Chandigarh: Opining that the NMC guidelines should be advisory in nature, the Punjab chapter of Indian Medical Association (IMA) recently wrote to the Central Government authorities urging to keep the autonomy of the State Councils intact.
Such a request on the part of the association is a part of its details suggestions regarding the recently released National Medical Commission Draft RMP Regulations 2022.
Writing to the NMC, the Apex Medical Body in India, IMA Punjab has expressed its concern regarding several provisions mentioned in the NMC Draft including the rules regarding Credit hours, registration numbers allotted by State Medical Councils, rules regarding filing an affidavit of financial receipts from pharma companies, prescription of generic drugs, usage of Med Dr. prefix, etc.
The former IMA Punjab Chief Dr.
Rajender Sharma and the present president Dr Paramjit Maan also stressed upon the need for a framework for protecting doctors from violence.
Medical Dialogues had recently reported that in an attempt to address the various issues of professional conduct of registered medical practitioners, the Ethics & Medical Registration Board (EMRB) of NMC has introduced the Draft RMP (Professional Conduct) Regulations, 2022. These new regulations have addressed the issue of Professional Conduct of Registered Medical Practitioners (RMPs) including their duties and responsibilities, continuing professional development program, remuneration, prescribing generic medicine, prohibition of commission, restriction on advertisement, responsibilities regarding sale of drugs, medical reports, etc.
Releasing the Draft on May 23, NMC had invited comments from the Medical Fraternity on the Draft within June 22, 2022. Accordingly, IMA Punjab has submitted its suggestions on several issues of the Draft Regulations.
Autonomy of SMCs:
While the NMC Draft has laid down detailed rules regarding the continuing
professional development programs, IMA Punjab has opined that each of the SMCs had been constituted under a separate state act and they have their own guidelines for renewals and need of credit hours. These guidelines have been framed while keeping in view the state specific standards.
Therefore, the association has opined that “autonomy of state councils must be protected. These guidelines should be advisory in nature and not binding upon the SMCs.”
“These rights should be respected and protected,” it has suggested.
The association has also questioned what will happen to the registration number allotted by the SMCs since the Draft has clarified that the NMC number has to be mentioned in the prescriptions, making the Registration number of SMCs irrelevant.
Referring to this, the association has opined it to be contradictory to the federal structure and mentioned, “So, this means Registration number by SMCs will become irrelevant? If so then it is an infringement on the rights and autonomy of the SMCs which is against the federal set up claims of the NMC Act.”
Affidavit of Financial Receipt:
NMC in the Section 36 of the Draft has stated, “RMPs may be required to file an affidavit regarding their financial earnings and or
benefits received in the past 5 past years from any pharmaceutical companies or
allied health sector.”
However, referring to this, IMA Punjab has opined, “asking RMPs to file an affidavit of financial receipts from pharma companies is not needed when any such receipts are anyways banned. Or is NMC thinking of giving some exemptions /relaxations on this issue?”
Monetary Compensation in Medical Negligence:
Section 41 (7) of the Draft has stated that while disposing of a complaint against a doctor, NMC can “Award monetary penalty to aggrieved party as it deems fit as per Section 30 of the
NMC Act, 2017 can be given by EMRB only as and when required.”
However, IMA Punjab has opined, “If NMC has to award monetary compensation in medical negligence cases then NMC must ask the Govt to legislate and exclude medical services from CPA by amending the CPA and inserting an exclusion clause specifically for health services. Since there can’t be two financial compensation mechanisms for a same complaint and again this will be against the principle of natural justice.”
Prescription of Generic Drugs:
Referring to the NMC’s insistence upon prescribing generic medicine, the association has termed it to be a “publicity gimmick” and it has also opined that id NMC and the Government is so serious about making cheap medicines available to the patients then it needs to follow other measures.
The measures as recommended by the association are as follows:
(1) Ensure pharmacological quality of these as per prescribed standards so that in name of the cheap drugs patient’s health is not put at risk.
(2) Ensure printing of rational MRP on these drugs because most the so-called generic drugs have a hugely inflated MRPs printed, almost at par with branded drugs and huge profits margins for the chemists, who may or may not pass on the benefits to the patients defeating the very purpose of this exercise.
(3) Ban all branded drugs, except some OTC drugs because if RMPs are not allowed to prescribe branded drugs then who else is to prescribe these, obviously none, so there is no need for branded drugs. It will also solve the problem of checking the prescriptions and NMC will be saved from the huge efforts needed for ensuring the implementation of these guidelines.
Med. Dr. Prefix:
In an attempt to differentiate doctors practicing modern medicine from other doctors and scientists and researchers, NMC in the draft has mentioned “Only those RMPs who are registered under NMC Act, 2019, can use Medical Doctor (Med Dr.) as a prefix before their names.”
However, Punjab IMA has termed it to be inappropriate and injustice to the treating physicians, who are known as doctors and have been using the Dr. Prefix since ages.
“Rather than foregoing a privilege of Dr. Prefix for RMPs, NMC should suggest to Govt to make others to use some identifying prefix related to study field of non-medical doctors and strictly ban usage of Dr. Prefix by physiotherapists, vets and Ayush practioners,” IMA suggested.
Consumption of Alcohol:
While the association has appreciated the NMC rule of punishing drunk duty of doctors, it has questioned extending this rule to off duty hours.
“Use of Alcohol or other intoxicants during
duty or off duty which can affect professional practice will constitute misconduct,” read the NMC draft.
The association questioned the NMC’s decision of extending this rule to off duty hours and mentioned, “This is a direct interference in the personal life of the RMP and is beyond the domain of the NMC which has a mandate to regulate only the professional activities of the RMP, it has no business to regulate his personal life. By the same logic of impact on his capability to treat a patient due to off duty alcohol consumption, tomorrow marriage, raising of kids, vacations etc. may also fall in this category! So, it needs to be deleted.”
Violence against doctors:
IMA Punjab also opined that in additions to prescribing ethics and duties for the RMPs, the National Medical Commission must provide a “robust framework for protection of doctors from violence, intimidation, and obstruction in line of duty. It must lay down a framework for protecting doctors from mindless litigation and mental harassment.”
Apart from these, the association has also questioned the rule of not allowing a lawyer to accompany an RMP during the hearing of a complaint against him terming it to be “an assault on his rights to seek expert legal help when his right to practice is under threat.”
It has also sought clarity regarding the Corporate Hospitals term, which has been used many times in the Draft but has not been defined by the Apex Body.