The Manipur Nursing Homes and Clinics Registration Act, 1992

Dr Th Suresh Singh *

A District hospital in Manipur :: Pix - DIPR

Greater regulatory mechanism by Health Department is the need of the hour. Health Deptt. and the Govt. have completely failed to monitor it.

What is this Act? All the private hospitals and clinics in the state are to be registered under this act. Directorate of Health Services is the regulatory authority with the Director as its Boss. While giving registration, an inspection team consisting various specialists inspect the clinic/hospital to see whether these conform to the standard norm. One of the criteria is the various charges listed by the applying clinic/hospital for the services it will render. It includes charges of various investigations and hospital occupation days. Infrastructure, various available equipments and staffing pattern etc. are also to be inspected. Only when satisfied, the registration is than given.

One of the important pieces of item under the Act is that this Registration is to be renewed every 3 years. A penalty up to Rs 2000/, imprisonment up to 6 months or both can be imposed in case of non-registration. In case of unsatisfactory performance/misdeeds by the clinic/hospital, the registration can be cancelled by the Director of Health Services. A court having at least a 1st class Magistrate is the competent authority for trial under this Act.

One of the objectives of the Act is to prevent private practice by doctors working in Government institutions.

Your writer take pride in that this Act was vigorously implemented while he was working as DHS during 2006-08. There was no let up. Strict instruction was given to the inspecting team for establishing new clinics as well as renewals. Many doctors, especially anaesthetists, were found working in many clinics on rotation. I did not allow that as it is against the Act. Mind you, proprietors of those hospitals are my friends and I convinced them and they readily agreed.

As a result, many hospitals had to bring them from outside by stepping out an extra mile. That those from Manipur (specially retired ones) tripled their money is another story. I also emphasised to those friends that it is better for both of them and the authority to strictly follow the rules to avoid legal tangle and public wrath in times to come. I also personally inspected those bigger hospitals to give credibility to the inspection team.

After I retired, the belt has been loosened to such an extent that it is now questionable whether the Act is still exiting or not. It can be seen from the following chaotic scene :
i) infrastructure – specially in floor space, many big private hospitals are not following the standard norm. This will definitely increase hospital cross-infection. In layman’s term, a 30 bedded infrastructure has been given one 60-bedded permission. These can be easily detected by an ordinary doctor visiting the hospital.

ii) Many facilities had been added to various hospitals without the permission of the regulatory authority, example, permission for 8 specialities/subjects has been converted into 12 specialities.

iii) The prices for investigation and treatment charged by these private institutions are far more than the ones approved by the regulatory authority. This has led to a situation that the poor and the have-nots are not able to go for treatment to the better hospitals. In fact, there is a fear psychosis in the mind of everybody for undergoing treatment in reputed private clinics/hospitals.

Even a doctor-pensioner like me will think twice before undergoing treatment there. One can imagine what will happen to the common people. In some hospitals, not all, investigations and treatment costs are even costlier than the best one in Delhi. Why it is so? iv) Unnecessary prescription for investigations and drugs. It is a common knowledge that the prescribing doctor got a share of 10% over and above the drug company axis. This practice is, however, prevalent throughout India and is difficult to prevent.

In spite of all these defects, a private hospital is far more cleaner, more easily accessible and has saved many valuable lives because of their prompt service. Any private ventures should be encouraged to the maximum, I am all for it. The only thing is that there should be a proper balancing check.

Let us come to the other hot topic, that of private practice by Govt. doctors. It is an unending area with debates and discussions gone and gone with no solution in hand. What is important is that more and more Govt. doctors are working in private hospitals openly without any check. These however, constitute a minor percentage. Under the above mentioned Registration Act, DHS can straight cancel registration if any Govt. doctor is found working there. However, he is not willing to do that. To be fair to the DHS, one should not expect him to do it alone. For this, a political willpower and backup is required. Is it there? Is that support available? The answer is a definite no.

NPA : 3 categories are available for this –
i) majority of those working in the far flung areas. In fact, their NPA should be enhanced at par with central Govt. doctors. It may even be given more to those working in difficult areas. We have a system enforcing at present. It is time to enhance this allowance more

ii) the 2nd category are those specialists who are practising at their residence with minimum fee during their free time. One can take these doctors doing service to the society. Willingly, they are not going to the private hospitals on moral ground and sticking to their Govt. duty fairly and squarely. Though they cannot do this as per rules, I am willing to bat for them and will insist to formalise this practice by the Govt. These doctors have to sacrify a share of their NPA. These doctors constitute about 60-70% of the specialist working force

iii) the 3rd and last one are those doing open practice at the private hospitals without fear. These constitute about 30-40% of the specialist working force. It is here that we require a firm solution. Either the Govt. allow them without NPA, or don’t allow them at all. We have to take stern action either way, there is no alternative. It has to be done before the situation is too late and to prevent chaotic situation.

What is the conclusion? :

1. enforce the Act vigorously by checking investigation and treatment cost, floor space and unauthorised specialist branches including manpower. Tell these institutions the factual position, give a fixed period to amend themselves or face the music.

2. The govt. should undertake immediate measures as outlined in the NPA column above.

3. These private clinics/hospitals and the regulatory authority (DHS) should take this suggestion in a +ve way for protecting themselves from any legal tangle that may arise. Remember, in the not so distant period, a Kolkota hospital was forced to give compensation of more than 1crore by a court.

4. Formation of a neutral co-ordinating body consisting various stake-holders by the Govt.; it is long overdue. Government cannot leave health care delivery system to a few incompetent IAS officers and doctors.