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On Wednesday night, CNN-News18 broadcast a story which showed ICUs in some private hospitals in both Indore and Bengaluru did not have an accredited intensivist or a critical care physician, in charge and instead were being managed by Ayush doctors.
Employing Ayush doctors in ICUs violates the Code of Ethics Regulations as prescribed by the MCI in several ways and is a professional misconduct.
There are no ICUs in Ayush systems of medicine. Hence, their practitioners are inexperienced and/or ill-equipped in managing critically ill patients even with Ayush therapies.
Critical care medicine is a highly specialized field that requires skills to diagnose and manage life-threatening conditions in patients who may be already severely ill. Minimum standards for ICUs to be adopted throughout the country have been suggested by a committee in 2012 under the chairmanship of Prof MK Arora, Dept. of Anesthesiology at AIIMS, New Delhi as below.
Director / Incharge
Resident doctors (Academic or non-academic or fellows)
Any doctor who employs an Ayush practitioner as an assistant is responsible for his/her actions. This has been clearly stated in Regulation 7.18 of MCI Code of Ethics “In the case of running of a nursing home by a physician and employing assistants to help him / her, the ultimate responsibility rests on the physician.”
While 7.18 does not “restrict the proper training and instruction of bonafide students, midwives, dispensers, surgical attendants, or skilled mechanical and technical assistants and therapy assistants under the personal supervision of physicians”, it does not allow issuing directions to Ayush doctors with regard to patient care in ICUs during rounds or otherwise. This would amount to training of training of Ayush doctors in critical medicine and violates the provisions of Regulation 7.10, which says, “A registered medical practitioner shall not issue certificates of efficiency in modern medicine to unqualified or non-medical person”.
Employing Ayush doctors to take care of patients in ICUs amounts to fraud, cheating and impersonification on the part of hospital owners, medical superintendent of that hospital including other doctors, if they are aware that Ayush doctors have been employed. Moreover, this does not have the consent of the patients.
All doctors who assign them duties including those who interview Ayush doctors to hire them in their hospitals are also liable for professional misconduct.
As per Regulation 1.6 Highest Quality Assurance in patient care: “Every physician should aid in safeguarding the profession against admission to it of those who are deficient in moral character or education. Physician shall not employ in connection with his professional practice any attendant who is neither registered nor enlisted under the Medical Acts in force and shall not permit such persons to attend, treat or perform operations upon patients wherever professional discretion or skill is required”.
As doctors, patient safety and care is our first and foremost concern.
The Govt., Association and Regulators should take suo moto cognizance of this report and take appropriate action.
Dr KK Aggarwal
Padma Shri AwardeeVice President CMAAOGroup Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Immediate Past National President IMA