clinical establishment act

The Government of USA enforced certain public health laws in USA because of the general consensus among the population is USA was that Doctors were bad and fleecing patient and then dumping them.In short doctors in USA were seen to be not doing there duties.Offcoarce this had to do something with the econnomic slump and inorder to placate the foul public mood various legislations were passed which included the EMTALA, COBRA and the SUNSHINE ACT.

The Government of India not to be outdone copied the essence of EMTALA and is trying to get it enforced as clinical establishment act.But is there any parity in the medical care in USA and India.

USA is notoriously espensive and you must have seen any patient going to USA from India would like to carry a huge supply of medicines to avoid the possible large medical bill in US if he is not insured.Besides that because the USA is Insurance and medicaid based medical services where government provides for the fees of the doctors such interference from the government may be desirable to some extent.But it does have a catch.The Insurance work in USA creates such large amout of paper work that many medical practitioners are leaving medical practice.That is when the number of patients they see is on average 13 patients per day.In India where the number of patients is substantially larger like say 70-100 patients per day the provisions of CEA 2010 of the doctors requiring to inform the governemnt of number of patients seen and their other demography variables will surely provide for mountains of paperwork.Surely medical care of the patient will suffer.
What will you choose,see a patient first or do the legal paperwork ,failure to do so will attract ahuge penalaty as if you have commited a felony.
It seems in all probability that the clinical establishment act in India is the result of goverment copying the health care bill from USA.A suspicioin arises that big corporations may be after it to undermine the stand alone practice,that has definitely suffered in America and this will surely be replicated in India.

When you will be forced to tell the government servant the number of cases you see and the fees that you are charging and other demographic details that he may deem fit.It is like enforcing a service tax which will follow soon.

Failure to do so will attract penalties much more in INR amount than criminal acts in IPC.

Another essential provisions of the statute is the clause related to the emergency stablisation of a patient.And that leads to an interesting law in USA under emtala known as 250 Yards rule.The strange clause is that any patient in the 250 yards of emergency outside the building has to be catered for.And so do all the drunken bums who have fallen in the ditches woutside the emergency have to be provided with the best that you have to offer.Free offcource!

Any patient who “comes to the emergency department” requesting “examination or treatment for a medical condition” must be provided with “an appropriate medical screening examination” to determine if he is suffering from an “emergency medical condition”. If he is, then the hospital is obligated to either provide him with treatment until he is stable or to transfer him to another hospital in conformance with the statute’s directives.
What constitutes “coming to the emergency department”? What constitutes “coming to the emergency department” is not always a simple one to answer. Over the years, the issue has arisen in connection with the transport of patients by ambulance or by helicopter, the development of a new emergency condition when a patient is already in-house, and similar situations. In 1998, an incident in Chicago raised this issue in a striking way. Allegedly because of a hospital policy prohibiting personnel from leaving the grounds while on duty, emergency room personnel at Ravenswood Hospital failed to provide assistance to 15-year-old Christoper Sercye, who had been shot at a nearby school playground and whose friends had brought him to an alley just off hospital grounds. The boy died from his wounds. The Clinton administration lost no time in announcing its intention to punish the hospital, and reportedly OIG imposed a $40,000 fine, but in truth there was
nothing in the hospital’s response to this tragic situation which violated the EMTALA rules as they then existed. 
This case exemplifies the fact that even a hospital fully in compliance may be subject to a citation and a fine, or worse, if the politics of the situation are wrong — and if it chooses not to contest the citation. It is only by challenging the citation that the hospital can vindicate itself if the CMS action is erroneous.In 2000, CMS issued new amendments to the rules under 42 CFR 489.24, expanding the responsibility of the emergency room to respond to any “presentation” on the hospital campus or at any provider-based off-campus facility of the hospital. In 2003, these rules were significantly revised.

The 250-yard rule comes from the definition of “Campus” found at 42 CFR 413.65:

“Campus means the physical area immediately adjacent to the provider’s main buildings, other areas and structures that are not strictly contiguous to the main buildings but are located within 250 yards of the main buildings, and any other areas determined on an individual case basis, by the HCFA regional office, to be part of the provider’s campus.”

This definition comes into play in connection with the complicated regulations which define “provider-based” facilities.

The significance for EMTALA under the 2000 regulations was that provider-based status was considered to bring some (but not all) off-campus facilities within the sphere of the hospital’s responsibility. For those facilities, a patient who presented to a facility requesting treatment, or who appeared and was perceived to be in need of treatment, had to be provided with the medical screening examination prescribed under EMTALA, and provided with stabilizing medical treatment if an emergency medical condition is found.

The 2003 revisions provide:

A person who presents anywhere on the hospital campus and requests emergency services, or who would appear to a reasonably prudent person to be in need of medical attention, must be handled under EMTALA. Other presentations outside the emergency room do not invoke EMTALA.
The 250-yard zone will continue to apply when defining the “hospital campus”. Now, however, that sphere does not include non-medical businesses (shops and restaurants located close to the hospital), nor does it include physicians’ offices or other medical entities that have a separate Medicare identity.
EMTALA does not apply to any off-campus facility, regardless of its provider-based status, unless it independently qualifies as a dedicated emergency department.

My suggestions are ———

No number of patients seen and other demographic details will be provided to the competant authority as it will only increase the paper work of stand alone practitioners.If the government is desperate for demography it should pay the independant medical practitioner for the demographic details on hours per work basis

The stringent act should not be applicable to stand alone or single doctor practice as it will only cause harasment to the allready busy person without a cause.Registration may be done but that should be all.

The Act should be not applied for clinics without beds as emergency care may not be posssible in OPD settings ,to provide or not provide emergency care should be left to the discretion of clinician.

The fines for the offences should be certainly at par with IPC and not 50000 to 5 lacks of rupees which will certainly cause corruption in the babudom of India.It should be token like 1000 rupees and no more.I did a goggle search and Indian Courts are fining INR 5000 for murder.


English: St Johns Accident and Emergency Depar...

English: St Johns Accident and Emergency Department (Photo credit: Wikipedia)


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