Even as the Maharashtra government has started initiative to pass the Clinical Establishments (Registration and Regulation) Act, the Association of Hospitals (AOH), a representative body of 52 public trust hospitals in Mumbai, has welcomed it and said that the Act will ensure registration and regulation of all clinical establishments in the state with an aim to ensure the minimum standards of facilities and services provided by them.

“For long there was no regulation for clinical establishments. They were developed haphazardly. There were institutions with excellent facilities and there were many which had poor infrastructure and inadequate and unqualified staff. There was a need to provide minimum standards and making it mandatory for all those institutions to be registered,” said Dr PM Bhujang, president of AOH.

“For example Bombay Nursing Home Act 1949 hardly provided any standards. Only registrations of hospitals and nursing homes were necessary. All other healthcare providers including government and semi-government institution were not required to be registered. There were some states which had their own Clinical Establishment Acts (CEA) providing some norms. But they were applicable only to private institutions. To provide uniform standards there was a need to have a statute to regulate health care institutions. Clinical Establishment Act filled that void,” said Dr Bhujang.

Unfortunately health being the state subject, the same cannot be operative unless the state legislators ratify it. Even Maharashtra government is yet to pass this Act. We hope all states would pass this Act with their own modifications, he added.

The Act has several good provisions. Clinical establishment definition is quite comprehensive, including all healthcare providing institutions – both government and non-government, Allopathy, Ayurvedic, Homoeopathic, Unani and Siddha systems of medicine.

All these establishments have to be registered. There would be a central registry of all such institutions. Standards for infrastructure, staff and management would be prescribed. Standards of treatment would be provided. Compulsory stabilizing treatment of all serious patients and transferring them if necessary.”

Meanwhile, some of the medical professionals and organisations have expressed their apprehensions and reservations about some of the provisions of the Act including display of rates, emergency treatment, standard treatment protocols, etc.

AOH president, agreeing with them, said with so many services and diagnostic modalities and different rates for different classes, it is not feasible to display rates of all medical procedures.

He further said all the institutions may not have the required facilities and skilled staff to stabilize the patients. The onus of shifting them to other hospitals is not practical and in fact may create conflict between patients and hospitals.

Provisions such as uniform standards of infrastructure and staff may not be possible to be followed by all institutions, especially small institutions and those in rural areas. Standard treatment protocols may not be acceptable to all practitioners. There should be guidelines but not mandatory, he opined.

Bureaucratic interference, threat of penalty and punishment may become harassment to doctors and owners. Experience of PNDT Act has created suspicion in the minds of the doctors, Dr Bhujang concluded.

The Clinical Establishments (Registration and Regulation) Act, 2010 has been introduced by the Union government to ensure registration and regulation of all clinical establishments in the country with an aim to prescribe the minimum standards of facilities and services offered by them. The Act has been implemented by small states like Arunachal Pradesh, Himachal Pradesh, Mizoram, Sikkim, and all Union Territories except the NCT of Delhi.