Crosspathy:
Article courtesy:
DR.C. SRINIVASA RAJU
Chairman - Hospital Board of India - IMA AP STATE.
Member-crisis management committe-IMA H.Q.
NR PET
ELURU
A.P.
The present times?
Verma et al. conducted a survey of OPD prescriptions of a
tertiary care allopathic hospital and an ayurvedic hospital, both belonging to
government setup.
The study found that
the prescriptions from tertiary care hospital had 12% ayurvedic drugs, while
prescriptions from ayurvedic hospital had 58% allopathic drugs.
In
2010, “The Common Review Mission (CRM) of the Union health ministry
which came to one of the states, to
review the National Rural Health Mission (NRHM) has suggested the state
government to depute Ayush doctors at the primary health centres (PHCs) if
doctors are not available in the state.”
Is it legal?
No.
Is it justifiable?
No.
Primary health centres have allopathic medicines. Will these
doctors from Ayush group prescribe allopathic drugs about which they are not
well acquainted or their own medicines or alternatively prescribe medicines
from two systems i.e. allopathic and their own system?
In case a serious adverse reaction occurs following
allopathic drug administered by Ayush doctor, he/she may not be able to handle
the situation appropriately. Who shall be held responsible in such a situation:
Ayush doctor or the appointing authority?
Who is a Genuine
Medical Practitioner?
Any individual who has acquired a qualification / degree
from an institute which is recognised by its registering authority, like
Medical Council of India, Dental Council of India, Homoeopathic, Ayurvedic or
Unani System of medicine, and is registered with respective authority is a
genuine medical practitioner for that specific system.
In case an individual
acquires degrees for two different systems, eg, a person who had passed BHMS
and later studied and passed MBBS examination, can practice homoeopathy as well
as allopathy provided he/she is registered with both authorities. All other
persons should be treated as quacks or fraudulent medical practitioners.
Who is the quack?
According to Supreme Court any person who claims to be
expert is a quack unless he has an adequately standardised training /
qualification for these supposed / specific specialties
What is the
difference between ANMs,compounders and Community Health Workers?
The issue regarding community health workers prescribing or
dispensing some medicines is very relevant and pertinent.
A compounder, nurse
or auxillary nurse (ANM) has to pass examination after a stipulated period of
training of 3-4 years, and then is supposed to administer any medicine which
has been prescribed or advised by a doctor. Compounders and nurses are not
permitted to administer any medicine on their own.
But, community health workers are permitted to administer
some medicines by themselves.
So, It
would be pertinent to have opinion of legal experts on this issue.
What is modern
medicine?
The modern medicine is evidence based, peer reviewed,
technologically assisted, preferred by meritorious students and hence probably
more accepted.
Is there any
difference between clinical care and clinical research?
Yes!
The Supreme Court forbids prescription or administration of
drugs from other systems but research is not forbidden.
Any person who prescribes a drug from other system is liable
for legal action by a court of law and suitable punitive action by respective
authority like Medical Council of India, Dental Council of India, etc.
An allopathic doctor
cannot prescribe Liv 52 or Calcaria Phos, very popular ayurvedic and
homoeopathic drugs respectively. Similarly, a vaid or a homoeopath cannot
prescribe Amlodipine in hypertension, Valproic acid in epilepsy and any
antibiotic
What is valid legal
prescription?
Supreme Court is very
stringent against crosspathy: the apex court laid out few directions about
issuing the valid prescription.
The honorable SC in, C A no. 3541 of 2002, Martin F. D’Souza
vs. Mohd. Ishfaq has observed that:
·
No prescription should ordinarily be given
without actual examination.
·
The tendency to give prescription over the telephone,
except in an acute emergency, should be avoided.
·
A doctor should not merely go by the version of
the patient regarding his symptoms, but should also make his own analysis
including tests and investigations where necessary.
·
A doctor
should not experiment unless necessary and even then he should ordinarily get a
written consent from the patient
Which Products can be
prescribed by anyone?
The products which are food supplements can be prescribed or
purchased by any one, because no prescription is required. Thus over the
counter (OTC) drugs like Strepsil, Vicks, Hajmola, Ferradol, Sharkoferrol,
Chyavanprash and protein preparations can be prescribed by any one.
What is the drug’?
The word drug is derived from the French word ‘drogue’ a dry
herb.
Drug is defined as any substance used for the purpose of
diagnosis, prevention, relief or cure of disease in man or animal.
According
to WHO “a drug is any substance or product that is used or intended to
be used to modify or explore physiological systems or pathological states for
the benefit of the recipient.
According
to The Drugs and Cosmetics Act, it includes all the preparations,
whether allopathic or ayurvedic.
Who can handle
drugs-sale,distribution,etc?
A drug can be sold or supplied by the pharmacist or druggist
only on the prescription of a “registered medical practitioner” defined under
Indian Medical Degrees Act of 1916.
What are the Licensed
Herbal Products ?
Some therapeutic indices mention group of ‘licensed herbal
products’ under many sections. Bonnisan is mentioned under section drugs for
gastrointestinal system, Liv52 under section drugs for hepatic disorders, Abana
is mentioned under section drugs for cardiovascular system, Eves Care for
menstrual disorders, Septilin as Immunostimulant in various infections.
Does Allopaths are
permitted to prescribe Ayurvedic drugs mentioned under licensed Herbal
Preparation?
Yes/no-ambiguity!
Is it legal, that
some private hospitals employ Ayurvedic or Homoeopathic doctors as resident
medical officers under supervision of consultants?
It’s illegal . This could be considered fraud with the
patients who attend that hospital for allopathic treatment by allopaths.
Even though, these AYUSH persons are trained and qualified
personnel and as their observations may
be accurate but they have to administer allopathic medicines as advised by the
consultant as like any compounder or nurse. Then it’s apt to appoint nursing
staff who are well trained in allopathic system.
So,don’t
appoint the AYUSH persons as RMOs in modern medicare hospitals.
So there is a urgent need for the Government, judiciary and
Medical Councils to look into these vital issues and to frame clear cut
guidelines keeping in mind the situation and facilities in our country..
There shouldn’t be confusion or paradox in legal, ethical or
evidence based scientific recommendations.
This is important so as to prevent / decide the cases of
medical malpractice and negligence in future.
At any
cost,we must stop the crosspathy.
Role of IMA?
Circular by the Union Health secretary requesting the state Governments entertain
AYUSH to practce modern medicine.
IMA filed the petition against this federal
order.
IMA has to
create the platform to converge all stake holders and extract legitimate
conclusion once for all.
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FAVORING CROSSPATHY
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Opposing crosspathy
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The other side(govt side ) of this issue is -------
That in many developing countries where rural health is
important and qualified practitioners are not available the authorities are
appointing community health workers (CHW). These CHW are provided with some
of the common medicines which can be used for domiciliary management of
common illnesses. Do they have the deep and complete knowledge of these
illnesses or medicine? If an unqualified CHW can prescribe or dispense
medicines why a graduate in medical curriculum (traditional or homoeopathic)
cannot do so?
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“The Apex Court in the Poonam Varma vs. Ashwin Patel case
has ruled that if you are practicing any other system it is Negligence per
se.
In judiciary the decision of SC will always be binding on
lower courts unless and until SC reviews its decision
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Paradoxically, some High Courts eg. Tamilnadu HC (Tamil
Nadu Siddha Medical Graduates Association, Vs. Smt. Letika Saran, Cont. P.
No. 775 of 2010 decision dated 23.07.2010) and State commissions (Manpreet
Kaur Vs. Dr. Veena Ghumber I 2005 CPJ 63) have pronounced that a practitioner
of Indian system of medicine can prescribe drugs of modern medicine
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S u p r e m e C o u r t j u d g e m e n t : A person can
practice only that therapy for which he/she has a degree / recognised
qualification or experience.
Medical Council of
India. Clause 1.1.3 of MCI prohibits the allopathic practitioners to
prescribe ayurvedic or homoeopathic drugs.
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