Doctors drawing NPA still flout rules

Despite being warned by the State government, a large number of government doctors who have been drawing Non-Practicing Allowance (NPA) were still found to be practicing in private hospitals/clinics, running unlicensed clinics and many not found in their respective places of posting especially in far flung areas.
These were among several issues that were also red flagged by the Nagaland Medical Council (NMC) in 2016 vis-à-vis non-implementation of The Nagaland Health Care Establishment Act 1997 and the unethical private practice of government doctors leading to negligence of duty and medical misconduct.
The matter was also recently taken up by the Nagaland Lokayukta after which it issued an order on March 30, 2023 making several recommendations based on the enquiry report.
The preliminary enquiry, started by the then State Vigilance Commission (now Lokayukta), was carried out between 2017-2020. During the course of investigation, the investigating team also took note of the statements made by several doctors, who had admitted to private practice during their free time.
The investigation team also carried out surprise visits and during which some doctors were found absent at their place of posting while some were found practicing in private hospitals.
As per the report of the investigation team, the Upa Lokayukta in its order on March 30, 2023 made recommendations based on the findings/admission during the period of enquiry. While taking note of the unabated private practice by government doctors, Upa Lokayukta recommended that the Health & Family Welfare authority initiate stringent measures to check private practice.
It, therefore, asked the department to implement the rules notified on September 19, 2011– H&FW directorate to constitute a committee each financial year to monitor and check private practice by government doctors and any government medical doctors after opting for Non-Practising Allowance (NPA) and doing private practice is liable for appropriate disciplinary action as notified by the Finance department on March 17, 2010.
Further, with regard to government doctors who are proprietor of hospitals/clinics and found practicing, the Upa Lokayukta recommended H&FW commissioner & secretary to take action under Sec. 8 (i)c of the Nagaland Health Care Establishments (NHCE) Act, 1997 against the private hospitals/nursing homes/clinics for violation of the terms and conditions for granting their license and against government doctors who are practicing in their own hospitals and clinics as per para (iii) of the Finance department March 17, 2010 notification.
The Upa Lokayukta observed that if the NHCE Act is implemented in letter and spirit, considerable number of unethical practices by government doctors could be curbed.
It further recommended that the H&FW commissioner and secretary take action against clinics operating without license and consider setting up of a mechanism to conduct scrutiny of license establishments on whether basic infrastructure/requirements were in place and whether terms and conditions of the license are followed as per the Act.
The Upa Lokayukta also recommended that the Health department consider coming out with a policy for government doctors who have opted out of NPA and engage themselves in private practice either in their own hospitals or other clinics in all hours.
Meanwhile, it recommended that the H&FW department consider taking steps with the government to include a member of the Nagaland Medical Council as member in the NHCE Authority.
It may be mentioned that the Nagaland Medical Council in its 2016 memorandum to the state government pointed out several anomalies particularly with regard to government doctors involved in private practice despite being granted the Non-Practising Allowance (NPA).
While stating that though most government doctors, over the years, have justified that the state had not defined private practice, NMC pointed out that the government had clearly defined private practice in its September 19, 2001 order that “any medical practitioner employed under the state government and practicing for his/her profession for personal earning monetarily apart from his/her official duty shall be termed as private practice.
It also pointed out that final salary of government doctors with NPA was significantly higher than their counterparts in other departments– NPA added to the basic scale from which all allowances like DA, ADA, HRA etc. are calculated.
NMC said that these allowances are given so that doctors can devote their time to ethical and competent health care at their places of duty.
NMC also flagged about many unlicensed clinics, nursing homes and hospitals operating with impunity, allegedly by some government doctors. It cautioned that practicing without license can result in even imprisonment and fines.
Expressing serious concern over the sorry state of affairs, NMC asserted that such injustice to the people in general, unethical practice, medical misconduct, disobedience to government orders etc. cannot be allowed to continue at the expense of the healthcare of the people of the State especially the poor and the underprivileged.
NMC made several suggestions to the state government, among which it called for immediate implementation of the NHCE Act 1997 in its old format till new amendments were passed by the cabinet and also include a member of NMC to be part of the NHCE authority.
It also called for immediate closure of all clinics, nursing homes and hospitals that are not registered and licensed under the NHCE Act. The council also suggested getting feedbacks from village councils, villagers, tribal bodies and public on medical personnel neglecting their duty for corrective steps. To initiate investigation into illegal private practice of doctors and also into referrals for percentage.