Every doctor should establish a firm written contract with hospital on terms of employment: NMC advice

New Delhi: The National Medical Commission (NMC) has advised doctors to have a firm written contract with a hospital or any other clinical establishment regarding their terms of employment or association.

Whether the doctor is joining for the purpose of consultation, admission, operation, or as a temporary/permanent/visiting doctor, the Apex Medical Commission has insisted on him/her having a firm written contract.

Further, NMC clarified that all modalities of payment by patients should be decided and approved in advance and receipts should be provided for the same.

NMC made these observations in its recently released E-Book "Professional Conduct Review- Lessons from Case Archives" while discussing a case where a patient's family alleged that the treating doctor refused to provide receipts for the full amount paid to him and the amount was in excess of the ceiling on treatment charges decided by the Municipal Corporation for COVID-19 patients.

Later, the hospital also filed a police complaint against the doctor for fraud and unauthorized use of the hospital name and its seals on fabricated bills and receipts.

"Every Registered Medical Practitioner should establish a firm written contract with a hospital / clinical establishment regarding his terms of employment/association for the purpose of consultation, admission, and/or operation as a temporary/ permanent/ visiting doctor. All modalities of payment by the patient should be decided and approved in advance and receipts should be provided," NMC observed.

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Case Background: 

The matter concerned a COVID-19-positive couple who were taken to a private hospital by their son for the purpose of treatment. As per the complainant, the son of the patient, the treating doctor asked him to deposit Rs 19.5 lakh in two bank accounts, details of which were given by the doctor. However, allegedly, the treating doctor refused to provide receipts for the full amount paid to him. After multiple requests, only receipts for Rs 14.6 lakh were provided.

Further, it was alleged by the complainant that the amount charged was in excess of the ceiling of treatment charges set by the Municipal Corporation for COVID-19 patients. Referring to this, he demanded a refund of the excess amount.

During an inquiry into the matter, the City Municipal Corporation also discovered that the doctor had posed as a critical care specialist without possessing the requisite qualifications. It was also revealed that an excess dosage of tocilizumab was administered to the patient.

Meanwhile, the hospital also filed a police complaint against the doctor for fraud and unauthorized use of the hospital name and its seals on fabricated bills and receipts. The hospital alleged that it was done by the doctor without the notice and the consent of the authorities. 

A doctors' association in the city also filed a police complaint against the concerned doctor for fraud and misrepresentation of his qualifications.

When the matter reached the State Medical Council (SMC), the doctor pleaded that proper history, examination, and investigations were done after obtaining the written consent of the patients. He claimed that the patients were attended to promptly and his treatment decisions were in line with the evolving COVID-19 treatment guidelines from ICMR from time to time.

The SMC removed his name from the State Medical Register for three years for unethical conduct. Challenging his order, the concerned doctor approached the NMC Ethics Board.

During the hearing, NMC Ethics and Medical Registration Board could not find any evidence to substantiate the allegations of overcharging. The charges of medical negligence could not be established. Noting that the matter of fraud and unauthorized use of hospital name and seal is subjudice, the NMC Ethics Board directed the State Medical Commission to restore his registration number in the State Medical Register. However, the Commission also issued a warning to the doctor asking him to refrain from claiming to be a specialist without the requisite qualifications.

NMC Observations: 

While discussing this case in its E-book, NMC noted that the matter concerned four important ethical and legal issues - overcharging, fraudulent use of hospital name and seal, overdose, and misrepresentation of qualification.

The Commission added that the allegation of financial irregularities and overcharging is currently pending before the consumer forum, whereas the issue of fraud is being investigated by the police.

However, NMC referred to the allegations of overcharging in its book and noted in this context, "According to the Clinical Establishment Act 2010, all professional charges and hospital charges should be displayed and made known to the patient before the treatment is initiated. Overcharging is an unethical practice and Registered Medical Practitioners must avoid exploitation of patients during emergencies or otherwise. All payments should be billed and receipts provided by individual doctors or hospitals, as the case may be."

Addressing the issue of overdose, the Commission observed that this case was unique because of the prevailing COVID-19 pandemic during which the treatment guidelines were frequently changing and doctors were treating patients according to the available evolving information from different sources.

Pointing out that there was no evidence-based standardized treatment for the same, NMC observed that the accusation of overdosage in this particular case could not be held against the doctor. "However, as far as possible, treatment in every context should be evidence-based or according to best practices," opined NMC.

The Commission also issued a warning to the concerned doctor for claiming to be a specialist in the absence of requisite qualifications. At this outset, NMC observed, "A physician shall not claim to be a specialist unless he/she has a special qualification in that branch, according to clause 7.20 of the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002. In view of this clause, Registered Medical Practitioners should register their additional qualifications with the respective Medical Councils."

Further advising the doctors to have a proper contract with the hospital, the Commission mentioned in the E-Book, "Every Registered Medical Practitioner should establish a firm written contract with a hospital / clinical establishment regarding his terms of employment/association for the purpose of consultation, admission, and/or operation as a temporary/ permanent/ visiting doctor."

"All modalities of payment by the patient should be decided and approved in advance and receipts should be provided," the Commission further observed.

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