectively, vast majority of unattached hospitals are left out. As a result, they are being run as per the will and wish of the respective managements with nobody to question them.
Naturally this unregulated sector is feeding a lot to grind in the mills of the print and visual media. Periodically, we hear and read negligence of patients, wrong treatments, wrong operations, unnecessary tests, uncalled for cesarean, excessive and unwanted prescriptions, unwanted drug reactions, exorbitant charges and even kidney transplantation rackets etc. Because of this state of affairs, not only the patients, but also the paramedical professionals are also affected. In order to earn more money, many hospitals are not appointing trained paramedics in their establishments to provide the services to patients, they deserve. Instead, semi-literates or SSLC qualified persons are appointed with little training in the same hospitals.
In many medium and small hospitals, nursing services are carried out not by diploma or degree holders in nursing, but by trained girls without basic professional qualification. The situation is still worse in the case of dispensing of medicines. Here anybody who can read the prescription is engaged and most of the time, the above girls are doing it. Thus the patients getting treatment in these hospitals are under constant risk to their life.
So the proposal to regulate the hospital by some authority is god sent, not only to general public, also to pharmacists and nurses. They must join hands with consumer organizations in speeding up the proposals and its implementation. On their part the Pharmacy Council of India (PCI), must send a strong representative to the proposed council, who can convince the council and able to include the demands of the pharmacy profession.
Already few years back, PCI has sent to MCI a proposal to fix standards and the specification for the department of pharmacy in teaching hospitals, which is yet to be included and implemented by MCI, for the reasons, known only to them. Now it is another golden opportunity knocking at our doors! Pharmacists cannot afford to miss it. Some concrete proposals can be put forth before the proposed council. The following suggestions may be considered to take up with the said council:
Grading of hospitals
If hospitals are to be graded into A, B and C grades then they should fulfill certain requirements, as far as pharmacy services are concerned in these hospitals, an A grade hospital, for example, should have a separate department of pharmacy under the guidance of a doctorate or postgraduate in pharmacy. He must have specialization in either in pharmacy practice or in clinical pharmacy. The department should have staff with M. Pharm qualification and facilities to carry out the clinical pharmacy services like medication history interview, individualization of dose, therapeutic drug monitoring and patient counseling etc. It should have a pucca clinical laboratory to do the needed test and analysis of the samples (body fluids etc) collected from patients for therapeutic drug monitoring. The hospital should also have a drug information centre, to provide information to doctors, patients, students and general public. Sufficient number of graduates in pharmacy must be appointed for dispensing and other patient oriented services. The grading of hospital should be done not on the basis of bed strength (quantity), but on the basis of facilities (quality) available.
'B' grade hospitals should also have separate department of pharmacy, with post graduates and graduates in pharmacy. The clinical pharmacy services can be optional. Nevertheless they can carry out simple clinical pharmacy services like medication history interview, patient counseling etc. For routine monitoring of the cases, clinical laboratories should be established, but the suspected cases of ADR or complicated and chronic cases of patients, should be referred to 'A' grade hospitals.
'C' grade hospitals should have B. Pharm and D. Pharm holders in their dispensaries, only a graduate in pharmacy should be appointed as chief pharmacist and D. Pharm holders as pharmacy assistants for dispensing etc.
All other hospitals without the above mentioned facilities should be given 'D' grade. Similarly nursing services should also be regulated with qualified nurses offering quality nursing care.
All the above hospitals should be periodically inspected and these inspections must be at least once in a year and without prior intimation to the hospital concerned. As the hospital and its staffs, are coming under essential services, they are supposed to present always on round the clock duty and hence there is no need for prior intimation for inspections. The inspection team must include at least one post graduate pharmacist and his finding regarding the pharmacy services must form the basis for continuing or discontinuing the existing grade of the hospital.
This apart the patients of the particular hospitals and consumer associations of the area must be involved in the evaluation process. They must be given printed questionnaires and answers obtained must be given due attention.
If not a foolproof system is evolved for grading and maintaining hospitals, the proposed council will also become yet another inspection authority of government missionary, without any improved result.
(The author is ex-president, IPGA, Madurai)