Morning Medtalks with Dr KK Aggarwal 29th May 2018


Dr KK Aggarwal    29 May 2018

Nipah virus has spread in north Kerala while most of the tourist destinations are in south Kerala


Hospitals and nursing homes in the city cannot withhold the bodies of patients who die during treatment on the ground of unpaid medical bills

Draft advisory will be put in the public domain to invite objections/suggestions within 30 days.

The Minister said that the Delhi Nursing Home Act would be changed to incorporate the final advisory chalked out on the basis of objections/suggestions/directions received.

Provisions could lead to cancellation of the clinic/hospitals licence.

If a patient dies, hospitals cannot refuse to hand over the body to relatives, saying that bills have not been paid.

In case a bill remains unpaid and has not been waived, a hospital can follow the legal route to get the family to pay up.

The Delhi government has proposed regulations that would restrict hospitals and nursing homes from marking up prices of several medicines and consumables over 50% from their procurement price in a move to curb alleged profiteering at these establishments.

Private hospitals can charge patients the maximum retail prices (MRPs) for medicines in the National List of Essential Medicines, 2015, as their prices have already been capped.

For non-essential drugs, disposables and consumables, all clinical establishments in the National Capital Territory of Delhi can bill patients at MRP or up to 50% over the procurement price as mark-up against administrative or handling charges, whichever is less. This mark-up is limited to 35% for implants, according to the advisory.

The government has also constituted a separate sub-committee to cap the prices that can be charged by private hospitals for investigations like diagnostic tests, according to the document.

The proposed amendments will come into effect in 30 days after seeking public comments

The draft recommends hospitals waive off 50% of the total bill in case the patient dies in the emergency room within six hours of arrival and 20% in case of death within 24 hours of arrival.

All doctors practicing modern medicine in the region should “preferably” prescribe drugs from the NLEM list and, prior to prescribing non-NLEM drugs, the patient shall be counselled. Hospitals also cannot force patients to buy medicines from their in-house pharmacies, according to the advisory.

Hospitals in the region should also ensure that rates of surgery packages should be “transparent, without any hidden charges” and should disclose whether it covers any complications during the procedure.

Hospitals levying extra charges in packages before surgery to insure complications have to display these charges “at conspicuous places”

Any additional procedure performed on the patient shall be charged at 50% of its original rate, while hospitals cannot charge more than 20% above the original package rate for “high risk” procedures covering complications

The hospitals are expected to bear any additional costs exceeding these package rates

Other proposed amendments in the draft include mechanisms to eradicate any cuts and commissions and treatment in case of emergencies.


In UK doctors are unwilling to own up to mistakes after the prosecution of a paediatrician over the death of a young boy, polling suggests. Dr Hadiza Bawa-Garba was convicted of gross negligence manslaughter over the death of six-year-old Jack Adcock, receiving a suspended two-year prison sentence, as well as being struck off the medical register. The case has provoked outrage among medics with claims that the doctor’s attempts to reflect on her errors had been used as ammunition against her.

“The Expert Committee concluded in their report that the nurse/patient and resident doctor/patient ratio in the NICU was inadequate, particularly, when the unit was functioning to its full capacity.  The Committee also stated that the method of segregating infected babies from the healthy ones should have been better.  Keeping in view over all facts and circumstances on record, we feel that the directions to give compensation of 5 lakh as well as punitive damages of 10 lakh for the deficiencies, inadequacies pointed out is excessive.  We feel that it shall be in the interest of justice that OP is made to pay a sum of  2 lakh to the complainant on account of such deficiency/inadequacies pointed out by the Expert Committee. (FIRST APPEAL NO. 220 OF 2008, INPRAPRASTHA MEDICAL CORPORATION LTD vs RAJIV GANDOTRA & ANR. NCDRC”

  1. Achutrao Haribhau Khodwa and others versus State of Maharashtra and others (1996) 2 SCC 634, Hon’ble Apex Court has observed as follows: “The skill of medical practitioners differs from doctor to doctor. The very nature of the profession is such that there may be more than one course of treatment which may be advisable for treating a patient. Courts would indeed be slow in attributing negligence on the part of a doctor if he has performed his duties to the best of his ability and with due care and caution. Medical opinion may differ with regard to the course of action to be taken by a doctor treating a patient, but as long as a doctor acts in a manner which is acceptable to the medical profession, and the Court finds that he has attended on the patient with due care skill and diligence and if the patient still does not survive or suffers a permanent ailment, it would be difficult to hold the doctor to be guilty of negligence.”

Public Health

  1. World Health Assembly has passed a resolution to tackle snakebite deaths in India as a public health concern.
  2. The CDC says congenital malformations is the number one cause of infants deaths in the United States. The condition can cause a cardiac arrest and the need for immediate CPR.
  3. Some private hospitals and nursing homes in Meerut have cancelled the leaves of their nurses who wanted to go to their homeland Kerala, which is under Nipah virus scare.
  4. When 26-year-old Muhammed Salih was admitted to Kozhikode’s Baby Memorial Hospital at 2 am on May 17, a team of six doctors took charge of his case. The medical team that attended to the patient from Soopikkada village in Changaroth gram panchayat of Kozhikode district included Dr C Jayakrishnan from the neurology department. Dr Jayakrishnan had recently read a book about various types of encephalitis. From the symptoms that the patient displayed, he concluded that Salih might have Nipah virus infection. He pressed the panic button. The team decided to send the cerebral spinal fluid, secretion from throat, blood and urine samples to the Manipal Centre for Virus Research on May 18. And the diagnosis was confirmed.
  5. The Nipah virus has spread in north Kerala while most of the tourist destinations are in south Kerala,
  6. Prime Minister Modi further said that on June 5, India will officially host the World Environment Day Celebrations. "This time the theme is Beat Plastic Pollution. I appeal to all of you, that while trying to understand the importance of this theme, we should all ensure that we do not use low grade polythene and low-grade plastics and try to curb the negative impact of plastic pollution on our environment, on our wild life and our health,"
  7. The University Grants Commission has directed universities to go single-use plastic free and the Environment Ministry has urged schools across the country to abandon all single-use plastic materials.
  8. Plastic Pollution: Adopt the 3 Rs approach - -reduce, reuse, and recycle. Ask yourself if you really need all that plastic. Can I reuse and companies need to redesign products, so that we throw away as little as possible?
  9. Ayushman Bharat:  In rural areas, families with only one room with “kuchcha walls and kuchcha roof” and families with no adult members aged between 16 and 59 will be among those who qualify for the Ayushman Bharat National Health Protection Mission (AB-NHPM). The others eligible in rural areas include female-headed households with no adult male member between 16 and 59, households with no able-bodied adult member, Scheduled Caste and Scheduled Tribe households and landless households that derive most of their income from manual casual labour. Households without shelter, destitutes and those living on alms, manual scavenger families and primitive tribal groups will also be covered in rural areas. In urban areas, families in 11 occupation categories will be covered including rag-pickers, beggars, domestic workers, cobblers, hawkers, construction workers, plumbers, painters and security guards.  The scheme would likely be launched by Prime Minister Narendra Modi on August 15.

Hospitals certified by the NABH for entry-level would get 10% more as incentive and those certified for advanced level would get 15%. Hospitals offering MD and DNB would also get 10% more. Hospitals set up in as backward and rural districts would get an additional 10%.

The Centre has included 1,354 packages under which treatment for coronary bypass, knee replacements and stenting, among others, would be provided at 15-20% cheaper rates than the Central Government Health Scheme.

  1. US FDA has demanded kratom herbal supplement manufacturers stop making outlandish health claims about their products. FDA turned its sites on companies that make sunscreen pills, declaring the products are completely fake.
  2. Minimum thickness of plastic carry bags is now 50 microns (Plastic Waste Management rules 2016)
  3. Nile red dye is used to fluoresce microplastic particles in the water – the dye tends to stick to the surface of plastics but not most natural materials. (A dye called Nile red helped researchers to find the microplastics. First used in 1985, Nile red adheres to plastic and fluoresces through an orange filter when viewed under a blue-green wavelength, which enables scientists to distinguish plastic particles from sediment, according to a study published in October 2016 in the journal Scientific Reports.)

CPR Video : https://youtu.be/OfKruIwwI14

Heart Attack Video: https://youtu.be/9Bw1sip3e_w


Temperatures Recorded at 1430 Hours IST of Today, the 28 th May, 2018 o Temperatures more than 40.0°C is observed at most parts of Punjab, Haryana, Chandigarh & Delhi, Rajasthan, Madhya Pradesh, Gujarat region, Marathwada and Vidarbha; at many parts of East Uttar Pradesh, interior Odisha and Telengana; at some parts of West Uttar Pradesh and at one or two pockets of Jammu division, Himachal Pradesh, Saurashtra & Kutch, Bihar, Jharkhand, Gangetic West Bengal, Chhattisgarh, Rayalaseema and Tamilnadu.

Temperatures recorded at 1430 hours of today have risen by 3-5°C at one or two pockets of North Interior Karnataka and Vidarbha by 1-3°C at most parts of Vidarbha and Telengana; at some parts of Tamilnadu & Puducherry and Bihar and at one or two pockets of Jammu & Kashmir, Himachal Pradesh, Madhya Pradesh.

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