Problems and pitfalls with various registrations for nursing homes

04/23/18 DR. MAHESH BALDWA 1
Problems and pitfalls with various
registrations for Nursing Homes/hospitals &
common discomforting allegation & charges
by Dr. Mahesh Baldwa,
M.D.,D.C.H,LL.B.,LL.M.Ph.D(Law)
PAPER SETTER & EXAMINER FOR LLM, PROFESSOR
OF LAW TO POSTGRADUATE STUDENTS OF
UNIVERSITY DEPARTMENT OF LAW, UNIVERSITY OF
MUMBAI, MUMBAI 400032
FORMERLY ASSISTANT PROFESSOR OF PEDIATRICS
AT T.N. MEDICAL COLLEGE AND NAIR HOSPITAL &
Grant Medical college & JJ Hosp. MUMBAI

BMC offices issue following
registration/ certificates / books
 Nursing Home registration, fill form in March
every year with relevant documents, submit in
ward office, pay fees, fill computer form, MOH
will issue registration for 1 year, renew every
year.
 Shop & establishment registration, fill form
before 15th
November every 1 year/3 yrs, pay
charges, valid registration issued. Maintain
various labour registers.

MTP registration for place
MTP registration for person
 MTP registration for place, fill form and submit to F south
ward, they will send to ward office, inspection done, state
govt. Will issue MTP registration with consent form and
register for place, person, anesthetist, blood bank for 12
weeks then apply for 20 weeks in similar fashion.
 MTP registration for person is available for MBBS who is
trained by doing 20 MTP’s & obtains certificate from such
recognized institute, MCI recognized MD Gyn-Ob & DGO
are exempt.
 Medico-legal risks:-
 Minor/ unwed/family dispute/divorce/+ 20 weeks
 Special consent form as per MTP act and register

Tubal ligation registration
Birth registration books
 Tubal ligation registration, fill form and submit to local
ward, they will send to F/S ward office, inspection done,
issue TL registration for place, person, anesthetist by
MCGM.
 TL deaths need to be informed to police & BMC
 Birth registration books- written request on letter head
and submit to local ward-Birth registration books, fill
birth and submit with in 15 days of delivery.
 Late entries & defaulters have to submit affidavit and
Rs.523/- fine
 Wrong entry in record books needs court order to correct
birth record of BMC

Still birth registration books
Death certificates books
 Still birth registration books- written request on letter head and
submit to local ward- serial no. still birth registration books issued.
 Medico-legal safety-Fill still birth forms for +++ 12-14 weeks
abortions to avoid disposal in garbage or biowaste
 Death certificates books- written request on letter head and submit
to local ward- serial no. Death registration books issued.
 DC only for natural deaths.
 Take signature of responsible authorized person on counter foil
 All violent / unnatural deaths needs police information and PM
 Avoid cardio-respiratory failure as cause
 Fill eye donation, death with in seven years of marriage column
 Maternal death, death after TL, MTP deaths, deaths due to septic
abortion, tetanus, gas gangrene, burns needs police information

Common allegations and complaints BMC
office
 Change of user from residential to nursing home
use- complaints by society or individuals
 Separate BMC water connection & water charges
for nursing home/hospitals- complaints by
society or individuals- still high with out OC
buildngs
 Separate drainage for maternity hospitals
-complaints by society or individuals
 Biomedical waste disposal complaints/marshal’s

Common allegations and complaints to
BMC office
 Separate stair case/entrance complaints by society
or individuals (Now, BMC has decided not to take
action for Separate stair case).
 Using common lift complaints by society or
individuals
 Property tax assessed higher for Nursing homes and
where building does not have Occupation certificates
complaints by society or individuals
 Complaints for parking vehicles by patients
 Complaints for patients making common passage
dirty and obstructing free common passage04/23/18 DR. MAHESH BALDWA 7

various authorities / police / court
 Complaints by society or individuals for leakages
from bath and WC and common drain pipes
 Complaints by society or individuals for leakages
caused by shifting toilets and making structural
changes
 Making internal staircase by breaking slabs
between floors
 Digging ground floor and making basement

 Placing of overhead loft water storage tanks
 Making under ground water tanks for receiving BMC
water supply with out permission
 Placing water tanks in common passages and premises
or chowk or terrace
 Drawing BMC water by electric pump suction.
 Using common borewell water of society
 Putting up a separate borewell for hospital/Nursing Home
 Putting up Reverse osmosis machine in common
passages and premises or chowk or terrace

 Placing too many split AC machines in common
premises or chowk or terrace
 Placing generator causing noise in common
premises or chowk or terrace
 Placing oxygen cylinders in common premises or
chowk or terrace
 Placing cooking gas cylinders in common
premises or chowk or terrace.

 Drying of clothes in common premises or chowk
or terrace.
 Hospital Kitchen activity in common premises or
chowk or terrace.
 Putting up sign boards/self illuminating boards in
common premises or entrance of building or
terrace or dead wall
 Temporary placement a serious patient or dead
body in common passage till hearse / ambulance
arrives

A study by CEHAT showed a few of
many identified problems with
Mumbai Hospitals/Nursing Home
 One seventh of them are actually in sheds or lofts in
slums
 77 percent do not have scrub rooms
 Less than one-third have qualified nurses
 Nursing Home have operating theatres less than 5
square metres
 A majority of them claim to be maternity homes, but only
one-third have labour rooms
 38 percent of all wards and 50 percent of the beds in
them are dirty and most are poorly lit

This Information may be useful to you:-
The Maharashtra government has announced a 400 per cent
rise in the FSI for private hospitals in the suburbs
 The state Cabinet has, however, put in two riders.
 First,
 private hospitals will have to pay 20 per cent of
the land price as per the ready reckoner to
purchase additional FSI.
 Second,
 a private hospital which avails of a higher FSI
must keep 10 per cent of its total beds reserved
for the people who belong to the economically-
weaker section and people below the poverty
line.

Medical Records as per MCI
 1.3 Maintenance of medical records:
 1.3.1 Every physician shall maintain the medical records
pertaining to his/her indoor patients for a period of 3 years
from the date of commencement of the treatment in a
standard proforma laid down by the Medical Council of
India and attached as Appendix 3.
 7.2 If he/she does not maintain the medical records of
his/her indoor patients for a period of three years as per
regulation 1.3 and refuses to provide the same within 72
hours when the patient or his/her authorised
representative makes a request for it as per the regulation
1.3.2.

Medical Records FORMAT FOR MEDICAL RECORD
 (see regulation 3.1) of MCI
 Name of the patient:
 Age:
 Sex:
 Address:
 Occupation:
 Date of 1st
visit:
 Clinical note (summary) of the case:
 Prov: Diagnosis:
 Investigations advised with reports:
 Diagnosis after investigation:
 Advice:
 Follow up
 Date: Observations:
 Signature in full ………………………….
 Name of Treating Physician:



PRACTICAL BIO-MEDICAL WASTE
MANAGEMENT
 The Environment (Protection) Act 1986 (29 of 1986) (EP
act 1986) was passed by Parliament on 23rd May 1986
which came Into force from 19th November 1986 in whole
of India.
 Central government notified above BMWM Rules on 20th
July 1998.
 Maharashtra Pollution Control Board
Kalpataru Point, 3rd and 4th floor, Opp. CineMax Theatre,
Sion (E), Mumbai-400 022
 http://mpcb.gov.in/
 This first step towards biomedical waste disposal is
getting AUTHORIZATION

BIO-MEDICAL WASTE MANAGEMENT
 1.We are all aware that which is infected or potentially
infections waste.
 2. Do not mix with general waste.
 3. Disinfect at the point of generation by using 1%
solution of NaOCl .
 4. Collect in colour coded bags- red, yellow, puncture
proof, black.
 5. Mark it with label & logo.
 6. Weigh & give it for disposal.
 7. Transport & disposal will be done by authorized
transporter for area by MPCB
 8. Disposal to BMC garbage-Marshall’s can fine up to Rs
20,000/-

New scare for NH above Gr. Fl.:-
Separate stair case, BMC has a solution The Supreme Court said that nursing homes and clinics
operating from residential apartments in Mumbai can only
function if they construct a separate stairway leading to
their premises, within six months.
 The order was delivered by a Bench comprising Justices R
V Raveendran and P Sathasivam which declined to
interfere with the decision of the Bombay High Court.
 Division bench of Justices D K Deshmukh and Amjad
Sayed, overturned a 2003 judgment and held that "separate
entrance''-as required under the Development Control
Regulation (DCR) 51 (III) for such nursing homes in
residential buildings-necessarily meant an "independent''
access and exit.
 Solution lies in changing DCR 51 (III) by BMC/Govt.

Minimum wages act
 No registration required but
 Display minimum wages on notice
board for skilled,semi,unskilled
 Issue identity card to employees
 Muster for employees
 Wage register for employees
 Pay as per minimum wages act

TPA registrations
 Third party insurance company
pay for cashless services
rendered to mediclaim policy
holders and pre insurance
check ups.
 Agreed Tariffs signed.
 MOU registration with each TPA

Agents get forms DL IV filled. Takes
authority letter
One has to apply every yearly for spirit
license if more than 3 bottles per month
are required
For less than three bottles license valid
for 3 years
Buy spirit from any authorized store
Spirit license

Professional tax as employer
 Registration & PTE number required
 One has to register as Professional tax
as employer and obtain a number
 If one pays Rs.2500/- pm or more to
employees and deduct Professional tax
from employees salary
 Employer has to deposit deducted
Professional tax from employees salary
to department of profession tax under
sales tax department every year.

Safeguard from Non qualified staff
-Hospital error and omission &
professional indemnity
 Safeguard from negligence committed by
non qualified staff can be done by
making hospital error and omission from
insurance company /PPS scheme of IMA
 Safeguard from negligence committed by
doctor himself is done by professional
indemnity from insurance company /PPS
scheme of IMA

04/23/18 MAHESH BALDWA 24
DOCTORS, BE CAREFUL OF
UNQUALIFIED NURSES

IV BOLUS INJECTION CHLOROQUIN GIVEN BY
UNQUALIFIED NURSE CAUSING CARDIAC ARREST:
 Spring Meadows Hospital v. Harjot singh Ahluwalia
 1998 (3) CPJ 1 (SC)
 Unqualified Nurse gave inj Chloroquin
instead of chloramphenicol IV bolus to 2
years 6 months old boy, resultant cardiac
arrest. Child revived but severe brain
damage-vegetative life. Awarded 17.5
lakhs
 SO FAR HIGHEST CLAIM AWARDED IS 1
CRORE


DOCTORS, BE CAREFUL OF
UNQUALIFIED NURSES
 ACCIDENTAL BURNS DUE TO HOT WATER
BAG BY UNQUALIFIED NURSE
 P M Ashwin V. Manipal Hospital Banglore
 1997 (1) CPJ 238:1997(1) CPR 393 ( Karnataka SCDRC)
 65 days old operated for Rt. Inguinal hernia.
Due to negligence of nurse, an extremely hot
bag kept under child’s leg, legs burnt,
prolonged treatment, permanent scars, and
permanent disability. Compensation of Rs12.5
lakhs.
 warmers are better than conventional methods

DOCTORS, BE CAREFUL OF UNQUALIFIED NURSES
 K.Kuttapan V. Banger hospital &
ors.1996(1) CPR 462 ( Kerla SCDRC)
 While treating marginal ulcer of Lt. Eye
by eye washing,
 Some carbolic acid was dropped in eye
by mistake by unqualified nurse
assisting ,
 Cornea damaged, vision lost,
 negligence,
 Awarded Rs 1.15 lakhs

Permission for fire brigade for storage of
oxygen cylinders
 Registration & NOC required
 One or two small oxygen cylinders do not require
permission.
 One has to apply for NOC & Permission to local fire
brigade authorities for storage of number of oxygen
cylinders.
 This becomes handy and useful when fire breaks out in
the building and hospital premises.
 Fire insurance policies become invalid if NOC &
Permission to local fire brigade authorities for storage of
oxygen cylinders is not made available.
 Better to register with fire brigade authorities if jumbo
cylinders and central oxygen is used

Ethics of IMC/MMC act requires you
to display
 Display of registration of medical degrees
required
 Renewal every five year
 1.4.1 Every physician shall display the
registration number accorded to him by the State
Medical Council / Medical Council of India in his
clinic and in all his prescriptions, certificates,
money receipts given to his patients.
 Display of fees:-
 3.7.1 A physician shall clearly display his fees
and other charges on the board of his chamber
and/or the hospitals he is visiting.

Obtaining Drug license- unethical
 MCI ethics rule no. 6.3
 Running an open shop (Dispensing of Drugs
and Appliances by Physicians): -
 A physician should not run an
open shop for sale of medicine for
dispensing prescriptions
prescribed by doctors other than
himself or for sale of medical or
surgical appliances.

Narcotic license
One can obtain a license for storing
and dispensing Narcotic license
Special stock books for same needs
to be maintained
Special medicine cabinet with lock
and key is needed

Electricity safety certification & more
 Electricity safety certification can be obtained
for hospital / nursing home by applying to
inspector of Electricity safety
 One needs to pay prescribed fees
 Certificate is valid for 1 year
 Three phase electronic digital meters are better.
 Change residential tariff to commercial to avoid
huge bill later on
 Get the name change done on bill by going to
reliance energy office.

Eye bank / organ banks and
transplantation
 Eye bank/ organ banks and transplantation needs proper
certification under human organ transplant act and rules
under S 17
 Today, even if relatives of the dead give their consent,
eyes can be retrieved.
 Corneal Grafting Act, 1991 was easy for cornea removals,
which unfortunately got thrashed by Human Organ
Transplant Act, into which eye donation has been
incorporated since 1994
 Under Sec.3 (4) of the Act, only the Registered Medical
Practitioner is authorized to remove a human organ
including eyes, for therapeutic purposes
 Section 6 of the Act provides that the person competent
under the Act to give authority for the removal of any
human organ from a dead body sent for post-mortem
examination

Blood banks and blood storage
facility
 Blood banks and blood storage facility
needs to be licensed by
 Food and drug authority
 Under drugs and cosmetic act 1940 &
 Drugs and cosmetic rules 1945
 122-G. granting of licenses to blood
banks
 122-H duration of blood bank license
 122-0 cancellation of license

Mismatch blood transfusion
 PGI v. Jaspal Singh 200 CTJ 799 NC
 Patient was having A Rh + blood group.
Blood bank dispatched blood which
was B Rh +ve not meant for that
patient, with out confirming blood
started, every thing done to save but
patient died, 2 lac awarded
 MATCH THE LABEL WITH NAME,AGE SEX AND
GROP OF PATIENT

PAYMENT OF BONUS ACT, 1965,
Payment of Bonus (Amendment) ordinance, 2007
 The Act is applicable for employing 10 or more
persons.
 Employees who are drawing salary/wages up to
Rs.10000/- are entitled to Bonus and that should
be calculated @8.33% on Rs.3500/-.
 Every employer shall prepare and maintain such
registers, records and other documents for bonus
 Contravention is punishable with imprisonment for
a term which may extend to six months, or with
fine which may extend to one thousand rupees, or
with both.

Maternity benefit act
 Under the provisions of the Maternity
Benefits Act, maternity benefits at an
average daily wage for a period of six
months in Maharashtra
 The Maternity Benefit (Amendment) Bill,
2008 to provide Rs. 1,000/- if no pre-natal
confinement and post-natal care is provided
by the employer.
 An employer who violates the provisions of
the Maternity Benefits Act is liable to
imprisonment up to three months or fine up
to Rs.5000/- (five thousand) or both.

RTO permission for ambulance
 One has to own a factory fitted Ambulance.
 Refurbished or Assembled units are not registered.
 Ambulance to have special registrations and number
plates & permission for flashing of light and siren.
 No toll tax for ambulance
 Relaxed traffic rules and jumping of red lights
permitted
 All resuscitation equipment, oxygen and drugs
 Qualified doctor/nurse to assist
 Preferably concerned doctor to accompany the
patient

Transferring a dying or dead under
the guise of serious patient
 Mr. Shakil v. Dr. P. Irani 1999(2) CPR 515
 LSCS done at Parsi general hospital, while in OT
patient developed cardiac arrest, revived and sent to
tertiary care centre in an ambulance with out oxygen,
Brain damage, anesthetist did not accompany the
patient in ambulance though she reached to tertiary
care centre in her own car, held negligent should
have accompanied the critical patient in ambulance.
It amount to abandonment.

TAKE CARE OF I V LINES
 IV CANULA CAUSING DEVELOPMENT OF GANGRENE &
AMPUTATION,DEATH
 Shivaji Gendeo Chavan v. Chief Director, Wanless Hosp,1995 (3)
CPJ 43 Maharastra SCDRC
 18 yr old son admitted for CRF. Advised kidney
replacement. Venous catheter in right thigh for
regular dialysis. Lack of care caused infection A
V fistula. Gangrene. Leg amputated. Died 20 days
later. Expert doctor’s witness submitted by
patient. Awarded 2 lakhs.
 INTRAVENOUS LINES NEED TO BE LOOKED
AFTER WELL

GOOD HAND WRITING WITH OUT
CLARITY OF NOT MENTIONING
UNITS

LEGIBLE HAND WRITING
WITH DOUBLE MEANING

Records Medical ethics 2002 for 3 years
 Income tax 7 years
 On top of each page the name of the patient
and the Dr.’s name should be written.
 Indoor sheet should be page numbered
 Write notes in chronological order of date or
time
 Xerox to be given to the patient if demanded
with in 72 hrs as per 2002 med. Ethics
 Destroy records giving notice in newspaper
(1 vernacular + 1 English) later than 3 years

Sample notice for record
destruction

TAKE CARE OF I V LINES
 IV CANULA CAUSING DEVELOPMENT OF GANGRENE &
AMPUTATION,DEATH
 Shivaji Gendeo Chavan v. Chief Director, Wanless Hosp,1995 (3)
CPJ 43 Maharastra SCDRC
 18 yr old son admitted for CRF. Advised kidney
replacement. Venous catheter in right thigh for
regular dialysis. Lack of care caused infection A
V fistula. Gangrene. Leg amputated. Died 20 days
later. Expert doctor’s witness submitted by
patient. Awarded 2 lakhs.
 INTRAVENOUS LINES NEED TO BE LOOKED
AFTER WELL

Maintenance and repair of major
equipment
 Dr. O.P. Lathwal, Former Director, Health Services, Haryana,
# 282, Old Housing Board Colony, Rohtak - 124 001
(Haryana).
 status of maintenance and repair services for the major
equipment
 There was no system of regular maintenance either
planned/scheduled or preventive.
 Only breakdown maintenance was found prevailing which was
also neither proper nor convenient.
 The breakdown or out of order equipment was 36.5% of the
total available equipment out of which only 20% was
repairable and the rest 80% had become unserviceable

Registrations, certificates, books,
record increase accountability of
doctors.
This weeds out those who do not want
to own responsibility

DR MAHESH BALDWA
M.D.,D.C.H,LL.B.,
LL.M.Ph.D(Law)
 MEDICO-LEGAL ADVISOR
 THANK YOU ALL

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