Private Practice: GMC Kozhikode Nephrologist faces suspension

Kozhikode: In a recent development, the Directorate of Medical Education (DME) in Kerala has suspended a nephrologist attached to the Kozhikode Government Medical College (GMC) for allegedly indulging in private practice even after the state government's strict ban on such practice.   

The doctor's suspension came after the reports suggesting involvement in private practice, a prohibited activity as per government regulations. The situation in Kerala regarding the private practice of government doctors is a matter of concern and controversy.  

It came to light that despite the government's repeated warnings against private medical practice, few government doctors in the state were found continuing private practice at private clinics and performing surgeries at private hospitals. 

Also read- JnK Govt Revokes Ban On Private Practice Of Three Doctors

However, the suspension of the doctor was issued in response to a December 2023 order by the Kerala Government explicitly stating that government doctors are not permitted to engage in private practice.   

In an order issued by the Kerala Health and Family Welfare Department on December 27, 2023, the government informed that certain modifications have been made to a previous government order which issued guidelines for the private practice of medical officers in government service in conformity with provisions under the Government Servants Conduct Rules, 1960. 

Before going into detail about the modifications, the order stated "It has come to the notice of the Government that despite the existing guidelines, several Medical Officers are violating the norms."

According to TH news reports, Government rules currently allow government doctors, excluding those in medical colleges, to provide consultations at their residences. However, treating patients requiring hospital admission outside of government facilities is strictly prohibited.

"The Medical Officer shall produce a Residential Certificate issued by the Secretary of the Local Self Government concerned when a complaint/investigation is held with respect to the building, where the private practice is being conducted," reads the order. 

In addition, the government also made changes in Serial No. 1 under the first part of the Government Order read above the word "in-patient" has been modified to "in-patient / proposed to be an in-patient" and the words "his residence/consultation room" has been modified to "the place where the medical officer usually resides".

However, the recent modifications in the GO have sparked anger among doctors of the Kerala Government Medical Officers’ Association (KGMOA) who disagreed with the modified clauses in the government order regarding the ban on private practice. 

The association responded flagging what they perceive as ambiguities in the government's order. They said that the order “hangs like the Sword of Damocles” over doctors who offer their practice genuinely, outside their duty hours and at places not linked to pharmacies, laboratories or other commercial establishments.

In a letter to the Principal Secretary of Health and Family Welfare, the KGMOA expressed concerns about the clause that patients proposed to be inpatients should not be seen in private practice. They argue that predicting a patient's need for hospital admission during an examination is challenging.

The KGMOA also challenges the clause requiring doctors to confine their practice to their usual residence, supported by a residential certificate. They argue that this doesn't consider the cultural practices of Keralites, who often change residences. 

"The resurgence of various life-threatening diseases such as COVID-19 and Nipah make it difficult and impossible to ensure infection control while examining patients at their residences. It is difficult to find suitable places for residence and practice after periodic transfer too," said the association. 

The association contends that strict enforcement of these clauses may make doctors vulnerable to exploitation by those with vested interests and calls for modifications to address these concerns.

Also read- JnK Health Dept Lifts Ban On Private Practice Of Two Government Doctors