Gazette Notification on PNDT Act unconstitutional, undemocratic and ill-thought: IRIA
Reacting strongly to the Ministry of Health and Family Welfare's Gazette Notification of 5 June 2012 - restricting radiologists/sonologists from visiting no more than two clinics within a district.
- (1888PressRelease) July 20, 2012 - Reacting strongly to the Ministry of Health and Family Welfare's Gazette Notification of 5 June 2012 - restricting radiologists/sonologists from visiting no more than two clinics within a district to perform ultrasound and making it mandatory to specify their consulting hours at each clinic - Padma Shri Dr Harsh Mahajan, National President, Indian Radiological and Imaging Association (IRIA) termed the order "unconstitutional, undemocratic and ill-thought", asserting it would exacerbate the shortage of radiologists, ultimately hurting patient welfare and leading to higher prices for ultrasound tests of all parts of the body, although the directive is actually meant to curb pregnancy ultrasound.
• New order restricting radiologists may end up endangering lives, raising costs, hurting patient wellbeing as well as increasing death and disease rates
• Government contradicts own argument on shortage of sonologists by creating a restrictive environment for radiologists to operate in
• IRIA goes to court against restraining order following nationwide protests by radiologists against the
Elaborating on the issue, Dr Harsh Mahajan said: "There's no doubt that India's female sex ratio has been falling progressively over decades. But to conclude that restricting sonologists from visiting more than two centres within a district will solve this problem is fallacious because the real problem lies elsewhere. On the other hand, charitable clinics and patients in critical need of ultrasound for other ailments will be directly affected, since it will worsen the shortage of sonologists, creating a greater artificial shortage."
Restrictions imposed by the new order will cause overall reduction in the number of sonologists, leading to lesser ultrasound machines and medical centres being served leading to patients being underserved; thus, adding to their problems by creating long waiting lists and a possible increase in charges. This notification will deprive the general public, and especially poor patients, as radiologists who go to more than two centres will quit those centres where the volume of work and fees are lower. The impact is already being felt across the country with radiologists stopping to go to charitable clinics in religious institutions like temples, churches and gurudwaras, trust hospitals and smaller nursing homes in outlying areas which usually serve the poor. The artificial shortage will increase morbidity and mortality rates due to lack of diagnosis or delayed detection, resulting in chaos in the healthcare delivery system, as ultrasound examination is a basic investigation for many diseases.
The ill-thought order could even endanger the lives of patients. For instance, according to the notification, the timings of the ultrasonologist would have to be fixed and notified to the authorities and that he/she would not be able to practice in a particular clinic outside that time. Therefore, if an emergency patient is rushed to a clinic when the radiologist is about to leave as the allotted time has elapsed, the new rule will prohibit the radiologist from attending to the patient. This new norm also goes against the Medical Council of India Act as well as contradicts a Supreme Court ruling, which states that any doctor has to provide help to a patient in an emergency situation. Moreover, in case a colleague falls sick or goes on leave, a radiologist will not be able to take his or her place in attending patients.
Cautioned Dr Mahajan: "These unwanted outcomes could ultimately create a crisis scenario due to lack of quick diagnosis, even increasing death rates in emergency situations. All this only because the Government has drawn unsubstantiated conclusions that restricting radiologists from practising in more than two centres would reduce female foeticide. This is simply not true. The authorities are overlooking the fact that pregnancy sonography constitutes barely 5% of all ultrasounds conducted for various parts of the body to diagnose numerous diseases."
Prior to 1996, only radiologists could conduct ultrasounds of any kind. After the Pre-Conception & Pre-Natal Diagnostic Technique Act, 1994 came into force in 1996, a wide and vague definition of a sonologist was given, permitting any Registered Medical Practitioner (RMP) with six months' ultrasound training to conduct ultrasound examinations. This led to ultrasound centres mushrooming all over India, ill-trained RMPs practised wherever and whenever they wanted, concentrating mainly on pregnancy ultrasound because other tests needed more rigorous training and knowledge of the human anatomy. It may be told that even 18 years after the PNDT act was passed, the "6 months training" that RMPs have to undergo to become sonologists is still not defined and it is a free for all. Interestingly, MCI in a recent reply under the RTI act has said that it does not recognise any short-term course in any field of medicine.
After a gap of 18 years the Government is now pushing through a Six-month Certificate Training Course in Ob-Gynae Ultrasound for MBBS doctors because India faces a shortage of sonologists. The new notification will inexplicably go against its own stand by creating a sudden shortage of sonologists.
"It should also be noted that, as independent professionals and citizens of India, radiologists/ sonologists are guaranteed the right to practice their profession, whereas this notification impinges on their constitutional right to livelihood," asserted Dr Mahajan.
Furthermore, registration rates for ultrasound centres have been arbitrarily hiked from Rs 3,000 to Rs 25,000 and from Rs 4,000 to Rs 35,000. Such an exorbitant increase in charges will either encourage non-registration of medical centres or lead to an increase in ultrasound charges since clinics will be forced to recover these costs from patients. Higher charges will again hurt poor patients, leading to lower number of tests as well as higher death and disease rates.
The above restrictions apart, the new norm now requires 30 days' advance notice on purchase of a new ultrasound machine or on joining of an ultra-sonologist at the clinic. Previously, one could inform the authorities within 30 days of installation or hiring. Additionally, the new request can only become operational after it is duly incorporated in the certificate of the clinic. The strange new norm is illogical because no centre will know one month in advance about an ultra-sonologist leaving; thereafter, it could take anywhere from three months to several years for the change to be incorporated in the certificate. During this period, the new machine or new ultra-sonologist will be rendered useless.
"In conclusion, as responsible professionals, doctors at the Indian Radiological & Imaging Association are as concerned about female foeticide as the rest of the country. We will gladly extend all cooperation and support required by the Government in combating the menace. However, for this to happen, the Government needs to seriously engage with radiologists and seek their suggestions too in overcoming the scourge of female foeticide. Ill-thought, unfair laws that target law-abiding radiologists will not stop this practice but instead hurt the wellbeing of poor patients. The IRIA is willing to meet the Government and discuss ways to identify and punish the real culprits behind female foeticide. In the interim, the IRIA appeals to the Government to withdraw this illogical law," Dr Mahajan said.
About Indian Radiological and Imaging Association
Indian Radiological and Imaging Association (IRIA) is promoting the study, practice of Diagnostic Radiological and Imaging Modalities, including X-ray, Ultrasound, C.T., M.R.I., PET CT, Molecular Imaging and Interventional Radiology and other related subspecialties/super-specialties. IRIA actively holds periodic meetings, CME PROGRAMMES and conferences on related sub-specialties/super specialties. At the social level, IRIA is working to stop female foeticide and "Save the Girl Child" by asking all members of the association to desist from providing unauthorized training in Ultrasound.
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