📰 Want to settle all issues in a friendly ambience: Hasina
Says India should put pressure on Myanmar govt. to resettle Rohingya refugees
•Bangladeshi Prime Minister Sheikh Hasina on Friday said that there are various pending issues between India and Bangladesh, and that they wanted to settle all of them in a friendly ambience.
•Ms. Hasina and Prime Minister Narendra Modi participated in two back-to-back events at Visva Bharati University in Santiniketan — the convocation of the university and the inauguration of the Bangladesh Bhavana — and laid emphasis on the shared cultural heritage.
•“We have sorted out many bilateral issues. There are still some pending ones but I don’t want to spoil the beautiful occasion by referring to them. We want to settle all issues in a friendly ambience,” Ms. Hasina said at the inauguration of Bangladesh Bhavana, a cultural complex with a museum narrating the history of the 1971 Liberation War, on the campus of Visva Bharati.
•Her comment was an obvious reference to the Teesta dispute.
•Ms. Hasina also urged for “cooperation from all to put pressure” on the government of Myanmar so that over one million Rohingya, who had taken shelter in Bangladesh, could return to their country. “We want them [the Rohingya] to return to their country. We want the region to remain peaceful,” she said.
‘A rare example’
•The Prime Minister of Bangladesh gave an emotional speech on how India stood by Bangladesh during its liberation war of 1971 and then in 1975 when her father Bangabandhu Sheikh Mujibur Rehman and other members of her family were assassinated.
•Reflecting on the land boundary agreement which settled the enclave issue, she said it was a rare example of border issues between two countries having been sorted out “amicably.”
•Mr. Modi said the relations between the two countries were born out of “shared struggles of the past” and both were facing common problems like climate change. “The kind of friendship between India and Bangladesh, contributing to each other’s development, is an example which the other countries can follow and learn from,” he said. Underlining the importance of “mutual cooperation,” he said both countries “can learn from each other in areas of public policy and culture.”
•“The progress made by Bangladesh in the area of social sector, particularly in improving the lives of people, is something we can take inspiration from,” he said. Mr. Modi spoke of increased cooperation in areas like connectivity, space connectivity and power. None of the leaders said anything on the sharing of river water.
•Minister of Cultural Affairs of Bangladesh Asaduzzaman Noor told The Hindu on Friday that they are optimistic about discussions on Teesta.
•In her brief speech West Bengal Chief Minister Mamata Banerjee quoted extensively from Rabindranath and Kazi Nazrul Islam to say that the relationship with Bangladesh will “deepen” despite differences.
•“Lot of water has flowed [regarding relationship] between the two countries and a lot will flow, but the relationship between the two countries will flourish,” she said.
•Ms. Banerjee will meet Prime Minister Hasina in her central Kolkata hotel on Saturday evening. Ms. Hasina is also expected to brief the press.
Shared heritage
•Both the leaders spoke about the contribution of Rabindranth Tagore and how the poet is a shared cultural icon between the two countries.
•“He is as important to India as he is to Bangladesh,” Mr. Modi said, adding that Tagore is a “shared heritage between the two countries which could not be divided by the British or even partition of the country.”
•The Prime Minister described the Nobel laureate as the first global citizen whose influence knew no borders.
•Just as the Government of Bangladesh has constructed Bangladesh Bhawan at Visva Bharati, Mr. Modi said the Government of India has taken up the task of renovating Kuthi Bari in Kustia district of Bangladesh.
•Both Mr. Modi and Ms. Hasina made repeated references to the fact that the national anthem of both the countries is by Tagore.
•Ms. Hasina said most of the poems written by Tagore were during his stay in Bangladesh and thus their claim on the poet can be no less than India’s.
•While recounting how fond her father was of the poems by Gurudev, Ms. Hasina announced setting up of two new universities named after Rabindranath Tagore, one at Shahajpur and the other at Kustia, both the places where the Tagore family managed large zamindari estates.
📰 Tipping point in West Asia
So far, Iran’s response to U.S. provocation has been rhetorical but President Rouhani has little room for manoeuvre
•The long-standing Palestinian-Israeli conflict in West Asia has been overshadowed by new flashpoints in the region, both internal and external, since the Arab Spring. The fight against the Islamic State and its offshoots, beginning with Iraq; the Syrian conflict that has drawn in the U.S., Russia, Iranand Turkey; renewed skirmishing between Israel and Iran across the Golan Heights; and the civil war in Yemen where the involvement of Saudi Arabia and Iran has heightened tensions, exposing old regional fault lines. Growing drumbeats of a wider conflict can threaten to overturn the boundaries imposed after World War I.
U.S. withdrawal
•To this volatile mix, new uncertainty was added on May 8 when President Donald Trump announced that the U.S. was walking out of the Joint Comprehensive Plan of Action (JCPOA). A flurry of diplomatic activity followed with Iranian Foreign Minister Javad Zarif visiting Beijing, Moscow and Brussels. In Brussels, he met the E-3 (France, Germany and U.K.) Foreign Ministers and the European Union (EU) High Representative Federica Mogherini to explore how the deal could be salvaged. This was followed by a summit in Sofia later in May where the EU leaders directed the European Commission to activate the Blocking Statute which forbids European companies from complying with the extra-territorial effects of U.S. sanctions. It also asked the European Investment Bank to set up a special purpose vehicle to protect European companies’ investments in Iran.
•Conceived in 1996, the Blocking Statute was a response to U.S. legislation imposing extra-territorial sanctions on companies engaging with Cuba. It empowered the EU to sequester assets of U.S. companies in Europe, equivalent to the penalties imposed on European companies. Eventually, the stand-off was resolved by introducing a waiver. The difference is that in 1996, the Clinton administration was sympathetic to the EU stand but in 2018, the Trump administration is prepared to be tougher than the U.S. Congress!
•This is clear from U.S. Secretary of State Mike Pompeo’s speech at the Heritage Foundation on May 21 that unveiled a dozen conditions for Iran to fulfil including a permanent end to uranium enrichment, unfettered access for the inspectors, end to missile proliferation, ending support to Hezbollah, Hamas, Houthi rebels (Yemen), Shia militias (Iraq) and Taliban and complete withdrawal from Syria. It is not a Plan B but an ultimatum, with no room for dialogue or diplomacy.
Rationale for the Iran deal
•Moreover, it throws down the gauntlet not just to Iran but also to its European partners. Many Europeans have expressed support for curbing Iran’s missile proliferation and testing and finding a way to extend nuclear enrichment restrictions beyond the 15-year timeframe set by the JCPOA. However, rather than walk away while Iran remains in full compliance with its obligations, the E-3 and EU would like to preserve the JCPOA and build upon it. On the other hand, the Trump administration would like to tear up the JCPOA and push Iran to negotiate a new deal under pressure of stronger sanctions.
•The push for JCPOA had come with the realisation by the Obama administration that Iran had successfully accelerated its uranium enrichment programme after the slowdown caused by the Stuxnet attack in 2009. By November 2013 when negotiations began and Iran agreed to freeze its programme, it was in a position to produce enough highly enriched uranium (25 kg) for one nuclear bomb within three months.
•After Libya, Iraq and Afghanistan, kinetic options were off the table and there was no appetite for regime change. Post-Arab Spring, Barack Obama felt that the U.S.’s West Asia policy of dual containment served Israeli and Saudi interests but restricted American options in the region. He concluded that the JCPOA with its stringent verification provisions would slow down Iran’s nuclear programme, freezing it for 15 years, with accompanying sanctions relief strengthening the moderate elements in Iran represented by President Hassan Rouhani, and consequently increasing U.S. diplomatic options.
•In the Trump administration, Defence Secretary Jim Mattis, Chairman of the Joint Chiefs of Staff Joseph Dunford, former Secretary of State Rex Tillerson and former National Security Adviser H.R. McMaster had pushed for retaining the JCPOA but with the induction of Secretary Pompeo and NSA John Bolton, the shift in the U.S. approach is apparent.
A coalition of the willing
•Mr. Pompeo’s speech questions the achievements of the 1979 Iranian revolution and is a barely veiled suggestion for regime change. His speech is reminiscent of the then U.S. Vice President Dick Cheney’s speech in August 2002 when he made the case for a pre-emptive strike against Iraq because Saddam Hussein was a leading sponsor of terrorism, had lied and cheated about his nuclear programme, had oppressed his people who deserved a life of dignity and freedom and was behaving like bully seeking regional domination. In March the following year, the U.S. invaded Iraq.
•Saudi Arabia and Israel had applauded Mr. Cheney’s speech then and today support Mr. Trump’s decision to dismantle the JCPOA. For both countries, the U.S. policy of dual containment (of Iran and Iraq) was a security bonus. They perceived the JCPOA as a move towards ending Iran’s isolation and Israeli Prime Minister Benjamin Netanyahu and Saudi Crown Prince Mohammed bin Salman are Mr. Trump’s original cheerleaders.
•Since 2015, Saudi Arabia has been engaged in a costly adventure in Yemen heightening tensions with Iran. In Syria, Iran has built up its presence by bringing in Shia militias and Islamic Revolutionary Guard Corps advisers to support the Syrian army, leading to growing tensions with Israel. Earlier, Israeli forces would strike weapons locations or convoys in Syria intended for strengthening Hezbollah. Since February, there has been an escalation targeting Iranian efforts to build infrastructure close to Golan Heights. After the U.S. announced its decision to withdraw from the JCPOA, Iran retaliated with a rocket barrage on Golan Heights resulting in a massive Israeli response targeting more than 70 Iranian targets inside Syria.
A critical point
•So far Iran’s response has been rhetorical but Mr. Rouhani has little room for manoeuvre as hardline elements in Iran critical of the deal are gaining ground. He is waiting to see if the Europeans, together with Russia and China, can save the JCPOA that has enabled oil exports to grow from 1 million barrels a day in 2015 to 2.6 million, and permitted access to western goods and technologies in sectors such as oil exploration, aviation, etc. In an address to Iranian officials, Supreme Leader Ayatollah Khamenei said he expected the E-3, Russia and China to take up the matter in the UN Security Council, for the E-3 to stop criticism of Iran’s missile tests and regional behaviour and ensure concrete economic guarantees.
•However, the signs are not promising as large European companies cannot afford U.S. sanctions; Total and Airbus are already pulling out of their multibillion dollar deals. Iran does not want to be accused of killing the JCPOA but soon it will need to decide how long it will continue to abide with its intensive inspections regime. The day it issues that warning or ratchets up its responses in the region towards Israel and Saudi Arabia, it might be the proverbial straw that breaks the camel’s back. Just as it is more difficult to verify Iran’s full compliance with the Nuclear Non-Proliferation Treaty without the JCPOA’s enhanced verification provisions, it is more difficult to justify going to war with Iran when it is in full compliance with JCPOA. The U.S. decision may just have tipped the balance.
📰 Missed opportunity: on cancellation of Trump-Kim summit
A series of avoidable mis-steps led to the unravelling of the Trump-Kim summit
•American President Donald Trump’s abrupt decision to call off his planned June 12 meeting with North Korean leader Kim Jong-un in Singapore has not only dashed hopes of a breakthrough but also heightened risks of a confrontation on the Korean peninsula. It brings a very unusual spell of diplomacy full circle. Unlike the standard practice of announcing landmark summits after working out an understanding on the agenda through quiet diplomacy, Mr. Trump accepted Mr. Kim’s invitation in March and let it be known to the public immediately. That was surprising given the acrimony in both Mr. Trump’s and Mr. Kim’s public utterances over the past year. Once Mr. Trump had cleared the summit proposal, North Korea also moved fast, making a series of gestures meant to smoothen the path for the meeting. In end-April, there was a summit between Mr. Kim and South Korean President Moon Jae-in at a border village in the demilitarised zone. The North pledged to halt nuclear and missile tests, and released three Korean-Americans. And, hours before Mr. Trump cancelled the summit on Thursday, it dismantled its Punggye-ri nuclear test site — critics say it was already inoperable, but that was a symbolic gesture nonetheless.
•The United States should have taken into account these steps by the North rather than harp on the rhetoric. It could also have made some goodwill gestures to lighten the air, such as cancelling a joint military exercise with South Korea. But it went ahead with the military drill, with Pyongyang slamming both Washington and Seoul even as preparations for the summit were under way. Besides, Mr. Trump’s new National Security Adviser, John Bolton, angered the North Koreans by suggesting that Mr. Kim could follow the 2003 Libyan disarmament model. This was followed by Vice President Mike Pence’s threat that Mr. Kim could meet the same fate as Muammar Qadhafi — who was killed by rebels after a NATO-led invasion in 2011 — if he failed to reach a deal with the U.S. This triggered the unravelling of the summit, with the North once again warning the U.S. of a nuclear showdown. Despite the setback, hopes for an eventual one-to-one meeting still exist. In a letter to Mr. Kim, Mr. Trump said the North was welcome to return to talks if it changed its attitude towards the U.S. Pyongyang also issued a conciliatory response, saying that it hoped the U.S. President would reconsider his decision to “unilaterally” cancel the summit. Both Mr. Trump and Mr. Kim should keep in mind the larger goal of de-escalation of tension, if not outright denuclearisation, on the peninsula and work to reschedule the summit. The only sound way to address the Korean nuclear crisis is diplomacy.
📰 PVC pipes: Supreme Court refuses to interfere with NGT fiat
Warning about hazardous lead content in pipes
•The Supreme Court on Friday refused to intervene with an order of the National Green Tribunal (NGT) to freeze its own directive to publish a warning about hazardous lead content in Polyvinyl Chloride (PVC) pipes.
•A Vacation Bench of Justices A.M. Khanwilkar and Indu Malhotra, however, granted petitioner-advocate Ashwini Kumar Upadhyay liberty to approach the tribunal.
Interim order
•The Bench reasoned that the May 2 order was an interim one and the issue could be sorted out in the NGT itself, instead of being litigated in the Supreme Court.
•Mr. Upadhyay’s lawyer and senior advocate Vikas Singh said lead was not globally used because of its harmful effect on health, and industries had phased it out.
•The petition contended that the publishing of the warning would safeguard the people from the adverse health effects of lead-contaminated water.
•On May 25 last year, the NGT asked the Ministry of Environment and Forests to lay down standards for the use of lead in PVC pipes. The measure was to be implemented in consultation with the Indian Bureau of Standards. The tribunal intervened after learning that lead content in water pipes, used in buildings, contained toxic materials.
•The NGT’s decision was based on a petition filed by Jan Sahyog Manch, an NGO, for a directive for remedy to ecological damage caused by lead in the manufacture of PVC pipes. The NGT, however, decided to keep in abeyance its May 25 order after plastic manufacturing units said they were not heard.
📰 The RERA report card
A year after the real estate legislation came into effect, the follow-up in many States has been dismal
•It is a year since the Real Estate (Regulation and Development) Act, 2016 (RERA) came into effect (May 1). But stocktaking presents a dismal picture as far as its implementation and expected benefits are concerned. There is still a long way to go before the real estate sector operates in an “efficient and transparent manner and protect the interest of consumers”, as set forth in the statute’s preamble
A record of extremes
•Only 20 of the 28 States (the Act is not applicable in Jammu and Kashmir) have framed the rules stipulated under RERA to carry out its legal mandate. In some States such as Uttar Pradesh, the Act’s provisions have been watered down in favour of builders by altering the definition of “on-going projects” which need registration under RERA. There is also a dilution on the penalties for non-compliance.
•Similarly, the speedy dispute redress mechanism envisaged by the Act is yet to take shape. Apart from Maharashtra, only Punjab and Madhya Pradesh have appointed a permanent regulatory authority (to be established within a period of a year). To ease the transition, RERA allows State governments to designate an existing body as the regulatory authority until a permanent one is established. This has resulted in 13 States working with only a designated regulatory authority. West Bengal is yet to even designate a regulatory authority.
•Additionally, only six States have set up the online portal contemplated by the Act. In the Northeastern States, RERA has been challenged on certain constitutional grounds — of land belonging to the community and autonomous councils.
•In contrast, Maharashtra, which has established both the regulatory authority (Maharashtra Real Estate Regulatory Authority, or MahaRERA) and the appellate tribunal, has shown that with earnest action, the Act and the establishment of the permanent regulator can have a positive impact in reassuring real estate purchasers. MahaRERA’s online portal has led to builders registering projects and a high degree of compliance in terms of registration by real estate agents. This along with fast track adjudication of consumer complaints has made the MahaRERA an example of how other States need to implement the Act.
Focus on the consumer
•Besides procedural compliances, implementation of the Act eventually needs to focus on consumer interests. In these efforts, rudimentary compliance must be eliminated and practicality adopted. For example, in U.P., a large number of new projects are concentrated in Ghaziabad or Gautam Budh Nagar/Noida. However, even though the Act provides for State governments to establish more than one regulatory authority, the interim regulator designated in U.P. is located in Lucknow. This has led to consumers being inconvenienced as they need to travel to Lucknow to file their complaints.
•One of the most notable provisions of the RERA is the requirement to keep 70% of funds received for a project in a separate escrow account, a step to prevent a diversion of funds which usually happens and in turn results in project delays. Perhaps because of this stipulation and the overall ill-health of the real estate sector, many developers are now facing insolvency proceedings under the new Insolvency and Bankruptcy Code (IBC). Most of these pertain to projects which are not registered under RERA. And while the Insolvency Law Committee has proposed to treat home buyers as unsecured financial creditors, the insolvency process has many other complexities which can tie up consumers for much longer than they may have bargained for. There also appears to be a potential conflict developing between the IBC and RERA which needs to be checked as it would be against consumer interests.
•To overcome some of these challenges, there is heightened interest in real estate investment trusts. Many promoters hope that the crunch they now face due to credit freezes from banks may get resolved by cash flows from institutional investors in the form of these trusts.
•RERA also provides for the regulation and maintaining of records of real estate projects, the objective being to facilitate the growth and promotion of a “healthy, transparent, efficient and competitive real estate sector”. Given that the Central government is keen to curb black money, a large part of which has its origins in or finds its way into real estate, it needs to ensure that States give full effect to RERA.
Some course correction
•Recently, the Central government notified June 30 as the date by which all States have to do away with dilutions and bring in all incomplete projects within the ambit of RERA. This date is also the deadline by when permanent regulators have to be formed and for the websites of all States to become functional.
•One hopes that in due course, developers will recognise that they can no longer operate with impunity by arbitrarily escalating costs of construction or missing timelines without being held responsible.
•Satvik Varma is a litigation counsel and corporate attorney based in New Delhi
📰 A cure for medical malpractice
Three families, who each lost a child in what they consider to be cases of malpractice, have started a movement to seek strict regulation of private hospitals. Vidya Krishnan reports
•On July 30, 2011, at 3.26 p.m., 10-year-old Yash Arora was declared dead at Gurugram’s Medanta, the Medicity, one of India’s leading super-speciality hospitals. Yash had gone through six readmissions, two liver transplants, and numerous bouts of infections over nine months. The bill for his treatment amounted to ₹45 lakh.
•The Aroras are from Rudrapur, a small town in Uttarakhand. They had brought their son to the hospital for liver treatment in March 2010. Yash’s father, Pankaj Arora, 42, claims that the doctors advised a liver transplant on the assumption that the patient’s family could afford it. “As soon as they discovered that we couldn’t, they started treating the patient differently,” he says. After Yash’s first liver transplant on April 1, 2011, Arora says the boy was discharged with an infection that caused the transplant to fail.
•As a result, Yash had to be readmitted in a few days, on April 5. “He had his second liver transplant on April 20, after which the hospital put him in a ‘shared room’ with a patient suffering from drug-resistant tuberculosis,” says Arora. “This led to a lung infection,” adds his lawyer Piyush Chabra. According to Arora, the hospital put Yash in a ‘shared room’ only because they realised that the family could not afford the isolation ward, which is mandatory for immunocompromised patients who have received new organs.
Seeking closure
•The Aroras were convinced that Yash was a victim of medical malpractice. But for three years they couldn’t do anything more than grieve for their only child. “I found the emotional strength to look at legal options only after the birth of my second child in 2014,” Arora says. Seeking closure, the family filed a Right to Information application with the All India Institute of Medical Sciences (AIIMS) on May 14, 2015. Arora’s first question was regarding the isolation protocol for liver transplant patients. The answer from AIIMS confirmed the family’s worst suspicion: “Absolute isolation is required.”
•In response to a question about the level of care to be given to immunocompromised patients, AIIMS listed several precautions to be followed that included providing a separate room in the isolation ward for the patient; masks, gloves and eye protection for those entering the room; disinfecting medical instruments; and incinerating used needles and syringes.
•The patient’s medical records and discharge certificate show that the doctors at Medanta initiated treatment for drug-resistant TB for Yash on July 6, 2011. Arora claims that the hospital did this without informing the family. “After my son died, I googled ‘ATT’. Only then did I realise that they had been treating him for TB. Yash caught TB only because the hospital put him in a room with a TB patient. This was a clear and absolute violation of medical protocol. This was much more than negligence. This was a death sentence,” says Arora.
•Seven years after his son’s death, Arora’s life revolves around documents — dozens of files of medical records, paperwork tracking legal proceedings, newspaper clippings on medical malpractice, and treatment protocols set by the government. Despite his meticulous data-gathering, there hasn’t been much progress on the legal front.
•Arora believes that the police never made a serious attempt to investigate the charges of medical negligence that he had made in his FIR against the hospital. Registering the FIR wasn’t easy either. It was only after directions from a district court that the police obliged. Subsequently, a medical board at the Postgraduate Institute of Medical Education and Research, Chandigarh, examined the medical records and dismissed the case without taking testimonies from the family. The family has appealed against the medical board’s decision in the Gurugram Sessions Court, where the case is currently pending.
Cases in the spotlight
•Arora is not the only parent or family member running from pillar to post. In Delhi, a few other families have found that they share similar stories of grief and loss, which they attribute to medical malpractice, and which have drawn them together to form a small movement against medical malpractice in India.
•Two such cases grabbed the headlines last year. During the dengue season (July to mid-September) in 2017, a girl named Adya Singh and a boy named Shaurya Parmar, both seven years old and unrelated, died in two state-of-the-art multi-specialty private hospitals: Fortis Memorial Research Institute in Gurugram and Medanta, respectively. Adya and Shaurya died of dengue.
•Adya’s family was handed a ₹16 lakh bill by Fortis and Shaurya’s family was given a bill of ₹15 lakh. The National Pharmaceutical Pricing Authority (NPPA) analysed the medical bills and found that the hospital had markup drugs and consumables from 200% to 1,700% in some cases. Fortis denied allegations of overcharging. To a specific query posed by The Hindu on the justification for this markup, Fortis handed out seven press releases in response. It maintained that the profit margins are not illegal as they do not violate the Drug Price Control Orders. The hospital said: “It should be noted that our end price to the patient is very much in line with what other private hospitals in India charge. Looking at individual prices of any single item as a standalone takes the margin/ profit topic out of context.” It added: “All consumables are transparently reflected in records and charged as per actuals. A total of 750 pairs of gloves and 600 syringes during a 15-day stay is justifiable and acceptable when the patient is in an ICU setting.”
•Adya’s father, Jayant Singh, and Shaurya’s father, Gopendra Parmar, reached out to the media in desperation. When they both made an appearance on television, Arora knew he had to meet them. “When I saw Jayant Singh and Gopendra Parmar on TV, I immediately realised that I could not let them make the mistakes that I did, such as wasting crucial time registering FIRs and retrieving medical records. We got in touch soon after that, and have been speaking to each other almost every day. My only goal now is to make sure that what happened to me should never happen to another family,” says Arora.
•Over the last seven months, the conversations between the families has acquired a sense of purpose and urgency. Following Adya’s death in October last year, Singh created a Facebook page called Fight Against Healthcare Corruption. It has quickly become a platform where about 6,000 people across the country have connected with him with their own stories. “Everyone who got in touch has faced similar problems. They all want to know how my case got highlighted by the media, and what they should do. They want to join the fight for justice,” says Singh. These families are now demanding that an independent body be set up, with civil society representatives, to investigate cases of medical malpractice.
•Amid mounting pressure from the affected families and the attendant media glare, Adya’s death led to the filing of a public interest litigation (PIL) in the Supreme Court. The PIL demands the regulation of India’s unregulated private health sector, from neighbourhood clinics to corporate hospitals, under Article 21 of the Constitution, which guarantees the right to life and personal liberty. On March 23, in response to the PIL, the apex court sent notices to the Medical Council of India (MCI), the Union Health Ministry, Haryana’s health department, the NPPA, and doctors at Fortis hospital. The PIL sought to turn the spotlight on “a larger systematic and structured loot of desperate patients... which is engineered by and between pharmaceutical companies, diagnostic labs, doctors and ultimately corporate hospitals.”
•Singh has high hopes from the PIL. “This is not about my daughter any more. It’s no longer just a personal battle. The experience of most people attests to the fact that the police, the medical councils, and the government health departments work against the patients. The entire system is fighting against patients and working for pharmaceutical companies, insurance companies and private hospitals instead of regulating them,” he says.
Regulate the private health sector
•In 1978, India signed the Alma Ata Declaration at the World Health Assembly, promising “Health for All” by 2000. Following up on that promise, with the aim of reaching as many patients as possible, the Indian government sought to increase the number of hospitals in the country by roping in the private sector. It allowed banks to fund privately owned hospitals. In 1983, Prathap Reddy set up Apollo hospital in Chennai, and thus was born India’s first corporate hospital chain.
•“Back then, there was no debate on laws to regulate clinical establishments. This was partly because we did not see this level of medical negligence at that time. What we see now is actually medical malpractice, driven by the urge to make inordinate profits. It is a peculiarity of corporate hospitals,” says Amit Sengupta, convener of Jan Swasthya Abhiyan, a network of civil society organisations working towards securing the right to health for all.
•The Central government has been pushing for the implementation of the Clinical Establishments (Registration and Regulation) Act, 2010, or the CE Act, which seeks to regulate all clinical establishments in India and set treatment guidelines for common diseases and conditions. The States have to ratify this law and implement it. While the law is in effect in Arunachal Pradesh, Himachal Pradesh, Mizoram, Sikkim and all the Union Territories (except the National Capital Region of Delhi) since March 1, 2012, most States haven’t made provisions to implement it. In Haryana, for instance, where Arora, Singh and Parmar lost their children, the Act has been ratified but not implemented. In Delhi, it has been neither ratified nor implemented, says R.K. Vats, Additional Secretary, Union Health Ministry.
•Families who have alleged overcharging by private hospitals have found common cause with the government, which has for years failed to regulate the booming private sector health industry. The Health Ministry’s recent interest in regulating the sector ahead of an election year perhaps stems from the rollout of the National Health Protection Scheme (NHPS).
•“When the NHPS is rolled out, most of our patients will be going to private hospitals,” says Vats. “We have told the State governments that while the Centre will give 60% of the funds for the NHPS, 40% will come from the States. It is in the interest of State governments to see where their money is going. There is no moral justification for this level of overcharging and overtreatment.” The Health Ministry is “seized of the matter” and private hospitals cannot avoid regulation for long, he adds.
•Proving medical negligence in India is almost impossible. There is only one major success story from which families can take inspiration. That victory was in 2013. Kunal Saha, an American citizen and doctor of Indian origin, had taken Kolkata’s AMRI Hospitals to court. In a legal battle that lasted 15 years, Saha proved that his wife Anuradha, who died in 1998, was a victim of “gross dereliction of duty” by the doctors. The patient, herself a doctor, was suffering from toxic epidermal necrolysis. This is a rare and painful condition where the top layer of the skin detaches from the lower layer all over the body. The doctor treating her administered a higher-than-recommended dose of a steroid called Depomedrol. Saha was awarded a compensation of ₹11 crore, the highest amount in a medical negligence case in India.
A reminder but no deterrent
•This case and the record compensation were hailed as a turning point in Indian medico-legal history. The Supreme Court judgment was deemed a “deterrent and a reminder” to the medical community. But five years later, it has become clear that the case hasn’t quite made an impact on the practices of corporate medical hospitals. At any rate, it has not served as a deterrent.
•Saha says that he has “absolutely no doubt” that the lack of cooperation from the medical community is a major factor for the rising incidence of “medical negligence” in India. In 2001, he set up People for Better Treatment, an NGO that works with victims of medical negligence. “I managed to get justice for Anuradha’s wrongful death,” he says. “But it would have been impossible had I not been a doctor myself. Living in the U.S. was tremendously helpful in obtaining opinions from renowned medical experts. It is noteworthy that while I was able to obtain honest medical opinions from different countries, including the U.S., France, Austria and Canada, doctors in India, where most of my medical school classmates practice, were mostly unwilling to give their honest medical opinion in writing or testify before the court of law.”
•In Indian law, a case of medical malpractice can be proved only by a committee of peers — by doctors who are members of various State Medical Councils. “Doctors do not go on record against other doctors, and especially against corporate hospitals. Therein lies the problem with proving medical negligence cases,” says Sengupta.
•This is also borne out by the MCI’s own data on action taken against errant doctors: Since 2012, only 167 doctors have been temporarily blacklisted by the MCI, with the duration of the suspension ranging from three months to five years. Not one doctor has lost his or her medical license permanently. While information about the number of complaints received, disposed of, and pending is available in annual reports, data on action taken against doctors are not.
•“The disciplinary action differs from case to case. The suspension of medical licence could range from one week to one month. In some cases it could even be three months,” says Girish Tyagi, Registrar of the Delhi Medical Council. Has any doctor permanently lost her license to practice medicine? “Not to my knowledge,” he says.
Uniting under one roof
•Today, after months of phone calls and hundreds of WhatsApp exchanges, five of the 12 affected families will meet for the first time in New Delhi. They will hold a press briefing to announce the formal launch of their pressure group for sustained advocacy against medical negligence and malpratice. The group has decided to call itself the Campaign for Dignified and Affordable Healthcare.
•The foundation for its formation was laid at a meeting on March 30, where the affected families, lawyers, activists, and journalists gathered in the office of the All India Drug Action Network (AIDAN) in Lajpat Nagar in Delhi. AIDAN is an independent network of many NGOs working for patient rights. It has become a coordinator of sorts for the families that want to pool their resources together for a common cause. “We have been overwhelmed by the number of families that have come forward after Jayant’s and Gopendra’s case became public,” says Malini Aisola, a health rights activist associated with AIDAN.
•The immediate reason for the March 30 gathering was a press briefing on Medanta’s decision to refund ₹15 lakh to Parmar, following the intervention of the Health Ministry and relentless media scrutiny. Medanta refused to comment when asked for its response.
•Every such meeting is an opportunity for the families to bond with each other, go into a huddle and come up with the best strategy to amplify their voice. As cameras were being set up, other families, new entrants to the pressure group, began briefing journalists about their own cases of medical malpractice. They had also brought their lawyers with them. “The families learn from each other’s experience, while activists and lawyers come up with the best strategy to highlight each case. The brainstorming sessions between the families, lawyers and activists gives all of them hope. More importantly, it gives them a strategy,” says Aisola.
•It was at one such meeting that Singh told Arora that he should approach Haryana’s newly constituted district medical board to look at cases of negligence. “When Yash’s death was supposedly being investigated, back in 2015, no testimonies were taken from the families,” says Arora. “The medical board simply submitted half a page finding to the effect that there was no negligence, without even looking at the FIR.” He has decided to take Singh’s advice and continue his battle for patient rights, and it is no longer his battle alone.
📰 ‘CoC is not proactive enough’
Insolvency and Bankruptcy Code not being put to optimum use: IBBI chairman
•The Committee of Creditors (CoC) is not being proactive enough in dealing with the cases, Insolvency and Bankruptcy Board of India (IBBI) chairman M.S. Sahoo said on Friday.
•Mr. Sahoo, who is the head of the regulatory body of the Insolvency and Bankruptcy Code 2016 (IBC), was of the view that the best of the code was not used.
•Speaking at a FICCI conference, Mr. Sahoo said, “It is the role of the CoC to tell a business what all the possibilities are, so that the resolution plan can address all the issues. Somehow, we are not making optimal use of the law. We are of the logic that we should maximise the value because the code said so, but the code says that it is of maximisation of value of assets for the corporate debtor. Not for a stakeholder or a set of stakeholders.”
•CoC comprises both financial and operational creditors. “While resolution tries to keep the company alive, recovery kills,” he said and emphasised CoC’s need to focus on the former.
‘Higher responsibility’
•Further highlighting the CoC’s responsibility, he said, “Today, CoC is in the position of a custodian or a trustee. So, it has a higher responsibility to look after the interest of all stakeholders. The objective is that we work in unison to resolve insolvency through a process that is not adversarial.”
•Speaking on the 75% creditor approval required for plans to be passed, FICCI president Rashesh Shah said, “We saw a lot more cases go into liquidation just because 27-28% of the creditors did not agree with the plan. The unintended consequence was that a lot of good plans were getting rejected because small creditors could hold up the whole process. We think the threshold of rejection of a plan should be brought as low as possible. It should be about 51%.”
📰 Out-of-turn coal to PSE utilities irks IPPs
APP urges Centre to ensure level field
•The Centre has directed Coal India to supply coal out-of-turn to State and PSU utilities, a move that has irked independent power producers (IPPs) that are already reeling under a shortage of the fuel.
•“ln order to avoid possible shortage of coal at thermal power plants it has been decided that wherever it is operationally feasible based on various factors like coal stock availability, where suitable transport arrangements are in place, out-of-turn coal allotment may be made to State and central PSU gencos to meet the surge in coal requirement for power generation,” the Coal ministry wrote in a letter to Coal India.
•IPPs, which are under stress on account of high levels of debt and less than optimum plant load factors that have left them struggling to keep the projects afloat, are not amused.
‘Sanctity of contracts’
•“Discrimination based on ownership of assets puts into question the sanctity of commercial contracts signed by CIL,” said Ashok Khurana, director general, Association of Power Producers (APP). “This would lead to more stress for the bankers. This is against the PM’s stated policy of level playing field and ease of doing business.”
•The APP has written to the government seeking a level playing field. “We have requested that same priority should be extended to private sector plants. In fact prioritisation beyond contractual obligation should be on basis of efficiency, so that same quantity of coal can produce more power,” Mr. Khurana said.
•While state-owned NTPC currently operates at a plant load factor (PLF) of more than 70%, IPPs are averaging about 55% PLF. The scramble for scarce coal has coincided with summer when demand for power is setting new records. This week, India’s electricity demand crossed 170 gigawatts.
•“Centre creates hurdles for coal starved power projects by prioritising PSU run projects,” the CEO of an IPP, said on condition of anonymity. “It will take a heavy toll on the ailing sector.”
