Employing Ayush doctors in ICUs is professional misconduct

New Delhi, March 16, 2018. On Wednesday night, CNN-News18 broadcast a story which showed ICUs in some private hospitals in both Indore and Bengaluru did not have an accredited intensivist or a critical care physician, in charge and instead were being managed by Ayush doctors.

Employing Ayush doctors in ICUs violates the Code of Ethics Regulations as prescribed by the MCI in several ways and is a professional misconduct.

There are no ICUs in Ayush systems of medicine. Hence, their practitioners are inexperienced and/or ill-equipped in managing critically ill patients even with Ayush therapies.

Critical care medicine is a highly specialized field that requires skills to diagnose and manage life-threatening conditions in patients who may be already severely ill.

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 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 .

Consultants

· 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 3 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.

Resident doctors (Academic or non-academic or fellows)

· 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 doctor must be a postgraduate in anesthesia or medicine or surgery with minimum of 3 months (preferable 6 months) full time working experience in ICU. The other resident doctor can be a trainee (Academic or fellow trainees after 1 years 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 assistants and therapy assistants under the personal supervision of physicians”, it does not allow issuing directions to Ayush doctors with regard to patient care in ICUs during rounds or otherwise. This would amount to 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 docyors), 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. 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 pays 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 non qualified nurses in ICUs.

The Govt., Medical Associations and Regulators should take suo moto cognizance of this report and take appropriate action.