EDITORIAL BOARD ASSOCIATION OF MEDICAL · PDF fileASSOCIATION OF MEDICAL CONSULTANTS, ... Dr. Lokras Girish Dr. Vaidya Deepak Dr. Patel Manoj Dr ... about it during continued medical

EDITORIAL BOARD

EDITORDr. Gupta Mukesh

CO-EDITORSDr. Baliga Pradeep

Dr. Rao NitinDr. Sushmita Bhatnagar

Dr. Baid Deepak

ADVISORY BOARDDr. Kapoor Lalit M.

Dr. Rao P. N. Dr. Oza Umesh

BOARD OF TRUSTEESMANAGING TRUSTEE

Dr. Shah Bipin V.

TRUSTEESDr. Badwe ShrikantDr. Kate SuhasDr. Nayak AchyutDr. Oza UmeshDr. Pandit BipinDr. Rao Suresh S.

WEBSITEwww.amcmumbai.com

WEB EDITORSDr. Checker Vipin

WEB CO-EDITORSDr. Arshad G. Moh’d.

Dr. Rao SujataDr. Dani Saurabh

DISCLAIMERUnless otherwise stated, the opinions expressed by the writers are their personal opinions. The AMC reserves the right to use material published in‘The Grasp’ for its Website or for any other purpose deemed necessary.The appearance of advertisement in ‘The Grasp’ is not guarantee or endorsement of the product or the claims made by the manufacturer/ advertiser.

ASSOCIATION OF MEDICAL CONSULTANTS, MUMBAI4, Ganpati Niwas, Old Police Lines, Opp. Andheri Station,

Andheri (East), Mumbai - 400 069.Tel.: 2684 4639 / 2683 6019 (10 a.m. to 6 p.m.)

Telefax : 2682 1109e-mail: [email protected]

MANAGING COMMITTEE (2012 - 2013)President Dr. Hariani Ajay R. President Elect Dr. Rao Sujata Imm. Past President Dr. Agarwal Niranjan Vice President Dr. Adyanthaya KishoreVice President Dr. Naik Sudhir Hon. Secretary Dr. Pandit VeenaHon.Treasurer Dr. Pikale SangeetaHon. Jt. Treasurer Dr. Baliga Pradeep Hon. Jt. Secretary Dr. Chawhan Rajendra Hon. Jt. Secretary Dr. Sharma SmitaProg. Committee Chairperson Dr. Parikh HiteshOffi ce Secretary Dr. Vazzifdar KhurshedEditor- The Grasp Dr. Gupta Mukesh

ZONAL DIRECTORS

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

COMMITTEE MEMBERSDr. Badwe Rohini Dr. Pradhan Sunay Dr. Bahekar Pramod Dr. Rao NitinDr. Baid Deepak Dr. Shah JayeshDr. Bhatnagar Sushmita Dr. Shah SuhasDr. Bhatt Hitesh Dr. Shetty RathnakaraDr. Checker Vipin Dr. Shukla Ashokkumar Dr. Dani Saurabh Dr. Suchak Anil Dr. Khambay Sabh Dr. Suradkar ShekharDr. Lokras Girish Dr. Vaidya DeepakDr. Patel Manoj Dr. Vora AgamDr. Pattiwar Sanjay Dr. Worlikar Umesh

CHAIRPERSON OF CELLSConsultants Benevolent Scheme Dr. Shah Bipin V.H & A Cell Dr. Rao Suresh S. MMC Cell Dr. Pandit BipinInfrastructure Cell Dr. Naik SudhirMedico Legal Cell Dr. Datar NikhilSocial Service Cell Dr. Agarwal Shivbhagwan N. Public Relations Cell Dr. Pikale SangeetaAffi liate Unit Cell Dr. Agarwal NiranjanDirector AMC India Dr. Kapoor Lalit M.

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

Telefax: 2885 1832 • e-mail: [email protected]

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

Vol. 40 Issue No.5 May 2012 1

DOCT

OR'S

DAY C

ELEB

RATIO

NS Dear Friends,

AMC is happy to inform all our members, that,

as per our tradition of past several years, AMC is

celebrating Doctors’ Day on July 1; 2012 in a usual

grand manner.

In the mornings, from 8 am to 2 pm AMC has organised

Blood Donation Drive in 20 Centers across

Mumbai; in collaboration with State Blood

Transfusion Council. The blood collected shall be

used for free treatment of the needy patients in

Government & Civil Hospitals in the city. Organ

Donation awareness Drive is also being held with the

help of Zonal Transplant Coordination Committee.

In evening 6 pm onward a gala “Haasya

Kavi Sammelan” shall be held at

Rangsharada in Bandra Reclamation Eminent

dignitaries from the fi eld of Humour e.g. Mr.

Ghanshyam Agarwal, Mr. Navneet Hullad,

Mr. Subhash Kabra etc. shall entertain the

audience.

Lifetime achievement award shall be conferred

upon Dr. Anil Suchak in acknowledgement of his

diligent & dedicated services to AMC.

Please keep yourself free to devote your

time for celebration of Doctors’

Day..

Failure in communication has been identifi ed as major

cause for Patient risks. One such interface which has been proven to be of great potential risk is Prescription writing. According to “Time”, Doctors’ sloppy handwriting kills more than 7,000 people annually in US. It’s a shocking statistic, and, according to a July 2006 report from the National Academies of Science’s Institute of Medicine (IOM), preventable medication mistakes also injure more than 1.5 million Americans annually. Many such errors result from unclear abbreviations and dosage indications and illegible writing on some of the 3.2 billion prescriptions written in the U.S. every year. Its irrelevant to say what might be the numbers here in India…

The question whether the legibility of doctors’ handwriting is more of a problem than that of other adults was studied by Donald M. Berwick and associates at the Institute for Healthcare Improvement. They compared the handwriting of 82 doctors with 127 non-doctors. The study was published in the British Medical Journal (1996;313:1657-8). The study data showed that doctors, in fact, have

handwriting no worse than that of non-doctors! So it may not be justifi able to wrongly use ‘Bad Handwriting’ and ‘Doctor’s Handwriting’ as synonyms.

Nevertheless, the potential impact of poor handwriting on healthcare must not be ignored. The authors point out that clarity of writing is a human problem rather than being unique to doctors as a group. But we as doctors can work towards

reducing the impact created by the handwriting related errors.

Gupta and colleagues, Am J Manag Care. 2003 Aug;9(8):548-52., analysed factorsassociated with increased prescription

EDIT SPEAKWhy write prescriptions in Capitals?Dr. Mukesh Gupta


illegibility,from the National Ambulatory Medical Care Survey, between 1990-1998. They investigated differences in handwriting between residents and medical students and found that the more experienced doctors had increasingly illegible handwriting compared to their younger

colleagues and to medical students.

The prescription writing habit is changing worldwide. Almost a third of all the prescriptions in the US are electronic. The e-change occurred after a Cornell University study in 2010 showed that nearly two in fi ve handwritten prescriptions had errors. The National e-prescribing Patient Safety Initiative (NEPSI) offered doctors in US access to eRx Now, a Web-based tool that physicians can use to write prescriptions electronically, check for potentially harmful drug interactions and ensure that pharmacies provide appropriate medications and dosages.

Closer home, given the uneven computerization levels in India, Mr Gadgil of FEQH suggested the movement for writing in capital letters as a better option, especially at stand-alone clinics. Now, a

movement has begun in Mumbai asking the medical fraternity to write prescriptions in “separate, capital letters”. The brainchild of the Forum for Enhancement of Quality in Healthcare (FEQH) and the Quality Council o f India (a semi-government

organization accrediting services), the fi rst meeting on the issue held last month was attended by representatives of medical associations including AMC, and NGOs. The idea would be best implemented by doctors themselves.

We could get doctors’ associations to put out statements in medical journals. We could have slides about it during continued medical education lectures.

Although lot needs to be done for the transition to EPrescriptions but the fi rst achievable step would be to start writing Prescriptions in Clear Capitals. The diffi culty would be in changing decades of habit. The habit (of writing in capitals) has to begin in medical schools for it to catch on. It is wrongly perceived as time consuming. We could write out 100 prescriptions in capitals in the time we take to answer phone calls from patients and chemists needing to reconfi rm the handwriting while dispensing the medicines.

Its time this idea catches up and is implemented to ensure lesser prescription related hazards.

e-mail: [email protected]

Vol. 40 Issue No.5 May 20124

Respected seniors & dear friends.I am extremely grateful to all of you for

your support and am honoured to have all of you here with AMC tonight.

Thank you, dear Dr. Niranjan Agarwal. It is an honour, as also a privilege, to succeed you as a president of this great organisation.

On behalf of the entire AMC membership, I thank you for your loyal and dedicated leadership over the last year. I am grateful to all the past Presidents and Board of Trustees who gave me great direction and encouragement. To my family and my friends, I say, I am indebted to you and I applaud you, nothing less.

There are far too many lovable people here I am answerable to. Sadly, I cannot name all. I am grateful for their unstinted encouragement and support.

It’s been said that the best reward in life is the chance to work hard at work worth doing and succeed. I promise you it is possible, but only with your support.

As a surgeon, I have been blessed with many opportunities to work hard at worthwhile projects. Tonight, I am specially blessed, as I have been given an opportunity to work hard for a most worthy cause one can work for and succeed.

I have been operating at various nursing homes in Western Suburbs. Wherever I have operated, I have witnessed the incredible infl uence AMC wields and the high regard it commands, especially among our consultant colleagues. I am energised by the prospect of serving the AMC and serve its mission, even in these diffi cult times of TPA’s, Change of Users, Fire Safety Norms, Assaults on Doctors, etc.

With hard work, enthusiasm and hope, we can tackle the challenges we face in our day to day healthcare system and turn them into opportunities for better healthcare for the downtrodden.

We must strive to be active united members of our profession. We must also leverage our wonderful diversity. Because all our strength is in our unity, and beware,all our dangers are in our discords and diversity.

As AMC president, I promise to work hard to create opportunities and overcome the barriers that we face. I also promise to remain enthusiastic and optimistic.

I give you a brief outline of the plans for next year, with blessings of our seniors.

Doctors’ Day Blood Donation Drive and Celebration on 01 July 2012, with a cultural event.

PRESIDENT'S REPORTDr. Ajay Hariani


AMCON, 16 Dec 2012, at ISKCON Auditorium, two workshops for our members on the subjects of Medical Photography, Enrichment of your Presentations and Management of your own Accounts in Tally,

There is a plan to start vocational training programme for our members’ children.

As usual, Nurses’ Training Programmes, Basic Life Support Programmes, Overseas Conference Tour, will go on. Details will be circulated to you all in near future.

You are aware that AMC is spreading its wings all over India and setting up AMC

centers. Soon we may have an enormous body of medical consultants — AMC India.

I hope to exercise the same passion and dedication that I have displayed for the past two decades in my profession to take AMC to newer heights.

I am happy to have a dream team of dedicated Offi ce Bearers and active Managing Committee Members, who will work in the best possible way to help AMC to retain the glorious heights of the past.

Long live AMC.Thank you.


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Cheques to be Dr.awn in favour of “Association of Medical Consultants, Mumbai”

Protocol for Advertisment in “The Grasp”• All advertisements to be submitted as soft copy (CD format) with a Print-out of the Advertisement. Handwritten copy of

advertisement will not be accepted.• Advertisement charges to be paid with a post-dated cheque at the time of booking.• If the advertisement data have been changed after submitting, kindly inform the printer also about the change in matter.• Technical details: Print Area 20.5 cms. x 15 cms. Printed by Offset Process.• All matter for the printed material to be supplied by the advertiser.Please note: For advertisement material other than the POSITIVE or MATTER FOR TYPESETTING, processing

charges at cost will be charged extra.

Due to unavoidable personal circumstances Dr. Ajay Hariani expressed his in availbility to pursue further as president, AMC. Vice President Dr. Kishore Adyanthaya has graciously agreed to take charge till further notice.


SECRETARY’S REPORTDr. Veena Pandit

Dear friends, Greetings from a new Managing Committee.

Our previous Secretary, Dr. Adyanthaya has passed on the baton to me. It is indeed a daunting task and I hope we can keep up the pace of work and achievement of goals as Dr. Niranjan Agarwal’s team.

Every year seems to start with a problem that needs to be addressed urgently. This year we have to achieve Fire Safety Norms for Hospitals and Nursing Homes. The AMRI Hospital fire brought home to all the need for fire safety in our hospitals and nursing homes. At AMC we have formed a committee that is attending to this. There have been several meetings and discussions with Fire Officers and Additional Municipal Commissioner Mrs. Manisha Mhaiskar, as registrations of nursing homes too hinge on this. Mr. M. V. Deshmukh, Director, Maharashtra Fire Services, was very receptive to our problems. He has suggested that some of us along with his team can arrive at practical and pragmatic solution to this problem.

On behalf of AMC, some agency will contact all our members who are Nursing Home owners, for data about the Nursing Homes. please co-operate.

Please do not approach Fire Officers

individually. We are trying to get the best set of norms for all.

COU: Out of the 494 demand notices to Nursing Homes from BMC, 250 have paid, 80 have gone to court and the remaining are sitting on the fence. 90% of those who have paid, have got their Change of User. The ones who are stuck are due to three issues: (1) separate drainage (2) NOC from fire and (3) lack of clarity on application of development charges. No application has been rejected. Only the Commissioner can give us clearance about separate drainage hence meetings with the Commissioners are very important. We hope practical fire safety norms will soon be ready.

TPA: The discussion at the AGM was for continuing our boycott of all cashless mediclaim services. We request all members practising in Nursing Homes or Corporate Hospitals to desist from doing cashless mediclaim. We are negotiating with the insurance companies for better terms. If any of our members agree to lower rates and terms, our chances of success will diminish. Many other Associations all over India have been inspired by our fight against the TPAs and have also launched their movement against this exploitation. So please co-operate with our stand.

Confederation of Indian Industries (CII)


is undertaking a study of inflation in medical billing. Soon you will receive a form requesting you for your charges for common procedures over the years. Please respond at the earliest. We hope this study will help us to get realistic rates from the insurance companies.

AMC India: Our dream of AMC India is being realised slowly but surely. Mangalore, Bangalore and Kolhapur are already our affiliates. Mysore is on the way to joining, and so is Kolkatta.

Many wonderful programmes await you in the near future.

“Tobacco and its implications for health” on Sun. 27th May 2012 at Mayfair.

A play “Two to Tango and Three to Jive.”

In June: Doctor’s Day, 1st July: Blood Donation and Organ Donation Awareness Drive, Hasya Kavi Sammelan.

Do attend in large numbers to encourage all our organising efforts. Please register early.

The Conference Tour of AMC will be to Russia this year in September.

All our members who wish to hold a First Responder Workshop should contact AMC. This is our charitable activity for the lay persons this year.

See you at all our programmes,


1st June 2012

NOTICE FOR A SPECIAL GENERAL BODY MEETING

A Special General Body Meeting of the Association of Medical Consultants, Mumbai shall be held on 1st of July 2012 at 7.15 pm at the Rangsharada, Near Lilawati Hospital, Bandra, Mumbai to transact the following agenda.

Installation of Senior Vice President Dr. Kishore Adyanthaya as the President for 2012-13 in view of resignation of Dr. Ajay Hariani as President.

In case of lack of quorum (minimum requirement is 100 members); the meeting will be adjourned for 15 minutes. The meeting will be reconvened at the same venue at 7.30 pm and the meeting will be then held even in the absence of quorum.

Thanking you,Yours truly,

Dr. Veena Pandit(Hon. Secretary)


Relationship between hospitals and doctors can be described variously as

inseparable, cohesive, complementary. Neither can do without the other. It is also a symbiotic relationship. And yet, there are times when the relationship shows cracks and evidence of strain.

It will be useful to analyse this relationship since a fall-out of the breaks in this relationship could become an impediment to the seamless delivery of healthcare and a matter of serious concern in the long term. I would like to focus on a couple of aspects.

Some years back, a dermatologist reported this bizarre experience. He was attached to a medium sized hospital which was part of a large factory complex near Mumbai. On one of his OPD sessions, the Reception informed him that the wife of the Managing Director of the organisation would like to consult him but could come only by about 12 noon---which was half an hour beyond the time he would have completed his OPD. As a courtesy he agreed to wait. However, the lady did not turn up even up to past 1 pm.The doctor then said he could not wait any longer as he was already late for another appointment at another hospital and accordingly left. The VIP lady arrived another 30 minutes later and not fi nding the Consultant in place was furious and started raving and ranting, reminding

everyone around who she was. She was of course informed that the doctor could not have waited any longer.

A couple of weeks later, this doctor was jogging at 6.30 am in the large ground which was part of the hospital complex, wearing shorts and Nike shoes. All of a sudden, he saw a hospital ward boy walking towards him with a white envelope in his hand. It was a letter from the management thanking him for the 12 years of excellent service he had provided to their patients, but regretfully the hospital did not need his services any more.

Needless to say, the doctor was shocked and humiliated, even more so, I guess, since his termination letter was delivered to him at 6.30 am on the jogging track where he was literally caught with his pants down!

Over the long years, I have been witness to many similar experiences of Consultants. In one case, a shocked Diabetologist was notifi ed at the reception counter of the hospital that his contract had been terminated and he need not go for his rounds. In another case, a lady Ophthalmologist was ‘sacked’ as Hon. Ophthalmogist in a charitable hospital when she pointed out to the management some serious problems in the Operation Theatre such as open drains going through the OT. A senior Pediatrician in a large

DOs' AND DON’Ts HOSPITALS AND CONSULTANTSDr. Lalit Kapoor


multispecialty hospital who insisted on RMOs being appointed in the NICU was told this was not possible and she could leave the hospital if she was not satisfi ed with the facilities.

These are just a few examples from a long list.

The common thread running through all the above examples, as you can undoubtedly visualise, is arrogance on the part of the hospital management. Really, this is one thing we can do without. As I said in the beginning of this article, doctors and hospital managements have complementary roles. Both are equally important. Shabby treatment of a Consultant by the management sends bad messages across the system and is to be condemned. Of course, this is not be construed as saying that hospital managements do not have a right to discipline errant doctors. But, in the process, there has to be legitimacy, transparency, sensitivity, dignity, and importantly, a protocol which includes Peer Review in the decision making. It is also necessary to work on a visible Consultant-Management interface whichcan only boost the healthcare outcomes andgo a long way in avoiding ugly situations.It would also ensure that the relationshipbegins to look more like partnership and less like master-servant relationship.

Undoubtedly, as part of the changing healthcare scenario, we can expect a greater ‘Corporatisation ‘of hospitals and Consultants will need to learn to deal with the attendant problems.

Take the issue of the Contract or the MoU which the Consultant is required to sign. This should be read carefully and the implications understood. A couple of years ago, a radiologist signed an MoU with a well-known hospital, rather hurriedly. One

of the conditions stipulated that the radiologist would ensure ‘business’ to the hospital to the tune of say, Rs. 5 lakhs. In the fi rst year the ‘target’ was met and everything was fi ne. However, the very next year, the amount which accrued to the hospital fell to Rs. 4.6 lakhs.The doctor was promptly informed by the management that since he had not fulfi lled the terms of the contract, his services could not be continued. The radiologist tried to persuade the management to re-consider their decision, but

to no avail. He now realised that he wasnow in trouble since he had given up his numerous attachments elsewhere, a prerequisite to being appointed to this hospital.

Clearly, you must study the contract you are going to sign very carefully, more so, because invariably these contracts are couched In legalese, not easily comprehensible and invariably hopelessly one sided and loaded in the favour of the management. Hence, sign on the dotted line only after understanding the implications. Take professional help sos.

Consultants in charitable / public hospitals beware!

Many Consultants in charitable and public hospitals believe that they are immune from action under the Consumer Protection Act

multispecialty hospital who insisted on


because they did not charge the patient. Currently, a couple of cases pertaining to ‘free cases’ treated by consultants attached to municipal or Govt. hospitals are on-going on Mumbai courts.

The fact of the matter is that as per the Supreme Court ruling, even if most patients are being treated free of charge, but some patients are being charged, then any patient, including a free patient, can fi le a complaint under the CPA. Now this could be the situation even in Public hospitals where nowadays charges are being levied to patients (other than registration charges).

Please remember, whereas the credit for doing charity to patients accrues to the charitable institution notices from the Consumer Courts are promptly passed on to the Consultants concerned to be handled by them,

Consultants from above categories of hospital are advised the following precautionary measures.

If you are working under substandard or even suboptimal conditions, do not accept these quietly and do not restrict your criticism to the staff room. Put your objections in writing and forward them to the Superintendent or CEO or

whoever is in-charge. This should be in duplicate and a proper acknowledgement of receipt of the same must be insisted upon. In case redressal of these objections is not forthcoming, or no written reply is received, keep sending reminders in writing, duly acknowledged. This correspondence, which could be of vital importance to the Consultants, should there be any medico-legal issues, may be preferably sent by the group or association of the consultants. To conclude: Harmonious relations between hospital managements and doctors can result in patient outcomes. However, the tilt in the balance of power vis-à-vis Consultants and Hospital Managements has now got accentuated, especially in the wake of corporatisation of hospitals. Consultants need get sensitised to the above mentioned issues and to put their act together before they are relegated to being non-entities. Associations need to be empowered by the energising of the dormant majority of its laid-back, disinterested, or shall we say self-centred members who remember the Association only when they have problems. We can ignore all this only to our jeopardy.



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THE RIGHT TOREMAIN SILENTProf. Gopinath N. Shenoy

Under the criminal law, every accused doctor is deemed to be innocent until

proved guilty and to prove him guilty is the responsibility of the prosecution. The accused doctor therefore does not need to prove his innocence – the law deems him to be innocent until proved otherwise.

The doctrine of Res Ipsa Loquitur (the fact speaks for itself) is not applicable in criminal law.

The doctrine of res ipsa loquitur is applicable only in civil law and that too in very special circumstances. By the doctrine of res ipsa loquitur, under certain circumstances, the law does not require the complainant to prove the doctor’s negligence but requires the doctor to prove his innocence. By this, it is meant that the burden of proof, which always rests on the shoulders of the complainant, shifts from the complainant’s shoulders and will come to lie on the shoulders of the doctor. Now the doctor will have to prove his innocence, as law now deems him to be guilt of negligence until proved otherwise. Res ipsa loquitur is a rule of evidence.

Criminal litigation usually starts with a police complaint. The alleged offence is violation of the provisions of the Indian Penal Code. After taking cognizance of

the complaint, the police investigate and statements are recorded from all persons connected with the complaint. As per the law laid down by the Hon’ble Apex Court in the Jacob Mathew v. The State of Punjab, the police are lay people as far as medical negligence issues are concerned. The law, therefore, makes it mandatory for the police to send the fi le to the Dean / Medical Superintendent of a Government hospital and ask for a opinion as to whether the doctors are guilty of any criminal act or not. The Dean / Medical Superintendent usually appoints an expert committee with an odd number of members who are experts on the issues involved. This expert committee has to deliberate and return a verdict as to whether the doctor is criminally guilty or not. Invariably these expert committees call the doctors and interrogate them.

Should the doctors attend such enquiries and be interrogated by the members of such expert committees and give them signed statements?

The law on this issue is settled. Pending criminal proceedings, the accused doctor has a right to remain silent and make no statements that can incriminate him in any criminal case. From where does the


doctor inherit this right? It comes from the Constitution of India and is one of the fundamental rights.

Article 20(3) of the Constitution of India reads thus:

No person accused of any offence shall be compelled to be a witness against himself.

Therefore, expert committees forcing appearance and written explanation from the doctors and making them sign documents, will amount to violation of the doctors’ fundamental rights bestowed upon them by the Constitution of India.

What is the legal validity of such signed statements made by the doctors?

Doctors need not worry about the signed statement made by them before a police offi cer because these statements can never be relied upon as evidence in the court of law.

Section 25 of the Indian Evidence Act states:

Confession to police-offi cer not to be proved. - No confession made to a police-offi cer, shall be proved as against a person accused of any offence.

Confession by accused while in custody of police not to be proved against him.

In Ram Singh v. State of Maharashtra, 1999 Cr LJ 3763 (Bom) the court held that any confessional statement given by accused before police is inadmissible in evidence and cannot be brought on record by the prosecution and is insuffi cient to convict the accused.

Statements thus given to the police cannot be per se relied upon as evidence. This statement becomes relevant only when the

same is made before a Judicial Authority.

But signed statements made before expert committees is on a totally different footing as these expert committees members are not “police offi cers” within the meaning of Section 25 of the Indian Evidence Act. Signed statements made before them can be relied upon by the prosecution as evidence and can go against the doctors.

In all such cases, the expert committee is expected to give only a prima facie opinion with respect to the alleged commission of a criminal offence. They have to base this opinion on the police records/fi le. Calling the doctor for interrogation would not be correct; forcing the doctor to give signed statements in violation of the doctor’s fundamental right would be incorrect; more than three experts grilling the frightened doctor is downright horrendous and fi nally during such interrogations, depriving the doctor of legal assistance (presence of an attorney) is atrocious and a violation of the doctor’s human rights.

So, during pendency of a criminal case, if such committees call the doctors for a grilling, what should the doctors do?

The doctors must attend such a call and make a written submission stating therein that they have a right to remain silent as anything said by them can go against them in the criminal case and they are protected under the circumstances by Article 20(3) of the Constitution of India.

Another problem that needs to be high-


lighted at this stage is – What opinion do the police expect from such expert committees?

The answer is simple. The cause of action complained of by the patient/relative to the police is a criminal one - that is - violation of some provision of the Indian Penal Code. The requirement therefore is to identify if there is any criminal negligence committed by the doctor. The Supreme Court in the Jacob Mathew case has differentiated criminal negligence from civil negligence. The sad reality is that this expert committee never expressly states if there is any criminal negligence committed by the doctor. They just return the verdict of “negligence” and the police take the

liberty of interpreting it as “criminal negligence”.

If ambiguous opinion is given by the expert committee to the police, the police in

the interest of justice and fair play must return the opinion back to the expert committee and request them to specify whetherthe negligence involved is “criminal” or “civil”.

The police will have jurisdiction to act only in cases of criminal

negligence and the expert committee is, most of the times, unable to differentiate civil negligence from criminal negligence.

No wonder medical practice today is a pain in the neck!


BEWARE OF CHEATS SOLICITING BUSINESS BY USING MY NAME AND PHOTOGRAPH

Dear Colleagues

I have been given to understand that some people are using my name and photograph to promote their so-called medico legal services. Beware of such frauds and cheats as I am attached to no medico legal � rm belonging to any of these fraudsters. DON’T GET CARRIED AWAY BY THEIR SMOOTH TALK AND FALSE PROMISES WHICH THEY NEVER HONOR. IF YOU SUBSCRIBE TO THEIR SERVICES, YOUR MONEY IS AS GOOD AS LOST. If their agents come to solicit business, please make them speak to me in front of you and expose these unscrupulous swindlers. If you have already subscribed to such good-for-nothing medico legal services banking upon my name or photograph, please do not renew the same again.

INSURE WITH AMC AND BE SECUREDr. Gopinath N. Shenoy

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

Total Membership of the Association : 7165Members under Professional Indemnity Scheme of AMC : 4499Persons (Members & Family) under H & A Scheme : 4108Members under CBS Scheme : 1100


HOW TO REDUCE OPERATIONAL COSTS OF A HOSPITAL Dr. Sushmita Bhatnagar

INTRODUCTION :In the present times costs of all commodities are rising at a very rapid pace. The rising cost in the healthcare industry is a major concern not just for the patient and the insurance companies, but also for the promoters of the hospitals. The ultimate goal of any non-public sector organisation is profi tability. The two ways to improve profi tability are either to increase the revenues through patient service, or to decrease the costs. Many a times both the mechanisms have to be utilised to increase profi tability. Where and how to reduce the costs without compromising on the quality of patient care is what every health manager must be aware of in today’s times. Discussed herein are the options available and the implications of cost-reduction.

CATEGORISATION OF HEALTHCARE COSTS :The costs incurred in any hospital can be categorised under two broad categories.(1)

1. Capital costs2. Operational costs

The capital costs involve the new building of an organisation, renovation of the old building and major equipment. Interesting fact to note here is that capital costs constitute only about 10% of the total costs of a hospital. Operational costs are the major cost to any healthcare setup and

constitute about 90% of the overall costs of the hospital or organisation, including costs of the salaries for personnel (about 40%), benefi ts and allowances (about 10%), utilities (about 3%) and supplies (about 20%), rent and maintenance (about 3%) and other miscellaneous expenses (about 20%).(2)

Many a times, the focus of the hospital executives is on reducing the capital costs and they struggle to maintain a reasonable profi t margin. Focus on operational costs is the fundamental strategy to reduce the recurring costs without any compromise in patient care, few areas of operational cost reduction are discussed in brief.

AREAS OF COST REDUCTION :Several methods or techniques are available and combination of few of these methods is needed to have a substantial cost reduction in the day to day activities of the hospital.

1. Salaries :

Since salaries constitute a large part of the operational costs, scope of reducing the expenditure on the salaries is huge. However, reducing the salaries will be detrimental to the hospital as there will be a large amount of attrition affecting the morale of the remaining staff. Thus, to retain good


staff, the pay scales will have to be at par with the neighboring hospitals. What can be done is reduction in number of staff by eliminating redundant positions. Assessment of the skills and performance of each existing staff should be determined, and the job descriptions defi ned appropriately. This would clearly defi ne the role of each staff allowing deployment of redundant staff.

2. Computerisation:

Computerisation of the hospital can be total or partial. Patient accounting, administrative records (payroll, accounts payable and receivable budget ), inventory management can lead up to 50% reduction in costs. Computerisation not only helps in reducing costs, it also contributes in improving the patient care and increases patient safety. Implemented Daily Operating Reports in all cost centers allow Managers and Directors to monitor volume, productivity and Quality of patient care.

The several ways in which computerization aids in reduction of costs are as follows :

a. Computerisation streamlines paper-work in various departments, e.g. pathology department, wherein requests can be sent via the computer, thus reducing the cost incurred for the printing of the forms. The concept of PAPERLESS hospitals(3) and COWS (Computer on wheels)(4) which is in existence in the western world, has proved to be a major step forward in the cost containment whilst improving effi ciency of patient care delivery.

b. Customised solutions on SaaS model (Software-as-a-service) for the future needs of all the major features of a hospital. (5)

c. If PACS is incorporated, huge amount of savings occur through elimination of x-ray fi lms.

3. Electricity :

Electricity/energy requirement costs are an essential and major part of the operational costs of any hospital. To improve the effi ciency of energy utilization and reduce the costs, it is pertinent to understand the electricity consumption at various levels in the hospital. (6)

a. HVAC: heating, ventilation and air-conditioning systems – which operate 24 hours a day.

b. Multifunction services such as surgery mainly the operation theaters, diagnostic departments with laboratory machines and equipment working round the clock, monitoring of the patients especially in the critical areas, food preparation, laundry, autoclave (CSSD), etc.

c. Medical equipment which consume high electricity, thus increasing costs such as X-ray, Radiotherapy machines, etc.

d. Air handling unitse. Lighting and fansf. Elevatorsg. Water treatment plantsh. Other equipment.

If the costs of several areas of energy consumption are analysed further, the air-conditioning consumes about 50% of the


total energy costs, the medical equipment takes up about 35-40% (depending on the equipment available on the hospital) and the remaining is attributed to the lighting used in the hospital.

The reduction in electrical costs upto 60% can be achieved by the following techniques which can be used as per the requirements of the concerned hospital(7) :

a. Shutting down AC plant at night where possible.

b. Shutting down electricity when not in use. Put stickers above light switches so that all the staff and other users remember to switch off the lights after use.

c. Decrease electricity consumption by computers - Desktop computers can use more than twice the energy used by a fl at-screen monitor, so it is important to sleep or power down computers that are not in use.

d. Use of energy star machines and equipment as and where possible, saves up to 50% of electricity costs.

e. Performing Energy Audits,(8) provides a clear picture of energy consumption and thus assists in energy conservation without adversely affecting the processes of the hospital.

f. GREEN healthcare operations - Green hospitals are buildings that utilise natural light and solar energy. The construction is done specially at an angle of alignment with the sun to maximize the use of natural light. Electricity consumption costs can be reduced from 25-30%.(9)

4. Maintenance and repairs :

While it is essential to have a system for

maintenance and repairs for the entire medical equipment, it is imperative that the cost consideration is given due signifi cance. Several methods can be used to decrease the costs in this area :

a. Developing in-house servicing and maintenance facility

b. Effective maintenance of the fi lters, which eventually reduce chilled water pumping requirement and in turn cuts electricity costs considerably

c. Regularly scheduled maintenance and periodic tune-ups save energy and extend the useful life of equipment.

d. Create a preventive maintenance plan for your hospital that includes regularly scheduled tasks such as cleaning, calibration, component replacement, and general inspections

e. Train each staff who handles equipment and instruments so that maintenance and repair costs (breakage due to mishandling) are minimised.

f. Repairs can be managed by service contract agreements established at the time of purchase.

Ingenious options for cost reduction can be utilized for individual situations in hospitals such as creating services in-house or utilizing shared services, economizing in products and supplies, protocol based purchasing, eliminating wastage and pilferage by a vigilant administrator and standardization and procedures. (10)

CONCLUSIONS

A very challenging task for the hospital administrators and executives in today’s times is to continue to maintain a reasonable


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profi t margin while maintaining the quality and standard of healthcare delivery. A judicious analysis of the operational costs and devise methods to reduce these would be benefi cial. Nevertheless, cutting the wrong costs could produce long-term issues which could lead to reduced patient fl ow for the hospital. Cost-cutting impacts real people’s lives and livelihoods. So utmost care must be ascertained while reducing costs.

REFERENCESMullins JD. Healthcare Reform from the Bottom Up: Reducing Hospital Capital and Operational Costs. www.hilintl.com. Accessed online on 31st January 2012.

Analysis of hospital costs : A manual for managers. Donald Shepard, Dominic Hodgkin, Yvonne Anthony. September 29, 1998, Institute of health policy, Heller school. Prepared for the Health System Development Program.

http://www.usatoday.com/news/health/2009-07-06-electronic-medical-records_N.htm. Accessed online on 2nd February 2012.

h t t p : / /wtnnews . com/a r t i c l e s /4083/Healthcare information technology: Computers on Wheels offer cautionary IT lesson . Accessed online on 20th February 2012

en.wikipedia.org/wiki/Software_as_a_service. Accessed online on 2nd February 2012.

Hu SC, Chen JD, Chuah YK. Energy. Energy cost and consumption in a large acute hospital. Intl Jour on Architectural Sc, 2004, Volume 5, No.1, p 11-19.

Environmental and Energy News. May 14, 2010. Hospitals can cut energy use by 60% by redesigning their energy systems. Accessed online on 2nd February 2012.

en.wikipedia.org/wiki/Energy_audit. Accessed online on 21st February 2012.

http://www.constructionbiz360.com/article. Green hospitals-Effective-solution-to-save-power.html.Accessed online on 2nd February 2012.

Principles of Hospital Administration & Planning. B.M.Sakharkar, Jaypee Brothers.



ANNOUNCEMENT OF LIFETIMEACHIEVEMENT AWARD 2012

Our Managing Committee, in its meeting held on

17 May 2012 unanimously decided to confer the Life Time Achievement Award 2012 to our outgoing Trustee Dr Anil Suchak as part of Doctors’ Day celebrations on 1st July.

Dr Anil Suchak has served the AMC for nearly 3 decades with dedication and consistency, having joined the Association in 1982.He has served the Association in various capacities as Treasurer, Vice-President, President (1996) and lately as Trustee, a position which he relinquished this year.

His commitment to the AMC has been phenomenal and his contribution to the Association is there for all to see, especially since it is a ‘concrete’ one viz. the AMC Offi ce. At a time when the AMC was ‘homeless’ or ‘offi ce less’ and functioned through make-shift arrangements, and at a time AMC was extremely low on funds, Dr Suchak spearheaded the fund-raising drive with his trademark enthusiasm, He personally cajoled and motivated reluctant colleagues to loosen their purse strings and contribute towards the amount needed to purchase the premises. This was replicated a second time when additional premises was acquired.AMC thus benefi ted from his special skills in fund-raising.

Similarly, on behalf of AMC, he undertook the massive task of publishing the comprehensive Telephone Directories of AMC on no less than 3 occasions over the years. It is signifi cant that all the Telephone Directories published by AMC so far bear his name as Chairperson of the Directory Committee. These Directories,which were widely acclaimed, apart from

being of great utility to members, were landmarks in AMC activities.

He was President of AMC in 1996, the Silver Jubilee year of the Association, when he put together a grand Silver Jubilee programe held at St Theresa school grounds at BandraThe programme was a gala one complete with illuminations and fi reworks, and one that is

remembered to this day.

Outside AMC, He has an impressive record of being involved in several social causes, To name a few relief work in the aftermath of earthquakes at Latur in 1993 and Bhuj in 2001, providing help to post-Kargil war injured soldiers in the form of raising funds for their personal requirements. He is acknowledged as an anchor and an asset to all the numerous organizations with which he is associated, viz. the Divine Life Society, a spiritual organization, the Malad Medical Association in which his contribution in acquiring offi ce premises and an auditorium is substantial. He was President of IMA Bombay West Suburban branch and is presently Joint Secretary if IMA Maharashtra State branch.

All these achievements assume even greater signifi cance when you consider the fact that he was a victim of end-stage liver disease and was nearly lost to it but for a Liver transplant conducted at the Apollo hospital, Delhi.

Now he counsels patients who desire to undergo Liver Transplant.

The Lifetime Achievement Award 2012 will be conferred upon Dr. Anil Suchak inacknowledgement of his diligent and dedicatedservices to AMC.


Dr. Shrikant BadweTrustee & Zonal DirectorUrologist & [email protected]

Dr. Ajay HarianiPresidentPlastic & Cosmetic [email protected]

Dr. Bipin PanditTrustee-Chairman-MMCInteraction CellGynaecologist & Obstetrician [email protected]

Dr. Suresh RaoTrustee & Chairman-H&A Cell Gen. [email protected]

Dr. Manoj PatelCommittee MemberGen. [email protected]

Dr. Rajesh DaveZonal [email protected]

Dr. Rathnakara ShettyCommittee MemberGastro-Enterologist-Surgeon [email protected]

Dr. Nikhil DatarChairman-Medicolegal Cell Gynaecologist & [email protected]

Dr. Suhas ShahCommittee MemberGeneral Physician [email protected]

Dr. Sangeeta PikaleHon. TreasurerGynaecologist & Obstetrician2447138/24467295/[email protected]

Dr. Rajendra ChawhanHon. Joint SecretaryGynaecologist & [email protected]

Dr. Umesh WorlikarCo-Opted MemberGen. & Laparoscopic [email protected]

Dr. Niranjan AgarwalImm. Past President & Chairman-Affi liate Unit CellGeneral Surgeon [email protected]

Dr. Saurabh DaniCommittee MemberGynaecologist & Obstetrician [email protected]

Dr. Jayesh ShahCommittee MemberRadiologist [email protected],

Dr. Vipin CheckerWebsite EditorGynaecologist & [email protected]

Dr. Deepak VaidyaCommittee [email protected]

Dr. Smita SharmaHon. Joint [email protected]

Dr. Sujata RaoPresident-ElectE.N.T. [email protected]

Dr. Ajit K. DesaiZonal DirectorMaxillo - Facial [email protected]

Dr. Ashokkumar ShuklaCommittee MemberGynaecologist & Obstetrician [email protected]

Dr. Shekhar SuradkarCommittee MemberGeneral [email protected]

Dr. Girish LokrasCommittee [email protected]

Dr. Rohini BadweCo-Opted [email protected]

MANAGING COMMITTEEAssociation with a Mission

2012-2013Dr. Veena PanditHon. [email protected]

Dr. Bipin ShahManagig TrusteeZonal Director & Chairman-CBSPaediatrician & Neonatologist [email protected]

Dr. Achyut [email protected]

Dr. Kishore AdyanthayaVice PresidentPaediatric [email protected]

Dr. Lalit KapoorDirector-AMC IndiaGeneral [email protected]

Dr. Umesh OzaTrusteeUrologist/[email protected]

Dr. Hitesh ParikhProg. Committee ChairmanGynaecologist & [email protected]

Dr. Khurshed VazzifdarOffi ce SecretaryGastro-Enterologists/[email protected]

Dr. Gurudas KulkarniZonal [email protected]

Dr. Sabh KhambayCo-opted MemberOral Maxillofacial [email protected]

Dr. Sunay PradhanCommittee [email protected],

Dr. Hitesh BhattCommittee MemberGynaecologist & [email protected]

Dr. Agam VoraCo-opted MemberChest Physicians/Allergy/[email protected]

Dr. Suhas KateTrusteeOrthopaedic [email protected]

Dr. Mukesh GuptaGrasp EditorGynaecologist & [email protected]

Dr. Sudhir NaikVice President Gynaecologist & [email protected]

Dr. Nitin RaoCommittee MemberGynaecologists/Obstetricians [email protected]

Dr. Shivbhagwan AgarwalChairman - Social Service Cell & Zonal DirectorGynaecologist & [email protected]

Dr. Anil SuchakCo-opted [email protected]

Dr. Deepak BaidCommittee MemberGeneral Physician [email protected]

Dr. Dilip NaikZonal [email protected]

Dr. Pradeep BaligaJoint TreasurerE.N.T. Surgeon [email protected]

Dr. Pramod BahekarManaging Committee MemberGeneral Surgeon [email protected]

Dr. Sushmita BhatnagarCommittee MemberPaediatric Surgeon [email protected]

Dr. Sanjay PattiwarCommittee MemberPublic Health [email protected]

and Commitment

Doctors are wary of technology, don’t you agree? Ask any businessman or an

industrialist and he will be having his own website. Most professionals in other fi elds too put up their website. All of us print stationery, visiting cards and put up sign boards outside our clinics to let people know that we exist. However, we do not think it necessary to have our own website. Today, the world is moving on information technology. There is no collegian who does

not own a mobile phone.

Gone are the days, particularly in cities, where the patient approaches the family physician to refer him to a specialist. Now the guy sitting in the offi ce bus or autorickshaw searches on his cellphone for anything that he needs. He types into Google whatever he has on his mind, be

WEB-SAVVY INDIANCONSULTANTS CAN DO MUCH MORE Dr. Rajan T. D.

How people use internet for issues of health

it a house to buy or a plumber to fi x his leaking tap. His shoulder is paining for a few days, he keys in “shoulder pain” in Google and within half a minute he gets 6,84,000 references. He changes the search to “shoulder pain doctor Mumbai” and the search results get reduced to 3,90,000. He makes the search more specifi c: “shoulder pain doctor Mumbai Andheri West Juhu Lane” and he fi nds 1,340 references.Once he fi nds the name of the clinic or

doctor, an IT professional would again make a search of the specifi c doctor, e.g. Dr. XYZ. This will tell him about all the information about XYZ. If the doc has his own website, specifi c details about his seniority, experience, clinic timings and services available etc., are readily available. Another search on www.google.com/places will actually point to the location of the doctor. By the time, the young man reaches

his offi ce, he would have identifi ed the hospital / clinic / doctor whom he wantsto meet. There have been instances where the patient has spotted the doctor’s sign board and got off to walk into his clinic! So, in a jiffy his shoulder pain is attended to!

In the previous issue of The Grasp,


Dr. Saurabh Dani and Dr. Rajesh Bijlani very nicely detailed the benefi ts of having our own website and the technicalities that go into making one.

Budget

Putting up a website is not a diffi cult task if you either spend some time learning the tricks or assign it to your college-going child. To begin with, one can search for websites providing free website builder programmes. This will help to understand the components of getting a website ready. Alternatively, one can engage the help of a professional to do the entire work. They charge anywhere from Rs.5,000 toRs.50,000 depending on the type of site that one wants to host and manage.

At the lower end of the budget the website manager will simply put up what matter you provide on pages that are ‘static’ which means that it will be a one-sided interaction. The reader can simply read what items have been hosted. He cannot reply to the matter unless he mails you separately. Also, the website would not have many pictures or may not allow videos to be hosted. The upper-end websites allow ‘dynamic’ pages to be hosted wherein the visitor to the website can type in queries, have discussions and chat sessions. Your clinical videos can be posted. You can have links to social networking pages like Facebook and Twitter.

This article does not delve into the technical details which have been dealt with by the previous authors.

Young consultants

For beginners in practice, it is a good idea to have a website which lists their practice details, their experience and expertise. Listing their affi liation to medical bodies /

associations / hospitals provides legitimacy to their ability since the internet is also liable to be misused by quacks and hoodlums in disguise. The traditional methods for building up practice, for getting known by people in the locality were by meeting general practitioners, distributing visiting cards to friends and relatives, participating in medical camps, becoming a member of social organisations like Rotary and Lions Club etc. With the arrival of the internet there is a wide world open to the young consultant. A website makes his biodata go international!

Senior specialists

For senior consultants, the internet serves several purposes. The website announces his expertise to anyone who checks his name.

• Like every other doctor, he too can get exposure to a large number of newer patients.

• Details of their consulting rooms, appointment schedule, services offered, can be available online 24x7. Thus, people need not have long telephonic conversations with the busy doctor. Instead, a crisp: “Please visit www.drXYZ.com for all the details,” will do the job.

• By the time a new patient visits the doctor he is well aware of the seniority or expertise of the latter. This makes the patient deal with the clinic staff in a dignifi ed way and he waits patiently for his turn knowing the seniority of the consultant.

• If he is skilful in articulating his views on various aspects of his speciality he can interact with patients as well as his counterparts across the globe in his spare time.


• He can join medical fora and take part in academic discussions with his international counterparts. Medical ‘rounds’ are available on the internet where the expert can opine on diffi cult cases.

• Unknowingly, having one’s website makes the technophobic consultant technophiles! Most doctors eventually get hooked on to search engines and news-related sites and enhance their hobbies and relationships once they get the hang of the PC / laptop!

• When doctor is out of station, he can interact with his patients comfortably and refer them to alternate hospitals. This ensures that he retains the goodwill of the patient.

Indians docs should not lag behind

Internationally every Tom, Dick and Harry has a web-presence. The western way of life is to market everything and make a lot of noise. Traditionally, Indians are publicity shy and media shy. Even though we have a huge pool of talent we do not think it is necessary to let everyone know that we are around. In fact it is this attitude which has led to the US patenting what Indians already “knew” e.g. medicinal value of turmeric, basmati, etc. With changing times, attitudes need to be changed and we Indians are slow to realise that.

A quick search of any medical information on the internet directly leads to several western doctors’ and medical bodies’ websites. Despite our abilities, Indian websites do not rank highly on the internet. It is necessary for us to put up articles on our websites and teach a thing or two to people overseas.

Beating quacks

With the system prevalent in India, quacks fl ourish in our country and gullible people get conned every day. People visit bone setters for arthritis, “ayurvedic” sex experts, beauticians masquerading as trichologists, only because highly qualifi ed orthopaedic surgeons, STD specialists and dermatologists are not ‘visible’ to them.

Medical associations and qualifi ed doctors, by having their websites can prevent, at least to some extent, people being fooled by these quacks. By informing people through our websites, the actual state of treatment for baldness, obesity and leucoderma we can minimise the damage caused by unscrupulous elements who advertise quick ‘cures’ for these conditions. Indirectly, we will be performing a social duty when qualifi ed consultants put up their websites.



http://www.google.co.in/url?sa=t&rct=j&q=gipsa%20hospital%20list&source=web&cd=4&ved=0C

GMQFjAD&url=http%3A%2F%2Fwww.ttkhealthcareservices.com%2FPages%2FAllIndiaPPNList.

xls&ei=KZq_T83bFMe3rAep7M36CA&usg=AFQjCNEU3iyUQCk7ecZ6GkRe0ZJC6_DT6A

Link for PPN List :

ACTIVITY 1 :BASIC LIFE SUPPORT AND CPR PROGRAMME• Sponsored and Supported by : Association of Medical

Consultants, Mumbai.

Organised by Medical Practioners Association (Palghar Doctors Association)

• Date : 6 May 2012 • 9.00- 12.00 am

• Venue : Tima (a/c) Hall, Boisar

Dr. Bharucha of BLS co-ordinated with Dr. Rajendra Chawhan, President of Medical Practioners Association (Palghar), Dr. Akshay Chalani demonstrator with his team did the programme.

In the above programmes different topic were discussed like choking, stroke, drowning, burns, accident, fracture, heart attack, etc. with its preventive measures and what type of fi rst aid will be life saving was stressed upon. Alsocardio- pulmonary resuscitation with minor details was explained and hands on training of cardiac massage, mouth to mouth respiration ECT was given.

In short, local doctors of Palghar appreciated the support of Dr. Ajay Hariyani, President of AMC and his committee for providing such a nice programme which would be life saving in this Boisar and Palghar area which is manly Industrial area. Total 110 doctors attended the programmes.

REPORT OF ACTIVITY AMC, MUMBAI

ACTIVITY 3 :

TOBACCO ADDICTION

AND

ITS IMPLICATIONS

Date : 27th May 2012

Venue : Mayfair Rooms,

Dr. Annie Besant Road,

Worli, Mumbai

ACTIVITY 2 :FIRST RESPONDER COURSE + CPR• Organised and sponsored by : Association of Medical Consultants, Mumbai• Date : 6 May 2012 • 3.00- 6.00 pm• Venue : Anand Ashram School Hall, Palghar.• Inaugurated by : Local Leaders, Dr. Rajendra Chawhan, Joint Secretary, AMC, Mumbai• Father Kiran Lopez, Principle, Convent Anand Ashram School • Shilpa Teacher, Incharge Intract Club, PalgharCo-ordination : Dr. Ajay Hariyani,Dr. Suhas Kate, Dr. Veena Pandit Dr. Bharucha and Dr. Navalkar.Details: Mixed crowd of about 250 peole and interact club students of Anand Ashram School, Nurses and other audience.Topic : Chocking, burns, fracture, accidents, fi re, snakesbite and CPR discussed in details and hands-on practice was given by Dr. Priyanka of BLS.The programme was highly appreciated by all and requested to keep one more such programme in future so that more people can come and attend and take advantage, knowledge of life saving.

REPORT OF ACTIVITY AMC, MUMBAI

As a healthcare professional do you remember?

When paper medical records were the method of choice for capturing patient’s course of illness and care?

When errors in prescriptions occurred – wrong patient / wrong fi le / wrong medication/ wrong dosage?

When diagnostic results went missing? When an X- Ray fi lm took more than 30 minutes to reach the ICU?

At re-admission, previous medical records / discharge summaries were not available?

Now imagine a future where hospitals have no paper case notes or fi les -

Patient’s medical condition is captured via intelligent contest aware devices and sent directly to central computer systems. Information such as X-Ray’s, Labs, medication history and drug allergies are also available at fi ngertips, at computers by Bedside. This means less time spent on hunting / tracking information and more time for doctors and nurses to provide better patient care.

Nursing Staff is able to retrieve and collate clinical information for review by clinicians. Savings could be up

GOING DIGITAL –TRANSFORMING HEALTHCARE**Dr. Anil Bhaya

** this article was also published in the Hospital build and Infrastructure magazine, Life Sciences Publications , April 2012.

to 750,000 USD per ward / year (US national survey 2008-2009)

Up to date clinical information

System alerts for abnormal results

Avoiding duplicate medication orders and drug - to - allergy information.

Medical innovations have been a norm rather than exception - ancient Egyptians performed surgery back in 2750 BC and Romans developed medical tools such as forceps & surgical needles. Modern medicine has been revolutionized by antiobiotics,vaccines & heart stents – all marvels of bio-technology .Information and communication technology in comparison was slow to impact healthcare partly due to infrastructure constraints but more so due to challenges in change management.

Industry leaders argue that a revolution is already on – “transforming biology from a discovery science to an informational science”. In medicine this essentially means the digitization of medical records and the establishment of an intelligent network for sharing these records.

The electronic medical / health records serve as searchable databases providing a ‘smart grid’ for medicine that will hopefully not only improve clinical practice but also help revive drug research. Devices


and diagnostics have already gone / are going digital – pushing the boundaries of telemedicine and telehealth – personal home care devices with remote monitoring and smart pills.

Access to Information & Communication Technology (ICT) has become a basic need – mobile and fi xed broadband communication is changing the world .Currently there are 5 Billion mobile subscriptions worldwide. The deployment of broadband is accelerating the deployment of digital healthcare.

Patients are likely to benefi t due to timely and more precise diagnosis. Digital health may help empower patients to play a bigger role in their own care and thus facilitate progressive primary care especially for chronic conditions such as diabetes, asthma, heart failure, renal failure .Through remote monitoring using healthcare devices and with commitment and participation by the patients and healthcare providers one can expect a better quality of life for these patients primarily due to reduction in unplanned hospital visits and admissions. (fi g.1)

Digital health enables effective patient management, increased effi ciency through remote diagnosis and reductions in management & treatment costs. Digitization promises to connect doctors not only to everything they need to know about their patients but also to other doctors who have treated similar disorders.

Healthcare insurance is already bleeding the economies of the developed nations – for example the cost burden of healthcare in USA is close to $ 2 trillion. Optimized patient monitoring conceivably would be able to reduce long term healthcare costs by reducing hospital admissions.

In addition to these direct cost reductions – digital healthcare also impacts the environment favorably by reducing paper and fi lm usage as it emphasizes online scheduling, electronic records, computerized physician order entry (CPOE), paperless billing and claims management and picture archival and communications system (PACS) (fi g. 2)

Despite all these so called advantages, many developed countries still lag behind

Fig 2: Picture Archival & Communications System (PACS) – the system confi guration and components are depicted (Courtesy VISUS, Germany)

9x JiveX DICOM Modality Gateway

2x Maquet OR system(incl. in the offer of Maquet)

2x JiveX Analog Modality Gateway(1x Olympus Endo system + 1x ECGGE (import via PDF))

JiveX Communication Server+ JiveX Archive Manager

X [CB]

Archive

Archive

Review

Web

4X JiveX Diagnostic Client

13x JiveX Review Client

unlimited JiveX Review Web Client

SAN

Integ

ration

into t

he HIS;

JiveX

HL7 Gate

way

JiveX

DICOM Work

list

Broker

HIS

Fig 1 : Remote monitoring device and tele- triaging by a qualifi ed nurse for assisting home monitoring and planned admissions / outpatient visits for patients with chronic diseases (Courtesy DOCOBO, Mauritius – UK)

DIGITAL HEALTHCAREDEVICE FOR REMOTEHOME MONITORING ANDTELE- TRIAGING FORCHRONIC CONDITIONSSUCH AS HYPERTENSION,DIABETES AND RENALFAILURE, ASTHMA ETC.


in the usage of digital health concepts .In USA, fewer than 15-20% of hospitals and less than 20-25 % of small physician groups use some form of standardised electronic recording system .Hence, the health and information technology for economic and clinical health act (HITECH 2009) has included more than 19 billion in stimulus to encourage use of ICT in healthcare.(fi g. 3)

The drawbacks and challenges include new privacy regulations, regulatory compliance, infrastructure capital cost (who pays and who gains?), integrations of various technologies etc.

Digital healthcare to be successful must be built on multidisciplinary approach from the healthcare, business and technology domains. Healthcare processes, at times will have to be re-invented / re-engineered and considerable time, effort & money may have to be dedicated towards the change management.

Digital Hospital

My own personal experience at ApolloSTS Hospital, Dhaka and Apollo Bramwell hospital, Mauritius, both tertiary, multispecialty hospitals, was enlightening as to the challenges encountered in opening a hospital with a vision to be paperless and fi lmless. We started with fully functional PACS and a WIP version of HIS with more than 60 % of the modules available from day one of operations .Over the last six years the modules have undergone appreciable changes, thanks to inputs from the end users, and the system per se has become more robust with negligible bugs .This has come at a price of severe stress on the ICT and MRD teams due to several change

requests initially over a short span of time. We realised that more than 75% of our time was being utilised towards end user training which despite initial resentments and resistances from physicians has ultimately reaped benefi ts in the form of quicker patient throughput and compliance to hospital policies and procedures /protocols. Halfway through the progress we also found that there was a tendency for becoming computer centric rather than patient care centric – a fact quickly identifi ed and corrective actions taken. As a result currently we are practically fi lmless and paperlite i.e. only diagnostic reports, outpatient prescriptions and discharge summaries are being printed. We have found digitisation of medical forms and charts particularly challenging and sometimes insurmountable – so much so that the MRD module has a separate tab for uploading paper charts. To our surprise the hospital information system (HIS) supported our endeavour towards accreditation for quality certifi cation and integration of care pathways into day to day practices.


Fig 3: Sample image of an electronic medical record with essential parameters.


1st Floor, ‘A’ Block, Shivsagar Estate, Dr. Annie Besant Road, Worli, Mumbai 400 018. India • Tel: + 91 22 66534200 • Fax: + 91 22 6661 4378 / 4379

* Smith H, Perioperative Intravenous Acetaminophen and NSAIDs Pain Medicine 2011; 12: 961–981

† http://www.accessdata.fda.gov/scripts/cder/ob/docs/obdetail.cfm? Appl_No =022450&TABLE1=OB_Rx, as Accessed on Nov 2, 2010

Years of research and dedication has resulted in a Stable IV Paracetamol Formulation

For Hospital Use Only TM TMComposition: Perfalgan solution for infusion contains 10mg/mL of paracetamol (50ml vial contains 500mg of paracetamol and 100 ml vial contains 1gm of paracetamol). Indications and usage: Perfalgan is indicated for the short-term treatment of moderate pain, especially

following surgery and for the short-term treatment of fever, when administration by intravenous route is clinically justified by an urgent need to treat pain or hyperthermia and/or when other routes of administration are not possible. Dosage and Administration: Intravenous route. TM

Perfalgan 10mg/mL, solution for infusion should not be mixed with other medicinal products. Adults- Paracetamol 1 gm per administration. The minimum interval between each administration must be 4 hours in patients without hepatic or renal impairment. In patients with renal and/or hepatic impairment the minimum interval between doses must not be less than 6 hours. The maximum daily dose from all sources of paracetamol must not exceed 4gm. Children weighing up to 33 kg (about 11 years old)- 15 mg/kg of paracetamol per

TMadministration, i.e. 1.5mL of solution per kg, up to four times a day. The minimum interval between each administration must be 6 hours. The maximum daily dose must not exceed 60 mg/kg. The safety and efficacy of Perfalgan in premature neonates has not been established. TM

There is limited data on the use of Perfalgan in neonates and infants < 6 months of age. Method of administration: The paracetamol solution is administered as a 15-minute intravenous infusion; it contains no antimicrobial agent, and is for single use in one patient only. TM

Contraindications: Perfalgan 10mg/mL, solution for infusion is contraindicated: • In cases of hypersensitivity to paracetamol or to propacetamol hydrochloride (prodrug of paracetamol) or to any of the excipients • In cases of severe hepatocellular insufficiency • In patients with hepatic failure Warnings: it is recommended to use a suitable analgesic oral treatment as soon as this administration route is possible. Check other medicines administered do not contain paracetamol. This medicinal product contains less than 1 mmol sodium (23mg) per

TM TM100 ml of, Perfalgan i.e essentially “sodium free”. Precautions: Perfalgan should be used with caution in cases of: • Hepatocellular insufficiency • Severe renal insufficiency (creatinine ≤ 30mL/min) • Chronic alcoholism • Chronic malnutrition (low reserves of hepatic glutathione), • Dehydration. If the daily dose of paracetamol from all sources exceeds the maximum, severe hepatic injury may occur. Hepatic injury: Patients with hepatic insufficiency, chronic alcoholism, chronic malnutrition or dehydration may be at a higher risk of liver damage following administration of

TMPerfalgan . Interaction with other medicinal products and other forms of interaction: A reduction of the paracetamol dose should be considered for concomitant treatment with probenecid. Use in Special Population: Pregnancy Category A: Paracetamol has been taken by a large number of pregnant women and women of childbearing age without any proven increase in the frequency of malformations or other direct or indirect harmful effects on the fetus having been observed. Lactating women/Nursing mother: No undesirable effects

TMon nursing infants have been reported. Caution should be used when administering Perfalgan to women who are breastfeeding. Adverse Reactions: Rare-Malaise, hypotension, increased levels of hepatic transaminases, agranulocytosis, neutropenia, macular rash, injection site reaction. Very rare cases of hypersensitivity reactions ranging from simple skin rash or urticaria to anaphylactic shock have been reported and require discontinuation of treatment. Isolated reports of thrombocytopenia have been observed. Overdose: There is a risk of poisoning, particularly in elderly subjects, in young children, in patients with liver disease, in cases of chronic alcoholism, in patients with chronic malnutrition and in patients receiving enzyme inducers. Poisoning may be fatal in these cases. Acute overdose with paracetamol may also lead to acute renal tubular necrosis. Symptoms generally appear within the first 24 hours and comprise of nausea, vomiting, anorexia, pallor and abdominal pain. Storage: Store below 30ºC. Do not refrigerate or freeze. Keep the container in the outer packaging. For single use only. PLEASE REFER TO PACKAGE INSERT FOR COMPLETE PRESCRIBING INFORMATION.For Further Information, Please Contact: Bristol Myers Squibb India Pvt Ltd., 703/704, Peninsula Towers, ‘A’ Wing, 7th Floor, Peninsula Corporate Park, Ganpatrao Kadam Marg, Lower Parel, Mumbai – 400013.Based on package insert dates May 2009 (Version 3) Issued: - Jan 2011

*440 million vials sold world wide

65 million patient exposure

Presence in over 80 countries

A decade of presence world wide

†USFDA approved

*

*

*

80 S EC IO RU TN

*V i ra els v S Oold

440 N M OII LL

with Cysteine and MannitolParacetamol 1g/ 500 mg

Take pain away the never before way!

In post operative pain management

PER/

1809

IN11

PM04

3

Perfalgan_AD_091211 AW

Size: W - 8.25 X H - 11 in (Non Bleed)

2 NIGHTS ESTONIA : VISIT TALINNA sea coast capital, a rare jewel in the north of Europe in the Gulf of Finland, that’s Tallinn. With one of the most completely preserved medieval cities in Europe it is a precious city on the UNESCO World Heritage List. Guided city tour of Talinn Old town, the Dome Church from inside, Alexander Nevsky Cathedral and medieval Old Town Hall from outside. Entrance to Dome church / city Musuem.

BEST OF RUSSIA & BALTIC TOUR SPECIALLYPREPARED FOR AMC 11 DAYS

2 NIGHTS LATVIA : VISIT RIGARiga, founded in 1201 by the German bishop Albert, is the largest of the three Baltic capitals and boasts a real kaleidoscope of architectural styles.The walking tour of the Old Town includes Riga Castle, the Dome Cathedral, St. Peter’s Church, the Swedish Gate, the Three Brothers, the Large and Small Guilds and the Freedom Monument.

Dome church / city Musuem.

2 NIGHTS ESTONIA : VISIT TALINNA sea coast capital, a rare jewel in the north

BEST OF RUSSIA & BALTIC TOUR SPECIALLYBEST OF RUSSIA & BALTIC TOUR SPECIALLYBEST OF RUSSIA & BALTIC TOUR SPECIALLYBEST OF RUSSIA & BALTIC TOUR SPECIALLYPREPARED FOR AMC 11 DAYSPREPARED FOR AMC 11 DAYSPREPARED FOR AMC 11 DAYSPREPARED FOR AMC 11 DAYS

Large and Small Guilds and the Freedom Monument.

PREPARED FOR AMC 11 DAYSPREPARED FOR AMC 11 DAYS2 NIGHTS LATVIA : VISIT RIGA2 NIGHTS LATVIA : VISIT RIGA2 NIGHTS LATVIA : VISIT RIGA

Riga, founded in 1201 by the German bishop

2 NIGHTS LATVIA : VISIT RIGARiga, founded in 1201 by the German bishop A sea coast capital, a rare jewel in the north A sea coast capital, a rare jewel in the north Riga, founded in 1201 by the German bishop Riga, founded in 1201 by the German bishop Riga, founded in 1201 by the German bishop Albert, is the largest of the three Baltic Riga, founded in 1201 by the German bishop Albert, is the largest of the three Baltic capitals and boasts a real kaleidoscope capitals and boasts a real kaleidoscope of architectural styles.The walking tour of architectural styles.The walking tour of the Old Town includes Riga Castle, the of the Old Town includes Riga Castle, the Dome Cathedral, St. Peter’s Church, the of the Old Town includes Riga Castle, the Dome Cathedral, St. Peter’s Church, the Swedish Gate, the Three Brothers, the Dome Cathedral, St. Peter’s Church, the Swedish Gate, the Three Brothers, the Large and Small Guilds and the Freedom Swedish Gate, the Three Brothers, the Large and Small Guilds and the Freedom Monument.

2 NIGHTS ESTONIA : VISIT TALINNA sea coast capital, a rare jewel in the north of Europe in the Gulf of Finland, that’s Tallinn. With one of the most completely preserved medieval cities in Europe it is a precious city on the UNESCO World Heritage List. Guided city tour of Talinn Old town, the Dome Church from inside, Alexander Nevsky Cathedral and medieval Old Town Hall from outside. Entrance to Dome church / city Musuem.

BEST OF RUSSIA & BALTIC TOUR SPECIALLYBEST OF RUSSIA & BALTIC TOUR SPECIALLY

Dome Cathedral, St. Peter’s Church, the Swedish Gate, the Three Brothers, the Large and Small Guilds and the Freedom Monument.

BEST OF RUSSIA & BALTIC TOUR SPECIALLYBEST OF RUSSIA & BALTIC TOUR SPECIALLYPREPARED FOR AMC 11 DAYSPREPARED FOR AMC 11 DAYSPREPARED FOR AMC 11 DAYSPREPARED FOR AMC 11 DAYS

2 NIGHTS LATVIA : VISIT RIGAA sea coast capital, a rare jewel in the north of Europe in the Gulf of Finland, that’s Tallinn. With one of the most completely

2 NIGHTS LATVIA : VISIT RIGARiga, founded in 1201 by the German bishop Albert, is the largest of the three Baltic of Europe in the Gulf of Finland, that’s

Tallinn. With one of the most completely

Riga, founded in 1201 by the German bishop Albert, is the largest of the three Baltic

A sea coast capital, a rare jewel in the north of Europe in the Gulf of Finland, that’s Tallinn. With one of the most completely

Riga, founded in 1201 by the German bishop A sea coast capital, a rare jewel in the north of Europe in the Gulf of Finland, that’s Tallinn. With one of the most completely Tallinn. With one of the most completely

Riga, founded in 1201 by the German bishop Albert, is the largest of the three Baltic capitals and boasts a real kaleidoscope Tallinn. With one of the most completely

preserved medieval cities in Europe it capitals and boasts a real kaleidoscope of architectural styles.The walking tour

Tallinn. With one of the most completely Tallinn. With one of the most completely Tallinn. With one of the most completely Tallinn. With one of the most completely preserved medieval cities in Europe it preserved medieval cities in Europe it of architectural styles.The walking tour

of the Old Town includes Riga Castle, the preserved medieval cities in Europe it preserved medieval cities in Europe it of architectural styles.The walking tour

of the Old Town includes Riga Castle, the Dome Cathedral, St. Peter’s Church, the

preserved medieval cities in Europe it is a precious city on the UNESCO World of the Old Town includes Riga Castle, the

Dome Cathedral, St. Peter’s Church, the

preserved medieval cities in Europe it is a precious city on the UNESCO World

Dome Cathedral, St. Peter’s Church, the Swedish Gate, the Three Brothers, the

preserved medieval cities in Europe it is a precious city on the UNESCO World Heritage List. Guided city tour of Talinn Dome Cathedral, St. Peter’s Church, the

Swedish Gate, the Three Brothers, the

BEST OF RUSSIA & BALTIC TOUR SPECIALLYBEST OF RUSSIA & BALTIC TOUR SPECIALLYPREPARED FOR AMC 11 DAYSPREPARED FOR AMC 11 DAYS

2 NIGHTS LATVIA : VISIT RIGA2 NIGHTS LATVIA : VISIT RIGA

BEST OF RUSSIA & BALTIC TOUR SPECIALLYBEST OF RUSSIA & BALTIC TOUR SPECIALLYPREPARED FOR AMC 11 DAYSPREPARED FOR AMC 11 DAYS

A sea coast capital, a rare jewel in the north of Europe in the Gulf of Finland, that’s Tallinn. With one of the most completely preserved medieval cities in Europe it is a precious city on the UNESCO World Heritage List. Guided city tour of Talinn

2 NIGHTS LATVIA : VISIT RIGARiga, founded in 1201 by the German bishop Albert, is the largest of the three Baltic capitals and boasts a real kaleidoscope of architectural styles.The walking tour of the Old Town includes Riga Castle, the Dome Cathedral, St. Peter’s Church, the Swedish Gate, the Three Brothers, the Large and Small Guilds and the Freedom Monument.

Riga, founded in 1201 by the German bishop

PREPARED FOR AMC 11 DAYSPREPARED FOR AMC 11 DAYS2 NIGHTS LATVIA : VISIT RIGA

Riga, founded in 1201 by the German bishop Albert, is the largest of the three Baltic

of architectural styles.The walking tour of the Old Town includes Riga Castle, the Dome Cathedral, St. Peter’s Church, the Swedish Gate, the Three Brothers, the

2 NIGHTS LATVIA : VISIT RIGA


TOUR DEPARTURE WILL BE IN FIRST WEEK OF SEPTEMBER, DATE TO BE ADVISEDTour Cost: Per Adult on Twin sharing / Per coach basisRs. 67,700/- + Eur 1225, Total Cost - Approx Rs. 1,51,000, Group Size: 45 AdultsTour Cost: Per Adult on Twin sharing / Per coach basisRs.67,700/- + Eur 1285, Total Cost Approx Rs. 1,55,080, Group Size: 40 AdultsTour Cost: Per Child with Bed (sharing room with min 2 adults) [Child below 11 yrs.]Rs.51,650/- + Eur 920, Total CostTour Cost: Single Supplement for Single RoomEur 650 over and above the Adult cost, Group Size: 45 AdultsDirect Joining Cost: Euro 1450 – 45 Adults, (Anyone who will join without buying air ticket, visa etc from us; in short fl ying on own and joining our tour in Moscow No airticket no visa included.) + Visa fees in : Rs.12,5001 Euro – calculated @ Rs.68 any increase will lead to change in cost

BOOKING PROCEDURE AND FOR ANY DOUBTS : CALL BETWEEN 10 AM TO 7 PM

VIKAS DANDEKAR 9920455228RAVI KOUL 9920785524 (Not avail between 27th May – 13 June)PRASHANT VINHERKAR 9823258556NOTE: FOR BOOKING, PLEASE SEND REGISTRATION FORM + Rs. 67,700 PER PERSON AND PASSPORT COPIES TOMR RAVI KOUL, 260 A 2ND FLOOR POWAI PLAZA OPP PIZZA HUT HIRANANDANI GARDENS POWAI MUMBAI 400076 TEL : 30688955THERE ARE ONLY 45 SEATS FOR THE DEPARTURE AND BOOKINGS WILL BE ACCEPTED AS PER FIRST COME FIRST SERVE BASIS ONLY NO NAMES WILL BE NOTED WITHOUT THE REGISTRATION AMOUNT.

Cancellation Procedure:

Cancellation Fee per head as mentioned below

45 Days or More Rs.15,000 per person + Deposit Amount

44 – 22 Days 25% of Tour Cost

21 – 08 Days 50% of Tour Cost + Deposit Amount

07 – 01 Days 100%

If Visa is Rejected (Not for last minute cases, deadline will be given)

Rs.20,000 (Visa Fees + Airline Deposit) not for last minute passports

The taxes are as on 28/4/2012, any change by Government will becharged extra on fi nal payments

Visa fees and deposit to airline are non refundable

For terms and conditions and itinerary please feel free to call us.

6 NIGHTS RUSSIA :VISIT ST PETERSBURG & MOSCOW

One of the world’s most beautiful cities called as the Venice of the north,St. Petersburg has all the ingredients for an unforgettable travel experience: high art, lavish architecture, wild nightlife, an extraordinary history and rich cultural traditions that have inspired and nurtured

some of the modern world’s greatest literature, music, and visual art.

St Petersburg : Hermitage Musuem, Peterhof palace, Neva River boat cruise. Russian folklore show.

1 Overnight Train : St Petersburg to Moscow.

Moscow : Metro tour, city tour, Russian circus, Red Square, Kremlin from inside.

TOUR DEPARTURE WILL BE IN FIRST WEEK OF SEPTEMBER, DATE TO BE ADVISEDTour Cost: Per Adult on Twin sharing / Per coach basisRs. 67,700/- + Eur 1225, Total Cost - Approx Rs. 1,51,000, Group Size: 45 AdultsTour Cost: Per Adult on Twin sharing / Per coach basisRs.67,700/- + Eur 1285, Total Cost Approx Rs. 1,55,080, Group Size: 40 AdultsTour Cost: Per Child with Bed (sharing room with min 2 adults) [Child below 11 yrs.]Rs.51,650/- + Eur 920, Total CostTour Cost: Single Supplement for Single RoomEur 650 over and above the Adult cost, Group Size: 45 AdultsDirect Joining Cost: Euro 1450 – 45 Adults, (Anyone who will join without buying air ticket, visa etc from us; in short fl ying on own and joining our tour in Moscow No airticket no visa included.) + Visa fees in : Rs.12,5001 Euro – calculated @ Rs.68 any increase will lead to change in cost

BOOKING PROCEDURE AND FOR ANY DOUBTS : CALL BETWEEN 10 AM TO 7 PM

VIKAS DANDEKAR 9920455228RAVI KOUL 9920785524 (Not avail between 27th May – 13 June)PRASHANT VINHERKAR 9823258556NOTE: FOR BOOKING, PLEASE SEND REGISTRATION FORM + Rs. 67,700 PER PERSON AND PASSPORT COPIES TOMR RAVI KOUL, 260 A 2ND FLOOR POWAI PLAZA OPP PIZZA HUT HIRANANDANI GARDENS POWAI MUMBAI 400076 TEL : 30688955THERE ARE ONLY 45 SEATS FOR THE DEPARTURE AND BOOKINGS WILL BE ACCEPTED AS PER FIRST COME FIRST SERVE BASIS ONLY NO NAMES WILL BE NOTED WITHOUT THE REGISTRATION AMOUNT.



charged extra on fi nal payments



6 6 NIGHTS RUSSIA :NIGHTS RUSSIA :VISIT ST PETERSBURG & MOSCOW

One of the world’s most beautiful cities called as the Venice of the north,St. Petersburg has all the ingredients for an unforgettable travel experience: high art, lavish architecture, wild nightlife, an extraordinary history and rich cultural traditions that have inspired and nurtured

some of the modern world’s greatest literature, music, and visual art.

St Petersburg : Hermitage Musuem, Peterhof palace, Neva River boat cruise. Russian folklore show.

1 Overnight Train : St Petersburg to Moscow.

Moscow : Metro tour, city tour, Russian circus, Red Square, Kremlin from inside.

COME FIRST SERVE BASIS ONLY NO NAMES WILL BE NOTED WITHOUT THE REGISTRATION AMOUNT.


Cancellation Fee per head as mentioned belowCancellation Fee per head as mentioned below

Rs.15,000 per person + Deposit AmountRs.15,000 per person + Deposit AmountRs.15,000 per person + Deposit AmountRs.15,000 per person + Deposit AmountRs.15,000 per person + Deposit AmountRs.15,000 per person + Deposit Amount

50% of Tour Cost + Deposit Amount

Rs.20,000 (Visa Fees + Airline Deposit) not for last minute passportsRs.20,000 (Visa Fees + Airline Deposit) not for last minute passports




charged extra on fi nal payments



400076 TEL : 30688955THERE ARE ONLY 45 SEATS FOR THE DEPARTURE AND BOOKINGS WILL BE ACCEPTED AS PER FIRST COME FIRST SERVE BASIS ONLY NO NAMES WILL BE NOTED WITHOUT THE REGISTRATION AMOUNT.

45 Days or More

44 – 22 Days

21 – 08 Days

07 – 01 Days





NOTE: FOR BOOKING, PLEASE SEND REGISTRATION FORM + Rs. 67,700 PER PERSON AND PASSPORT

FLOOR POWAI PLAZA OPP PIZZA HUT HIRANANDANI GARDENS POWAI MUMBAI

THERE ARE ONLY 45 SEATS FOR THE DEPARTURE AND BOOKINGS WILL BE ACCEPTED AS PER FIRST COME FIRST SERVE BASIS ONLY NO NAMES WILL BE NOTED WITHOUT THE REGISTRATION AMOUNT.COME FIRST SERVE BASIS ONLY NO NAMES WILL BE NOTED WITHOUT THE REGISTRATION AMOUNT.


Rs.15,000 per person + Deposit Amount



25% of Tour Cost


25% of Tour Cost

50% of Tour Cost + Deposit Amount50% of Tour Cost + Deposit Amount

100%

Rs.20,000 (Visa Fees + Airline Deposit) not for last If Visa is Rejected (Not for last minute cases, Rs.20,000 (Visa Fees + Airline Deposit) not for last minute passports

If Visa is Rejected (Not for last minute cases, minute passports

The taxes are as on 28/4/2012, any change by Government will be

If Visa is Rejected (Not for last minute cases,

The taxes are as on 28/4/2012, any change by Government will be

If Visa is Rejected (Not for last minute cases,


FLOOR POWAI PLAZA OPP PIZZA HUT HIRANANDANI GARDENS POWAI MUMBAI

THERE ARE ONLY 45 SEATS FOR THE DEPARTURE AND BOOKINGS WILL BE ACCEPTED AS PER FIRST COME FIRST SERVE BASIS ONLY NO NAMES WILL BE NOTED WITHOUT THE REGISTRATION AMOUNT.


Cancellation Fee per head as mentioned belowCancellation Fee per head as mentioned below




MR RAVI KOUL, 260 A 2400076 TEL : 30688955THERE ARE ONLY 45 SEATS FOR THE DEPARTURE AND BOOKINGS WILL BE ACCEPTED AS PER FIRST COME FIRST SERVE BASIS ONLY NO NAMES WILL BE NOTED WITHOUT THE REGISTRATION AMOUNT.COME FIRST SERVE BASIS ONLY NO NAMES WILL BE NOTED WITHOUT THE REGISTRATION AMOUNT.




44 – 22 Days 25% of Tour Cost

21 – 08 Days 50% of Tour Cost + Deposit Amount

07 – 01 Days 100%


Rs.20,000 (Visa Fees + Airline Deposit) not for last minute passports






Eligible donor is :

1. His/her age should be between 18 to 60 years.

2. His /her weight should be more than 45 kg.

3. The level of Haemoglobin (HB) should be more than 12.5 gm%

4. He/she not suffering from any disease etc…

Can anyone Donate Blood when he/she is not eligible to Donate that too around 50 or 100 Blood Bags in a day… …!!!

Surprised or confused? Ok, ok, I know you are eager to know answer of this confusing question… right?

Dear friend, the answer is ‘YES’, anyone can do this! Let’s see HOW… I will give you 4-5 examples to prove my point…

1. In 2005, on Martyr’s Day, i.e on 14th August I had arranged Blood Donation Camp at our Palghar Railway station. While Camp was going on, I saw an old person watching our camp curiously. I went to him and request him to come and have some snacks and Tea. He came, and while taking tea he told me that he is 65 years old and his name was Atmaram. He also told me that he was very impressed with the work we

were doing. He was retired peon of a D.Ed College.

While telling me this, suddenly he stops for a while. Then he took out a coin from his pocket and went to nearby telephone booth, to call his son. He asked his son to come for the camp, and told him to bring his friends also. Within 10-15 minutes his son came with 4-5 friends. They all donated Blood. Meanwhile Mr. Atmaram again called in his college. He spoke to principal and informed about the Blood donation camp. After half an hour, we were please to see that principal himself come with his staff members. Principal also called some of his students who are eligible to donate blood. Can you imagine, because of Mr. Atmaram, we got 48 Blood bags!

Friends, this is very nice example of a person who cannot donate Blood, but still was instrumental in donating 48 Blood bags.

2. The next example was about very well known personality. In 2008, again on 14th August Mrs. Manishatai Nimkar, MLA of Palghar visited my Blood donation Camp. As she is a political Leader, to set a good example she decided to donate Blood. But when

THEY DONATED BLOOD, THOUGH THEY WERE NOTELIGIBLE..!!! HOW…???(TRUE STORY) Dr. Rajendra Chawhan


her blood was checked, Hemoglobin was less in her Blood, and she was not eligible to donate Blood. But she wasn’t discouraged. As she was MLA, she decided to help me to get some extra blood bags with her infl uence. She called her party workers, explained the importance of donating Blood and asked them to donate blood. And I want to say proudly that with her infl uence; almost 150 Blood bags were collected. Even though she was having hectic schedule, she stood in the camp till more than 100 workers donated blood. But totally 147 Blood bags were donated by her party worker. And all the 147 blood bags collected were goes to her account. So friends, by this way a person can donate blood more and more even when they are not eligible to donate Blood..

3. I want to tell you a very interesting example of a muslim lady. Her name is Mrs. Baig, (wife of a Doctor). Friends, We know that the muslim lady generally not actively participating in public activities. But I have a very pleasant experience.

I still remember that place and date. It was 18 June, 2006 and camp was arranged in Manor. As it was month of June, the atmosphere was rainy. When camp was going on, suddenly atmosphere becomes stormy. The heavy rain started with thunder storm. Our situation become worst when the camp pandal/Mandap fell down. We immediately shifted our camp related materials to nearby shop/gala. we thought that now no one will come to

donate blood. At that time a muslim lady with a tightly holding umbrella was passing from there. She saw our pitiable situation. She came to us and told us she is a social worker in that area. As she had donated blood just a few days ago, she was unable to donate blood; because at least 3 months gap is required to again donate the blood. However she promised us to help for the camp. She called her supporter and co-worker and went house to house with them for motivating donors. Can you believe we saw so many muslim ladies came in burkhas to donate blood. What we saw was a big queue in front of that gala with so many muslim ladies in burkhas with holding umbrellas in their hands were standing in the rain in short time. To our surprise, almost 168 Blood bags were collected, simply unimaginable. We thank her & heartly congratulated her for her honest & sincere efforts. Because of her effort, she was got credit to donate 168 blood bags. This is very nice example of a lady who cannot donate Blood, but still was instrumental in donating 168 Blood bags.

These are the examples of the persons who are having good mass contact

4. Now a heart touching example which happened in my hospital itself. As we know, we don’t have Blood bank in our Palghar Taluka. But in our Kanta Hospital, we have a Blood storage centre. On that day a lady named Muktabai was admitted for operation and she was having heavy bleeding (menorrhagia) with HB 6.5 gms. her

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blood group was O+ve and in our blood storage centre Fortunately we were having only two blood bags of the same Blood group. We cross matched the Blood for transfusion. At the same time a pregnant lady with AntiPartum Haemorrhage (APH with low HB) got admitted to hospital. An immediate caesarean was required as the lady and her child both were in danger. To our surprise, the blood group of this lady was also O+ve, and we were having last two blood bags which were already issued to Muktabai. We were in dilemma, as blood was required for cesarean operation too. At that time, Muktabai called us. And she told us to

give that blood (already issued to her) to pregnant lady. She gave the reason that if she took that blood, her life (one life) will be saved, but by giving the blood to pregnant lady, by doing so she is going to save two lives!! (mother & child). I give full credit to her for gesture.

I salute to all above non-eligible great donors for helping me to get more no. of Blood bags and serving the nation by motivating and encouraging the people to donate blood. I request you do the same and support the National Health Policy.


From June 2012 onwards,

Dr. Niraj L. Vora,Consultant Joint Replacement and Trauma Surgeon, will be available for consultation on every Saturday

between 4 and 7 pm. At

Nova Specialty Surgery, Tardeo,

Famous Cine Labs, Konark Shram,

156, Pt. M. M. Malviya Rd.,Tardeo, Mumbai - 400 034,

Landmark: Next to Sardar Pav Bhaji and Ganga/Jamuna Cinema

T: +91 22 43324500/43324550

Dr. Vorais also available

at present for consultations from

Monday to Fridaybetween 2 and 6 pm at

Bellevue Multi Speciality Hospital,

1st Floor, The Link,Next to Audi Showroom,

New Link Road, Andheri (W),Mumbai 400053.

For appointment please

ring up phone

*91 9619156877


These are a few of my favourite things,I would like to admire and see.

I can tell you with my closed eyes,That one of them is AMC

Many plans (Prof.Ind.Policy),Many Schemes (CBS, ESR) etc,AMC provides to its Member.

I feel it is just the love and affection Render by Father and Mother.

AMC thinks (Grasp) in advance,So as to prevent a further loss

There are no words.I can describe AMC and its Class.

AMC is doing everything possibleFor the welfare and for the best

Whether you are placed anywhere,North, East, South or West.

I think, I wish, AMC should becomea well-known Medical Body.

Which will be called later“AMC –INDIA” by everybody.

AMC is my past, present,AMC is my future,

If you agree with me,Please call me on my number.

Dr. Ajit Desai

AMC INDIA

March 11, 2012: Three doctors convicted of violating anti-sex

determination lawMumbai: On Friday three doctors were convicted by a magistrate for failing to maintain proper F-form records. They were sentenced to a one-month rigorous imprisonment and imposed a fi ne of Rs.5,000 each. The case against these doctors was registered in June 2011. This is the fi rst conviction of a doctor under the PCPNDT Act this year.

March 18, 2012: Health minister says ‘silent observer’ is totally uselessMumbai: The state health department has fi nally decided to put an end to the usage of the ‘silent observer’ - a microchip meant to deter people from conducting sex determination tests, by keeping a record of the tests conducted. Calling it completely ineffective, state health minister said that the piece of equipment, which was being tested in Kolhapur district, will not be introduced in other parts of the state.

March 20, 2012: Security plan on cards for hospitalsMumbai: Two years after it tried giving protection to doctors from attacks they face by creating stricter laws, the state government is now drawing up a comprehensive security master plan for every major hospital across Maharashtra.

FROM THE PRESS Compiled by: Dr. Pradeep Baliga

(Sourced from various Agencies)

The plan, which will also include an internal code of ethics and conduct for the doctors, will be completed after a meeting of all stakeholders soon.

April 19, 2012: Hospitals get time till May to ensure fi re safetyMumbai: In light of a recent inspection which revealed that adequate fi re safety norms were not being observed in most major hospitals in the city, the state government said that action would be initiated against hospitals that do not make amends within a month and a half.

April 21, 2012: Panel seeks inputs to frame doctor codeMumbai: Maharashtra Medical Council is seeking the views of the public on the ethical issues. The MMC has put out a public notice on its website asking its 80,000-odd members, health activists and the public to email their views before April 30. MMC wants these inputs in order to evolve ethical guidelines for its members. The guidelines would take at least a couple of months to be drawn up.

April 24, 2012: Return vow must for doctors before US educationNew Delhi: The Union health ministry has said doctors looking to pursue higher studies in the US must sign a bond that makes it mandatory for them to return home


after completion of the course. In case of violation, the government will not provide a No-objection Certifi cate, something the US has insisted on from this academic session for every student enrolling with an American institute. Without the NOC, they cannot practice in that country.

April 24, 2012: Doctors, activists join hands for patient safetyMumbai: Unintended medical errors are the leading cause of deaths all over the world, say experts. The World Health Organization calls patient safety as an endemic concern. A group of doctors, activists and legal consultants have therefore come together to form ‘Patient Safety Alliance’, an initiative (started by Chairman – Medico-legal Cell of AMC – Dr. Nikhil Datar), that will empower patients and create a movement to promote awareness of patient safety and take action to reduce harm in healthcare.

April 26, 2012: Stricter fi re safety norms for hospitals, nursing homesMumbai: The state government had passed a resolution in the winter session last year, making it mandatory for nursing homes to obtain a No-objection Certifi cate from the fi re department. The fi re brigade is expected to fi nalize them by the end of the month, while guidelines for hospitals with over 100 beds are in place, the fi re brigade has made new fi re safety rules for nursing homes.

April 27, 2012: HC respite for sonography clinic doctorsMumbai: In a relief for doctors across the state, the Bombay high court has said that ‘‘offi cers visiting sonography clinics should record statement of the doctor in case they are to be charged with violating the pre-natal diagnostic rules. In such statement, a

person would get ample opportunity to put forward his or her explanation’’, said the judge. “The authority should consider each case on its merits, examine it meticulously, preferably with the help of a legal advisor and then fi le complaint in the court.”

May 02, 2012: Grade action against sex-test violatorsMumbai: Several organizations representing doctors have appealed to the Centre, asking it to incorporate graded punishment for those convicted under the PCPNDT Act, depending on the degree of crime. Many cases fi led against doctors are for not fi lling forms properly and not maintaining records. These are clerical errors and cannot be treated with the same vigour as non-registration of a sonography machine or conducting sex-determination tests.

May 06, 2012: Brain drain or not, the right to emigrate is fundamentalAll doctors going to the US for higher studies must sign a fi nancial bond that will be forfeited if they do not return, said the union health ministry. However, the right to emigrate is fundamental. States can curb immigration, but not emigration. The UN declaration of human rights says in Article 13, “Everyone has the right to leave any country, including his own.”

May 09, 2012: Finally, TB is a notifi able diseaseNew Delhi: India has fi nally declared Tuberculosis (TB) a notifi able disease. The announcement signifi es that with immediate effect, all private doctors, caregivers and clinics treating a patient suffering from TB will have to report every single case of the air-borne disease to the government. The notifi cation was sent to all states on May 7. Till now, doctors in the


private sector across India were free to treat TB patients, and weren’t required to keep a record. May 14, 2012: 1,333 doctors migrated abroad last year New Delhi: While India faces an acute shortage of trained medical manpower, as many as 1,333 doctors migrated to foreign shores over the past one year. The Union health minister’s proposal of return vow has found resistance from former members of the governing body of MCI. They felt that the bond can’t work till the government can guarantee the students a good job worth their skills, once they return to India.

May 15, 2012: 2 Lakh doctors and 63% Nurses exist only on paper: Govt New Delhi: Around 27% of India’s registered doctors and almost 63% nurses aren’t active anymore. The health ministry’s pre-sentation to the consultative committee,which included several MPs, admitted to some worrying trends in human resources in health. Medical Council of India has 7.5 lakh doctors registered under it.

However, the health ministry’s scrutiny has found that two lakh of the registered doctors aren’t working anymore. Of the 10.7 lakh nurses registered, six lakh don’t exist.

email: [email protected]


DETAILS FOR FIRE SAFETY NORMSDear Members,

Kindly provide the following data to AMC offi ce by telephone or email to facilitate the forming of new NORMS for FIRE SAFETY.

Name of Nursing Home :

Year of Starting Nursing Home :

Year of Building being established :

Location :

Carpet Area :

Bed Strength :

Independent Building or Floor of a building :

Building Residential/Commercial :

Which Floor :

Number of Entry/Exit :

Association of Medical Consultants4, Ganpati Niwas, Old Police Lane, Opp. Andheri Station (East). Mumbai - 400 069Tel : 2683 6019 E-mail: [email protected]

“Some say the world will end in fi re,Some say in ice.From what I’ve tasted of desireI hold with those who favor fi re.But if it had to perish twice,I think I know enough of hateTo say that for destructi on iceIs also greatAnd would suffi ce.”

(Robert Frost, 1920)

Nursing home owners are losing their sleep over yet another NOC requirement for getti ng their license renewal. When the Offi ce- bearers met the Chief, Fire Services, Maharashtra, he echoed the same senti ments expressed in the above poem. Yes, fi re safety is essenti al but the existence of nursing homes off ering ti mely treatment to Mumbaikars is most crucial!

The Fire Training Insti tute at Kalina is a fi ne example of right investment of Govt. expenditure. The fi re simulati on cubicles with the latest gadgets ensured us that we are in safe hands as regards fi re safety. Now, if only our Medical Colleges followed suit to off er simulati on training modules to their students….

High Court, Mumbai… (PIL of Cashless health insurance)

If a doctor att ached to a hospital frets about the huge number of pati ents to be seen and the challenges of doling out an accurate diagnosis & treatment within few minutes, we have company. The courtroom is crowded but monitored by self- discipline as you dare not transgress the rules of a courtroom. The Judge towers over the

audience and hears the arguments with a multi tude of eyes staring at him. And yes, he is also supposed to deliver a fair judgment within the confi nes of this environment.

Moral of the story…. Doctors should not be compared with Lawyers but with Judges who face a similar magnitude of challenges while carrying out their job!

And yes, the PIL did not come up for hearing at all aft er waiti ng for 4 hours and the consumers were destarved….

Media & Doctors

Doctors are in news again- whether in print, TV or Twitt er – courtesy Mumbai’s new acti vist, Mr. Aamir Khan. Did you noti ce that each episode is well researched, criti cally analysed, of course dramati cally executed but the experts called in to discuss and off er soluti ons are doctors (at least on 2-3 ti mes when I watched). The last episode was catastrophic! I cringed at the doctor bashing in the fi rst half but the second half was a thorough scruti ny of the root cause of this malady aff ecti ng the medical profession. Do we get defensive about the general negati ve percepti on concerning us doctors practi cing in a moral bankrupt society? Or should we take it as a wake- up call to be united and strengthen our associati ons in order to project a judicious percepti on of the medical profession?

“God and the Doctor we alike adoreBut only when in danger, not before;The danger o’er, both are alike requited,God is forgott en, and the Doctor slighted.”

- Robert Owen

MUMBAI DIARY


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EDITORIAL BOARD ASSOCIATION OF MEDICAL · PDF fileASSOCIATION OF MEDICAL CONSULTANTS, ... Dr. Lokras Girish Dr. Vaidya Deepak Dr. Patel Manoj Dr ... about it during continued medical