Private hospitals in Indore and Bengaluru were caught red-handed when Ayush doctors were seen practicing medicine and seeing patients instead of accredited intensivist or trained critical care physicians.
Employing Ayush doctors in Intensive Care Units (ICUs) violates the Code of Ethics Regulations as prescribed by the Medical Council of India (MCI) in several ways and is a professional misconduct.
There are no ICUs in Ayush systems of medicine. Hence, their practitioners are inexperienced and ill-equipped in managing critically ill patients even with Ayush therapies.
Minimum standards for ICUs to be adopted throughout the country have been suggested by a committee in 2012 under the chairmanship of Prof MK Arora, Dept. of Anesthesiology at AIIMS, New Delhi as below.
Director / Incharge
- Ideally an ICU must have a full-time director or in charge, with full-time appointment or at least dedicates 30%- 50% of the professional time in ICU.
- Senior accredited specialist in intensive care medicine with Postgraduate degree (PG) or equivalent degree in anesthesiology or internal medicine or surgery or critical care medicine. He should have formal education/ training and experience in intensive care medicine with preferably 5 - 7 years (full time) work experience in intensive/ critical care medicine. Available upon request on notice in the hospital during "off-duty hours.
- Should possess MCI (Medical Council of India) recognized postgraduate degree in (PG) or equivalent degree in Anesthesia, Medicine or Surgery or Physicians qualified in intensive care medicine.
- Should have minimum three years experience after post-graduation of which 3-6 months experience in intensive/ critical care medicine (One with teaching experience in critical care medicine is preferred.
- A minimum of two resident doctors must be on duty in an ICU, and they must be on duty for 24 hours x 7 days.
- One of the resident doctors must be a postgraduate in anesthesia or medicine or surgery with a minimum of 3 months (preferably six months) full time working experience in ICU. The other resident doctor can be a trainee (Academic or fellow trainees after one year of training in their primary specialty and within the frame of their specialty, work in an ICU under clearly defined supervision).
- One resident doctor to take care of not more than five patients.
Any doctor who employs an Ayush practitioner as an assistant is responsible for his/her actions. This has been clearly stated in Regulation 7.18 of MCI Code of Ethics "In the case of running of a nursing home by a physician and employing assistants to help him/her, the ultimate responsibility rests on the physician."
While 7.18 does not "restrict the proper training and instruction of bonafide students, midwives, dispensers, surgical attendants, or skilled mechanical and technical assistance and therapy assistants under the personal supervision of physicians," it does not allow issuing directions to Ayush doctors about patient care in ICUs during rounds or otherwise. This would amount to the training of training of Ayush doctors in critical medicine and violates the provisions of Regulation 7.10, which says, "A registered medical practitioner shall not issue certificates of efficiency in modern medicine to unqualified or non-medical person."
Employing Ayush doctors to take care of patients in ICUs amounts to fraud, cheating, and impersonification on the part of hospital owners (non-doctors), medical superintendent of that hospital including other doctors if they are aware that Ayush doctors have been employed.
Moreover, this does not have the consent of the patients.
All doctors who assign them duties including those who interview Ayush doctors to hire them in their hospitals are also liable for professional misconduct.
As per Regulation 1.6 Highest Quality Assurance in patient care: "Every physician should aid in safeguarding the profession against admission to it of those who are deficient in moral character or education. A physician shall not employ in connection with his professional practice any attendant who is neither registered nor enlisted under the Medical Acts in force and shall not permit such persons to attend, treat or perform operations upon patients wherever professional discretion or skill is required".
As doctors, patient safety and care is our first and foremost concern.
Insurance companies pay double the amount for ICU beds. ICU admission in some corporate hospitals costs up to one lac a day. There is no way one can justify non-MBBS doctors or nonqualified nurses in ICUs.
The Govt., Medical Associations, and Regulators should take suo moto cognizance of this report and take appropriate action.