MCI Allows Branded Medicines Now

Major hospitals in the city can prescribe branded medicines along with their generic equivalents. According to a source, the Medical Council of India (MCI) recently approved the demand of Association of Hospitals (AOH), a body of 53 major hospitals in the city, which complained about the risks of unqualified chemists dispensing generic medicines.

The MCI had issued a circular on April 21, instructing doctors to prescribe drugs with generic names as much as possible. The move was to benefit millions of poor people as branded medicines are extremely expensive.

“Every physician should prescribe drugs with generic names legibly and preferably in capital letters and he/she shall ensure there is a rational prescription and use of the drug,” the circular had read. “As observed, most pharmacies are run by unqualified chemists who might prescribe medicines that are similar or choose manufacturers with higher commission rate and not keep the effectiveness in mind. Thus, we had requested the MCI to allow us to also prescribe branded medicines along with generic ones,” said the president of AOH. However, doctors said they have already been prescribing medicines with their branded names and also mentioning the generic equivalents. “Eventually what matters is patient care. Secondly, it is not feasible for all doctors to remember all the generic variations of a certain medicinal component,” said  CEO of  A famous Hospital in Bombay.

Experts said physicians have been prescribing branded drugs along with generic ones. However, MCI approval will give legal protection to the practice. “MCI’s attempt has failed because of no mechanism to ensure implementation. If MCI agree to the demands of AOH on paper, it will further nullify the order completely because pharmacies will officially start dispensing only branded medicines again,” said an expert from the health ministry.

The MCI had issued a circular on April 21, instructing doctors to prescribe drugs with generic names as much as possible.

Source : Hindustan times, Mumbai Edition.

POST-OPERATIVE BLADDER CARE

BLADDER CARE
A urinary catheter may be required for some procedures. Early catheter
removal reduces the risk of infection and encourages the woman to walk.
• If the urine is clear, remove the catheter eight hours after surgery or
after the first postoperative night.
• If the urine is not clear, leave the catheter in place until the urine is
clear.
• Wait 48 hours after surgery before removing the catheter if there was:
- uterine rupture
- prolonged or obstructed labour
- massive perineal oedema
- puerperal sepsis with pelvic peritonitis.
Note: Ensure that the urine is clear before removing the catheter.
• If the bladder was injured (from either uterine rupture or during
caesarean or laparotomy):
- Leave the catheter in place for a minimum of seven days and until
the urine is clear.
- If the woman is not currently receiving antibiotics, give
nitrofurantoin 100 mg by mouth once daily until the catheter is
removed, for prophylaxis against cystitis.
- If there is a suspicion of a bladder injury (e.g. the woman has
had prolonged obstructed labour), consider leaving the catheter in
for seven days. 

MCPC 2017, C-74 Operative care principles WHO

Hyderabad: Doctor arrested for selling adulterated blood to patients

Hyderabad: One medical practitioner, along with two employees of a Venus Blood Bank have been booked by the Special Operations Team(SOT), Rachakonda, after they were found allegedly selling diluted blood to patients.
The case came to light, after the family of an accident victim went to this private blood bank paying Rs 3000 for two units of blood. When they took the blood back to Global Hospital, the doctors there refused to infuse it, stating that the blood has been diluted. The family then filed a complaint with the police, which led to the SOT raiding the blood bank
During the raid  Rachakonda’s Special Operations Team police conducted checks and arrested a doctor, blood bank manager and a lab technician, who confessed that he diluted the blood. The owner has been identified has Dr Chakravarthi, who is MD in anaesthesia , manager as Sravan and technician as one Kumar. Five packets of white blood cells and seven bottles of NS Sterile were seized from the blood bank and sent to forensic department . The cuplrits have been booked under 420 (cheating), 308 (attempt to commit culpable homicide if such act causes hurt to any person), 272 (adulteration of food or drink intended for sale), 273 (sale of noxious food or drink) of IPC.
The blood bank is also being investigated for selling broken (Haemolysed) RBC, a fresh report in New Indian Express states.
Why Adulteration of Blood is dangerous
Explaining the adulteration and its harmful effects on the patient, Dr.K.K.Kohli ,Member Delhi State Blood Transfusion Council said “Normally Blood is collected in blood bags which is a  closed system .If  someone adds normal saline to the blood from outside ,there are chances of contamination and spread of  microbial diseases  to the patient .In addition to this transfusion of such diluted blood will not increase haemoglobin of patient to the expected level.”
” Moreover there are chances of haemolysis of RBCs if saline is added to the blood bag. Haemolysis of blood can also occur due to improper storage at inappropriate temperatures that is, extreme cold or hot temperatures ,  improper handling storing beyond expiry date. When haemolysed RBCs are transfused, a patient may develop minor reactions ranging from fevers, chills, Tachycardia to serious life threatening reactions including anaphylactic reactions, hemoglobinemia and hemoglobinuria ,renal impairment and cardiac arrhythmia,” he added

Private practice by government doctors no criminal offence: court

Private practice by a government doctor cannot be construed as a criminal offense, and at the most, departmental action can be taken against him or her, the Supreme Court has held.
In a big relief to government doctors, a Bench of Justices Markandey Katju and Gyan Sudha Misra said: “The demand for/receipt of fee while doing private practice by itself cannot be held to be illegal gratification as the same obviously is the amount charged towards professional remuneration. It would be preposterous, in our view, to hold that if a doctor charges fee for extending medical help and is doing that by way of his professional duty, the same would amount to illegal gratification as that would be against even plain common sense.”
A government doctor doing private practice could not be booked under the Prevention of Corruption Act or the Indian Penal Code.
Writing the judgment, Justice Gyan Sudha Mishra said: “If a particular professional discharges the duty of a doctor, that by itself is not an offense but becomes an offense by virtue of the fact that it contravenes a bar imposed by a circular or instruction of the government. In that event, the act would clearly fall within the ambit of misconduct to be dealt with under service rules, but would not constitute [a] criminal offense under the Prevention of Corruption Act.”
The Bench said the doctor's duty to treat patients was in the discharge of his/her professional duty and it could not be held a ‘trade' constituting an offense under Section 168 of the IPC. If the medical professional acted contrary only to government instructions dehors any criminal activity or criminal negligence, his/her conduct would not constitute either an offense under the IPC or a case of corruption under the Prevention of Corruption Act.
However, “if it was alleged that the government doctor, while doing private practice, indulged in malpractice in any manner as for instance, took money by way of illegal gratification for admitting patients to the government hospital, or any other offense of a criminal nature like prescribing unnecessary surgery for the purpose of extracting money by way of professional fee and a host of other circumstances, the same would obviously be a clear case to be registered under the IPC as also under the PC Act.”
In the instant appeals, Kanwarjit Singh Kakkar and Rajinder Singh Chawla challenged a Punjab High Court order refusing to quash a first information report which alleged that they were indulging in private practice while holding the post of government doctor.

Appeals allowed

Allowing the appeals, the Bench said that even as per the FIR, the doctors could be held to have violated only government instructions which themselves had not termed private practice ‘corruption' under the Prevention of Corruption Act merely on account of charging of fee. In any event, it was a professional fee which, however, could not have been charged since doing so was contrary to government instructions.
The Bench quashed the impugned order and the FIRs against the two doctors.
SUPREME COURT

Madhya Pradesh: New orders on private practice by govt doctors (2013)

Bhopal, Aug 17:  

Through a new order regarding private practice, the Madhya Pradesh government has sought to further strengthen arrangements at government hospitals in the state.

Giving this information, an official release said here on Saturday that along with it, orders have also been issued for appointment of 503 medical officers.

Following this, urban and rural people will get better treatment facilities and appointment of 266 more doctors is also being made soon. Similarly, 769 newly appointed doctors will provide their services to patients.

The General Administration Department had lifted the ban on private practice of doctors of Public Health and Family Welfare Department vide its order dated January 13, 1999.

The department has issued new orders regarding private practice by government doctors in the context of that order.

It has been made clear now that private practice can be done only after duty hours. Under private practice at their residences, government doctors can only give consultation to patients.

Government doctors cannot operate any clinic, nursing home or private hospital in their or their relatives’ names.

Government doctors will not be permitted to render their service including consultation at any private nursing home, private hospital or private clinic.

For consulting patients, they can keep only basic medical examination equipment/instruments like stethoscope, BP instrument, ophthalmoscope, auto scope, ECG machine etc.

They cannot keep at their residences machines for which licence is required (Like X-ray machine, USG, Eco-cardiography machines etc.)

Besides, they cannot get these machines registered for use at their residence in their own or their relatives’ names.

They will also be permitted to get registered/installed other equipments not required in surgery in their own or their relatives’ names including dental chair, yelgar laser machine etc. No equipment for pathology or bio-chemistry test can be kept by them.

If any government doctor violates this new system, he or she will be held guilty of violation Sub-rule (4) of Rule 16 of Madhya Pradesh Civil Service Conduct Rules 1965 and will be punishable under Madhya Pradesh Service Rules 1966.

Supreme Court favors amendments to MTP Act

On Friday, the Supreme Court ruled in favor of amendment to the Medical Termination of Pregnancy (MTP) Act to make the law “meaningful” by allowing women to abort terminally ill fetuses beyond the current limit of 20 weeks, as reported in ET Healthworld. A bench of Justices D Y Chandrachud and Sanjay Kishan Kaul said a holistic approach was needed in dealing with such cases. “You have to also see the quality of life of the mother after pregnancy. The mother will have to live under the constant threat of losing her child. The law must be stretched to make it meaningful,” it said. The court made the observations while hearing the plea of a Kolkata-based woman for medical termination of her 25 week pregnancy due to life-threatening abnormalities in the fetus … (ET Healthworld – PTI, Amit Anand Choudhary, June 24, 2017)

Magnesium Sulfate to Prevent Cerebral Palsy

Women should be given magnesium sulfate at the time of delivery to obtain a blood level between 3.7 and 4.4mg/dL. This will optimize neuro-protection and prevent cerebral palsy in extremely preterm infants.A study was conducted in which 636 women received magnesium sulfate and 1269 recieved placebo.
"Women have traditionally received a standard dose of magnesium sulfate to prevent cerebral palsy in the extremely preterm fetus, but this study is the first to use pharmacokinetic modeling to suggest a therapeutic target maternal serum level we should aim for," said Dr. Kathleen Brookfield, lead author of the Journal of Clinical Pharmacology study.
 "The dose of magnesium sulfate can now be tailored depending on maternal factors and the clinical situation to achieve this target."
‘Magnesium sulfate is indicated for neuroprotection of preterm fetuses; however, the optimal dosing schedule to prevent cerebral palsy is not known’
 An intravenous 4 g loading dose over 20–30 minutes should be given followed by a 1 g/hr maintenance regime to continue for 24hours or until birth, whichever occurred soonest.However, there are insufficient data to define aminimum effective dose of magnesium sulphate.