drsujnanendra's DOCTORSDOC: May 2016

Monday, May 16, 2016

New cerebrospinal fluid test to tell time of death

Ahmedabad: Ascertaining the time of death is crucial in several criminal cases as that can corroborate several aspects of crime such as presence of suspects, circumstances in which someone died, motive and so on. Forensic experts keep developing methods of determining time of death because the same method cannot be applied to all cases. Factors such as decomposition (or preservation) of the body, temperature and humidity among others have a bearing on the what investigators conclude to be the time of death.

Researchers of Gujarat University's department of forensic science have proposed a new method in a paper published recently. The paper titled, 'Estimation of postmortem interval through albumin in CSF by simple dye binding method' recently appeared in the international journal, 'Science and Justice'. Ankita Parmar, a masters student of the department, along with head of the forensic science department, Shobhana Menon, analysed changes in albumin - a protein - from the cerebro-spinal fluid (CSF) to come to an estimate about the time of death.

The researchers claim that the method can estimate the time of death to within 1 to 4 hours of the actual time of death in bodies deceased for up to 72 hours.

Menon said that for the project, they collected CSF from 100 cadavers brought to Civil Hospital in Ahmedabad for autopsy.

"The CSF lies in close proximity to the brain and hence reflects changes occurring there. Another advantage is, fluid is well-protected in the skull even during severe accidents and, thus, it is less affected by putrefaction. Therefore, CSF is widely used for chemical analysis while estimating the time of death," said Menon.

MCI cracks the whip on ghost faculty

MCI has resorted to taking strict measures against the medical colleges and the doctors-who pose as ghost faculty, during inspection visit to colleges. A penalty can be imposed on such doctors, on the grounds of misleading and supplying incorrect information.

The decision was taken in the last meeting of MCI executive committee recently. It also has also written to state governments, to not allow any transfer of faculty from one college to another, for the purpose of MCI assessments. The council implied this in context of transferring of faculty (from one college to another) for filling up faculty positions during the assessment.

MCI has also suggested that the name of Dean, HOD, and the doctor concerned, involved in such malpractices, be removed from the Indian Medical Register (IMR) for a year.

A heavy punishment is likely to be imposed for showing fake documents, or in case of posing a non-medical person as a medical teacher or resident. If it happens during the assessment, then Dean, HOD, doctor, and the resident concerned will be removed from IMR for three years. Besides, an FIR will be filed against the person for posing as faculty.

The aforementioned situation in all its probability is likely to pose difficulties for district level medical colleges and general hospitals in any state. As implied in a media report, more often than not the state government is challenged by these factors i.e. shortage of faculty, or lack of infrastructure. It is exactly during this time, when the government resorts to redeploying staff from one college to another, temporarily during MCI inspection.

A doctor may also be censored from the services, as in a case of maximum punishment given for the offence. A case in 2012, led to removal of 32 doctors in a private medical college in Tamil Nadu by MCI. They were removed for 3-5 years from the State and national medical registers.

“The MCI has made it clear that the norms would be no different for government doctors. Not just the doctors who are transferred, but the Director of Medical Education (DME) who issues the transfer orders or “temporary redeployment orders” for the purpose of managing MCI assessments in medical colleges could face penalty,” a senior doctor and health activist pointed out to the Hindu.

A similar incident was reported in Idukki and Palakkad government medical colleges last year, when the state of Tamil Nadu was on the verge of losing 150 seats. However, it was only after the intervention of the health ministry, on request of the state government to give it more time to address the shortage, did the matter get sorted.

How Medical Representatives lure doctors : Gujrat Study

When around 150 physicians were interviewed, more interesting facts came to light. These include:-

71% doctors said that sometimes MRs tried to persuade them on to make irrational prescriptions.
Nearly 82% of the doctors believed that MRs concealed vital facts such as major adverse effects (99%).
Around 64% of the doctors believed that refusal of freebies and drug samples can reduce prices of drugs.
98% of the respondent doctors did not know of ethical guidelines for drug promotion.
89% of the doctors interview expressed their total dependency on the MR for information about the drugs, yet 75% of the doctors believed there to be a discrepancy prevailing in what was said and what was the truth in actual practice when it came to efficacy of drugs. Source

Thursday, May 5, 2016

Supreme Court Clips MCI Wings, Appoints Panel To Monitor

NEW DELHI: Saying the Medical Council of India (MCI) had "repeatedly" failed in its duties and the quality of medical education in the country was at its "lowest ebb", the Supreme Court on Monday appointed a high-powered committee headed by former CJI R M Lodha to clean up the system by taking over the functions of MCI.

"The medical graduates lack competence in performing basic health care tasks. Instances of unethical practices continued to grow. The MCI was not able to spearhead any serious reforms in medical education. The MCI neither represented the professional excellence nor its ethos," said Justice A K Sikri, who wrote the judgment for the five-judge Constitution bench comprising justices A R Dave, R K Agrawal, A K Goel and R Banumathi. The system keeps out most meritorious and underprivileged students, the bench said.

The order signals the end of the road for MCI that has been in the midst of controversies since its president Ketan Mehta was arrested in a corruption case. The government has been actively considering scrapping MCI in its present form.

The court asked the oversight committee, also comprising retired comptroller and auditor general Vinod Rai and eminent doctor Shiva Sareen, to oversee all statutory functions under the MCI Act and said policy decisions would require the panel's approval. The committee will function till the Centre puts in place a new mechanism for regulation by amending the statute or bringing a new legislation.

The court said deep-rooted corruption is prevalent in MCI and its members, coming from commercialised corporate private hospitals, were also found indulging in unethical practices such as carrying out unnecessary diagnostic tests and surgical procedures to extract money from hapless patients. It said the law needs to be amended as the Centre has no power under the present system to disagree with MCI and give policy directives to the regulatory body.

"The existing system of graduate medical education is required to be re-invented. The admission process was not satisfactory as majority of seats in private medical colleges were being allotted for capitation fee. The system keeps out most meritorious and underprivileged students," the bench said.

A day before the Supreme Court is to hear the controversy on a national eligibility test (NEET), the Constitution bench strongly batted for a common entrance test by scrapping exams conducted by private medical colleges. It said that common window test would tackle the menace of capitation fee and bring transparency in the admission process.

The court passed the order on a bunch of petitions filed by private unaided medical colleges of Madhya Pradesh challenging the validity of state legislation to bring into force Common Entrance Test (CET) for all medical institutions and regulate fee structure for medical education.

Dismissing their plea, the bench said the state government was justified to regulate education to ensure that merit could not be compromised in admissions to professional institutions nor capitation fee could be permitted. "The Constitution is primarily for the common man. Larger interest and welfare of student community to promote merit, achieve excellence and curb malpractices, fee and admissions can certainly be regulated," the bench said.

"It is to be borne in mind is that the occupation of education cannot be treated at par with other economic activities. In this field, the State cannot remain a mute spectator and has to necessarily step in in order to prevent exploitation, privatization and commercialisation by the private sector," the bench said.
timesofindia SC-clips-MCIs-wings-sets-up-ex-CJI-headed-panel-to-regulate-medical-education
May 3, 2016

Endorsing a Parliamentary Standing Committee report of March 2016 that medical education and profession in the country is at its 'lowest ebb' and suffering from 'total system failure' due to corruption and decay, the Supreme Court has used its rare and extraordinary powers under the Constitution to set up a three-member committee, headed by a former Chief Justice of India, to oversee the functioning of the Medical Council of India (MCI) for at least a year. A Constitution Bench, led by a Justice in a 165-page judgment, said that the apex court was constrained to exercise its extraordinary powers under Article 142 of the Constitution as the government had not acted on the report of the Parliamentary Standing Committee on Health and Family Welfare. Its report on 'The functioning of the Medical Council of India, was tabled in Parliament on March 8, 2016. The judgment referred to the parliamentary panel report, which described the MCI as an 'ossified and opaque body' unable to cope with the 'humongous' task of managing medical education in over 400 colleges across the country. Unethical practices up "Quality of medical education is at its lowest ebb, the right type of health professionals were not able to meet the basic health needs of the country. Products coming out of medical colleges are ill-prepared to serve in poor resource settings like Primary Health Centres. Graduates lacked competence in performing basic health care tasks. Unethical practices continued to grow. The MCI was not able to spearhead any serious reforms in medical education" the judgment said, citing the panel report. 'The MCI neither represented the professional excellence nor its ethos under the MCI Act' said a Justice who authored the judgment for the Bench, referring to the Parliamentary panel report. Besides Justice (retired) Lodha, the committee has Professor who is the Director of Institute of Liver and Biliary Sciences and a former Comptroller & Auditor General of India. The Supreme Court said the Justice Lodha committee "will have the authority to oversee all statutory functions under the MCI Act. All policy decisions of the MCI will require approval of the Oversight Committee. The Committee will be free to issue appropriate remedial directions. The Committee will function till the Central Government puts in place any other appropriate mechanism after due consideration of the Expert Committee Report." The court referred to how the Centre had set up the Dr. Ranjit Roy Chaudhury expert panel in July 2014 to study the Indian Medical Council Act, 1956 and make recommendations. No action taken Though the committee did submit its report in September the same year, no action was taken on the reforms suggested by it, including overseeing undergraduate and postgraduate medical education. Unethical practices Medical professionals indulge in unethical practices conducting unnecessary diagnostics tests and surgical procedures in order to extract money from hapless patients, the judgment said. "The challenges facing medical education of the 21st Century are truly gigantic... Game changer reforms of transformational nature are therefore the need of the hour and they need to be carried out urgently and immediately" it said.

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