August 31, 2010

Medical entrance scam busted in J-K

In a shocking exclusive exposé, candidates were caught impersonating kins of the wealthy and the powerful, including the daughter of a current cabinet minister and the son of a former minister in the entrance exams of Acharya Sri Chander College of Medical Sciences.

The seven youngsters arrested for impersonating in a medical entrance examination of the elite Acharya Sri Chander College of Medical Sciences (also known as Batra Medical College) near Jammu, are those booked for taking exams on behalf of relatives of individuals holding high profiles such as Huma Tabussum, daughter of state's cabinet minister for roads and buildings, G.M. Saroori, Lovish Bharat son of former minister of the National Conference Ram Pal, and Sihla Kumar, son of a senior doctor based in Greater Kailash in Delhi.

The impersonators are all medical aspirants, belonging to families with low incomes in Uttar Pradesh and Bihar. These youngsters took up the task for a meagre Rs 25,000. The culprits, however, seem to be those in power, who misused money and position for the murky deal.

Despite documentary evidence available with CNN-IBN, Cabinet Minister G.M. Saroori has denied any connection with the scam, calling it a “misinformation campaign by vested interests to tarnish his image.” He also stated that his daughter is a student of Humanities and not a medical aspirant.

The police, meanwhile, have booked all seven impersonators, candidates and two staff members of the medical college. The case is now being handed over to the CBI, while demands for resignation of the cabinet minister are on.

Although the cabinet minister and the hospital management have refused to comment on camera, their ominous silence exposes the ugly underbelly of the medical education in the country.

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MCI bill passed amid acrimony

As over 100 school students watched from the visitors’ gallery, Lok Sabha plunged into complete turmoil with Samajwadi Party and Rashtriya Janata Dal disrupting proceedings with their demand for a higher raise in salaries for parliamentarians.

Amid the din, a bill to amend the Medical Council of India Act was passed by a voice vote, triggering angry protests by Bharatiya Janata Party which wanted a debate on the legislation. The House passed the Medical Council of India as well as amendments to the Trade Marks bill within five minutes, as Samajwadi Party and Rashtriya Janata Dal MPs stormed into the well of the House shouting slogans against the ‘low hike’. They said it was an insult to Parliament.

After deputy speaker Karia Munda adjourned the House for the day, agitated Bharatiya Janata Party, Samajwadi Party and Shiv Sena members sat on a dharna in the well of the House, shouted slogans and threw torn copies of the MCI bill. Bharatiya Janata Party MP Kirti Azad was seen shouting, “is this democracy” as he tore a copy of the bill.

Bharatiya Janata Party members were heard saying that they will continue to sit in the well of the House till Saturday morning. As the protests continued in the House, Lok Sabha staff asked the media, by then the only spectators of the agitation, to leave the press gallery as the House had adjourned for the day. Later, the Left too joined the protests against passage of the MCI bill without any debate.

Earlier in the day, the Samajwadi Party and Rashtriya Janata Dal led by their leaders Mulayam Singh Yadav and Lalu Prasad created a ruckus forcing two adjournments.

While business remained almost paralysed in both Houses on Friday, Parliament is sitting on Saturday to make up for the lost time. The government has conveyed to political parties that the session could be extended beyond August 28 if pending business is not completed. Major legislative business includes the nuclear liability bill and the MPs salaries and allowances bill.

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Bigger city hospitals in Mumbai bill 20% ‘service charge’ on Insurance

Though medical insurance policy holders shell out 5.4% extra to avail cashless benefit, scores of patients are being refused the facility on various grounds.

Many policy holders have had to arrange for money as the hospitals they chose did not feature on the list of preferred provider network (PPN), a programme launched by insurance companies on July 1.

Andheri resident Parmeshwari Agarwal, 65, was detected with breast cancer last month and the doctors at Bombay Hospital advised immediate surgery. Agarwal’s son Manoj applied for cashless mediclaim to Raksha TPA but was refused because the hospital was not on the PPN list. “I sold my mother’s jewellery to pay the Rs1.11 lakh required for the surgery,” said Manoj, who pays an annual premium of Rs10,000.

Moreover, bigger hospitals charge 20%extra on the cashless amount, which is not reimbursed by the insurance companies, as ‘handling charges’. “There is no justification for this charge and therefore the insurance companies decided against reimbursing this amount,” said a senior insurance consultant.

According to Col Manesh Masand, president of Association of Hospitals (AOH), “Surcharge is an internal matter of a hospital and it covers overhead charges like the electricity, water, staff salary, etc.” The insurance companies, however, question this stand as the hospitals apply surcharge only on the cashless claims and not on reimbursement claims.

Interestingly, only 2% of the Indian population has a medical insurance cover, while the figure in Mumbai is about 17%.

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August 30, 2010

Centre dumps medical CET plan

Bowing to pressure from Tamil Nadu Chief Minister M. Karunanidhi, the Centre has put on hold the decision by the Medical Council of India for conducting a common entrance test (CET) for MBBS courses from the next academic session.

The move has also been opposed by the All India Anna Dravida Munnetra Kazhagam (AIADMK).

The decision comes just two days after the Medical Council of India (MCI) announced with much fanfare its decision to hold an all-India entrance test for admission to medical colleges for undergraduate courses from 2011-2012. The MCI was awaiting formal approval of the notification to this effect. Mr. Karunanidhi had written to Prime Minister Manmohan Singh, urging him to “reconsider'' its move to conduct a national-level common entrance examination for MBBS courses and said that the State could not accept the move as it amounted to an “infringement by the Union government on the autonomy of States.” A copy of the letter was sent to Union Health and Family Welfare Minister Ghulam Nabi Azad

Mr. Karunanidhi wrote to the Prime Minister on Monday referring to the submission made by the Centre in the Supreme Court on the MCI recommendation to conduct a common entrance examination from next year. The Board of Governors of the MCI formally announced the decision the following day, saying that a notification would come in a day or two. According to Mr. Karunanidhi, Tamil Nadu had scrapped the entrance examination for engineering and medical admissions in 2007-08 through legislation with the Presidential assent. This had been done to safeguard the interests of the socially and economically disadvantaged students from the rural areas. The move benefited many such students and also resulted in more doctors agreeing to work in rural areas.

Tamil Nadu had also implemented 69 per cent reservation for socially disadvantaged sections, which would be difficult to implement when there was a common entrance examination, Mr. Karunanidhi said in his letter.

Supreme Court moved

On Thursday, Tamil Nadu moved the Supreme Court seeking to implead itself in a pending matter on which the Centre submitted that the MCI would come out with a notification for the CET for admission to medical courses.

On the same day, the Dravida Munnetra Kazhagam and the AIADMK raised the matter in Parliament with the members demanding that the common entrance examinations for medical and engineering admissions be done away with, alleging infringement on the rights of the States.

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Maharashtra Doctors oppose state decision on pvt practice

The state government may want to believe that discontinuing private practice will ensure commitment from doctors for public hospitals but it may have to deal with mass resignations and more vacancies instead.

Just about 18 months after allowing teachers from government medical colleges to start their own private practice post duty hours, the Medical Education Department scrapped the clause on Wednesday and made it `unlawful' for these doctors to practise outside the hospital. The state's grouse is that public hospitals were getting step-motherly treatment.

However, many miffed doctors are already determined to say bye to the government sector. For instance, a skin specialist from JJ Hospital who did not wish to be named, said that he was already toying with the idea of quitting his alma mater.

At least five of his colleagues from the hospital were deliberating the same dilemma of whether to quit or stay. Another dentist from Government Dental College, Mumbai, voiced the same concerns saying the government's decision was ill-conceived. The associate professor has invested close to Rs 15 lakh for setting up a 280-sq-ft dental clinic in Parel.

A cardiac surgeon from JJ Hospital pointed out that almost 35-40% of the young doctors in the hospital had their own private practices. A radiologist from St George Hospital went on to say that a section of doctors who have been illegally indulging in private practice for years will remain unaffected. The Maharashtra Medical Teachers' Association is yet to take a stand on the issue.

Secretary, medical education, Milind Mhaiskar said the idea was to ensure more accountability.

Link: Original Article

August 29, 2010

Private institutions opposed to single entrance exam for all medical colleges

The Medical Council of India's (MCI) latest decision to introduce a single entrance exam for all medical colleges in the country from 2011, is likely to draw some stiff opposition from private unaided institutions in Maharashtra.

On August 13, MCI counsel and senior advocate Amarendra Saran conveyed the decision to the Supreme Court bench of justices R V Raveendran and H L Gokhale, which was hearing a petition that seeks the court's directives for a single window system for admissions. The Union health ministry has accepted the MCI's decision.

For now, students wanting to take up courses in medicine have to appear for at least five to six entrance tests for various colleges and worry about accompanying issues like clash of exam dates as well as travel to distant places for counselling regarding allotment of seats.

The MCI decision means there will be just one entrance test each for MBBS and MD courses offered by all 271 medical colleges 138 government-run and 133 under private management. These colleges together offer over 31,000 seats for MBBS courses and another 11,000 for PG.

Kamal Kishore Kadam, who heads the Association of Managements of Private Unaided Medical and Dental Colleges (AMPUMDC) in Maharashtra, said, "The MCI decision is against the very spirit of the Supreme Court's judgement in the TMA Pai case, which recognises and safeguards the freedom of private unaided institutions in a range of matters, including the right to admission."

The AMPUMDC controls 11 medical and 21 dental colleges in Maharashtra and also conducts a separate common entrance test (ASSO-CET) every year for admissions to these colleges. "We strongly believe that education and educational institutions must prosper without any government control," said Kadam.

On its part, the state government has shown a favourable disposition towards the single entrance exam, which would mean that the Maharashtra Health and Technology-Common Entrance Test (MHT-CET) will have to be scrapped. The MHT-CET is a combined entrance exam for admissions to health sciences, engineering and pharmacy degree courses in the state.

A senior state health department official said, "The MCI decision is good and the state government has conveyed its positive opinion for the same to the Union government." However, the official, who did not wish to be identified, conceded that much would depend on how private institutions react to the decision.

When contacted, state director for medical education and research Wasudev Tayade said, "We will follow whatever guidelines and instructions we get from the Union government and the MCI." The question of scrapping the MHT-CET will arise only when the guidelines for the MCI-proposed entrance exam are finalised and issued to the state governments, he added.

Meanwhile, Kadam said, "The government cannot be expected to interfere with the functioning of private unaided institutions, considering that the apex court has aptly defined freedom for private institutions through various judgements. For instance, the court upheld St Stephen's college's decision to put a bar on admission for students scoring below 70 per cent marks. The college took the decision to maintain a certain level of standard and this was upheld by the apex court."

Kadam said, "The government should worry about improving standards of their own colleges, it is unfair to interfere with the functioning of private colleges. Any decision relating to matters like admission, has to be in consonance with the apex court judgement in the TMA Pai case. Each private institution has the right to conduct an entrance exam of its own."

Asked about the inconvenience caused to students, Kadam said that the market forces will ensure that only the best institution survives and students will have to apply to only those institutions where they stand a realistic chance of securing admission.

The prospect of MHT-CET getting scrapped from 2011, is also causing a measure of worry for private coaching classes, which fear the national-level entrance exam would be tougher to crack for students in the state compared to the MHT-CET, which is relatively easier and carries no negative marks.

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US probes pharma cos over bribing doctors

While the Indian government fights shy of legislating against bribes and kickbacks paid by pharma companies, the US department of justice has started investigating whether major drug and device companies have made payments to doctors and health officials while doing business in foreign countries.

Those being investigated include some of the largest pharmaceutical companies in the world such as GlaxoSmithKline (GSK), AstraZeneca, Merck, Bristol-Myers Squibb, Eli Lilly and Pfizer. These companies have received letters enquiring into their activities in a number of countries. If any company is found guilty it could mean penalties running into several million dollars and huge loss of reputation internationally.

The trigger for the DOJ focus could be a recent report that revealed that 40-65% of clinical trials for FDA-regulated products were conducted outside the US. The report found that 20 of the largest pharma manufacturers of the US were conducting one-third of their clinical trials exclusively at foreign sites. And it also noted that 80% of marketing approvals for drugs and biologics contained data from foreign clinical trials.

Hence, DOJ will be examining whether any corrupt practices like payments made to doctors running clinical trials for drug makers abroad affected the reliability of clinical data from studies outside the US. That should send warning signals to several operations in India that is becoming a hub for clinical trials for a large number of pharmaceutical companies.

The kind of payments that would be considered as corrupt could be broad including cash gifts, charitable donations, meals, entertainment, speaking fees, research grants, consultations and hospitality. The definition of “foreign official” under the FCPA too could be rather expansive including employees and managers of the public healthcare system which could mean doctors, administrators, procurement officials and other health professionals. The DOJ has made it clear that they will be going after not just the companies but will also focus on prosecuting individuals for their role in FCPA violations, even for actions taken even by a third party on behalf of the company, if someone in the company knew of the violation or if the circumstances suggested a high likelihood that the violation would occur.

During the last couple five years, about half a dozen of years pharmaceutical and medical device companies have had to agree to settlements with the Securities and Exchange Commission (SEC) and the department of justice (DOJ) for alleged kickbacks paid abroad. The payments made in the form of huge amounts in cash stashed in suitcases, so-called charitable donations and luxurious study trips to Las Vegas and Miami were mostly made to doctors or purchasing officials of public health systems to get them to buy the company’s products.

In November 2009, a senior DOJ official has warned the pharma industry that it intended to aggressively investigate violations of the Foreign Corrupt Practices Act (FCPA), 1977 in the pharma and medical devices industry. The DOJ, having recognised that the pharmaceutical industry with a third of its sales generated outside the US, was fertile ground for FCPA violations, has shown just how serious its intent is by setting up a healthcare fraud group dedicated to looking at bribery offences.

The FCPA enforcement is obviously a priority area with both the SEC and DOJ with 57 FCPA cases reportedly prosecuted in the last four years- more than double the number of prosecutions since FCPA became law in 1977. It is said that the DOJ is currently pursuing 120 investigations under the FCPA.

Not only the United States, but several other developed countries like the UK and Germany have adopted laws similar to the FCPA. Investigations into the pharmaceutical industry with its operations spread across several countries have resulted in international cooperation in anti-corruption investigations. In the Siemens settlement, the DOJ investigators worked with their German counterparts to bring Siemens to book. The consequent December 2008 settlement had the company agreeing to pay $800 million to the US authorities and $287 million to the office of the prosecutor general in Munich, Germany. Siemens employees had resorted to falsified accounting records, foreign intermediaries and hidden bank accounts to bribe government officials in eight different countries to secure billions of dollars in contracts in these countries.

While the cases so far seem to be mostly about operations in Latin America, China, Russia, Saudi Arabia and Iraq, could an India operation be far behind with its booming clinical trial industry and well documented corrupt practices in the drug industry?

Link: Original Article

Star hospitals blink, to okay cashless deal

Cashless hospitalization facility may soon be restored at most corporate hospitals in Delhi, Mumbai, Bangalore and Chennai, with the impasse between insurers and big hospital chains on the verge of a resolution.

After intense negotiations spread over several days, a three-tier package has been worked out for 42 standard medical procedures, covering almost all common ailments requiring hospitalization.

As per the compromise formula, hospitals have been divided into three groups based on infrastructure capabilities. In Delhi, negotiations have already been concluded with Gangaram and Medicity, Gurgaon, which figure among the list of high-end hospitals. Others such as Apollo and Fortis, which have presence in other metros, are also ready to come on board on the same rates that Gangaram and Medicity have agreed to.

The Delhi hospitals that have been found eligible to charge the highest rates include Gangaram, Medanta, Max (Saket), Apollo and Fortis. In Mumbai, the category will comprise Breach Candy, Hiranandani, Jaslok, Leelavati and Hinduja. Manipal in Bangalore and Apollo and Fortis in Chennai may also make the top grade.

The complete list will be available once these hospitals sign the deals with third-party administrators (TPAs).

While 450 hospitals across these cities had already joined the cashless network, the absence of corporate hospitals constituted a vital missing link in the medical insurance chain.

Corporate hospitals had been taken off the preferred network after July 1 when they refused to standardize their treatment procedures, and agree to a package deal with insurers.

The package rates have been worked out by a committee headed by Raksha TPA CEO Pawan Bhalla who facilitates the northern region business of health insurers. Earlier, all four major public sector insurers, in consultation with high-end hospitals, had empowered a committee comprising Dr Pervez Ahmed, CMD of Max Healthcare, and Bhalla to work out a compromise on rates and a common slab for different ailments.

"The rates have been segmented into three categories because high-end hospitals cannot be pushed to accept tariffs applicable for smaller ones," said Bhalla. Once these are signed by major chains in north, the package deals will be extended to other regions.

The packaged rates, when implemented across the country, are expected to result in 20-25% savings for insurance companies which were finding it hard to stay afloat because of the hefty rates corporate hospitals charged under the old scheme. Four PSU insurers -- National Insurance Company, New India Assurance, Oriental Insurance and United India Insurance Company -- command nearly 80% of the total health insurance business.

At least 18 insurance companies, including the four public sector entities, had dropped from their designated list more than 150 hospitals in Delhi and NCR. A similar number was taken off the list in Mumbai and other cities, following allegations of overcharging that led to these insurers reporting a loss of more than Rs 2,000 crore annually on a premium of Rs 9,000 crore.

These insurance companies had been so far providing cashless services at over 3,000 hospitals in the country. But a recent study carried out by TPAs had found that only 350 of them, or roughly 11%, were consuming more than 80% of the total claims.

The four metros account for almost 50% of the Rs 9,000 crore annual mediclaim premium collected by the insurers.

In Mumbai, however, some of the high-end hospitals are still agitating on the question of a package deal. Dr Sujit Chatterjee of Hiranandani Hospital in Mumbai said it was not possible for them to sign on the rates that could be applicable in Delhi. He cited difference of real estate prices in the two cities as one of the reasons to justify the case for higher rates in Mumbai. Dr Chatterjee said at least 50 charitable hospitals like Hiranandani had refused to service CGHS clients as the rates, being so low, are simply not acceptable to them.

Link: Original Article

August 28, 2010

Rival political parties of TN join hands to oppose CET for medical admission

In a rare show of unity, DMK and AIADMK today joined hands in Rajya Sabha to oppose the Centre’s decision to introduce Common Entrance Test for medical colleges.

Raising the issue during Zero Hour, Paul Manoj Pandiyan (AIADMK) said the decision amounts to infringement on the rights of the States and will affect the prospects of students from rural areas.

He said the decision has sent shock waves among poor students wanting to enter into medical field.

Supporting him, Tiruchi Siva (DMK) said students from rural areas were not getting opportunity to enrol in medical colleges.

Members of AIADMK and DMK, rival political parties in Tamil Nadu, said that the entrance test in the State has been abolished.

Mr. Siva said the decision for CET was unwarranted. “We strongly oppose the move, which is aimed at usurping the powers of the State government,” he said, demanding that the status quo be maintained.

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MCI mulls new training facilities

As the faculty crunch in medical colleges becomes a major issue of concern, the Medical Council of India (MCI) is now mulling conducting tele-classes for students.

An All India Medical College Tele-Medicine Network is under the consideration of the health ministry, Sita Naik, a member of the MCI's board of governors, said Tuesday.

'We are seriously considering using distant education through tele-medicine for things like classroom lectures,' she said.

'We have a shortage of faculty, so if we can share it through web based programmes, it will solve the problem to some extent,' she said.

Looking towards modernising medical education and training facilities, the MCI is also considering setting up more regional training centres for training medical teachers.

'We are looking ahead for setting up at least five more centres, focusing specially on the regions which lack them,' Naik said.

Increasing the number of seats as well as courses at the post-graduate level is another major issue being looked into by the council.

'Presently we have a rocket shape structure - more undergraduate students and lesser post-graduates. We want it to be cylindrical,' board of governors' head S.K. Sarin said.

To meet the aim, the council has proposed easing of norms and increasing the number of post graduate seats as well as introducing new post-graduate courses.

'We have already received 1,300 applications from medical colleges for starting the new courses proposed by the council,' board member R.N. Salhan said.

The council is also looking ahead to setting up special skill labs across the country to give targeted skill training to the students.

'In most developed countries, learning on live patients is considered unethical. There are dummies available in international market on which the training can be done. We are looking ahead to start skill labs across the country which will train students without using live patients,' Naik added.

Meanwhile, the MCI said that the dates for receiving applications for registering new medical colleges has been extended to Sep 30, from the earlier deadline of Aug 30.

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Indian American doctors form political action committee

The American Association of Physicians of Indian Origin (AAPI) has formed a political action committee (PAC) to protect the interest of Indian American doctors at the Capitol Hill. "Our new PAC will empower Indian American doctors to do that by pooling our resources and ensuring the voices of nearly 60,000 physicians are heard throughout state legislatures and the halls of Congress," said Krishna Aggarwal, a physician helping to spearhead the PAC's formation.

"With the mid-term elections less than 80 days away, API-PAC will play an important role this election cycle and beyond to provide strength and unity to Indian American physicians across the United States," Aggarwal said.

The PAC will be a separate legal entity unaffiliated with the American Association of Physicians of Indian Origin (AAPI). It will be professionally led by a political firm in Washington with experienced American advisors, a media statement said.

Link: Original Article

August 27, 2010

Doctors will now have to register in all states they practise

Medical Council of India (MCI) is planning to introduce a new registration system for doctors. As per the proposal, a doctor practising in multiple states will have to register in all those states simultaneously, unlike now when a single registration is enough to practise anywhere in the country.

“This means doctors practising in Maharashtra, Karnataka and Uttar Pradesh will have to be registered in all three states simultaneously, irrespective of the place they got their degrees from. This will give us a better idea about availability of doctors in a state,” Sita Naik, a member of MCI’s board of governors, said.

Similarly, all doctors will have to keep state medical councils updated about the higher degrees, such as post-graduation, they acquire.

In fact, the health ministry is already considering another MCI proposal to introduce a national exit examination for medical professionals to ascertain if they are suitable to practise as doctors. It will be a qualifying examination in each discipline of health for those who want to practise in more than one state. It will evaluate the outcome of training and proficiency attained after the completion of graduate or postgraduate medical courses.

Can’t endorse products
MCI has given a strong warning to doctors and medical associations endorsing products for private companies. “There is a code of medical ethics in place according to which no doctor or association can endorse products. There is a watchdog in the government and a group of people is monitoring all such endorsements,” SK Sarin, chairman of the MCI board of governors, said.

Taking on Indian Medical Association (IMA), which also reportedly endorses about six products, including Dettol, Lizol and Aquaguard, Sarin said MCI had jurisdiction over not only doctors but also their associations.

“If doctors can’t, even IMA cannot,” he said.

MCI has sent show-cause notices to all doctors and associations that have been prima facie found to be involved in endorsements. It is learnt that roughly 50% of IMA’s funds come from endorsements.

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Cashless medical facilities restored in 449 hospitals: Govt

ashless medical facilities for persons insured with PSU companies have been restored in 449 hospitals in four big cities after hospitals have agreed to charge them at par with non-insured patients, Rajya Sabha was informed today.

Replying to a Calling Attention on the issue, Minister of State for Finance Namo Narayan Meena said public sector insurance companies had to resort to rationalisation of rates for cashless facilities as they suffered a loss of Rs 2,000 crore because of overcharging by hospitals in Mumbai, Delhi, Chennai and Bangalore.

He said if the hospitals were allowed to overcharge, it could result in "serious consequences" leading to insolvency of the insurance companies.

Meena said the cost ratio for the public sector companies was 140 per cent of the premium received under the health portfolio.

Citing an example, he said while the private hospitals were billing Rs 1.35 lakh from an insured for caesarian operation, the rate was Rs 55,000 for uninsured and the CGHS rate was only Rs 15,000.

While the standard health insurance policy did not provide any assurance of cashless facilities, it was agreed to extend such a facility through a network of hospitals in some cases, he said.

In the four cities which accounted for over 50 per cent of the malpractices and had led to the problem, a Preferred Provider Network (PPN) of hospitals has agreed to provide the cashless facilities at the rates equal to those paid by non-insured patients, he said.

The four PSU insurance firms - National Insurance, New India Assurance, Oriental Insurance and United India Assurance - had last month stopped the cashless facility in private hospitals, including the expensive ones known as 5-star hospitals.

However, through mutual consultation a broad agreement has been reached between 449 hospitals and insurance companies.

"More hospitals are joining (the PPN)", the minister said adding the problem was limited to the four cities where rationalisation was underway. For rest of the country, the cashless facility was available like in the past, he said.

Earlier, members said patients should not suffer because of overcharging by hospitals and some cases of manipulation.

S S Ahluwalia (BJP) said there was no standardisation of rates. "The government was leaving the people at the mercy of hospitals," he said.

T Siva (DMK) demanded that the cashless facility should be available in all hospitals. Syed Azeez Pasha (CPI), E M Sudarshana Natchiappan (Cong) and Moinul Hasan (CPI-M) also expressed similar concern.

Link: Original Article

Tibetan medical centre opens in Chennai

Most doctors spend a couple of minutes taking a patient's pulse. But Dr Dorjee Rapten Neshar takes over 20 minutes, gently touching and tapping different parts of the patient's wrist and palm. "Pulse analysis is very important in Tibetan medicine," says the chairman of the central council of Tibetan medicine. "You can get all of a patient's problems by understanding the energy patterns of the pulse."

Dorjee is in town for the opening of the state's first Tibetan Medicine Centre, which will function out of the CP Ramaswami Aiyar Foundation on Eldams Road. For the past eight years, Dorjee has been coming to Chennai twice a month to treat over 1,000 patients for everything from arthritis and asthma to diabetes and cancer. "Most people come to us when conventional methods of treatment have not worked," says Dr Nyima Gyaltsen, who runs the Chennai centre with his wife.

Tibetan medicine, the doctors explain, is an ancient form using meditation, diet and lifestyle corrections to treat diseases. Many of the Tibetan medical texts were destroyed and the doctors imprisoned or put to death during the Chinese occupation of Tibet in the 1960s, and what is left is the knowledge that those who escaped have passed on.

"We still have a lot left and we continue to do research at the centre in Dharamsala. The medication takes lots of forms Himalayan herbs, pills made of precious and semi-precious stones, decoctions. It can be a little inconvenient to take as you have to crush or boil them but it's very effective," says Dorjee. The doctors claim that their medication also helps patients with cancer.

Link: Original Article

August 26, 2010

Plan for common entrance test for medical courses from next year

Students aspiring to become doctors will soon be spared the agony of multiple pre-medical tests (PMT). From session 2011-12, performance in a single common entrance examination will form the basis for admission to all central, state and private medical colleges. On an average a student takes 7-10 PMTs annually.

Apart from making life easy for medical aspirants, this would close the possibility of backdoor entry as no private college will be able to grant admission to students other than those clearing the common entrance examination, even through management quota.
The same applies to minority institutions.

In fact, all the around 300 medical colleges in the country will have to choose students from a single merit list prepared on the basis of this exam. The PMTs conducted by state governments would become invalid.

The exam will, however, not guide admissions to All India Institute of Medical Sciences, Delhi, Postgraduate Institute of Medical Education and Research, Chandigarh, and Armed Forces Medical College, Pune, as these institutes were created by an Act of parliament.

The ministry of health and family welfare ministry, which has approved the common entrance examination, is expected to issue a notification in this regard shortly.

“This has been done to curb corruption in admissions and instill confidence among students,” SK Sarin, chairman of the board of governors of Medical Council of India (MCI), said.

The examination will be conducted by Central Board of Secondary Education (CBSE), which already conducts an all-India PMT for roughly 15% MBBS seats in government colleges.

Of the around 300 medical colleges in India, roughly 120 are run by private trusts. Admissions to these colleges are based on PMTs conducted by state boards, CBSE and armed forces.

Besides, many private colleges conduct their own entrance examinations.

Meanwhile, MCI is preparing a Vision 2015 document to improve medical education. “We will have career paths for medical graduates and give them attractive options,” Sarin said.

While trying to increase the number of undergraduate and postgraduate medical seats, MCI is also exploring the possibility of restructuring some of the less popular courses and introducing new ones such as critical and emergency care, infectious diseases and disaster management.

Link: Original Article

IIT medical courses on ice

The IITs cannot launch their own medical colleges just yet. The human resource development ministry has put the proposal on hold following the law ministry’s advice to seek Medical Council of India approval.

This will be a setback for IIT Kharagpur, whose plans to open its own medical college on its campus, in collaboration with the railways, were in an advanced stage.

The provision for medical education has been dropped from the IIT Act amendment bill, which the Union cabinet cleared today, a senior HRD ministry official said. The bill seeks to grant statutory status to the eight new IITs so they can award degrees.

It also proposes to convert the Institute of Technology, Banaras Hindu University, into a full-fledged IIT.

Link: Original Article

August 25, 2010

Apollo Hospitals to set up stem cell facility

Apollo Hospitals Enterprise Ltd., is focusing on stem cell therapy. The company, tied up with USbased StemCyte today and would together invest $15 million to set up a stem cell facility besides conducting research development activities at its Hyderabad centre.

Stem cells can be sourced from umbilical cord blood and bone marrow and are used in medical therapies. They can be grown and transformed into specialised cells for future therapies.
"The idea is to undertake intensive research and provide personalised medicine in future for patients. It's a 50:50 joint venture and will carry out research in several areas including chronic stroke, spinal cord injury and muscular dystrophy," said Dr Pratap C Reddy, Chairman, Apollo Hospitals Group.

While phase I involves $15 million, both companies would pump in capital as required.
The upcoming facility, which will focus on stem cell culturing, trials and research, will be the fourth such unit for StemCyte. It currently has three facilities, one each in the US, HongKong and South Korea. Apollo also said it has also tied up with Quintiles to start clinical trials unit at Apollo Health City in Hyderabad. It had earlier announced $10 million investment in this venture. The company is waiting for regulatory approvals to conduct first in human (FIH) studies.

Apollo is also conducting a study to assess the reasons for widespread CardioVascular Diseases (CVDs) in India. "Many young patients these days are prone to cardiac arrests. We want to assess why Indians are predisposed to cardiovascular diseases at an younger age," said Reddy adding that Apollo performed 9,800 cardiac surgeries last year alone. The hospital chain is working with the Institute of Genetic Engineering and Integrative Biology and National Institute of Biomedical Genomics in this regard. As part of its 2014 growth strategy, Apollo will invest Rs 2,200 crore to create 3,000 new beds.

Link: Original Article

H1N1 Pandemic over, but it's just peaking in India

For the World Health Organisation, the H1N1 swine flu pandemic is over. The world is no longer in an influenza pandemic alert and is moving into the post-pandemic period, WHO director general Margaret Chan said this week.

According to the global health watchdog, the new H1N1 virus has largely run its course. But for India, the reality seems to be different. Some say the pandemic is actually peaking in the country now. Take for example the number of new cases in just the past week. Between August 2-8, the number of lab-confirmed cases of H1N1 infection stood at 942. India recorded 83 deaths due to H1N1 during the same period.

The worst affected states include Maharashtra which recorded 400 positive cases and 51 deaths, Karnataka 200 cases and 12 deaths, Andhra Pradesh 105 cases and six deaths and Delhi with 106 cases with no death. Since May 2009, India has recorded nearly 37,000 H1N1 infections and 1,833 deaths.

A health ministry official said, "Many would say the virus has now settled down to replace the seasonal influenza strain. But there is no doubt that H1N1 continues to infect Indians in large numbers. In fact, the highest number of deaths reported of swine flu in a single week, 83, was between August 2 to 8. Majority of those who died were pregnant women and the elderly — the vulnerable group."

According to Dr Chan, the post-pandemic period does not mean that the H1N1 virus has gone away. "Based on experience with past pandemics, we expect the H1N1 virus to take on the behaviour of a seasonal influenza virus and continue to circulate for some years to come. In the post-pandemic period, localised outbreaks of different magnitude may show significant levels of H1N1 transmission," she said.

According to her, the actions of health authorities in India, in terms of vigilance, quick detection and treatment and recommended vaccination, provide a model of how other countries may need to respond in the immediate post-pandemic period.

Globally, the levels and patterns of H1N1 transmission now being seen differ significantly from what was observed during the pandemic. Out-of-season outbreaks are no longer being reported in either the northern or southern hemisphere. Influenza outbreaks, including those primarily caused by the H1N1 virus, show an intensity similar to that seen during seasonal epidemics.

During the pandemic, the H1N1 virus crowded out other influenza viruses to become the dominant virus. This is no longer the case. Many countries are reporting a mix of influenza viruses, again as is typically seen during seasonal epidemics.

"Pandemics, like the viruses that cause them, are unpredictable. So is the immediate post-pandemic period. There will be many questions, and we will have clear answers for only some. Continued vigilance is extremely important, and WHO has issued advice on recommended surveillance, vaccination, and clinical management during the post-pandemic period," Dr Chan said.

Read more: In 7 days, H1N1 claims 83 lives - India - The Times of India

Link: Original Article

August 24, 2010

MCI in a fix over plea against 159 docs on endorsements

The Medical Council of India’s attempt to wriggle out of taking action against the Indian Medical Association for endorsing products of various companies has come to naught with the council being given a list of names of 159 doctors who were party to making the decision to endorse the products.

The list includes the names of Dr Ketan Desai, former president of the MCI who had brought in the MCI regulation banning doctors and doctors professional organisations from endorsing products, the current IMA national president Dr G Samaram, and current national secretary Dr Dharam Prakash.

The MCI had responded to a complaint against IMA’s endorsement saying that “the IMA do not (sic) come under the purview of MCI”. MCI’s response further assured that if complete details of any medical practitioner, registered with MCI, who indulged in violation of the MCI regulations, was provided, the council shall initiate appropriate action.

The complainant Dr K V Babu has now provided the names of 159 doctors who were party to the decision to endorse products in 2008 and sought action against every one of these doctors who come under the purview of the MCI.

In November 2008, the Central Working Committee of IMA had approved the MoU signed with Pepsi to endorse Quaker Oats and Tropicana juices and the MoU with Dabur to endorse its Odomos cream, gel and lotions. The endorsement, supposed to be in operation till March 2011, brought in Rs 2.25 crore revenue for the IMA.

The proceedings of the Central Working Committee meeting show that endorsement money was meant to be used for clearing travel allowance of the IMA members and for international activities affecting IMAs global presence.

Dr Babu pointed out that the MCI regulations clearly stated that doctors were not to take travel allowances from any private industry or endorse products. He calculated that the amount of Rs 2.25 crore earned on the decision of 159 doctors when divided amongst them, worked out to be over Rs 1 lakh per head. According to the quantum of punishment decided by the MCI for various levels of violations, the penalty for accepting anything above Rs 1 lakh is penal erasure from the registry for one year. However, no action has been taken so far.

Link: Original Article

August 23, 2010

PM announces constitution of education and health councils

Prime Minister Manmohan Singh on Sunday announced constitution of two separate councils for higher education and health to accelerate reforms in these sectors. Addressing the nation from the ramparts of the Red Fort on the 64th Independence day, Singh said improvement in the areas of education andhealth is an important strategy for inclusive growth.
"It is also necessary for higher economic growth in the years to come," he said.

Singh said, "Today almost every child in our country has access to primary education. Now we need to pay more attention to secondary and higher education".

The Prime Minister said there was also a need to improve the quality of education at all levels.

"We will soon bring a bill to Parliament for constitution of two separate councils in higher education and health respectively so that reforms in these two areas can be accelerated," he said.

Human Resource Development Minister Kapil Sibal and Health Minister Ghulam Nabi Azad have both favoured such councils. The National Knowledge Commission has also backed the formation of such bodies.

On the health front, Singh said though nutritious food and good health services are necessary, they are not enough for ensuring good health of the citizens.

There are many diseases which would be difficult to prevent in the cities, towns and villages without cleanliness and good sanitation, he said.

Singh said, "The truth is that our country lags behind in this area. I consider it a primary responsibility of all our citizens to maintain cleanliness and hygiene around them. I would like our children to be taught the importance of cleanliness and hygiene in schools from the very beginning under a campaign for a Clean India".

He appealed to the state governments, Panchayat Raj Institutions, civil society groups and common citizens to make this campaign successful.

Link: Original Article

'New Delhi Superbug’ - ‘Named’ to kill Indian Medical Tourism

Naming of a new superbug after the name of Indian capital by a UK based research team, is seen as a move to scare the UK patients from India while hospital acquire infection rates in UK itself , especially MRSA, continue to be alarming.

Within few days of India’s top IT outsourcing company Infosys was called ‘Chop Shop’ by a US senator, a UK infection control research team led by Prof Timothy Walsh, in a study published in Lancet, has dropped another bombshell by naming a new Superbug gene NDM-1 after the name of Indian capital, as ‘New Delhi metallo- lactamase-1’ and blaming Indian Medical Tourism industry especially Cosmetic Surgery centres for its worldwide spread.

“This act of naming Superbug after New Delhi, while none of the samples collected was from Delhi and its presence in UK itself indigenously, appears a ‘Racially’ and commercially motivated act to malign Indian Medical tourism sector.” said Dr K M Kapoor, Senior Consultant, Cosmetic Surgery at Fortis Hospital, Mohali and a Medical Tourism exponent in India. The charge of the name being racially biased gets all the more credence as Prof Timothy Walsh had reported a similar, but far more dangerous Superbug from an infection outbreak in a hospital in Houston, Texas in 2006. This bug was named VIM 7 rather than being called ‘Houston Superbug’ and was never publicized much. VIM 7 was more dangerous than NDM 1 as it was resistant to all the drugs except Polymyxin B (Source: while NDM-I is susceptible to Tigecyclin and Colistin.

I3-IRG researcher Prof Timothy Walsh, PhD, who is still in the process of obtaining his MRCPath (London) and DSc (Australia) (source, had earlier also resorted to publicity gimmicks to draw world’s attention to his pet topic of Metallo-β-Lactamase gene, but failed to do so in his previous attempts. This time by deliberately naming the ‘Superbug’ after New Delhi and implicating India’s burgeoning Cosmetic Surgery tourism industry for its spread, he has raised a big controversy and has managed to get all the attention. Moreover the credibility of this study suffers from another account as this study has been funded by EU, Wellcome and Wyeth, with Wyeth being the manufacturer of Tigecyclin, one of the two drugs effective against NDM 1. The lead author has reported receiving a travel grant from Wyeth and another author has reported holding or managing shares in AstraZeneca, Merck, Pfizer, Dechra, GlaxoSmithKline, and Eco Animal Health.

By creating a false scare and a doomsday scenario, Prof Timothy Walsh is trying to gain international limelight .The proof of how serious is the threat, of NDM 1 gene, can be had from the excerpts of a press release from Hong Kong’s public Health Dep’t. ‘ According to test results of Public Health Laboratory Services Branch (PHLSB), there was one isolate of E. coli harbouring NDM-1 in a 66-year-old male patient attending a government out-patient clinic in October 2009.The organism was however susceptible to oral antibiotic agents commonly used to treat urinary tract infection, the spokesman said. The patient fully recovered.’ (Source: Press release dated 12 August 2010, ). In this case patient has recovered even after contracting the ‘dreaded’ NDM-1 E Coli infection.

Prof Timothy Walsh had earlier also tried to create scare with this Super bug theory in 2004 through his article (Published in 2005 in American Society of Microbiology), titled ‘Metallo-ß-Lactamases: the Quiet before the Storm?’ (Link: ) .The ‘ Quiet before storm’ has lasted well for over 6 years now without a major international outbreak and now Prof Timothy Walsh is again back with his pet topic, trying to serve the same old wine in a new bottle.

UK’s own record in infection control is dismal and high infection rates due to ‘MRSA Superbug’ are driving patients abroad to safer destinations. The EARSS (European Antimicrobial Resistance Surveillance System) monitors antimicrobial resistance in Europe. It maintains a comprehensive surveillance and information system that provides comparable and validated data on the prevalence and spread of major invasive bacteria such as MRSA. Its 2002 data shows that in UK hospitals, 44.5 % of Staph infections were of MRSA type, carrying 15 % mortality. (Source: ).

In a report ‘Superbug fear drives NHS patients abroad’ written by Sophie Goodchild, Health Editor , London Evening Standard on 11th March 2008, it has been mentioned ‘About 22,000 people in the capital and 100,000 from UK went overseas for surgery and dental treatment last year - a rise of nearly a quarter on 2006. Fear over infection from superbugs is now a major reason for them opting to go private instead of receiving treatment on the NHS. More than half of surgery patients said they were worried about contracting an infection such as MRSA in a British hospital. This comes a day after the Evening Standard revealed more than nine patients a week are dying from hospital acquired infections. The findings are published by research group Treatment Abroad from its international medical tourist survey.’(Source: ).

Another report had quoted- Keith Pollard, a director of Treatment Abroad, a website on medical tourism, told the media: "We are getting reports that worries about hospital infections such as MRSA are driving people abroad." Katherine Murphy, of the Patients Association, said: "Hospital infections are the number one concern from callers to our helpline. It comes as no surprise that some people are going abroad because they're frightened of NHS infection rates in this country. The government is not doing anything to reassure the public, particularly when we know key people are being lost from hospital infection posts and cleaning budgets are being cut" ( source: ). High costs and fear of UK Superbug, MRSA, led to the growth of outbound medical tourism from UK with India as one of the top beneficiary. As per a study by treatment abroad , in 2006, for cosmetic surgery procedures like Breast augmentation, tummy tuck, liposuction and facelift , around 14,500 patients traveled outside the UK, spending around £3,500 each, creating an estimated market worth £50 million(cosmetic surgery getting 31% of total market share). This trend has been increasing rapidly since then.

Dr K M Kapoor also shared story of one of his patients from UK, a leading glamour model, Toni Samantha Wildish, who underwent a Breast Implant surgery in Czechoslovakia and contracted a major infection in right breast during surgery and was discharged and sent back after 3 days. ( ). By the time, she reached back home in UK after 5 days, she had started developing features of septicemia. She was taken up for emergency surgery and her right breast implant was removed, leaving her with asymmetric breasts. This left her with no option to look for a better place outside Europe and finally she was operated successfully in India at Fortis Hospital, Mohali by Dr K M Kapoor. Her previous left side breast implant was also removed and a new set of implants were placed to put her modeling career back on track. “Why this case was not much publicized by ‘Infections from other countries’ experts like Prof Timothy Walsh could be anybody’s guess but one reason could be that Czechoslovakia is part of EU” said Dr Kapoor.

By Implicating Indian Cosmetic Surgery industry for the spread of NDM- 1 gene, without any substantial supporting evidence, this UK based research team is trying to help UK’s floundering Cosmetic Surgery market due to popularity of less expensive and safer Asian destinations like India, Thailand, Malaysia etc, amongst UK population. It is important to note that while samples were collected from India, Pakistan and UK, the bacteria gene was deliberately named after New Delhi. The reasons are not very far to see as India in recent years has risen to become one of the top medical tourism destinations in Cosmetic Surgery. The same bacteria could have been named ‘Islamabad bug’ but as Pakistan is not yet a significant player in Medical Tourism, so it was spared.

Cosmetic Surgery, one of the safest surgical specialties, is the biggest contributor to the medical tourism revenues in India. The UK team had reasons to discredit India’s dominance in the field of Medical Tourism as western medical industry has started seeing Asian countries led by India as their major competitors and fear that Medical outsourcing industry could go the IT way. They have found a potent weapon in the form of NDM-1 to win their patients from India by scaring them with this superbug. Dr K M Kapoor, while concluding said, “It is high time Indian government takes a tough stand on this issue to protect its medical tourism industry and asks the UK govt for a clarification & removal of word ‘New Delhi’ from the name of this Superbug.”

Dr K M Kapoor, MS, MCh, DNB
Sr Consultant, Cosmetic Surgery,
Fortis Hospital, Mohali.

Link: Original Article

August 22, 2010

Indian medical journal first documented ‘superbug'

Though a paper on the ‘New Delhi Metallo-beta lactamase bacteria' in the latest issue of a British medical journal has led to allegations of a ‘Western plot' to undermine medical tourism in India, the first formal documentation of NDM-1 — dubbed the ‘superbug' because of it being resistant to most antibiotics — was done by the P.D. Hinduja National Hospital and Medical Research Centre in Mumbai last year. The study was published in the Journal of the Association of Physicians in India (JAPI) in March 2010, with an accompanying editorial on the “worrisome” outcome calling for an end to the indiscriminate use of antibiotics.

The identification of NDM-1 being present among Enterobacteriaceae has the potential for further dissemination in the community, said the study “New Delhi Metallo-b lactamase (NDM-1) in Enterobacteriaceae: Treatment options with Carbapenems Compromised” by Payal Deshpande, Camilla Rodrigues, Anjali Shetty, Farhad Kapadia, Ashit Hedge and Rajeev Soman of the Hinduja hospital.

Such dissemination may endanger patients undergoing major treatment at centres in India and this may have adverse implications for medical tourism. Besides stringent infection control in hospitals, good sanitation in the community is also needed to contain the spread of such clones, the paper concluded.

The study conducted in the hospital itself found 22 patients having NDM-1 bacteria of a total of 24 carbapenem (a strong antibiotic) organisms that were collected in a period of three months. This made the hospital come up with an antibiotic policy that did not allow indiscriminate use of carbapenems. However, being a tertiary centre, the researchers claimed the hospital received transfer cases and referrals from other hospitals.

Carbapenems are among the few useful antibiotics multidrug-resistant Gram-negative bacteria. An alert issued in the U.K. in 2009 warned of an increasing number of carbapenems-resistant Enterobacteriaceae strains identified in U.K. hospital patients, many of whom had been hospitalised in India and Pakistan and had a new type of metallo beta lactamase designated as New Delhi Metallo-1, the study said.

The superbug, a bacterial gene called New Delhi metallo-lactamase-1 (NDM-1), was first identified last year in a Swedish patient admitted to a hospital in India. The bacterium was identified in 2008, but it was given an official identity in December 2009. As a standard practice bacteria are named after the place they are believed to have originated from. In this case, it was New Delhi.

The publication of the study was followed by an editorial in the same issue of JAPI by Dr. Abdul Ghafur K., consultant in Infectious Diseases and Clinical Mycology, Apollo Hospital, Chennai, who said the study was an eye opener on the deep trouble India was in.

“If a single hospital can isolate such a significant number of bacteria with a new resistant gene in a short period of time, the data from all the Indian hospitals, if available, would potentially be more interesting and shocking than the human genome project data, which is considered as a discovery more important than the moon landing itself.”

The Indian medical community has to be ashamed of the NDM-1 gene, Dr. Ghafur wrote. Even though we have not contributed to carbapenem development, we have contributed a resistance gene with a glamorous name. The overuse of antibiotics is embedded in our Indian genes. Accusing Indian physicians of adopting an “ostrich-like” approach to the problem, Dr. Ghafur says the easiest way of tackling the superbug problem is to deny the existence of the problem: stop looking for these bugs, stop looking for the hidden resistance mechanisms and close your eyes even if you find them.

“It is an Indian tradition. Why should we Indians worry? We can always depend on honey, yogurt and cow's urine,” his editorial piece says.

According to Dr. Ghafur, we come across multi-drug resistant or even pan-resistant Gram-negative bugs quite often and such bugs are reported in almost all major centres in India and most international centres, though to a lesser extent than in India. “We Indians are the leaders in antibiotic resistance. Many multidrug-resistant superbugs are from bacterial cultures taken at the time of admission to the hospital. By the time a patient is being admitted to a tertiary care centre, that patient has already visited many other hospitals and doctors and has received multiple courses of different antibiotics. These patients are literally walking culture plates of superbugs and you don't have to be Nostradamus to predict their clinical outcome,” he says in the editorial.

Criticising the indiscriminate use of antibiotics in India, Dr. Ghafur also blames international and Indian pharmaceutical companies for contributing to this resistance saga. The lack of restriction on the usage of newer antibiotics with specialist spectrum has given fertile ground for companies to exert their excessive pressure on doctors to increase prescription of antibiotics.

Further, the medical curriculum lacks importance on the teaching of infectious diseases to undergraduate and post graduate students. According to him, a general medicine candidate can clear his or her examination without reading the chapter on infectious diseases and antibiotic usage.

Link: Original Article

Bill soon to regulate medical education

The government is preparing a bill to regulate and coordinate medical, dental, nursing, pharmacy and paramedical education in the country, parliament was informed Friday.

In a written reply in the Lok Sabha, Health Minister Ghulam Nabi Azad said that the government proposed to bringing reforms in the health sector, especially in coordinating all aspects of medical education.

He said the government is considering the setting up of an overarching regulatory body called the National Council for Human Resources in Health (NCHRH) that will coordinate all aspects of medical, dental, nursing, pharmacy and paramedical education.

'The bill for the proposed council is being worked out in consultation with various stakeholders,' Azad added.

He said in order to make the proposed council more effective that the existing system, it is proposed to trifurcate the regulatory functions of the council by forming three bodies under its ambit for accreditation, academics, ethics and registration.

Apart form its regulatory work, the proposed council will also enhance the supply of skilled manpower in the health sector.

Link: Original Article

August 21, 2010

Bill to replace Medical Council of India board with panel of doctors

A bill was introduced in the Lok Sabha today to amend the Medical Council of India Act to replace the existing board of the Medical Council of India (MCI), facing corruption charges, with a seven-member panel of eminent doctors.

The corruption-ridden MCI, set up 76 years ago to regulate medical education in the country, has already been dissolved through an ordinance in May this year.

A six-member panel of doctors, led by gastro-enterologist SK Sarin, has replaced its board of governors.

Introducing the Indian Medical Council (Amendment) Bill, 2010, health minister Ghulam Nabi Azad said certain events in April had evoked public demand for immediate action.

One suggestion was bringing in an altogether new body. Another idea was to amend the MCI Act, 1956.

The amendment bill deems that the MCI shall stand superseded and the president, vice-president and other members of the council shall vacate their offices and have no claim for any compensation.

It says the council shall be reconstituted within a period of one year from the date of supersession. Until a new council is constituted, the board of governors shall exercise the powers and perform the functions of the council under the new bill.

MCI president Ketan Desai was arrested on April 22 by the CBI for allegedly accepting a bribe of Rs2 crore to give permission to a Punjab medical college to recruit a fresh batch of students without having requisite infrastructure.

The MCI was established in 1934 under the Indian Medical Council Act, 1933, now repealed, with the main function of establishing uniform standards of higher qualifications in medicine and recognition of medical institutions in India and abroad.

In 1956, the old Act was repealed and a new one enacted.

Opposing the amendment bill, Prabodh Panda (CPI) said this is an attempt to encroach on the rights of autonomous institutions. The government plans to bring the MCI under the proposed National Council for Health Research.

Congress member Chintamani said MCI was only helping the profit-making colleges. "It had become the money-making council of India," he added.

Link: Original Article

Health ministry rejects ‘superbug’ report

The government has strongly refuted the study published in ‘The Lancet Infectious Diseases’, which claimed that a ‘superbug’ bacteria that creates an enzyme called New Delhi-Metallo-1 (NDM-1) has travelled to the UK with patients who went to countries like India and Pakistan for medical treatment.

Strongly objecting to the naming of this enzyme as NDM-1 and the claim that hospitals in India were not safe for treatment, the Indian health ministry said that similar plasmids have been reported in Israel, USA, Greece and even in Scotland, as the report claims.
The ministry’s health experts underlined the fact that this study was funded by the European Union and two pharmaceutical companies — Wellcome Trust and Wyeth — who produce antibiotics for the treatment of such cases.

According to VM Katoch, the director general of the Indian Council of Medical Research (ICMR), the study presents a frightening picture that is not supported by any scientific data. ‘The conclusions of the study are scientifically invalid and contain wrong interpretations, indicating unfair bias,’ said Katoch.

According to him, plasmids present in gram negative bacteria can be transmitted among bacteria and may also encode resistance for many drugs. However, this is a phenomenon that occurs commonly in nature — in the environment, and in the intestines of humans and animals, universally.

He added that it was unfortunate that this new bug had been attached to a particular country. He said that the bug is present in nature and is a biological phenomenon.

Instead, he added, the fact that getting infected by such drug-resistant bacteria is preventable by common infection prevention strategies, should have been highlighted.

Katoch further explained that while such organisms may be circulating more commonly in the world due to international travel, to link this with the safety of hospitals in India and insinuate that India is not a safe place to visit waswrong.

The health ministry in a statement said that ‘a lot of sensation has been created by this report... The conclusions are loaded with inference that these resistance genes/organism possibly originated in India and it may not be safe for the UK patients to opt for surgery in India.’

Link: Original Article

August 20, 2010

IRDA: Will follow HC direction on cashless facility

Insurance regulator IRDA today said it will follow the Delhi High Court’ direction to take steps on resuming cashless facility to policyholders provided by four PSU general insurers.
“Now that HC has given direction, we will follow that,” IRDA Chairman J. Hari Narayan told reporters on the sidelines of a FICCI event here.

On Tuesday, the Delhi High Court had asked IRDA to make some arrangement to provide cashless facilities to policyholders, amid the suspension of cashless treatment facility at several big hospitals by four public sector general insurers - New India Assurance, United India Insurance, National Insurance and Oriental Insurance.

“The Insurance Regulatory and Development Authority (IRDA) should, as a regulator of the insurance industry, intervene and ensure that such changes do not affect existing policyholders ...,” High Court Justice S. Muralidhar had ruled.

Mr. Hari Narayan said the regulator comes into picture, if there was breach of contract between the company and the insured person. “It becomes a regulatory issue if there is a violation in terms of policy,” he said.

The PSU insurers have stopped the cashless service from July 1 because of alleged over-billing by some private hospitals.

At a meeting of private hospitals and public sector insurance companies last month, both the parties had agreed to restore the cashless treatment facility under the mediclaim policy within a maximum of 30 days.

The hospitals have already restored the cashless facility for emergency, ICU, cardiac care and trauma cases.

When asked if the premiums would increase post the settlement of cashless mediclaim issue, he said, “I think it would help bring in more products with differential features in the market.”

Link: Original Article

Bypassed by implant makers & doctors, Mumbai city chemists cry foul

Mumbai city chemists will approach the state health department over an alleged nexus between manufacturers of surgical implants and doctors. They say that contravening Medical Council of India (MCI) guidelines, sales representatives of these corporate giants influence doctors and sell products directly.

Chemists are, in particular, unhappy about stents— used in angioplasty— being allegedly sold to doctors directly. The stents cost between Rs 1-3 lakhs. In private hospitals, patients have to bear the cost entirely, besides the other costs involved in angioplasty. “Despite having certified drug licences, these companies refuse to sell stents to us. They strike deals with cardiologists and influence them by giving perks. Moreover, they sell their products at subsidised rates. But going by the current rates, this subsidy is not translated to the cost incurred by the patient,” Prasad Danave, secretary of the Retail and Dispensing Chemists Association, said.

Hospital administrators say the choice of stent is entirely in the hands of the doctor who performs the surgery. “A basic package for angioplasty includes the patient’s stay in the ICU and ICCU, basic tests, cost of the wire and balloon required for the surgery and the doctor’s fee. This is fixed,” said Major General Vijay Krishna, CEO, Breach Candy Hospital. He said the cost of the implanted stent was additional and variable.

“Extra costs are covered under a category called actuals. The cost of the stent varies according to quality, size and number of stents that a doctor suggests for the patient.”

According to cardiologists, decisions are taken on medical grounds. “The surgeon and the patient’s family discuss their options and arrive at a consesus.There is no question of commercial influence as the equipment is purchased by the hospital. If a patient is ready to go for a stent that reduces long term costs, but is available at a higher cost. Why should not he be told about it?” said Dr Hasmukh Rawat, head of the department of cardiology at Fortis Hospital, Mulund. Hospital authorities say that buying stents from phramacists is not feasible. “If chemists buy stents from the companies directly, they will never sell it to hospitals below the MRP. We cannot sell it to patients above the MRP, so it’s a no profit-no loss situation for us and it is not cost efficient,” said the CEO of a leading private trust hospital on condition of anonymity. “Since we buy (implants) in bulk from manufacturers, the market cost of 1.50 lakh will reduce by around Rs 50,000.”

Chemists have also cried foul over the intra occular lens surgeries, popularly known as cataract surgeries. A doctor at a state-run hospital conducts around 80 surgeries a day. In private hospitals, the number varies between 15 and 20. Patients have to pay for the implanted lenses at both public and private hospitals. Dean of JJ Hospital and opthalmologist Dr TS Lahane says the onus is on the patients, here.

“Under the national blindness control programme, the basic foldable lenses costing Rs 400-600 are available entirely free.” However, this surgery requires a larger incision, where non-foldable lenses can be implanted by means of an “ultra modern surgery.”

“These lenses cost anywhere between Rs 30,000 and 90,000 in private setups. State-run hospitals provide the same service for an amount between Rs 3500-6000,” said Dr Lahane. Consultant opthalmologist of Hinduja Hospital Dr Sunil Morekar says the choice of lens is decided in a discussion with the patient.

Link: Original Article

August 19, 2010

IRDA sketching new health insurance norms

THE Insurance Regulatory Authority of India (IRDA), on Monday, said revenues of insurance companies are likely to be impacted once the proposed guidelines for unit-linked plans fall in place. The regulator also advised the insurance providers to maintain costs by reducing expenses.

“I do hope there will be an impact on revenues. Ultimately, the idea of guidelines is to have an impact. My concern for the insurance industry is not what is going to happen in 2010-11, but to see that the industry remains healthy and be sustainable,” said J Harinarayan, Chairman, IRDA.
Speaking to the media after launching the 106th testing and assessment centre of NSE.IT, a subsidiary of National Stock Exchange, he said, insurance companies should redesign their products suiting the interest of policy hodlers. He added that companies should adopt cost-cutting measures to maintain profitability.

On the other hand, insurance companies feel that capping of surrender charges and distribution of charges over the lock-in period of five years will affect profitability. Similarly, ULIP sales will also be affected as agents may be unwilling to sell them at lower commissions.
Meanwhile, in a bid to resolve the issue on varying charges by hospitals and insurance companies, IRDA will soon introduce norms pertaining to the administration of insurance policies.

“The mechanisms are being put in place to improve efficiency in health insurance and administration. Expert committees of industy bodies like CII and FICCI have recommended measures including uniform claim forms,re-authorisatoin. We are also looking into aspects related to billing,” he said . As of July 1 328 hospitals were in the network for cashless facility across four cities namely Mumbai, Delhi, Chennai and Bengaluru. However, they withdrew from the same citing steep charges.

“They (hospitals) have renegotiated rates and as per the last count, over 390 have signed up with the partnership network,” he said.

Link: Original Article

Higher medical claims erode insurers' earnings

Profitability of some non-life insurance companies got eroded, among other reasons, owing to higher claims on health portfolios in the quarter ended June 30.

ICICI Lombard General Insurance Co, India’s biggest private sector non-life insurance company, reported a 13 per cent drop in its net profit to Rs 33 crore in the three months to June 30, compared with Rs 38 crore in the same period a year earlier.

The claim ratio in ICICI Lombard’s health portfolio was around 100 per cent. This is despite an increase in premium income during the quarter by 27 per cent to Rs 1,118 crore from Rs 878 crore in the first quarter of the last financial year.
Likewise, Reliance General Insurance posted a loss of Rs 39 crore in the first quarter as against a profit of Rs 1 crore a year earlier. The shareholders have infused Rs 95 crore in the first quarter of this year.

“The company incurred losses this quarter on account of high claims from its health portfolio,” the company said. Therefore, the insurer had re-priced its health portfolio and also significantly reduced its exposure to the unprofitable group mediclaim.

Still, other insurers such as Bajaj Allianz General Insurance and Tata AIG General Insurance Company registered an increase in their respective profit. Profit before tax for Tata AIG stood at Rs 12 crore as against a loss of Rs 17.5 crore in April-June 2009.

Bajaj reported Rs 31 crore profit in the first quarter compared with Rs 27 crore during the first quarter last year. Though the claim ratio for Bajaj Allianz under group mediclaim stood at 100 per cent at the end of the quarter, it managed to report a rise in profit because of their in-house third party administrator and a lower claim ratio under retail health segment.

Link: Original Article

August 18, 2010

Right to Health, Right to Food next on agenda: Finance Minister

Emphasising the Congress's commitment towards “inclusive growth,” Union Finance Minster Pranab Mukherjee said here on Sunday that after enacting laws on the Right to Information, the Right to Education and providing 100 days employment, the Centre would take steps to ensure the Right to Health and the Right to Food for all citizens.

“The government will provide 25 kg of rice or wheat at a predetermined price of Rs.3 per kg, irrespective of what the market prices are,” Mr. Mukherjee said.

Mr. Mukherjee said Minister for Human Resource Development (HRD) Kapil Sibal had estimated that Rs.2.31-lakh crore would be required over the next three years to implement the Right to Free and Compulsory Education Act, 2009. The funds would be directed towards building of schools, appointment of teachers and providing infrastructure, he said.

“I will be in a position to give the HRD Minister the required funds,” Mr. Mukherjee said.

Economic growth

He said that spending on measures such as the Rs.70,000-crore waiver of loans for farmers and the National Rural Employment Guarantee Act would not have been possible without the recent growth witnessed in the economy. “I was the Finance Minister in 1982 as well, but at that time I could not have done this,” he said.

“In my Rs.11-lakh crore budget, apart from the committed liabilities, the biggest allocation of Rs.3.73-lakh crore is on planning,” Mr. Mukherjee said, adding that investment had been made on rural infrastructure and social and health sector.

He was addressing a seminar on “Vision of Inclusive Growth and the Evolution of Indian Economic Policy” organised as a part of the celebrations of 125 years of the Indian National Congress.

“The Indian economic policy has flexibility and that flexibility has been provided by the Indian National Congress,” Mr. Mukherjee said, asserting that “the Congress was never a dogmatic party.”

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Insurers want finance minister's support to deal with 'overcharging' hospitals

Insurance companies have taken their fight against hospitals for overcharging patients covered by health insurance to the finance ministry, seeking support for their plan to take hospitals off the preferred list if they do not reduce drastically the costs of standard procedures. The insurers have presented a detailed report to the finance ministry, naming the big hospitals and the amount they charge to the health insurance holders for some of the standard procedures, which is often double of what it costs a patient who pays out of his own pocket.

"This (overcharging) has serious consequences for the stability and solvency of the insurance companies," said a senior finance ministry official, adding that the ministry would take a view soon as the near Rs 2,000-crore losses of health insurance portfolio is unsustainable. Hospitals under the preferred network provide cashless hospitalisation services to policyholders.

Withdrawing the tag would affect both hospitals and patients. These hospitals will lose business to ones still on the preferred network, creating pressure on a lesser number of hospitals. Alternatively, patients will have to settle the bill themselves and claim a refund later from insurance company, which can be a very tedious process with risk of the claim being rejected.

Shankar Nath, CEO, Policy Tiger, an online insurance comparison portal, feels creating a stake for policyholders through a co-pay system will bring more pressure on hospitals to keep the cost of treatment low. "If a system can be set up, wherein 80% of the cost is borne by the insurer and the rest 20% by the person insured himself, he will question the hospital about inflated charges," he said.

The insurance regulator, Insurance Regulatory and Development Authority (IRDA), has already written to the health ministry requesting it to prescribe standard operating procedures for hospitals to bring uniformity in pricing. "Apart from surgery cost, other components such as consultancy charges, investigation charges and other expenses are also disproportionate, which needs to be looked into," the official said.

The move comes after the leading insurance companies, including the four state-owned ones, had withdrawn the cashless facility for 150 private hospitals of the National Capital Region from July, 1 in protest against highly inflated cost of treatment. The cashless facility for emergency, ICU, cardiac care and trauma cases was restored after the industry body CII managed to get all stakeholders - hospitals, insurance companies and third party administrators - together but the dispute continues.

According to chairman of a state-run general insurance firm, the insurers have told the finance ministry that if the hospitals don't bring down the rates, they'll have no option but to increase the premium charges. "Only 5% of the total population has access to insurance-funded health care, increasing the premium charges can drive away potential beneficiaries," he said. As of now health insurance is a loss making business for insurers with gross claim ratio is as high as 105%, which means that for a premium of Rs 100 collected, the claim received by insurance firm is Rs 105.

Public Sector insurers currently hold 59% share in the health insurance segment, which has a total premium of Rs 8,305 crore.

Link: Original Article

August 17, 2010

Acute shortage of doctors, paramedics in rural areas

The shortage of doctors and paramedical staff for the country's poor and downtrodden is assuming alarming proportions.

According to the latest data on rural health statistics, a huge number of posts sanctioned for medical staff in primary and community health centers have been lying vacant.

Consider the case of primary health centres. The vacancies stack up to 5,224 doctors, 7,243 health care workers and 1701 health assistants, respectively. The situation is equally grim for community health centres.

As many as 4,026 sanctioned posts for specialists are up for grabs, while that of pharmacists are 5,000.

Cumulatively speaking, 5,591 slots for lab technicians are yet to be filled, and there is a dire need for 10,089 nurses and midwifes. Sub centers for health are short of 26,208 health workers.

Unionhealth ministerGhulam Nabi Azad maintained that the appointment of doctors and paramedical staff is done by respective state governments. "The reasons of shortage may vary from state to state. It could be because of shortage of trained manpower or even less development of basic infrastructure like roads, connectivity and banks," he reasoned.

According to the ministry, human resource engagement is a priority issue, and an integral part of the flagship National Rural Health Mission.

"This includes multi-skilling of doctors and paramedics, provision of incentives, to serve in rural areas like blended payments, difficult areas allowances, PG allowance, case based payments and improved accommodation arrangements. Provision of Ayush doctors and paramedics in PHCs and CHCs to serve as additional doctors in rural areas are also being looked at. Block pooling of doctors in underserved areas, engaging with the non-government sector for underserved areas are also being worked out," Azad said.

Experts say more than the vacant positions, absconding doctors are a genuinecause for concern.

Officials claim though many doctors don't even turn up to treat patients in primiary and community health centres, they continue to draw their salaries on a regular basis.

An earlier ministry report had pointed out while only 6.3% of the posts for doctors are vacant on paper, a staggering 67% of them play truant.

To make matter worse, the nation has been facing an acute shortage of doctors for long.

As per a Planning Commission study, the country is short of six lakh doctors, 10 lakh nurses and 2 lakh dental surgeons, leading to a dismal doctor-patient ratio.

In fact, for every 10,000 Indians, there is only one doctor. Though there is an annual demand for 30,000 specialised doctors, only 12,000 post-graduate students pass out every year.

In a bid to tide over the growing crisis, the ministry is now mulling over the option of curtailing the duration of the undergraduate medical degree to three and a half years.

Under the scheme, the Bachelor of Rural Medicine and Surgery (BRMS) degree can be acquired in two phases and at two different levels -- in community health facility (one-and-a-half-year duration) and sub-divisional hospitals (secondary level hospitals) for a further duration of two years.

Link: Original Article

MCI amendment Bill tabled in Lok Sabha

The government on Thursday tabled the Indian Medical Council (Amendment) Bill in the Lok Sabha, to replace the Ordinance promulgated on May 15 this year that superseded the Medical Council of India (MCI).

The Bill provides for reconstitution of the Council within one year from the date of its supersession, until which time a Board of Governors shall exercise the powers and perform the functions of the Council.

It has been decided to empower the Central government to issue policy directives to the Board of Governors or the Council, as the case may be. This has been done to bring in transparency and accountability in the functioning of the Council, according to the statement of objects and reasons of the Bill.

The MCI's main function is to make recommendations to the Central government on matters of recognition of medical qualifications, determining the courses of study and examinations required to obtain such qualifications, inspection of examinations and maintenance of register of medical practitioners.

However, the Act did not contain any enabling provision for taking over the powers of the president or superseding the Council in case it was required, and as had happened when its president was arrested on charges of corruption.

It has, therefore, been considered necessary to entrust the affairs of the MCI to a Board of Governors, consisting of eminent doctors, till such time the Council is reconstituted or altogether a new set-up such as the National Council for Human Resources in Health as an overarching regulatory body is established by suitable legislation, the amendment Bill says.

Link: Original Article

August 16, 2010

Medical interns to get 80% hike in stipend

Interns at medical colleges affiliated to central universities will soon get a nearly 80 per cent hike in their monthly stipend, raising it from Rs 5,000 to Rs 8,900. In Delhi, interns at Maulana Azad Medical College, Lady Hardinge College and the University College of Medical Sciences — all attached to Delhi University, a central university — are among those who will benefit.

After months of bureaucratic wrangling, the finance ministry has approved a University Grants Commission (UGC) proposal backed by the HRD ministry to raise the stipend, government sources told HT.

It will now be at par with what is paid to their counterparts in autonomous central universities like AIIMS get, where stipends were raised two years ago.

"The HRD ministry and the UGC argued that the hike was essential to end the 'discrimination' between institutions like AIIMS and central university medical colleges," a finance ministry official said.

The Rs 5,000 stipend, fixed in 1999, has been criticized as paltry and there have been agitations by medical students demanding it be raised.

In India, MBBS students must complete a year of mandatory internship at a hospital attached to their medical college after their course, to get their degrees.

Link: Original Article

Cheap medicine stores to open at 2 govt hospitals in Kolkatta

Here's some good news for people looking for quality medicines at affordable prices. Two government hospitals in the city will soon have drugstores that will offer generic medicines and costly cancer drugs at discounted rates.

An initiative of the department of pharmaceuticals under the Union ministry of chemicals and fertilizers, the subsidized medicine chain called Jan Aushadhi Stores (JAS) will sell the generic version of essential medicines at half the market price. The outlets, to come up at NRS Medical College and Hospital (NRSMCH) and MR Bangur Hospital (MRBH), will be thrown open to public on August 25.

Though some states like Delhi, Punjab, Haryana, Rajasthan, Andhra Pradesh and Orissa already have outlets like these, this is the first time the state is going to have a JAS. The outlet at NRSMCH will be run by the Electro-medical and Allied Industries Ltd (EMAIL) while the one at MRBH will be run by Glucolate India Ltd (GIL).

"The outlet will be located at the Centenary Building ground floor and will be easily accessible. Renovation work is on in full swing. OPD as well as in-house patients will be able to purchase medicines from the outlet," said NRSMCH medical superintendent and vice-principal Dr L K Ghosh.

The JAS outlets will sell about 350 generic drugs, including tablets, syrups, injections and other products like surgical material. Generic medicines in categories like painkillers, antibiotics, cold and cough medicines and medicines for cancer will be on the shelves. Five PSU drug manufacturing companies, including Bengal Chemicals and Pharmaceuticals and Hindustan Antibiotics, will supply the medicine.

"We are drawing up the list of medicines to be stored in the JAS. The store will be opened round the clock," said EMAILmanaging director D C Pal.

Both the hospitals have chosen a centrally located space in the hospital premises for easy access. Adequate and attractive signage will be put up at these stores so that patients and their relatives do not miss these outlets. Doctors will also be asked to tell patients to get medicines from these stores.

"Many doctors tend to prescribe branded medicines. That is partly because most medical stores do not stock generic medicines these days. But once the JAS takes off, doctors in the hospital have to prescribe the medicines by the generic name. There will be strict instruction on this," said MRBH medical superintendent Dr Subhasish Saha.

Some of the scheduled drugs provided free to poor patients at government hospitals often run out of stock. Doctors at these hospitals said they could acquire medicines from JAS to tide over the situation during such crisis, as medicines at these stores cost less than half of what is prevalent in the market.

Link: Original Article

August 15, 2010

Pay higher premium, go cashless to big hospitals: insurance plan in the works

To break the stalemate with big corporate hospitals, the four state-owned insurers are planning to introduce a new variant of health cover — the Premium Mediclaim. Subscribers will be charged a premium higher than that of a regular health insurance policy, but will be offered cashless facility at all major hospitals on the insurer’s network.

“Big hospitals have agreed to revise their package rates and share it with us in a few days. We will compare it with a list of ‘reasonable rates’ that we have prepared in consultation with doctors and third party administrators (TPAs). If they are within a reasonable range, it is fine. Else, we may introduce a premium product for customers who insist on getting treated at 5-star hospitals,” an insurance official privy to the negotiations told The Indian Express.

The four general insurers — National Insurance, New India Assurance, United India and Oriental Insurance — had taken about 150 hospitals, including the big ones, off their network list from July 1 following instances of differential treatment and charges for insured patients.

The insurers have alleged that the big players in the healthcare business overcharge patients who have insurance, leading to losses for the insurers. PSU insurers are currently not offering cashless facility at these hospitals except in the case of emergency services.

Health insurance is a fast-growing industry, but it does not bring profits to insurers. Despite premium collections having jumped 500 per cent since the financial year 2004, the claim ratio has not changed. For FY 2010, the gross claim ratio of health insurance companies stood at 105 per cent. After accounting for acquisition cost and other management expenses, the claim ratio rises to over 140 per cent.

“If we allow big hospitals to inflate medical costs at this rate, good healthcare will be out of reach for the poor. India will become like western countries, where medical costs have now shot through the roof,” said the official.

Link: Original Article

CET by pvt medical colleges in Kerala ''void'': HC

Kerala High Court today declared as "void and inoperative" the Common Entrance Test (CET) conducted by an association of private medical colleges for management quota seats in its 11 member colleges for 2010-11 academic year. Allowing petitions by three candidates who failed to secure admission, Justice S Sirijagan held that the Kerala Private Medical Colleges Management Association was not entitled to make admissions based on the CET. The petitioners, Rizwana and two others, had challenged the legality of the test conducted on May 30 last. The court directed the association to make admissions to management quota based on Common Entrance rank list of the Entrance Commissioner appointed by the state government. The court said the admission procedures did not satisfy the triple test -- fair, transparency and non-exploitative. Justice Sirijagan also found the CET was not supervised by the Admission Supervisory Committee headed by Justice P A Mohammed. The Committee also informed the court that there was no prior information about the conduct of the test. The test was conducted for 550 seats in 11 colleges under the association. The court found that admission was not made as per law declared by the Supreme Court and High Court.

Link: Original Article



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