New Delhi: For the first time, the National Medical Commission (NMC) has defined the graded levels of penalties that would be given to doctors for violation of rules specified in the recently released Draft Registered Medical Practitioner (Professional Misconduct) Regulations 2022.

In this manner, the Apex Medical body is trying to bring uniformity across the country regarding the assessment of liability and award of disciplinary action in case of Professional Misconduct committed by the medical professionals in India.

Specifying separate guidelines (Guideline-4) for determining penalties, NMC has clarified that while assessing misconduct, the State Medical Councils or the Ethics and Medical Registration Board of NMC should consider and evaluate other issues that may have contributed to the situation being assessed. Besides, the Draft mentions that the severity of the situation must be decided for each of the allegations made against the doctors.

Levels of Disciplinary Action as per Breach of Conduct:

The draft mentions that while investigating a case alleging breach of conduct, the SMC/EMRB/NMC should award disciplinary action while keeping in mind the severity of the act of commission or omission.

Also Read: Doctors to declare their earnings from pharma in affidavit, violations to bring 3-month suspension: NMC draft ethics guidelines

NMC has graded the disciplinary actions at five levels-

Exoneration:

NMC has mentioned in the Draft that “This level is appropriate when the Council finds that the doctor is not at fault and
has followed all regulations of the National Medical Commission Registered Medical Practitioner
(Professional Conduct) Regulations, 2022. No disciplinary action is warranted and the RMP is
Exonerated. This decision should be widely published.”

Level 1:
Reformation-
This may be awarded singly or in conjunction with other levels, in the form
of advisory, instruction, or warning.
Some examples are provided below:
(1) General/detailed instructions to the doctor to be more careful (Advisory)
(2) Instruction to display qualifications/degree appropriately, especially with regard to
specialization/super specialization.
(3) Instruction to attend a workshop or academic programs on Ethics, personal/social
relations, and/or professional training for medical professionals
(4) Instruction to attend Continuing Professional Development (CPD) programs in a
specified field; the number of CME credit points to be specified.
(5) Instruction to attend specialized workshop/conference/training (with NMC
accreditation)
(6) Warning to be careful in future
For instance, doctors who shall not abide by the rules for using Prefixes such as “Med Dr”, or the rules of displaying the unique registration ID in their prescription, certificates, may be penalized under the Level 1 (L1) disciplinary actions.

“RMPs who have been exonerated and those who have completed penalties under Level 1 should not be barred from receiving “good standing” certificates if required later,” mentions the Draft.

Level 2:
This penalty may be awarded even when the role of the doctor in causing direct harm
was not conclusively proved but the doctor was found to have breached any of the codes listed
above.
The maximum action is a suspension of the license to practice for up to one month
(30days).
For instance, the doctors who will be found to be violating the rules and regulations regarding the Continuing Professional Development (CPD) program may be penalized under Level 2 (L2) disciplinary action.
Level 3:
This penalty may be awarded when the role of the doctor in causing direct harm was
conclusively proved and the doctor was found to have breached relevant regulations.
This maximum action is a suspension of the license to practice for a maximum period of three
months. Holding suspension can be given in this level as per regulations.
Among the several misconducts that have been specified as Level 2 (L3) violations, using alcohol on or off duty has been categorized as one such violation of rules. If penalized under L3 disciplinary actions, a doctor might get a suspension order for a maximum period of three months.
Level 4:
This penalty may be awarded when the role of the doctor in causing direct harm was
conclusively proved and the doctor was found to have breached relevant regulations.
(1) The maximum action is a suspension of the license to practice for a period ranging
from 3 months to 3 years.
At each of Levels 2, 3, and 4, the extent of action recommended may range from reformation
alone to a maximum of suspension for the period indicated at the level, depending on the quantum
of responsibility of the RMP for the harm/injury caused.
For instance, doctors who do not respect the boundaries of the doctor-patient relationship, specifically, those who violate sexual boundary might get penalized under Level 4 (l4) disciplinary action by being suspended for a period up to 3 years.
Level 5:
Level 5 disciplinary action refers to permanent suspension of license. Referring to this, the Draft mentions, 
“The last resort is to debar a member permanently from practice (Permanent suspension
of license). This penalty may be awarded only after a detailed inquiry, carried out by an Expert
Group constituted under the Guidelines, finds that the treating doctor has committed a wilful, or
intentionally harm/unlawful, prohibited action. This will be taken as a ‘unique case’ and no
precedent will need to be cited.”

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