The National Accreditation Board for Hospitals and Healthcare Providers (NABH) has initiated surprise assessment in hospitals following a TOI report about several, including those accredited by NABH, employing non-allopathic doctors for clinical duties.
NABH has conducted 15 surprise on-site assessments of hospitals in Maharashtra, where this practice is particularly prevalent. “It has been decided to do a larger surprise surveillance exercise in all states over the next three months to find out of the severity of the problem,” Dr Atul Kochhar, the CEO of NABH told TOI.
Last month, TOI had reported that many hospitals, including large corporate ones and mostly in big cities, are employing Ayush doctors as resident medical officers, emergency casualty officers and even to manage ICUs at night. Following the report, some hospitals have taken down the advertisements they had placed for Ayush doctors on various job sites with details about the kind of clinical duties they would be involved in. However, while hospitals have become more careful about placing ads directly, they are relying on ads through placement agencies.
‘Need MBBS docs for services, Ayush staff not counted’
If any state government allowed Ayush doctors to be involved in any activity concerning allopathy, some hospitals could take advantage of this permission to utilise them in mandatory services assigned to MBBS resident medical officers,” said Dr Kochhar. If a state has not notified that an Ayush doctor can practice allopathy, allopathic hospitals hiring them for patient care would be illegal.
Surprisingly, while NABH believed that 13 states allow Ayush doctors to practice allopathy, mostly after a bridge course, there are just three states where this is allowed — Maharashtra, Gujarat and Haryana. In Uttar Pradesh and Jammu and Kashmir, Ayurvedic and Unani doctors are allowed to prescribe a restricted number of allopathic medicines and do certain procedures after a bridge course, but only in public health facilities.
Many of the hospitals with Ayush doctors doing clinical duties are accredited by the NABH. The NABH claims “high quality of care and patient safety” as the objective of its certification and is relied upon by the Central Government Health Scheme (CGHS) and the Ex-Servicemen Contributory Health Scheme and (ECHS) meant for armed forces veterans and their dependents. NABH has also partnered with the Insurance Regulatory and Development Authority (IRDA) to carry out entry level certification of hospitals, which has been made mandatory for providing cashless insurance facility. On this assumption of better quality and standards, NABH accredited hospitals are allowed to charge more for every procedure and fix higher bed charges too.
Dr Kochhar told TOI that NABH standards require the hospitals to have adequate MBBS resident medical officers to manage round-theclock services. “NABH specifies the mandatory norms in terms of competence of staff and assesses it at the time of accreditation and surveillance,” said Dr Kochhar, adding that Ayush staff are “not counted towards the required complement during assessment”.
“Ayush doctors, even if appointed in accredited hospitals, cannot be assigned and involved in direct clinical care. The practice of their being deployed for direct care, it appears, is during the time between accreditation assessment and surveillance assessment,” stated NABH in response to TOI’s queries. Assessments are done every two years.
As per NABH standards, every staff should have documented job description and for Ayush doctors, it includes reception and instructions for patients, following up a consultant’s advice, helping with documentation and screening of general parameters.
No invasive procedures are allowed. Most hospitals that hire Ayush doctors claim they only do what is in the job description. However, many patients and their families refute this claim.
NABH pointed out that it was not a regulatory body and that since accreditation is voluntary, a majority of hospitals are not accredited. Though the practice of using Ayush practitioners for clinical duties is more widespread in Maharashtra and Gujarat, it is being done in many states where the government does not allow this as Ayush doctors can be hired for as little as Rs 20,000 per month, while MBBS doctors might have to be paid Rs 40,000. However, patients are never told that they are being attended by Ayush doctors nor are their bills any less because of lower salary costs.
“Hospitals claim these Ayush doctors work as assistants to allopathic consultants, but that’s not true. It is just backdoor entry of people from entirely different systems of medicine into allopathy. It is being challenged by the Indian Medical Association,” said Dr Jayesh Lele, secretary of the Hospital Board of India, a wing of the IMA.