EMERGENCY MEDICAL TREATMENT PART II, Sec. 12(2) “The clinical establishment shall undertake to provide within the staff and facilities available, such medical examination and treatment as may be required to stabilise the emergency medical condition of any individual who comes or is brought to such clinical establishment”. • “emergency medical condition" means a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) of such a nature that the absence of immediate medical attention could reasonably be expected to result in— (i) placing the health of the individual or, with respect to a pregnant women, the health of the woman or her unborn child, in serious jeopardy; or (ii) serious impairtment to bodily functions; or (iii) serious dysfunction of any organ or part of a body;” • "to stabilise (with its grammatical variations and cognate expressions)" means, with respect to an emergency medical condition specified in clause (d), to provide such medical treatment of the condition as may be necessary to assure, within reasonable medical probability, that no material deterioration of the condition is likely to result from or occur during the transfer of the individual from a clinical establishment”. OUR OBJECTIONS: That act bounds to provide emergency room patients with a full medical screening regardless of ability to pay, and to refrain from transferring them until they have been stabilized. It will create new policy dilemmas. Many indigent patients, knowing that they cannot be denied an assessment, visit emergency rooms for minor ailments. This introduces delay in treating legitimate emergencies, adds to hospital financial pressures, since the care is not reimbursed, and places new cost pressures on the overall health care system, as emergency care is extremely expensive. Dis-satisfaction or in cases of complications/casualty during emergency care will increase the cases of medical negligence. Imposing a statutory duty on private establishments to provide treatment in emergency without a corresponding right to obtain fees for such treatment either from the patient or the statutory authority imposing such condition. less well equipped establishments may not be able to provide full and complete treatment. Who will pay for the treatment? Where will the patient be transferred? Who will pay for the transfer? The basic legal principle is that there cannot be a duty without a corresponding right. The act imposes a duty to provide expensive treatment without any provision for paying the cost. The original Supreme Court directive was in the context of life-saving first aid for accident victims. It is irrational, unrealistic and unfair to expect doctors to extend it to all kinds of emergency situations. Supreme Court of India Pt. Parmanand Katara vs Union Of India & Ors on 28 August, 1989 Equivalent citations: 1989 AIR 2039, 1989 SCR (3) 997 ACT: Constitution of India, 1950: Article 21--Obligation on the State to preserve life--Every doctor has professional obligation to extend services to protect life--All Govern- ment hospitals/Medical institutions to pro vide immediate medical aid in all cases. “every doctor whether at a Government hospital or otherwise has the professional obligation to extend his services with due expertise for protecting life.” Single doctor clinics may receive different handling as they may not be able to keep pace with the situation in view of their size of work. This law is more suited to big government institution and corporate private healthcare providers. Attending emergencies in small clinics may be an issue, which needs further elaboration. This may also lead to double registration fees if both systems exist parallel. The Report of the Law Commission submitted as “201st Report On Emergency Medical Care To Victims Of Accidents And During Emergency Medical Condition And Women Under Labour August 2006” which contained detailed provisions for creating a state funded compensatory mechanism for compensating the medical profession for providing such statutorily mandated services, must be taken into consideration. lawcommissionofindia.nic.in/reports/rep201.pdf In 2006, the Law Commission looked into the issue, and from a comparative study of the legislations in other countries, suggested a legal right to emergency medical care, reiterating that concerns like legal formalities, monetary considerations or even the infrastructure restraints of the institutions should not stand in the way of providing basic and emergency medical treatment.It may be noted that hospitals fall within the State list, and therefore, a central act cannot be legislated. The Law Commission therefore, drafted a model bill which can be adopted by the States. As per the recommended model bill, hospitals and medical practitioners would need to initially screen patients to determine if they require emergency medical treatment, and if hey do, refusing such treatment without justifiable reason would amount to an offence. A patient may be eventually transferred to another hospital which is better equipped to handle the patient, but the primary responsibility of stabilizing a patient in need of emergency medical care cannot be avoided. This recommendation by the Law Commission is not mere wishful thinking. In fact, it is modeled closely along the lines of the Emergency Medical Treatment and Labor Act, 1986 of the USA. In fact, the US legislation has even been referred to by the Supreme Court in Paschim Banga Khet Mazdoor Samiti, approving, in principle, the substance of the legislation and its applicability in India. There are already guidelines of MCI regarding emergency medical treatment, so matter would be of double jurisdiction. Indian Medical Council Act, 1860: Section 33--Indian Medical Council/Code of Medical Ethics--Clauses 10 and 13--Obligation to sick--Patient not to be neglected. This is major infringement of fundamental right of a medical professional provided under article 19(1)g, and not fall in category of “reasonable restrictions”. Thus Article 19(1)(g) read with Article 19(6) spells out a fundamental right of the citizens to practise any profession or to carry on any occupation, trade or business so long as it is not prohibited or is within the framework of the regulation, if any, if such prohibition or regulation has been imposed by the State by enacting a law in the interests of the general public. Emergency patient care is always Moral & Ethical bounding for Doctors & it should not be Legal bounding which would be against the doctrine of natural Justice.
Posted on: Sun, 18 Aug 2013 03:33:06 +0000