IN THIS ISSUE - Association of Medical Consultants, …...˘ˇ ˆ ˇ ˙ ˝ ˝ ˛ ˚ ˜ ˘ˇ ˇ ˝ Vol. 40 Issue No. 3 Nov. 2011 AMC MEET II at ISKCON Auditorium, Juhu AMC MEET II IN

�� Vol. 40 Issue No. 3 Nov. 2011

AMCMEET II

at ISKCON Auditorium, Juhu

AMCAMCAMCAMCMEET IIMEET IIMEET IIMEET IIMEET IIMEET IIMEET II

IN THIS ISSUE�� HOW LONG SHOULD YOU PRESERVE

PATIENT'S RECORDS

�� DETENTION UNDER THE GUISE OF PROTECTION & ITS REMEDY

�� ACCREDITATION STANDARD FOR NURSING HOMES

�� HOW MUCH YOU REMEMBER

�� HOW MUCH YOU REMEMBER

�� FROM THE PRESS

� � ��

COMINGSOON

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Views andreviews on health andpharma related subjectsInterviews

with important personalities

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EDITORIAL BOARD

EDITORDr. Gupta Mukesh

CO-EDITORS Dr. Baliga Pradeep Dr. Shukla Ashok

ADVISORY BOARDDr. Kapoor Lalit M.

Dr. Rao P. N. Dr. Oza Umesh

BOARD OF TRUSTEES MANAGING TRUSTEE

Dr. Kapoor Lalit M.

TRUSTEESDr. Suchak Anil N. Dr. Pandit Bipin Dr. Rao Suresh S.Dr. Nayak AchyutDr. Naik Dilip S.Dr. Shah Bipin V.

WEBSITEwww.amcmumbai.com

WEB EDITORSDr. Checker Vipin

WEB CO-EDITOR Dr. Arshad G. Moh’d.

Dr. Rao Sujata Dr. Dani Saurabh

DISCLAIMERUnless otherwise stated, the opinions expressed by the writers are their personal opinions. The AMC reserves the right to use material published in ‘The Grasp’ for its Website or for any other purpose deemed necessary.

The appearance of advertisement in ‘The Grasp’ is not guarantee or endorsement of the product or the claims made by the manufacturer/ advertiser.

ASSOCIATION OF MEDICAL CONSULTANTS, MUMBAI

MANAGING COMMITTEE (2011 - 2012)President Dr. Agarwal Niranjan rrPresident Elect Dr. Hariani Ajay R.rrImm. Past President Dr. Walavalkar Rajeev rrVice President Dr. Khambay Sabh SinghrrVice President Dr. Rao SujatarrHon. Secretary Dr. Adyanthaya KishorerrHon.Treasurer Dr. Arshad G. Moh'drrHon. Jt. Treasurer Dr. Pikale Sangeeta rrHon. Jt. Secretary Dr. Pandit VeenarrHon. Jt. Secretary Dr. Baliga PradeeprrProg. Committee Chairperson Dr. Sharma SmitarrOffice Secretary Dr. Vazzifdar KhurshedrrEditor- The Grasp Dr.rr Gupta MukeshWeb Editor Dr. Checker Vipin

ZONAL DIRECTORS

Dr. Agarwal Shivbhagwan N. Dr. Badwe ShrikantDr. Dave Rajesh Dr. Desai Ajit K.rrDr. Kulkarni Gurudas B. Dr. Naik DiliprrDr. Oza Umesh Dr.rr Shah Bipin V.

COMMITTEE MEMBERSDr. Bahekar Pramod Dr. Begani ManmalrrDr. Chawhan RajenDr.a Dr. Dani SaurabhrrDr. Desai Ajit G. Dr. Gandhi RajeshrrDr. Hedge Dinesh Dr. Kate SuhasrrDr. Lokras Girish Dr. Matcheswalla YusufrrDr. Mital Kushal Dr. Patel ManojrrDr. Pattiwar Sanjay Dr. Rao NitinrrDr. Sahetya Raju Dr. Sangoi ManojrrDr. Sawant Ganpat Dr. Shah SuhasrrDr. Sheikh Parvez Dr. Shukla AshokkumarrrDr. Vaidya Deepak

CHAIRPERSON OF CELLSConsultants Benevolent Scheme Dr. Shah Bipin V.rrH & A Cell Dr. Rao Suresh S.rrInfrastructure Cell Dr. Naik SudhirrrMedico Legal Cell Dr. Datar NikhilrrSocial Service Cell Dr. Agarwal Shivbhagwan N.rrPublic Relation Cell Dr. Pikale Sangeetarr

Edited by : Dr. GUPTA MUKESHCo-ordinated at JAI GRAPHICS, Kandivali (East), Mumbai - 400 101

For Association of Medical Consultants, Mumbai. (For Private Circulation Only)

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...

ASSOCIATION OF MEDICAL CONSULTANT, MUMBAI NURSES TRAINING PROGRAMME

ON SUNDAY, 20th NOVEMBER, 2011 TIME 08.00 A.M TO 05.30 P.M.

AT SHIV LILA SADAN, OPP. MUNICIPAL CORPORATION,

RAM MANDIR ROAD, BEHIND DENA BANK, STATION CROSS ROAD, BHAYANDAR WEST, THANE 401 101.

��

PROGRAMME DETAILSREGISTRATION & BREAKFAST

09.00 AM TO 09.15 AM INAUGURATION

09.15 AM TO 09.30 AM �� DR. NIRANJAN AGARWAL

09.30 AM TO 10.00 AM � �� DR. S. N. AGARWAL

10.00 AM TO 10.30 AM �� DR. SMITA SHARMA

10.30 AM TO 11.00 AM BED SIDE MANNERS DR. ASHOK SHUKLA

11.00 AM TO 11.30 AM ��

11.30 AM TO 12.00 PM LABOUR ROOM MANAGEMENT ��

12.00 PM TO 12.30 PM �� DR. SAMIR SHEIKH

12.30 PM TO 01.00 PM �� DR. NIRAJ JINDAL

01.00 PM TO 02.00 PM ��

02.00 PM TO 02.30 PM �� DR. KOPPIKAR

02.30 PM TO 03.00 PM �� DR. RAJESH JIWARKA

03.00 PM TO 03.30 PM �� DR. SHARAD SHELAR

03.30 PM TO 04.00 PM BLOOD PRESSURE DR. S. R DESSAI

04.00 PM TO 05.00 PM ��

LANGUAGE: HINDI/MARATHI/ENGLISH MIXED REGISTRATION FEES: Rs�� LIMITED REG. � PLEASE REGISTER EARLY.

��

DR. NIRANJAN AGARWAL ��DR. KISHORE ADYANTHAYA ��DR. S. N. AGARWAL PRESIDENT HON. SECRETARY CHAIRPERSON,

SOCIAL SERVICE CELL

DR. ASHOK SHUKLA ��DR. VIPIN CHECKER ��DR. PRAMOD BAHEKAR��

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EDIT SPEAKDr. Mukesh Gupta

Dear Friends,The festive season brings tremendous

sense of well being in our lives. On behalf of Team Grasp I wish all the readers a very Happy Diwali and new year.The forthcoming AMC Meet is on Spirituality in Medicine. A subject very interesting and �� the relationship of science to religion and spirituality has developed in complex ways. The popular notion of antagonisms between science and religion has historically originated with "thinkers with a social or political agenda" rather than with the natural philosophers t h e m s e l v e s . Though physical and biological scientists today avoid supernatural explanations to describe reality many scientists continue to consider science and spirituality to be complementary, not contradictory.One of the great gifts of spiritual knowledge is that it realigns your sense of self to something you may not have even ever imagined was within you. Spirituality says that even if you think you're limited and small, it simply isn't so. For some it is the guiding force for others it may be inspiration or motivation or support system to fall back on. No denying its presence in our life. Although religion and spirituality are sometimes used interchangeably, they really indicate two different aspects of the human experience. You might say that

spirituality is the mystical face of religion.We look forward for interesting interactions in the journey to analyse this complex issue in the next AMC Meet. In this issue interesting issue of protection vs detention is dealt with. The mystery of legal requirement of Record keeping has been dissected. Standardisation and accreditation is the need for our health care services. AMC has been forefront in accepting and implementing this felt need. Dr. Ketan Parikh

throws some light on the recent developments on this subject. The storm of that smart tool in our hands …Smart phone is analysed.very rarely do we come across great inspiring leaders who dedicate their time and efforts

for fellow colleagues. AMC has been lucky to have with us Dr. Lalit Kapoor who has been friend, supporter, guide to all practicing consultants in their times of need. The AMC team felicitated him with the honour of “Life Time Achievement” award this year. We have incorporated some salient aspects of his vision and thoughts on that occasion in the present issue. We thought that many of us would take inspiration from his words and will keep it as fond memory. Grasp is the only medium which reaches to all members of AMC. Hence we feel it appropriate to use this opportunity of gaining insight to his vision by all members.We salute him and the other leaders and workers who have made AMC.

e-mail: [email protected]

EDIT SPEAKEDIT SPEAKEDIT SPEAKDr. Mukesh Gupta

The world we see merely reflects our

own internal frame of reference -the

dominant ideas, wishes and emotions in

our minds. We look inside first, decide

the kind of world we want to see and then

project that world outside, making it the

truth as we see it. We make it true by our

interpretations of what it is we are seeing.

AAAAAAAAMMMMCCCC &&&& BBBBHHHHAAAAKKKKTTTTKTKTKKKTKKTKTKTTTKTTKTKKTTKTKTKTIIIIVVVVEEEEDDDDAAAANNNNTTTTAAAATATTTAAA HHHHOOOOSSSSPPPPIIIITTTTAAAATATTTAAALLLLLLLL

proudly present

AMC MEET II a conference with a difference on

“THE ROLE OF SPIRITUALITY IN MEDICINE -THE FOURTH DIMENSION OF HEALTH”

on 11th December 2011 at Mayfair Rooms, Worli from 8.30 am – 2.00 pm

PROGRAMME

8.30 TO 9.00 REGISTRATION & TEA/COFFEE, BISCUITS

9.00 TO 9.10

INAUGRAL FUNCTION

AGARWAL ANDLIGHTING OF THE LAMP BY DR. SURESH SHETTY –HONORABLE HEALTH MINISTER GOVT. OF MAHASHTRA

9.10 TO 9.30SKIT – HAPPY DOCTOR HAPPY PATIENT DR. YUVRAJ BHOSLE –DEPT. OF ANATOMY, KEM HOSPITAL, MUMBAI

9.30 TO 10.00NEED FOR SPIRITUALITY IN HEALTH DR. K. P. MISHRA –SENIOR CONSULTANT CARDIOLOGIST

10.00 TO 10.30 CONCEPTS OF SPIRITUAL HEALTH DR. SANKHE –DIRECTOR BHAKTIVEDANTA HOSPITAL

9.30 TO 10.00 SPIRITUAL HEALTH BEYOND RELIGION HIS HOLINESS RADHANATH SWAMY –SPIRITUAL LEADER

11.00 to 11.30 HIGH TEA / SNACKS

11.30 to 12.00ECONOMICS OF SPIRITUAL HEALTH DR. SWATI PIRAMAL

12.00 to 01.00DEBATE –IT IS SCIENCE AND NOT RELIGION WHICH IS BASED ON BLIND FAITH MODERATORS : DR. DHAWAL DALAL & DR. K. F. VAZIFDARSPEAKERS : DR. CHITRE & DR. ASHOK KRIPLANI

01.00 to 01.30 INTERACTIVE SESSION WITH THE FACULTY

01.30 onwards LUNCH

REGISTRATION CHARGES

MEMBER/SPOUSE: Rs. 300/- ON FIRST COME FIRST SERVE BASIS AGAINST PAYMENTSPOT REGISTRATION & GUEST: Rs. 600/- SUBJECT TO AVAILABILITY.

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Dear Members

On behalf of my entire Managing Committee I wish you all a belated Happy Diwali and a prosperous new year. We at AMC pray and hope that the illuminations at the festivals may have lightened up your surroundings and eliminated the darkness around.

The strength of any organisation is derived from the unity amongst its members. AMC strength in keeping its members united on the TPA front has been largely successful though, I agree that there are stray incidences which need to be revisited. The fact that the claim ratios of the insurance Cos have increased inspite of the PPN introduction proves that most of us are abstaining from the cashless/PPN facility. In fact many have agreed that they are actually happy not doing cashless and that their gross collections at the end of the month has in reality not suffered inspite of refusing these cases. The special AGM on 18th September at Thane on this issue again reiterated its earlier stand of boycotting all forms of cashless facility and intensifying the stir. This decision was taken after much deliberations on the three options placed in front of the members present viz, 1) Continuing the existing boycott call 2)Total withdrawal of the boycott call 3) Allowing members to offer cashless services to corporate policy clients and private insurance company clients and

continuing the boycott of all PPN related cashless facility. A large majority was in �� volunteers was formed to visit members who continued doing cashless services and further convince them to withdraw. More members are requested to join the volunteers team and area wise teams have been formed to conduct meetings under the able leadership of respective zonal directors. This we believe will not only help in creating awareness but also give us a �� and feelings of an ordinary AMC member. All respective area representatives need to proactively help the zonal director who will ��trustee. We take this opportunity to invite suggestions for effective implementation of our boycott call of all cashless facilities. I would also like to share a good news with you – Doctors from Ahmedabad have also joined hands in boycotting the cashless/PPN facility and we are in constant touch with them. AMC has also decided to take legal course in this matter after the non-relenting attitude of the Insurance Cos. We are preparing to intervene in the ongoing PIL in the Mumbai High Court ��Damani. We want to update the Court �� the arbitrary and unreasonable behavior of the TPAs and the Insurance Cos and forced to seek the help of the Court. A lot of hard

PRESIDENT'S REPORTDr. Niranjan Agarwal

work is being done overtime but needs more ��instances of harassment at the hands of TPAs with attached proofs. You could give us examples of non-sanction of AL, part sanctions, delayed payment, unreasonable cuts etc. etc. We would also appreciate your suggestions on the methods you could think of achieving a reasonable solution to the whole issue in general. Please forward your suggestions and proofs of harassment on [email protected] or send hard ��

AMC has been also participating with various other specialty organisations and NGOs in �� !"#�issue. I agree, a lot of hardship has been caused to many doctors for minor offences ��$�� %�� a Central Law, needs representation at that level which may take some time. In the meantime we are trying to do whatever best we can for our members. In the same breath I would like to inform you that AMC has pro-actively started a campaign of creating awareness amongst our members about the importance of the girl child and towards that effect you must have noted the beti bachao logo on the front page of last Grasp as well as on the brochure of the 18th September programme at Thane. We had also conducted a panel discussion at the AMC meet at Thane on the topic. Change of User applications of nursing homes thorough being facilitated at the upper level, I admit is facing some slow pace at the zonal level and we are trying to sort that out with their seniors. Unfortunately � �� take their own time.We have two interesting programmes lined up for you in the coming months. First is a AMC Meet at Mayfair Rooms on 11th December from 9 am. to 2 pm. a programme with a theme of role of spirituality in medicine. We are conducting this programme in association with the

% �$�� &�� "�� said programme can be viewed in this GRASP as well as in the brochure sent along with it. The next is our annual conference AMCON which is scheduled on 4th and 5th of February instead of the routine One-day programme. The theme of the conference will be focused on the hospital infrastructure needs. There will be a perfect blend of other topics based on Medico-legal and various socio-medical issues as well. We will have an associated exhibition related to infrastructure needs of hospitals. Here, I must laud the efforts ��"��%��'��$��"�� %��along with all others for ensuring a highly successful AMC meet at Thane on 18th

September 2011.

The doctors who went on tour to Spain and Portugal are back and are very happy with the arrangements made there by our tour operator. Most of the doctors are looking forward to the next year trip and the President Elect must be already working on it for sure.

AMC's earlier initiative of forming a federation of medical associations in Maharashtra is now witnessing some more activity with IMA Maharashtra now taking the lead along with other organisations like us for the same. We are actively involved in this so that a long drawn dream comes true for the doctors whose cause can be directly and effectively voiced through this channel.

Friends, AMC's strength lies in your beliefs and the Managing Committee’s convictions on proving them right. Please help us realise and seek solution to all the issues of your times. We promise to go overboard to try and get an answer for all of us. Let us all act in a manner which will win many a day for us and decide the ways we practice in near future.


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HON. SECRETARY'S REPORTDr. Kishore Adyanthaya

Season's Greetings from all at AMC!With festivities behind, it is time for

us to return to the grind. With immense pleasure, I would like to inform you - our esteemed members - that your AMC is no more restricted to Mumbai. We are already ��'�� %�� (��have been invited to Kolkata for initial ��body. These events amply demonstrate the trust reposed in us and our functioning, by the distant medical communities.��%��ing was held on 18th September to discuss the amendments to the constitution and PPN matter. Repeated discussions with the Insurance Cos having failed, our demands for Apex body formation, empanelment, fees and non-victimisation were not accepted. They have agreed on Apex body formation, but, it is only to redress grievances. They have agreed to empanel - with certain amount ��)��)��*++�� %�� the geographical clause - that if there are more nursing homes meeting the criteria in one area they may select only one; naturally, the one offering services at the lowest rate negotiated by them will be preferred. In the SGM the mandate was that boycott of cashless services should be �� # �� AMC Meet I was held at Thane. The theme was "Declining sex ratio - A medico-social concern". PCPNDT Act was also discussed. "�� '��$�� "�� %�� an excellent programme. One Credit Hour

was awarded by MMC to the delegates who attended AMC Meet I.A unique interactive workshop on "Preventing Medical and Legal Mishaps was conducted by Dr. Datar And Dr. Rajan Madhok, Medical Director, NHS, Manchester. It was well attended and appreciated by the delegates.Regarding the seizure of Ultrasonography equipments, AMC with its representatives along with Professional bodies like MOGSI and IRIA and NGOs discussed the matter with Government and Municipal authorities to streamline all issues related to PCPNDT �� )�� in Thane and Navi Mumbai, with Mumbai following soon.Many nursing homes have got their change ��(�� has been slow. Here we should appreciate the help rendered by the Chief Engineer Mr. Kukanoor, who visited all zonal ward ��,�� &��would like to inform that there has been ��$��-.�

��/�� the case of COU has been refunded as ��%��

AMC conference tour of Spain and Portugal is back. After 12 days bus tour �� 0�� )� �� %��Torremolinos, Alicante, Granada, Velencia, Sevill, Rhonda and Lisbon - the group spent two nights in Istanbul. Tour directorsMr. Koul and Dandekar saw to that every demand was met with.

We now look forward to two very important programmes. First is AMC Meet 2, which will be on December 11th

� � �� % �$��Hospital. The theme is "Role of Spirituality in Medicine - The Fourth Dimension of Health". There is a gamut of excellent speakers and the capacity of auditorium is small. So book in advance to avoid disappointment. The other programme is the much awaited AMCON. This year for � ��

�� %�� -�� "��and Panel discussion we are having talks on how to build, operate, renovate hospitals etc. There is going to be a trade exhibition on medical infrastructures. The organising committee is already on full swing and we plan to apply to the MMC for credit hours.So mark your calenders and block February 4th and 5th!Hoping to see you all in Mayfair Rooms.


ANNOUNCEMENT FOR PROPOSED ORATION AT AMCONAMC invites application for a proposed Oration* to be held at AMCON . The said Oration will continue for next 8 years of AMCON for a contribution of 1��2��0��for details.

*Terms and conditions apply.

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We all know the crucial importance of maintaining good patient records.

Accurate and accessible patient records can become a boon and an asset in the event of patient allegations of any kind. Good records can be your best defence against any malpractice action.Well written and systematic records are �� 3�� quality medical care. In one case, a judge who was examining the original records of a patient, made this remark to the doctor concerned: "Doctor, if your records are so shabby." I am sure y."your treatment must have been equally shabby In other words, not only should our treatment of patients be diligent and conscientious, it should also appear to be so. And this can only happen if your records are good. Remember: shabby records denote shabby treatment!What are the implications of not keeping records at all or records being unavailable on demand? Apart from the fact that defending your case becomes extremely ��of the code of medical ethics and actionable in case of a complaint against you before the Medical Council. Absence of records could also invite adverse inference from the courts.

Assuming that you maintain good patient records, which as we know should be correct, clear, comprehensive, chronological and contemporaneous, the next question that needs to be considered is: How long should we preserve these records?This is a question which does not have a straight answer and may invoke different responses from different people. There is considerable ambiguity as no precise statutory guidelines are available in our country.%�� 0��

the relevant issues to whatever extent I can.To begin with, let us take the assistance of what is perhaps the only substantial guideline available to us viz. The MCI Regulations 2002.As per regulation 1.3.1

of the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations 2002:“1.3 Maintenance of Medical Records.1.3.1 Every physician shall maintain the medical records pertaining to his/her indoor patients for a period of three years from the date of commencement of the treatment in a standard proforma laid down by the MCI and attached as Appendix 3”.Of course, this is a highly inadequate guideline drafted very casually, but

DOs' AND DON’Ts HOW LONG SHOULD YOU PRESERVE PATIENT RECORDSDr. Lalit Kapoor

Every physician shall maintain the

medical records pertaining to his/

her indoor patients for a period

of three years from the date of

commencement of the treatment in a

standard proforma laid down by the

MCI and attached as Appendix 3.

nevertheless can be a life-saver and must be held on to whenever the need arises.For example, some years back, a cardiologist, an AMC member, received a summons from a Court demanding case papers of a patient whom he had treated nearly ten years ago. The Court was insistent that these records be produced despite being told that it was not possible to do so, being such an old case. The problem was resolved when, on our advice, this doctor produced a copy of MCI Regulations 2002 clause 1.3.1. before the Court and said that since the medical profession in India is governed by MCI, he strictly follows all its regulations including the one dealing with preservation of records. The Court stopped bothering him after that!The reason for the period of three years is a moot point but I believe it has something

to do with the Statute of Limitation. An understanding of this Statute will be useful in the further discussion. This Statute or law has been enacted to prescribe the time period during which legal action can be taken. It is meant to restrict the period during which the plaintiff (complainant) must assert his right to start legal proceedings.In any claim for damages for medical negligence before a Civil Court, as per the Limitation Act 1963, the suit must be instituted within three years of the cause of action i.e. from the time the damage was caused or was discovered, whichever was later.As far as Consumer Courts are concerned, as per amendments made in 1993, they are

not supposed to admit a complaint unless it �� which the cause of action has arisen. After this period the complaint is supposed to be time-barred.It is therefore easy to understand why MCI has prescribed three-year period for preserving records.Does it then mean that we should preserve records for only three years and no more? The answer is No.We can, of course, conclude that the bare minimum period for which records should be maintained is three years -and no less. Going back to the Regulation 1.3.1 of MCI there are three points which need to be �� 4�5� -�� 6�� 7have been mentioned. In fact, this should also apply to OPD records as nothing �� - "� �� complaint against you within the limitation period viz. two or three years. It is therefore advisable to preserve these records as well even though the MCI does not indicate so. (b) The regulation asks you to preserve the records for “……a period of three years from the commencement of treatment” In fact, the three-year period should be calculated from the time the patient saw you last. (c) This regulation is directed to doctors and not hospitals who, in any case, do not have to register themselves with a Medical Council and follow their own protocol.WHY RECORDS SHOULD BE PRESERVED FOR LONGER THAN THREE YEARS?As mentioned earlier the limitation period of two or three years is computed from the time the service to the patient was completed or from the time the defect in service is noticed. Hence, in reality, the maximum three-year period could get extended and hence we must make allowance for the same.Few examples: After an eye surgery, there �� the treating doctor assures the patient

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that this would improve over the next six months. Say, at the end of one year there is no improvement and the patient now “discovers” that no improvement is going to occur. The two or three year limitation period will start from that day, which means, the limitation period will get extended by that much time.0�� 8�� %��after surgery manifest after say, ten months, the limitation period will start after the �� )�� 8%� ��not from the date of the surgery. The date �� 8%��the date of cause of action. In Consumer Courts, there is a provision for condoning �� beyond the two-year period. Often complainants come up with some sob story (or even a cock-and-bull story!) for delay in the complaint and the Forums are quite liberal in condoning the delay. This is one more reason for preserving records for a longer period. It may be noted that in Civil Courts, condoning of delay beyond the three-year period is unusual.It is thus amply clear that preservation of records for merely three years may not ��$��the above factors which can legally extend the period of limitation.In my opinion, keeping in mind the above possibilities, it is prudent to preserve records for a period of six years – a period which gives you enough safety margin.Having said that, it must be made clear that there are some important exceptions whereby records must be preserved for a longer period. These should be carefully noted.EXCEPTIONSRecords pertaining to any unresolved/

ongoing criminal or civil proceeding, CPA, Medical Council enquiries or other administrative proceedings against you � �� never know when the matter may return to haunt you again following an appeal by the plaintiff to a higher forum.Records of Medico-legal cases such as accidents, assaults, poisoning, major burns, etc. may be preserved for at least ten years and longer if the judicial proceedings are ongoing.Theoretically, obstetricians and

pediatricians need to keep records of minors till they attain the age of majority. However, I have not come across �� effect in our country though it would be implied as per the 9�� %�� 0� �� a legislation passed by the Washington Legislature and those of several other States in USA, on the subject. It reads:"…the records of minors, which shall be retained and preserved for a period of no less than three

years following attainment of the age of 18 years, or ten years following such discharge, whichever is longer" I do not know how many obstetricians and pediatricians follow this in India. Our law seems to be silent on this subject. May be we will have to wait for some precedent or judicial pronouncement on this issue before we get some guidelines on this issue.

0�� c periods of retention of records �� (e.g. PcNDPT Act), these should be adhered to, irrespective of the above. In some cases, Insurance Companies may specify retention period of records. These should ��

PRESERVATION OF RECORDS BY HOSPITALS# ��

those referred to above. Each hospital seems to have its own protocol which could be quite different from the others. However, I came across the following �� 6&��7�� :++:�� Director General of Health Services. It �� ;

Inpatient medical records 10 years; Medico-legal registers 10 years; Outpatient records 5 years.However, Civil Medical Code emanating from Director of Health Services gives the following guidelines:Indoor records - 5 years, OPD - 3 years, �� "�� 1�� %�� Register, Death Register, Permanent Retention, OT Register - 5 years, Medico-legal Case Register – 10 years. These are all guidelines.PUBLIC NOTICE OF DESTRUCTION OF RECORDSI know of several large hospitals in Mumbai who follow the practice of issuing a Public notice in two newspapers - one in English newspaper and another in the regional press, announcing the intention to destroy case papers pertaining to a particular period. The notice invites anyone interested in collecting his/her record to collect the same from the hospital before a particular date failing which the records are destroyed. I think this is a good system which can provide legal protection.ELECTRONIC MEDICAL RECORDS (EMR)This mode of record-keeping is becoming increasingly prevalent and even getting legal sanction. In fact, MCI Regulation (2002) No. 1.3.4. reads “Efforts shall be made to computerise medical records for quick retrieval” Even nine years ago MCI � �� <�1�� 0�� USA, recently President Obama initiated a special campaign to have all hospitals get into the electronic mode of record-keeping.

Of course there are issues of privacy, �� tampering of records. I believe these issues are being addressed successfully. For example, a tailor-made software has been �� records and any tampering with the records is promptly detected. With EMR it will be easier to maintain records for the requisite periods as outlined above.!��;� 0�� <�� :++:� �� =2)%�permits electronic records, such as EMR to be admissible in any proceedings as evidence. This is also stated in Schedule-II of the Information Technology Act 2000. TO SUMMARISE:1. Accurate, accessible patient records

are your best defence against any malpractice allegations leveled at you.

2.MCI Code of Ethics (2002) prescribes a three-year period for retention of records. This is the minimum period for which you should preserve your records.

3.Other than this, there are no proper guidelines and periods of retention of records mentioned by others are arbitrary and vary greatly.

>�%�� should be kept longer than three years. These have been discussed.

5. Six-year period of retention with certain exceptions, is considered safe.

6.Electronic Medical Records - A good option.

7. MCI or other statutory bodies must come out with clear-cut, non-confusing guidelines and preferably legislation for period of retention of patient records as is the case in Western countries.

(Acknowledgement: I wish to thank Dr. Sugandhi Iyer, Asst. Director, Legal & Medical, Hinduja Hospital and Dr. Bhujang, Medical Director, H. N. Hospital for their useful inputs)


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Today, the Honourable Supreme Court has laid down the law when it comes to

arresting a medical practitioner for alleged �� %�� practitioner’s problems are far from settled because the Supreme Court is still not aware of another possibility by which the medical practitioner is neither arrested nor is he allowed to leave the police station after recording his statement. # �� within the four walls of the police station, offered tea and biscuits but prevented from leaving the police station. In short, he is detained within the police station and restrained from going home or to his hospital. This usually happens at night when legal assistance is available with ��

When this happens, the police say that they cannot and will not arrest the medical practitioner and at the same time they also say that they cannot allow the medical practitioner to leave the police station and the reason given is that there is a mob waiting outside and the police apprehend that the medical practitioner’s life is in danger or he may suffer grievous hurt at their hands. In short, they detain the medical practitioner against his will, presumably to save his life without complying with the formalities required to be undertaken whilst detaining a person.The reason (apprehension of danger to the life of the medical practitioner / grievous hurt), for restraining and detaining a

medical practitioner is verbally given and the police do not record anything in writing and if the medical practitioner tries to record his objections to the restrain and detention, the police do not accept any letters or even if they do, they do not acknowledge the same. If the medical practitioner, being totally helpless, �� same story is repeated there as well. In short, creating evidence of such illegal �� The consequence of this is that the medical practitioner has to spend the night in the police station to “protect himself” from a mob waiting to kill him or grievously injure him on his way home. The medical practitioner can be thus illegally restrained and detained by the police in the police station under the guise of protection and the most frustrating part of this entire frame-up is that care is taken to show that there is no evidence in existence to see that the wrong doers can be brought to books.Restraining and detaining the medical practitioner within the premises of the police station without the due process of law amounts to infringing upon his fundamental rights of personal liberty and freedom of movement guaranteed by the Constitution of Indian. This also amounts to an act of wrongful restrain and wrongful �� penal offence.Article 21 of the Constitution of India guarantees that no person shall be

DETENTION UNDER THE GUISE OF PROTECTION AND ITS REMEDY Dr. Gopinath N. Shenoy

deprived of his life or personal liberty except according to procedure established by law. When it comes to restraining the movements of a person, the Constitution of India Article 19(1)(d) guarantees that a person has the liberty to move freely throughout the territory of India and thus cannot be restrained save and except by due process of law.Therefore, for alleged medical negligence, if a medical practitioner has to be restrained / detained, he has to be either ��$��custody (detention). Arrest can take place only in accordance with the procedure as laid down by the Supreme Court in Jacob Mathew v. The State of Punjab and if he is to be detained, the police has to comply with the requirement as laid down by � ��,�� %��case.The Supreme Court has held that a person cannot be held in preventive detention (custody) without adequate evidence, as by doing so it would violate his/her “personal liberty” guaranteed by the Constitution.The Supreme Co�� %�� ?�� "�� % �� /��%�� "��$�%��Customs Authorities under the Conservation of Foreign Exchange and Prevention of Smuggling Activities Act (COFEPOSA), has held that in matters relating to preventive detention, authorities have to examine whether there was any organised act or activities giving room for an inference that the detainees would continue to indulge in similar prejudicial activity warranting detention of the person.The Apex Court said "In an appropriate case, if there is no adequate material

for arriving at such a conclusion based on solitary incident the Court is required and is bound to protect him in view of the personal liberty which is guaranteed under the Constitution of India".Under the law, a person can be held under "preventive detention" for a certain period �� that the accused has the propensity to indulge in criminal activities, if he/she is not detained by the authorities.The question that comes up here is whether � �� /�� /�� @detaining a medical practitioner within the premises of the police station just on the hypothesis that his life may be in danger

if he is allowed to leave the police station and go to his residence / hospital? The answer to this question is in the negative.On the contrary, if the police have the information that the medical practitioner is going to be killed or grievously

hurt, it becomes their bounden duty to investigate and prevent such a crime.Section 149 of the Code of Criminal ��;�<��interpose for the purpose of preventing, and shall, to the best of his ability prevent, the commission of any cognisable offence. Under the circumstances, if any person has to be detained or taken into preventive custody then it has to be the members of the mob who are supposedly waiting to perpetrate the crime against the medical practitioner.Furthermore, once the police are aware that the medical practitioner’s life is in danger, does it not becomes their bounden duty to give protection to such a person? Can this protection be given only by illegally restraining / detaining him within the boundaries of the police station thereby violating his constitutional right of personal liberty?

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If the police are really sure that the medical practitioner’s life is in danger then it becomes the bounden duty of the police to assist the medical practitioner to safely reach his residence and also protect his life from unruly elements but they positively cannot illegally restrain / detain him against his will in the police station. Such a restrain / detention will amount to ��@��

Now what needs to be understood is – What is wrongful restrain and what is wrongful ��A

Section 339 of the Indian Penal Code ��(��1�� ;

Whoever voluntarily obstructs any person so as to prevent that person from proceeding in any direction in which that person has a right to proceed, is said to wrongfully restrain that person.So when the medical practitioner is not �� he is not allowed to proceed out of the police station to his residence / hospital, the medical practitioner is said to be wrongfully restrained by the person who prevents him from proceeding out of the police station.Section 340 of the Indian Penal Code ��(�� ;

Whoever wrongfully restrains any person in such a manner as to prevent that person from proceeding beyond certain circumscribing limits is said "wrongfully to ��B��

In the instant case, when the medical practitioner is not arrested and not �� $�� walls of the police station against his will, then the medical practitioner is �� circumscribing limits of the police station. ofIn short, �� a form of wrongful restrain, is preventing the medical practitioner from taking the

path out of the police station and keeping him within the circumscribing limits of the police station out of which he wishes to go and has a right to go. What is the remedy to such atrocities? # �� &�� with the Human Rights Commission. The �� ,�� very effective. The problem faced by the medical practitioners in both the places is production of evidence of this illegal / wrongful restrain and detention forced on the medical practitioner under the garb of protection. It goes without saying that there will be denial “simpliciter” of such an act in the court of law. Under the circumstances this is what needs to be done. Dial 100 and inform the control room authorities that a particular medical practitioner is illegally detained in the police station against his will and without due process of law. All information given to 100 is recorded and these records are available to the High Court when the writ petition will be heard. Relatives and friends of the illegally detained medical practitioner must record their complaints with the control room and also call for help and assistance. For all that you know, a mobile van may come to the police station where the medical practitioner is detained and thus excellent evidence of such illegal detention under the garb of protection will be created by the police department itself. �� ( �� shall be punished with imprisonment of either description for a period which may �,�� extend to one thousand rupees or with both (Sec. 342 IPC).This article is based on true incidents that took place in Maharashtra.


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The Association of Medical Consultants has been seized of ensuring quality

healthcare to the society and is also aware that this will ensure a more laudable and prestigious position for its members in the society. A large section of our members are practising in the relatively unorganised health sector of nursing homes.

The Association has been steering an initiative to ensure quality care in nursing homes along with various other medical and healthcare consumer organisations for almost 10 years. Two years ago, the Association formalised this initiative of Nursing Homes Standardisation and ASNH (Accreditation Standard For Nursing Homes) was launched in October 2009. The Standard has been well received by its members and more than C:+�� Over time, a need was felt to bring in some changes in the Standard and hence help was sought from Quality Council of India (QCI), who in turn deputed Dr. Aarti Verma ��"��D��D�� !�%&��# �Standard was discussed with them and they suggested a few changes which are now incorporated, and on 1st October 2011, we have launched ASNH: 2011 edition. The changes were in the area of safety, documentation and legal compliance.

Accreditation, besides being a patient and society-centric initiative, has also helped medical professionals of these establishments immensely. There are many �� include Improved processes, reduction in wastage, better utilisation of manpower,

training to staff members etc., resulting in an organised system of healthcare delivery. As Dr. Seetharaman of Shree Ram Eye Hospital, puts it: �� of the outcome as all the parameters are scrutinised periodically. After the accreditation, I am a more �� now”.

As Dr. Vinod Goyal of Surya Eye Institute says: ASNH being formulated and monitored by medical professionals and being audited by professionals who are aware of healthcare processes is more useful than ISO 9001 Standard.

At ASNH, the cost of the accreditation is very reasonable and is true value for money.

We are enclosing herewith a list of nursing homes accredited till date.


ACCREDITATION STANDARD FOR NURSING HOMES Dr. Ketan Parikh

A A S T H A C E N T R E , D H U L E M A L H A R M AT E R N I T Y, S A N TA C R U ZA D I T I H O S P I TA L , B A N D R A M A L PA N I I N F E R T I L I T Y, C O L A B AA G A R WA L N U R S I N G , B O M B AY M A R K E T M A N G A L A N A N A D, C H E M B U RA G A R WA L N U R S I N G H O M E , B H AYA N D E R M A R U T I N U R S I N G H O M E , M U L U N DA G G R AWA L E Y E , A N D H E R I E A S T M E D I C A R E H O S P I TA L , A N D H E R I A G R AWA L C L I N I C M E D I C A R E H O S P I TA L , T H A N EA M E YA M AT E R N I T Y, B O R I V L I M E E R A H O S P I TA L , K A LYA NA M R U T H O S P I TA L , D O M B I V L I M U K U N D H O S P I TA L , A N D H E R IA N I L E Y E , D O M B I V L I M U M B A I R E T I N A , S A N TA C R U ZA S H A P O LYC L I N I C , G H AT KO PA R N A G V E K A R E Y E C L I N I C , S A N TA C R U ZA S H W I N I H O S P I TA L , B H AYA N D E R N AV K A R E Y E , V I L E PA R L EA S H W I N I M AT E R N I T Y, G H AT KO PA R N AYA N E Y E C E N T R E , G H AT KO PA RB E D E K A R H O S P I TA , T H A N E N E T R A J YO T, M U L U N DB H A R G AVA N U R S I N G , S A N TA C R U Z E A S T N E T R A R E T I N A , M A H I MC A U V E R Y U R O D E R M , K A LYA N N I R M I T Y F E R T I L I T Y, T H A N EC E N T U R Y H O S P I TA L O M N AVJ E E VA N , K H A R G H A RC I T Y H O S P I TA L , K A L M B O L I PA R A M O U N T, PA N V E LC O M F O R T C L I N I C , P E D D A R R O A D PA R A M O U N T, S A K I N A K AC R Y S TA L H O S P I TA L , B O R I V L I PA R E E K D E A F N E S S , A N D H E R ID A F TA R Y, J V P D PAT I L H O S P I TA L , PA N V E LD ATA R N U R S I N G H O M E , J O G E S H WA R I P H O E N I X H O S P I TA L , D O M B I V L ID AT TA M AT E R N I T Y, G O R E G A O N P R A J WA L E Y E C L I N I C , M I R A R O A DD E O D H A R H O S P I TA L , T H A N E P U R O H I T C L I N I C , PA N V E LD E S A I E Y E , A N D H E R I R . L . E N T. H O S P I TA L , B H AYA N D E RD O C T O R E Y E , A N D H E R I S A I A S H I R WA D, B H AYA N D E RD R . B H AT T ' S H O S P I TA L , G O R E G A O N S A K H A L K A R , A N D H E R ID R . D O S H I C H I L D R E N , T H A N E S A L A S A R N U R S I N G H O M E , B H AYA N D E RD R . PA R I K H ' S N U R S I N G H O M E , VA S H I S A N C H A I T I H O S P I TA L , K A N D I V L ID R . R A G H O J I K I D N E Y S A N J E E VA N I , B H AYA N D E RD R . T H A K U R ' S E N T. , B H A N D U P S H A H N U R S I N G H O M E , M AT U N G AD R . T I LW E N U R S I N G H O M E , VA S H I S H I VA A N I , B H A N D U PD R . VA I D YA E Y E C E N T R E , T H A N E S H R E E A S H I R WA D H O S P I TA L , D O M B I V L IG A N AT R A H O S P I TA L , M U L U N D S H R E E G U R U , G O R E G A O N E A S TG O K U L N U R S I N G H O M E , M U L U N D S H R E E H O S P I TA L , VA S H IG O M AT H I E Y E C E N T R E , M U L U N D S H R E E K R I S H N A , B O R I V L IH I G H WAY H O S P I TA L , T H A N E S H R E E R A M E Y E , M U L U N DJ A G TA P H O S P I TA L , D H U L E S H R E E R A M A K R I S H N A N E T R A L AYA , T H A N EJ AY D E E S H , VA S H I S H R E E S I D D I V I N AYA K , B H AYA N D E RJ E E VA N S H R E E H O S P I TA L , D O M B I V L I S H R E E J I K R I PAJ . J . O R T H O, B YC U L L A S H R E YA S I N F E R T I L I T Y, M U L U N DK A D E R I H O S P I TA L , D H U L E S H R U T I N U R S I N G , B A N D R AK A L S E K A R , M U M B R A S I TA R A M H O S P I TA L , D H U L E K A M D A R H O S P I TA L , G H AT KO PA R S O N A G R A H O S P I TA L , G H AT KO PA RK A M D A R H O S P I TA L , S A N TA C R U Z S U C H A K K A N TA H O S P I TA L , PA L G H A R S U R A L ATA , D A D A RK A S T U R I H O S P I TA L , B H AYA N D E R S U R E S H E Y E C L I N I C , G O R E G A O N K E N I A E Y E , S A N TA C R U Z S U R YA E Y E , M U L U N D E A S TK E VA LYA H O S P I TA L , T H A N E S U S H R U T K A S T U R I H E A LT H C A R E , B H AYA N D E R S WA S T I K M AT E R N I T Y, T H A N EKO R A N N E H O S P I TA L , K A LYA N T U N G E K A R H O S P I TA L , U R A N K R I S H N A E Y E C E N T R E , S I O N U N I Q U E H O S P I TA L , A N D H E R IK R I S H N A N U R S I N G H O M E , B H A N D U P VA I D YA E Y E H O S P I TA , A N D H E R IK U M A R ' S M AT E R N I T Y, D O M B I V L I VAT S A LYA N U R S I N G , K A LYA NL A K S H D E E P, VA S H I V I S H WA N AT HL E N E S T, N E E L A M N U R S I N G H O M E , M A L A D W E S T V I TA L C A R E , A N D H E R I W E S T L E E L A E Y E I N S T I T U T E , K A LYA N WA L AWA L K A R H O S P I TA L , D E R VA N M A D H U P O LYC L I N I C , B H A N D U P YA S H O D A M AT E R N I T Y, M I R A R O A D M A D H U R A , VA S A I Z Y N O VA H E A R T H O S P I TA L , G H AT KO PA R

LIST OF ASNH ACCREDITED NURSING HOMES

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MMC CREDIT HOURS APPLIED FOR

EARLY BIRD REGISTRATION AMC MEMBERS: Rs.1500/- NON-MEMBERS: Rs. 3000/-

PROGRAMME HIGHLIGHTS

DICATED TALKS ON HEALTH INFRASTRUCTURE,

EDICO-LEGAL AND MEDICO-SOCIAL TOPIC

HEALTH AND INFRASTRUCTURE RELATED EXHIBIT

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BANQUET ON 4TH FEBRUARY EVENING

Detailed information will be provided in the Brochure We look forward to your participation in this event.

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Season’s greeting to you.

AMC has been quite busy in the last quarter with its various activities and plans are on in full swing for the next few months.

On 17th September 2011, AMC held a medico-legal workshop on Patient Safety �� -�� 0�� by Dr. Nikhil Datar and supported by D r . K h u r s h e e d V a z i f d a rand Dr. Mukesh Gupta. The chief faculty was Dr. Rajan Madhok, Medical Director, NHS, Manchester, UK. Dr. Lalit Kapoor actively participated in it and shared his pearls of wisdom with the delegates. It was awarded two MMC Credit Hours.

AMC Meet I was held on 18th September 2011 at United 21 Thane, under the able guidance and chairmanship of "�� '��$�� "�� %��and Dr. Sudhir Naik were the Organising Secretaries. It was attended by 200 doctors. The highlights of the programme were the various talks by eminent speakers on yoga and lifestyle diseases along with a panel discussion on Declining sex ratio. The panelists were experts from various walks of life and they shared their concerns regarding the girl child. This exchange then

led to a healthy discussion on the PcNDPT Act. I acknowledge the organisers for a good show. This programme was awarded one MMC Credit Hour.

On 25th September 2011, there was a Nurses Training Progamme held by "�� !�� % �� 0�� very enthusiastic response from the local nurses and was packed to full capacity.

The convener of the programme was Dr. Ashok Shukla.

AMC Meet 2 is being planned for 11th

December 2011 at the Mayfair Rooms, Worli. The theme of

this programme is Role of Spirituality in Medicine. It is being co-hosted by the % �$�� &�� # �� basis of spirituality in an unbiased fashion. There are always proponents & opponents of every philosophy and we look to a healthy and free discussion from both sides. The programme is sure to stimulate the mind and soul and we look forward to a good attendance from across the city and suburbs. The venue is very accessible and has ample valet parking

So kindly mark this Sunday morning in your diary.


PROGRAMME COMMITTEE REPORT

Dr. Smita Sharma - Programme Committee Chairman

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"I have always sincerely believed that if an Association does not help a member in his or her time of need when he or she knocks its door for assistance, then that Association is not worth its name. No amount of banquets, foreign trips or entertainment programmes can redeem its sense of purpose and reason for existence. A member must get a sense of security by virtue of belonging to an Association. Only those Associations which do so will stand above the crowd of Associations."

Honored guests and invitees, President Dr. Niranjan Agarwal, team AMC,

dear AMC members, friends, ladies and gentlemen. I am indeed overwhelmed and deeply touched by the elaborate acknowledgementof my humble contribution to the growth and development of the Association of Medical C o n s u l t a n t s , Mumbai. I accept this award with a great sense of pride and humility since it is being given to me by an Association which I served for nearly four decades uninterruptedly, an Association which became an integral part of my life -an obsessive, compulsive passion, a labor of love, if you like.What appealed to me was the uniqueness �� E�� )��composition—viz. Consultants from across the entire spectrum of Medical specialities—all coming under a single umbrella, on a single platform. Secondly,

what drew me to it was the fact that there was a crying need to address the problems faced by Consultants, very vital problems ��F��%��$�� determination. The birth of the Association �� )�� G��

vacuum and that is why it grew so rapidly and so convincingly. From 215 members in 1974 to 7000 members in 2011.Ladies and Gentlemen, receiving this award means a great deal to me and I will forever treasure the beautiful sentiments behind it. I

am grateful to AMC for honouring me thus and I thank AMC from the bottom of my heart. I must also thank each and every one of you present here for being part of the occasion which is indeed memorable for me and my family.I must confess that this award does not belong to me alone. My share of the award is a small one and there are several others to whom this award belongs .It is impossible to name and thank each one of them, but I

ACCEPTANCE SPEECH LIFETIME ACHIEVEMENT AWARDDr. Lalit Kapoor

do need to acknowledge a few. A good part of this award belongs to my wife Prabha without whose contribution I would not be standing here before you today. We both joined the Association in 1974 just a year after its inception. She was equally passionate about the cause for which this Association stood. Over the long years, she partnered me in my mission, supported me with her tremendous inner strength, and even tolerated me with great patience, and understanding. And importantly, she cheerfully accepted the cost of devoting continuous and disproportionate time to the AMC. I cannot thank her enough except to say that I owe this award to her since she allowed me to indulge in this obsession. The next person I would like to thank is the person who introduced me to this �� 0� �� membership form of the Association. He is a man who conceptualised this Association. This man is a brilliant guy and his name is Ajay Kothari. I requested him to be present today so that I could thank him specially for initiating the concept of AMC, for sowing � �� and for overseeing the initial baby steps of this Association.Another person whom I cannot thank ��"�� His contribution to the Association was recognised in 2005 when he was presented this very award. It is a matter of great regret to me that he could not continue his involvement with AMC on account of a medical disability. I was privileged to work alongside him and I fondly recall the innumerable hours we spent together in the challenging process of building an organisation along with the others, brick by brick, despite lack of resources, �� fellow professionals. Thank you Mahendra for the great partnership. And of course, we cannot forget the invaluable contribution of our �� "��

Dr. C. L. Jhaveri, and the others. I must also mention the great privilege I had of working as Secretary of AMC when Dr. Subhash Dalal was our President. He is �� 0� �� wish to thank him for enriching not only AMC but my personal life as well. I also sincerely thank each and every of the subsequentPresidents of the Association some of whom we are honouring today a little later. Each one of them in their individual capacities successfully took the Association to the next higher level. I also recognise the contribution of the several members of the various committees who worked devotedly with the sole aim of carrying AMC forward. Thank you one and all. Ladies and Gentlemen, You are aware that the AMC has been best recognised for its pioneering efforts in providing support and guidance to members affected with Medico-legal problems which had been growing in intensity over the years. Even today, Medico-legal back-up is considered to be the hallmark of the Association and its USP. I will not dwell much on it since you know all about it. I do wish to acknowledge some of the several people who were instrumental in making our medico-legal cell, substantive.Many of them are present here today and it is a great personal honour for me that they agreed to be part of this occasion. Justice Dr. S. Radhakrishnan, Adv. Raja Thakre, Rui Rodrigues, Avdhut Chimalkar, �$ �� $�� $��% ��Karkhanis. They are great friends of AMC, who have assisted so many of our members and were always there for us whenever we needed them. I have learnt a lot from them and have been fortunate in forming enduring relationships with them. Their �� and I would like to thank all of them. -Thank you Gentlemen, part of this award belongs to you. Where do we go from here? Change is the

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essence of life. With the passage of time, newer problems and newer challenges have emerged. We have no option but to cope with the changing scenario of society and medical practice.And what is this changed scenario ?H�# �� thing of the past.H� # �� ,�� doctors and medical science have risen sharply, thanks to the mind-boggling advances in science and technology.H� ��I�� coming under the purview of the CPA, the patient is a consumer in the legal sense and a doctor is referred by some as a Health-care Provider, much like an Internet Service Provider, Telecom Provider and so on.H�-�� patients and doctors has been gradually eroded.AMC has achieved only a fraction of its potential. It must act as a pace maker in the process of creating cohesiveness amongst the various medical bodies so as to generate a powerful single voice against the various injustices and display zero tolerance to being made soft targets and punching bags.

Having said this, I would like to point out how crucial it is for us to refurbish the image of the medical profession by a conscious and concerted effort. It is a fact that much higher standards are expected from our profession compared to any other profession. We need to do aggressive self-monitoring to isolate the unethical elements in our profession who spoil the fair name of the profession. I read somewhere the other day that theDoctor-patient relationship comes next only to the mother-child relationship. We need to repair the cracks that have appeared in this relationship in recent years.Recently, a Public Poll agency called ORG Marg in collaboration with Times of India �� the most respected professions. And their �� profession was amongst the top two most respected professions. Even today we are highly respected. We must build on this knowledge and do our best to restore the honour and dignity of our great profession.Thank you very much, once again for the great honour you have bestowed upon me.


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MCQs 1. A patient who wants to claim damages of Rs. 60 lakhs from a doctor for alleged

negligence will have to file the complaint before:p gg

(A) National Commission (B) District Consumer Redressal Forum (C) State Consumer Forum (D) Sessions Court

2. If a nurse mistakenly gives an injection intravenously instead of by intramuscular route and the patient suffers damage, the hospital owner will be responsible for compensation under:

(A) Doctrine of Contributory Negligence (B) Law of Torts (C) Vicarious Liability (D) Indian Penal Code

3. Which of the following will be covered by your Professional Indemnity Policy:

(A) Complications following MTP at 22nd week gestation (B) Complaint against you following negligence in treatment (C) Medico-legal problem in the course of treatingHIV positive patient (D) Litigation involving dispute in Professional charges.

4. In legal parlance res ipsa loquitur means:(A)The master must pay for wrong doing of his employee (B)The thing speaks for itself (C) The matter is under litigation (D) Location of cause of action.

5. The limitation period for filing a case before a Consumer court is: (A) 1 year (B) 5 years (C) 2 years (D) 3 years.

-Dr. Lalit Kapoor

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Seventy year old man was addressing �� 6"��7� �� &��

friend was amused, ‘After so many years of marriage, still you love her so much?’

Old man took him on the side and said, 'Yaar, I can’t recollect her name so I save myself by saying Darling’.

This may sound exaggeration but the underlying fact is that after 55 years of age people often cannot recollect the name of the person whom they are referring or of the person whom they know well but memory stabs them at a crucial point of conversation (I know you are smiling because you also have the same problem). They remember all the details like where they met, what that person was wearing and even the conversations they had except the name. This becomes very embarrassing as he cannot introduce that person to the person accompanying him. This phenomena of forgetting the name as the age advances is universal and affects both the sexes equally.

How many times you have forgotten to renew all your licenses, passports, insurances policies, paying vehicular taxes, membership dues, telephone and electricity bills or paying advance taxes and then paid penalty? How often you have forgotten birthdays and wedding dates of your close ones? It is said that best way to remember your wife’s birthday is to forget it once. Thereafter you will never forget it.

Memory Loss is a very loose symptom.

%�� 6!�� 7�� several other types of Amnesia. Recent news of Kalmadi claiming Amnesia has prompted me to write this article. One can add Yedurappa, Chidambaram and Omar Abdulla to that. So many clinical ��,��social purpose I give following types:

%��!�� other types:

J .��dates

J .�� , even his own telephone numbers. (Our Netas fall in this category as they do not remember � �� ,they pay, etc.)

J #�� 7��## just read.

J #�� ##continuity of conversation.

J Unable to remember the purpose of the talk, trip or conversation. While talking on the phone, they specify that they want to say three things but after second �� 6�� 0forgot. I will call you again’. They put down the receiver and suddenly they recollect the third point and rejoin the call. My advise is that when you hear such a tele-talk from an elderly person, remain by the side of phone. You will immediately receive his call. Another advise to people past 55 years is that never give the number of points you

�� &-(��.�&�K-.�1<�<�%<1 Dr. Ajay Kothari

intent to speak in your talk. This should �� the organisation who are mike lovers. Memory lapse becomes amusement for the audience who is counting. At times unable to complete the sentence as he has lost the link. It can be very very frustrating and can be a problem in both, your professional and your social life. %�� $� �� something that will either hamper your route to the top and can even get you ��

Often we hear these types of Amnesia: It is on tip of my tongue but not coming out. "�� %�� brain.

J�Unable to remember the place he has visited or met a known person even when photo of the place is shown and narration of the place is done. Also falls in this type is: Oh! God knows where I left my car keys/sunglasses, mobile, etc. It can upset the time schedule, make you irritable, angry, ventilate anger on spouse, children and servants for not helping. With the advancing age, memory loss and decreased � �� it tough to focus, stay motivated, or accomplish the simplest of tasks.

J�.�� faces.

J� !�� his own talk or memory. &��making decisions.

J��mber recent event or talk but rattles out what happened in earlier days. Grandpa chews our head what he was taking in dabba in his school days but forgets what he ate in the morning.

J� Earlier events go out of his memory

slate. This reminds me of character of Aamir Khan in Gajini.

J�� mental shockor accident but memory is revived suddenly when similar incident occurs. Remember Sadma picture of Kamal Hasan and Shridevi?

J�Combination of above mentioned type of Amnesia. It is seen in an otherwise normal person or observed in brain damage.

J Temporary amnesia occurs in migraine, �� 3�� severe malnutrition, depression, person suffering from severe snoring resulting into Sleep Apnea, mental fatigue. Lack of sleep affects remembering and stress

affects sleep in the long run. It is a vicious cyclo-emotional and physical stress fuels the release of stress hormones such as Cortisol and Adrenaline. Continuous exposure to stress hormones results in the death of nerve cells and memory loss.

Temporary memory loss or brain function is found in people taking sleeping pills, antihistamines,

blood pressure and arthritis medication, antidepressants, anti-anxiety medicines. %C:� �� L�� %C�� painkillers, aminophylline, barbiturates, bromide, digoxin, diuretics, isoniazid, methyldopa and tricyclic antidepressants, can also cause transient amnesia. Any drug-related impairment is usually resolved once the drug is discontinued. Short term memory loss is experienced by some women during pregnancy, and also during approaching menopause due to low estrogen levels. This happens when there

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is a hormonal imbalance in the body to those proportions.

J "�� Amnesia but in practice I have not come any patient complaining forgetfulness.

J Psychiatric disorders like Paranoia and Schizophrenia may affect memory adversely.

J 8�� 0��Frontal lobe of the brain, forgetfulness may be the only present symptom of frontal lobe disorder. They stop watching TV serials having serial episodes, novel where continuity is to be remembered after taking a break. Unless one takes the support of notes, one is unable to deliver long speech, one jumps from one topic to another without completing, like Arabian Nights stories, and losing the track how and where one started.

J Deliberately produced amnesia as in the case of operation under general anaesthesia.

J #��:��=2��##to be developing memory loss. I do not agree for a simple reason that I know many diabetic doctors and patients with razor sharp memory. Old diabetic politicians unless they are caught in some scam have good memory.

J Faking Amnesia is often used to protect being caught in family relationship or by criminals.

The precise biological mechanisms of memory are still not fully understood, but I believe that changes in connections strength between neurons in the brain. Most types of memory appear to be stored in the cortex. Memory area is called a “buffer” where incoming visual information is stored as a picture or icon. Similarly, there is also memory for auditory informationand other buffers related to the other

senses: taste, smell and touch. Different areas of cortex specialise in different kinds of information, so that visual information of Taj Mahal may be stored in one location (e.g. the inferior temporal cortex), while information about its associations might be stored in another (e.g. the frontal cortex). "�� ,� ��"�� 6��things’ (e.g. animals) but maintains knowledge about other categories such as furniture. Amygdala near the hippocampus in the medial temporal lobes is related to emotional memory.

��3�� in the exact form it was received. It may last only a few seconds before decaying or being overwritten by new, incoming information.

J # � �� involved in the formation and retrieval of memories, often deteriorates with age.

J �� ;�&��that protect and repair brain cells and stimulate neural growth, decline with age.

J -��,��3�� -��at absorbing brain-enhancing nutrients.

WHAT IS THE REMEDYFor years people with hearing loss and amnesia are used in drama, stand up

comedy, on television and movies to provoke laughter or to give twist to the story. Let us not become one of such characters. �� curing of Amnesia. People deny or even �� 6��forgetting all the while’. We all forget once in a while. We are human but what we are concern about is frequent or compulsive Amnesia. The brain is capable of producing new brain cells at any age. Few suggestions and remedy will help in reducing Amnesia and protect your grey matter. Even elders and villagers suggest taking daily Almonds when they come across forgetful person. Let this expensive suggestion remain on paper.��$�� %�� #�� remedy suggested. I have used in cases of Tinnitus and found that it gives no relief. There is long list of drugs I have downloaded from net:

lQ-150 Memory Support called Cognizin® Citicoline, Turmeric Root Extract, and %�� <,�� Phosphoryl Choline (GPC), Ashwagandha, Phosphatidylserine, Grapeseed Extract, Pregnenolone and DHEA, Vinpocetine.

Huperzine A, Vitamin E (alpha-tocopherol), �%�� 4 ��)��F�� 5� �� 0� ��not sure how many are available in India. I have never bothered and never prescribed.

In hormone-related memory loss Estrogen, HRT can be tried on the advice of the specialist.

��6��7�� $��the spouse when they can’t recollect the name. I suggest that strictly avoid begging. 68�� 7�� I have been practicing this remedy with almost 100% success. Run through the alphabet A to Z slowly in your mind. You

will be surprised that brain stops you on a particular alphabet of the name you were tying to recollect. Try it.Keep a diary and frequently refer it, keep a 3�� %��$��!��0��policies and due date of paying the premium, advance and wealth tax dates, birth dates and anniversaries of near and dear ones, Passport and Driving License expiry, car nos. Refer that on 1st of every month and transfer that to appointment diary on page at least three days prior to expiry date.Keep a proper diary all the time with you. Insert birthdays, anniversaries, marriage functions date wise. Do not write on chit and then forget to transfer in to the diary.Speak different lies to four different friends. Now it is the test of memory what you told whom. (Please ignore this).My Gujrati friends may recollect short �� %�$�� &�� 6 �Cha Pe Ru before leaving the house or �� 4 �$��) ��5� � �4� ��)$��5�Pe(Pen), Ru(Rumal-Handkees) Till today I am following that with total success. One must add to that Mo(Mobile).Memory exercises are good on paper and for ��Seeing dozen articles for a minute and then recollect and write them was a game played when we were in school or picnic. There are classes to improve memory. Financially it helps only the speaker and not the listeners.Gradation of Amnesia: Dementia is memory loss that doesn’t improve and continues to degrade over time.Alzheimer’s disease is an extremely serious case of Dementia that interferes with the brain’s chemical balance, destroys brain cells, and eventually leads to death. I have covered only Amnesia in present article.

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ASSOCIATION OF MEDICAL CONSULTANTSM E M B E R S H I P

Total Membership of the Association : 7099Members under Professional Indemnity Scheme of AMC : 4362Persons (Members & Family) undzer H & A Scheme : 3958Members under CBS Scheme : 1082

LEPROSY RE-EMERGENCE IN MAHARASHTRA

It is alarming to know about the increasing incidence of Leprosy in Maharashtra, where claims were made of it having been “eradicated” long back. While the Government

is trying to gear up, to address this reemerging issue, it is the NGOs who need to pull up their socks, since they have been a major player in case detection and treatment, fordecades, in the state.

One more distressing concern is the Government plan to set up separate schools forLeprosy affected children. Is this ever feasible and why is it trying to further increase theso called stigma against Leprosy?


When to consult specialist or undergo investigations for memory loss:

Frequent overall forgetfulness if symptoms are related to nose/sinus. It needs ENT check up. Once again reminding you that 8�� 6�� 7��-�� early symptom of it is forgetfulness. Consult Neuro-physicians if other parameters as mentioned in types of Amnesia are found wanting.

At times we try hard to forget misbehavior �� %�� $�to us like a rewind. Is it not funny that what we want to remember we can’t and what we want to forget haunts us? I have written this article with very few medical jargons. It will be of interest to your family members and friends. Do pass it on.


MCQ - ANSWERS 1. (C) 2. (C) 3. (B) 4. (B) 5. (C)

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C�� /�� quality and features available to us

on mobile phones has advanced so much that they are slowly becoming laptop replacements. Dual core CPUs running at over 1GHz was the power which even desktop computers would not routinely have just a decade back. So the current generation of Smart phones packs a lot of power and there are a lot of options available to the savvy buyer in the market looking for a new mobile phone.Most of us just look for the latest avail-able expen-sive models and only after buying them, realise that the particular model does not have a feature or two that is on top of our wish list.I remember I ran into a friend at a party who was wowing people with his iPhone 4 and it’s music player. I tried to bring him to ground by telling him rather innocently, “Hey, that’s a cool song. Can you send it to me via Bluetooth?” I would have been happy to get an answer like “That is not �� $�� M� %��instead he hands me his phone and tells me, “Do it yourself yaar, I am not into all this tech stuff.”� %��

HOW SMART IS YOUR SMARTPHONE Dr. Rajesh Bijlani

�� via %��th is not possible. So why is %�� A�(�� 7�� day and another article.So we come back to the point. Our buying decisions MUST be based on only one criterion. Our requirements and expectations from the Smart phone which

we are buying. This of course must also be linked to another very basic, often forgotten requirement, which is that the transition from the old phone to the

new phone must be painless. I have roughly 1400 contacts on my cellphone. If I buy a new one tomorrow, I should have all of them available to

me as painlessly as possible.

Apart from the common things like making and receiving calls, and exchange SMS messages, let’s see a number of things that are there in the list of requirements. Needless to say, one must have GPRS or 3G activated on the device.

1.e-mail. In today’s connected world, e-mail is almost a part of our day to day life. More for some than others. Some doctors I know don’t check mail for weeks and some like me check it (or it is automatically checked) several times

a day. So if this is a deal breaker, the e-mail functionality should be absolutely top class. In the current generation iPhones and the Android phones, this is indeed very well built in. In fact one gets an almost instant alert of new e-mail arriving in the inbox. Gone are the days when mobile companies wanted to charge you for push mail. Now this is in-built into the functionality of the phones. With Androids the advantage is that one can get away with an inexpensive Android, �� and still retain this function for less than even Rs. 10,000/-.

2.Social networking. Almost all of us must know that social networks like LinkedIn, Facebook, Twitter, Google Plus etc. are useful, if not for relaxation and making friends, then at least for business contacts and making yourself more prominent online. Many patients do online searches �� afford to have a zero online presence today.

3.Internet browsing. Previous phones had such poor software that internet �� /��experience and was also extremely slow. Now mobile browsers produce web pages resembling what we would see on our laptops or desktops. A quick Google search on the cellphone has often saved me embarrassing moments.

4.Assistance in medical practise. There are many free and paid for applications available for mobile phones, which not only let us see the common drugs listed in the pharmacopoeia but also their details like usage, side effects and contra-indications. Also a bunch of journals can get available to us, some for free and some paid. Software like Epocrates or Medscape can be invaluable assistants to us in day to day practice. I remember running Epocrates on my Palm Treo about six-seven years back and now it is available for a lot more devices.

5.Entertainment. Games, music and movies. Most mobile phones are capable of being excellent sources of relaxation after a period of stress. Gone are also the days when we had to request someone to “load” games on our phone. Now most phones come with a Market where applications or games can be downloaded on a free or paid for basis. Of course the phones with bigger touch screens give a better experience in this area than the small phones. Already we have phones like Dell Streak which has a 5” touch screen or the upcoming Samsung Note that has a 5.3” touch screen, which are the largest screens in this segment. Anything larger and you are going into tablet computing.

6.Saving, sharing our life’s moments.Almost every phone now comes with a camera built in. Mobile phone cameras can in no way compete with the picture quality of the larger expensive dedicated cameras but the quality of their output is getting much better. It’s not all about mega pixels. Even a 5MP mobile might give better pictures than an 8MP mobile. So it is important to asses this feature well. If you are very fond of clicking away on your cellphone, then this area needs a lot of research.

�� Many of us �� -�� "8�� # �� support for opening, reading and editing � �� ,�� into this sort of work.

These are some of the common features in current generation phones. Most phones will have these features but the strength of implementation varies. So it is better �� is best suited for you so as not to land up being the seller of a “Almost New” product on Ebay.


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FROM THE PRESS Compiled by: Dr. Pradeep Baliga

August 18, 2011: State institutes losing PG seats for want of teachers.

Mumbai: Aspiring doctors say one must take a deeper look at the curious case of vanishing postgraduate medical seats in the State government colleges at a time seats in private and deemed colleges have been steadily rising. The number of government postgraduate seats in 2001 was 1,900, but in 2008 had come down to 750 because of a shortage of �� ) �� vacancies resulted in a seat increase to about 1,100. Still, 40% of teaching posts in 14 State medical colleges remain vacant.August 27, 2011: Scheme to stem drop in sex ratio upheld.Mumbai: In a blow to radiologists but supporting a move aimed at curbing �� %��&�� 8�� 6��Observer’ scheme in Kolhapur on ultrasound images of pregnant women. The scheme, which requires installation of a device to permit data collection and review by third parties in a remote location, was initiated by Kolhapur Collector last October to stem the drop in sex ratio.September 04, 2011: Maharashtra to �� . Mumbai: MCI Regulations have been amended in a bid to promote medical education in the country; Maharashtra is ��$�� in view of the large number of medical colleges it has. Norms for setting up of new

medical colleges relaxed in terms of land, faculty, staff and bed strength. Intake �� %%� �� 150 to 250; Maximum ages for appointment of faculty members increased from 65 to 70 years.To reach the target of 1:1000, from the current doctor-population ratio of nearly 1:2000 the country will require an additional 15.4 lakh doctors. September 09, 2011: Kin get emotional, doctors turn easy targets.Mumbai: In April 2010, the State Assembly passed the Maharashtra Medicare Service Persons and Medicare Service Institutions (Prevention of Violence and Damage or Loss to Property) Act, making attacks on any doctor or hospital staffer a non-bailable offence that might result in imprisonment �� 1��2+�+++��%��such attacks still occur quite frequently. After each incident, the police try to avoid arrests as generally the family is mourning the loss of a loved one. Past cases depict that the attackers are generally released on bail, even though assaults on doctors or hospital staffers is a non-bailable offence. “No amount of law makes any impact on the aggressive relatives and such incidents keep taking place” lamented an affected doctor. September 14, 2011: Rising medical care in medical syllabus.� ��;� �%%� �� trained in cost of treatments, �� )��

of high medical bills on patients as part of a two month foundation course, the Medical Council of India (MCI) has decided. The national summit on medical education in Delhi on Monday also made it mandatory for all medicos from 2012 to learn sociology, ethics, communication and stress management.September 14, 2011: HC relief for docs with super-speciality degrees.��;� # �� %�� &�� ordered the State government to return � �� super-speciality degrees. This will enable them to pursue further studies and aim for � ��"!%�<,��"�� The HC directed these super-speciality degree holders be appointed as assistant professors in broad speciality, and if no �� in super-speciality or speciality hospitals.A circular by DMER and the director of public health had rendered doctors who had completed their super-speciality courses open for appointment as medical �� year. �� !!"� #�� study Kolhapur active tracker scheme. ��;�# ��%�� $�� 6�� $��7�� version of the silent observer scheme that was introduced in Kolhapur. The scheme had created a stir within the radiologist community, but showed results in tackling the declining sex ratio in Kolhapur and was �� %��&��last month.September 29, 2011: State to move SC on medical CET.Mumbai: Maharashtra is up in arms against the Centre’s move to introduce a common examination for the country’s medical colleges next year. The State education department has decided to challenge the decision in the Supreme Court.

October 03, 2011: 17 years to meet WHO norm for doctors?New Delhi: India will take at least 17 more years before it can reach the World Health Organisation’s recommended norm of one doctor per 1,000 people. The Planning Commission’s high-level expert group on universal health coverage has predicted the availability of one allopathic doctor per 1,000 people by 2028. It has suggested setting up 187 medical colleges in 17 high-focus States during the 12th and 13th

Five-Year Plans to achieve the target. October 08, 2011: UN blames sex test for India’s ‘missing’ girls.Mumbai: An overwhelming majority of the 117 million “missing” girls in Asia are from India and China, the United Nations has said. And it has laid the blame for this phenomenon squarely on the ultrasonography machine, which has been a topic of debate and heartburn in Mumbai. The UN Population Fund says that 102 to 106 boys should be born for every 100 girls. %�� successive year, say health activists, means technology is being misused to determine the sex of the unborn child and thereafter to abort it if it’s a girl. October 08, 2011: HC raps State govt over vacant doctors’ posts.��;�# ��%��&�� 8��got testy with the State Government and called for a reply from the “highest level” as to why ad-hoc doctors’ posts were being cancelled even when posts were vacant for seven to 10 years in government hospitals. The Court was irked that the State had not implemented earlier order on posting super-specialty doctors who had to give bonds for a one-year placement to super-specialty posts.

(Sourced from various agencies)


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Vol.39 Issue No.2, Aug 2010

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Documents

IN THIS ISSUE - Association of Medical Consultants, …...˘ˇ ˆ ˇ ˙ ˝ ˝ ˛ ˚ ˜ ˘ˇ ˇ ˝ Vol. 40 Issue No. 3 Nov. 2011 AMC MEET II at ISKCON Auditorium, Juhu AMC MEET II IN