Audit of Stenting Procedures soon Mandatory: MCI

CHENNAI: With the growing allegations about high costs of cardiac procedures as well as unnecessary Cardiac Stenting by medical professionals, the Medical Council of India is reported to have formed a committee to look into the issue to frame out guidelines and recommendations to bring about transparency   and accountability in the procedures.

The move comes in response to the direction of Government of India as well as directions issued Allahabad High court asking council to intervene in the case of unnecessary stenting. MCI, in response,  has formed a 3 member committee to lay down the criteria for appropriateness of the stent procedures as well as set the minimum experience required to perform the said procedure. The three member committee consists of Eminent Cardiologists, headed by Chairman, Dr C V Bhirmanandam, and having members Dr Ashok Seth and Dr GD Gupta

The said committee had met recently with an agenda to frame rules to prevent unqualified medical practitioners from doing interventional cardiac procedures as well as to frame the outlines for developing the Standard Operating Procedures (SOPs) on the issue.

Speaking to Medical Dialogues team, Dr C V Bhirmanandam, Chairman of the committee, stated that in the recent meeting following main agendas were discussed

Inappropriate stenting

There is increasing allegations of inappropriateness of stenting by medical professionals.The committee is now going to define the broader outline for laying down Standard Operating Procedures for Stenting, which is then going to be taken up by a bigger panel for detailing.

"Many a times stenting is done upon Oculo- Stenosis, i.e. the anatomy of the coronary artery. Whether this blockage is significant or not is not clear , specially in cases where the blockage is more than 50% and less than 80%. We are recommending certain guidelines to assess the Physiology or functional status to be also considered before taking decision of stenting. This will surely reduce the number of stenting procedures in the country."  said Dr C V Bhirmanandam,

Elective Versus Emergency CAses

The said committee is also considering is the difference in strategy in the cases of emergency and elective stenting. It was highlighted by Dr Bhirmanandam, who is also the vice president of MCI, that except for acute heart attack, adhoc stenting- that is- stenting immediately after angiography should be avoided. In elective cases, patient should be given total information about the status of disease, the alternate risk and benefits and costs of the different procedures should be advised. On the basis of these, the patient must be counselled and given ample time to take more opinion from other physicians before deciding on the stenting procedure. Doctors should have an ideal checklist based upon clinical condition, the procedure involved and the also academic evidence.

The doctor also highlighted," In cases of emergency, every procedure done in the country, should go through an internal as well as external audit. We recommend that  every hospital or institution audits cardiac procedures on the back ground of appropriateness of procedure and process. The same shall be forwarded to central registry office,which shall be conducting an external audit. Such an activity will bring confidence in the mind of general public and appropriateness of procedure."

Degree Not Enough- Training Necessary to Do Stenting

On the move for framing the guidelines, the committee is likely to frame a clause to prevent fresh Cardiologists from conducting procedures without training.

Fresh pass outs without any hands on experience, operating on patients is too risky. These doctors should be trained properly under a senior of a team, so that they can develop their skill to operate, before being allowed to work independently, Countries like the US insist that doctors should have assisted at least 75 cases as assistants before doing the procedure on patients. We plan to recommend some hands on training for fresh pass outs before they are allowed to work independently ," Dr Bhirmanandam

It has also been proposed that doctors planning to begin their practice as Interventional Cardiologists  would have to first register themselves. Trained doctors should also register themselves as interventional cardiologists before beginning practice, Dr Bhirmanandam said

" We want to develop SOPs, which bring total transparency to help patient in informed decision-making. The decision to go for stenting should be primarily made by the patient and not the doctor

The committee is going to submit its recommendations in the next 10 days

Medical Dialogues had earlier reported that following a PIL filed with the Allahabad high court alleging the practice unnecessary stenting  by practitioners, the court has now issued notices of several authorities including the Union health ministry, the Medical Council of India as well as the Cardiology Society of India, seeking their response on the issue.

Read more at Medical Dialogues: High Court notice to MCI, CSI, Health Ministry on Alleged practice of Unnecessary Stenting