The 8th National Convention on Medicine & Law 2023 invites the thought-leaders, policy makers, regulators, opinion formers, and all stakeholders in healthcare for a focussed and meaningful discussion on this issue
The law regarding qualifications and registration of doctors (‘credentialing’) is fairly well settled in India.
Interestingly, appropriate regulations and / or clarifying the policy regarding ‘privileging’ are still missing. Unfortunately, this legal void has not stopped Indian courts from repeatedly holding doctors and hospitals negligent in this regard and the number of such cases in courts is increasing exponentially.
Privileging is a doctor’s capability to perform specific skills and procedures and provide certain patient care services consistent with his/her training, experience and qualifications.
Globally, proper demarcation of clinical privileges is an important factor in healthcare delivery. In developed countries, hospitals are statutorily mandated to have a ‘Credentialing and Privileging Committee’. Privileging is specifically granted and reviewed at regular intervals. Privileging can be temporary or permanent. Each speciality and super-speciality have well-established core, non-core and context-specific privileges. Training, experience, work history, and professional references are taken into account in granting clinical privileges
Unfortunately, in India, privileging has still not got the attention of the regulator and policy makers which is posing problems to doctors, hospitals and patients as well as to the courts. An obstetrician performing a USG scan, a general surgeon performing a hysterectomy or caesarean, or a MBBS doctor giving local anesthesia are the most common disputes that are finding their way to the courts.
This issue is not limited to law and courts but has other ramifications too. Admittedly, India has a skewed doctor-patient ratio. Furthermore, qualified doctors do not find rural or semi-urban India appealing although a majority of the Indians live in these places. Specialists and super-specialists are simply not available in such places.
Imitating the legal principles of the developed countries and tying the hands of an otherwise qualified doctor does not bode well for this country. If duly qualified doctors find themselves in a dilemma while delivering healthcare services, all the stakeholders are bound to suffer.
A few important pointers on this aspect that need to be answered and acted upon:
- In a country where finding a qualified doctor is a big task, what should be the legal definition of ‘privileging’?
- Is the recent spate of adverse judgments from courts further straining an already overstretched healthcare delivery system?
- Should routine privileges of different specialities that doctors learn during their residency programs be recognised?
- What should be the policy for special privileges?
- How can the professional bodies and medical societies be involved in this exercise?
- Should there be different standards for different areas / facilities?
- What should be the contours of ‘privileging’ in the Indian context?
- Does India require a special mechanism?
In a recent judgment (Dr Usha Mukhi v/s Seema Deswal & Anr.), the National Consumer Commission while holding an obstetrician negligent for performing a Target (level-II) scan, specifically directed the regulator, the National Medical Commission, to formulate appropriate guidelines in this regard.
An inadequately qualified or incompetent doctor is undoubtedly a serious threat to patients’ safety. But putting obstacles in the way of a duly qualified doctor from providing health care services is a crime in a country like India.
An India-specific system needs to be evolved that is flexible enough to address the current constraints without diluting the standard of care delivered to the patients. Courts are exhorting the regulator to act in this direction. There is therefore a pressing need to discuss and deliberate on the problems and solutions associated with privileging.
The 8th National Convention on Medicine & Law 2023 invites the thought-leaders, policy makers, regulators, opinion formers, and all stakeholders in healthcare for a focussed and meaningful discussion on this issue.
Date: Sunday, 17th December 2023
Time: 9.30 am to 12 noon
Format: Online meeting using a video-conferencing platform
Viewing link: https://www.youtube.com/live/
Doctors and hospitals, members from judiciary/legal fraternity, representatives from policy making bodies, medlegal experts and patient’s bodies/representatives will be the panelist.
A ‘Whitepaper’ will be prepared and circulated among the relevant authorities, media, and the general public.
The Convenor for the session will be Dr Shivkumar Utture. He is a Member of the National Medical Commission, President of the Maharashtra Medical Council, and the National Vice President – IMA (National)
The session will be moderated by Dr Parag Rindani. CEO (Maharashtra) of the Wockhardt Group of Hospitals, he is also a Principal Assessor & part of Programme on Implementation Training, Accreditation and Assessor Training Team – NABH