The Indian Medical Association in Rajasthan is on the warpath ever since the Ashok Gehlot-led Congress government passed the Right to Health Bill on March 21. On March 27, thousands of doctors attached to government and private hospitals, paramedics and health professionals demonstrated against the law and demanded its withdrawal with immediate effect, describing it as ‘draconian’. Some members of the Gehlot government, which has staked its re-election bid on the success of this Act, among other things, have claimed the protest is politically motivated.
Sunil Chugh, Rajasthan president of the Indian Medical Association, is one of the key persons leading the protest. He claims to have the backing of “all the 55,000 public and private doctors of Rajasthan”. He spoke to The Indian Express on why the doctors are protesting.
What is the main demand?
Since March 2022, we have been talking to the government, and have been promised relief many times, some of which we have got. But most of the times, the government has backtracked from what it had committed. Hence, we do not have faith in their commitments anymore. We’re saying the Bill is draconian, so please take it back.
The government says that there is a process and once passed in the Assembly, it can’t roll back the Act.
When we had been telling the government of our problems, including a formal letter to the Chief Secretary submitted on March 17, enumerating all pending issues, then why weren’t these taken care of before the Bill was passed? If we don’t tell you what is wrong with the Bill before it is passed, then it is our fault. But when we told you about our objections, why didn’t you take any action?
What are the specific issues in the present Bill which are being opposed by doctors?
They only defined ‘emergency’ in the Bill after we asked them to, which is fine. But they still didn’t remove obstetric emergency from the final legislation. You have to understand that all deliveries are emergencies.
Next, we clearly told them that smaller hospitals do not have the facilities to treat emergency cases as they do not have ICU or multiple doctors. They said we will take care of it by saying (in the definition of designated hospitals) that those below 50 beds will not have to mandatorily offer emergency care. But in the final Bill, this definition of designated hospitals hasn’t been included.
There are so many other things. They have included the Charter of Patients’ Rights as recommended by the National Human Rights Commission. But the same Charter contains duties of patients towards healthcare providers. These have not been incorporated in the Bill. If you are including the rights of patients – there are two parties – you have to look after the rights of the other person — healthcare professional — too.
This Bill is full of many such draconian clauses one doesn’t expect in a democratic society.
The perception the government is giving is that you go to any private hospital and everything will be free for you. And the MLAs are already boasting to their constituents that you go to any private hospital and there is free treatment for everything. This will create trouble. People will come to the hospital and say treat us for free. If we were to tell them that a particular treatment or procedure is not covered, they would insist there is RTH, so how dare we deny them. They might also threaten legal action, but before that there might be vandalism on the spot itself.
How did the talks break down with the government?
The Health Minister has said a number of times that they have agreed to what the doctors demanded. At the Health Department meeting on January 18, we made a powerpoint presentation on the issues that needed to be addressed. But nothing was done. Before that, we had given details of our proposals in 49 pages. In spite of that, nothing was done.
Then we were called to a meeting of the Assembly’s Select Committee on February 11. I was there. They did not let me speak, saying they have not come to listen to my bhashan (speech). I told them I am representing 55,000 doctors of the state and that I have to communicate their feelings to them, otherwise why did they call us. I was asked to be quiet a number of times. They eventually asked me to leave. Is this the way?
So we said okay, we are escalating things and announced the boycott of government schemes including Chiranjeevi and RGHS, and announced a full day strike of private hospitals in Rajasthan.
Then we were called by the Chief Minister, who asked me not to worry, saying that we are taking care of everything, that he’s going to instruct his Chief Secretary and Additional Chief Secretary (Finance), who would listen to our demands and problems, and take care of everything.
Next day, when I called the ACS (Finance), he said we would first have to withdraw our boycott before they could talk to us, even though the CM himself did not put any such condition. I spoke with our Joint Action Committee, and we agreed to suspend our boycott till March 10 so that they (the government) are given sufficient time for a positive result.
During this period we had a number of discussions with the CM’s team and our issues were addressed. There was a meeting of the Select Committee around March 15, to which we were not invited.
However, when the changes we had agreed upon, were put before the Select Committee, it backtracked and changed many other things. It was the third time we were deceived.
When we brought it to the notice of the CM and the CS, they again assured us that whatever has been committed, will be incorporated, and on March 17 we gave them a complete list of demands.
But eventually, the Bill left out many things.
What has happened is, if the things we had suggested were taken care of, then the emotions would not have run so high.
What is the course of action now and how long will the protests continue?
Right now the emotions are running so high, doctors are so aggrieved that they have been deceived a number of times that their confidence in the promises of the government has plummeted. For any discussion, there has to be confidence between two parties. We are saying we don’t want what has happened to be repeated. And so, on Sunday, you saw the biggest rally by the medical community not just in Rajasthan but the whole of India.
Basically, the entire medical community in India is looking at us, as they feel this is going to turn into a pilot project for the rest of the country. Once this Bill is implemented in Rajasthan, other state governments would also like to emulate this Bill. So now nobody wants us to accept this, as it may become a precedent.
How will it lead to closure of private hospitals, as you fear?
Everyone (in the medical fraternity) feels that if it is implemented, roz humare liye jhagde honge aur kamai ka jo source hai woh khatm ho jaayega (there will be fights daily and our source of income will end). Moreover, the government is yet to pay Rs 44 crore to hospitals. This is due from before December 31, 2019, under the Bhamashah Scheme.
The Government is saying the real reason for protests is that private hospitals won’t be able to insist on in-house medicines, or overcharge for services…
I had given some data, some 3-4 studies to the government. There are certain studies by FICCI and sponsored by the Government of India, where the cost of running a single bed in a general ward for a private hospital comes to Rs 5,000 per day and Rs 12,000 in the ICU, excluding the cost of medicines, investigations, anaesthesia, etc.
But under Chiranjeevi, the Rajasthan government gives Rs 2,100 per day for general ward and Rs 4,700 for ICU, including for medicines, investigations, etc. So you are giving us peanuts, and then you will delay it again and again, before actually giving it.
So what will happen, how will hospitals run? Under Chiranjeevi, there are similar rates for government and private hospitals, which is anyway unjustified.
The government says there are a lot of misconceptions among doctors, who are being deliberately misled by the leaders of the protest. Some doctors are still citing the old Bill.
There are still so many things that are troubling us, why don’t they take care of these? If they are so particular that we have to take care of doctors’ sentiments, they should have done it on their own. Why did they backtrack three times?
It is being alleged that this whole issue has now become political and is being backed by a political party.
I am completely apolitical. The health secretary has brainwashed the government so much that they will get so many votes. I am telling you, they will not get any votes. Because this will create more trouble.