Straight from the Heart: International IMA Activities Report 2017

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The Indian Medical Association IMA actively participates in World Medical Association WMA Confederation of Medical Associations in Asia and Oceania CMAAO Commonwealth Medical Association CMA and World Organization of Family Doctors WONCA meetings. Internationally WMA deals with all policies related to health education and regulations related to all the countries in a broad base. Policies with regard to the above issues in Asia and Oceania regions are broadly dealt by CMAAO and that in Commonwealth countries are dealt with by CMA. Of late many have criticized why IMA should participate in such meetings. Here is a brief note International interactions play a major role in deciding most National or International policies. World Medical Association WMA with the help of 112 National Medical Associations periodically develops concurrence statements concurrence declarations and resolutions on subjects of common interest. Such Statements Declarations and Resolutions are revised based on the current day requirements. There are two types of Revisions Minor revision which can be made any time and major revision which can be made after 10 years of a Declaration Statement . All member countries NMAs can raise their national issues even including work conditions of their Resident Doctors like their duty hours etc. through the International bodies. When these International bodies raise an issue even if it relates to individual countries or segments all member countries follow up such matters with the relevant related authorities in those country ies Segment s creating a huge impact on the early resolution of the issue. IMA led two major revisions polices on behalf of WMA both of which were passed in the last WMA General Assembly held in October 2017 at Chicago. o WMA STATEMENT ON HIV AIDS AND THE MEDICAL PROFESSION Adopted by the 57th WMA General Assembly Pilanesberg South Africa October 2006 and amended by the 68th WMA General Assembly Chicago United States October 2017 o WMA RESOLUTION ON TUBERCULOSIS Adopted by the 57th WMA General Assembly Pilanesberg South Africa October 2006 and revised by the68th WMA General Assembly Chicago United States October 2017 IMA is leading the revisions to third WMA policy on assisted reproductive technologies which is likely to get passed in 2018 WMA is in the process of revising the under mentioned policy in their ensuing meeting The following Declaration of Geneva now called The Physicians Pledge has been amended by WMA. Dr KK Aggarwal and Dr A Marthanda Pillai were members of the Working Group on behalf of IMA. As a member of the medical profession I SOLEMNLY PLEDGE to dedicate my life to the service of humanity THE HEALTH AND WELL BEING OF MY PATIENT will be my first consideration I WILL RESPECT the autonomy and dignity of my patient I WILL MAINTAIN the utmost respect for human life I WILL NOT PERMIT considerations of age disease or disability creed ethnic origin gender nationality political affiliation race sexual orientation social standing or any other factor to intervene between my duty and my patient I WILL RESPECT the secrets that are confided in me even after the patient has died I WILL PRACTISE my profession with conscience and dignity and in accordance with good medical practice I WILL FOSTER the honour and noble traditions of the medical profession I WILL GIVE to my teachers colleagues and students the respect and gratitude that is their due I WILL SHARE my medical knowledge for the benefit of the patient and the advancement of healthcare I WILL ATTEND TO my own health well being and abilities in order to provide care of the highest standard I WILL NOT USE my medical knowledge to violate human rights and civil liberties even under threat I MAKE THESE PROMISES solemnly freely and upon my honor Adopted by the 2nd General Assembly of the World Medical Association Geneva Switzerland September 1948 and amended by the 22nd World Medical Assembly Sydney Australia August 1968 and the 35th World Medical Assembly Venice Italy October 1983 and the 46th WMA General Assembly Stockholm Sweden September 1994 and editorially revised by the 170th WMA Council Session Divonne les Bains France May 2005 and the 173rd WMA Council Session Divonne les Bains France May 2006 and amended by the 68th WMA General Assembly Chicago United States October 2017 IMA also organized attended various international conferences as follows o Annual Scientific Meeting of Chinese Medical Association Nanjing China 14 15 January 2016 o International Summit on Air Pollution Health Advisories New Delhi March 10 2017 o 12th World Conference on Bioethics Medical Ethics Health Law Cyprus March 19 24 2017 o 206th World Medical Association WMA Council Meeting Zambia April 15 22 2017 o International Congress of Indian College of Interventional Cardiology Dubai May 4 7 2017 o 10th Geneva Conference on Person Centered Medicine Geneva May 7 10 2017 o Annual Meeting of Swedish Medical Association Sweden May 29 31 2017 o Annual Meeting of the American Medical Association Chicago June 10 14 2017 o BMA Annual Representative Meeting Bournemouth June 25 29 2017 o 32nd CMAAO General Assembly Tokyo September 13 15 2017 o WMA General Assembly Chicago October 11 14 2017 o European End of Life Issues Vatican November 2017 IMA now has direct one to one association and communication with other Medical Associations of the world. IMA has entered into a Memorandum of Understanding for Developing Strategic Cooperation Partnership with the Chinese Medical Association International collaborations o BMA Chair always attends the NATCON of IMA o Presidents of all National Medical Associations are invited in NATCON. o IMA is affiliated to BMA o Nepal Medical Association is affiliated to IMA. o IMA donated drugs worth Rs. 45 Lakh to Nepal Medical Association during the flood disaster in 2015. o Dr A Marthanda Pillai Past National President and Dr KK Aggarwal National President IMA addressed a press conference in Nepal during their visit to Nepal during flood disaster in 2015. o Dr Ketan Desai Past National President IMA served the highest post of WMA as its President during the year 2016 17. o Dr V C Pillai Past National President IMA served as President CMAAO during the year 1992 93. o Dr Vinay Aggarwal Past National President IMA served as President CMAAO during the year 2013. o Dr KK Aggarwal Hony Secretary General IMA served as Vice President CMAAO during the year 2015 16 o Dr KK Aggarwal National President IMA is serving as 1st Vice President CMAAO during the year 2016 17 o Dr KK Aggarwal National President IMA will take over as President Elect CMAAO for the years 2018 19 o Dr. S Arulrhaj Past National President served as President CMA o Dr K Vijaya Kumar Past National President served as Vice President CMA o Dr Ajay Kumar Past National President IMA is serving as Council Member WMA o Many Past National Presidents of IMA Dr Vinay Aggarwal Dr Ajay Kumar Dr A Marthanda Pillai Dr KK Aggarwal National President IMA and Dr RN Tandon Hony. Secretary General IMA have served have been serving on various Committees of WMA CMAAO o An international conference on Person Centered Medicine will be held in November 2018 at New Delhi o IMA will be hosting 2019 CMAAO meeting in September 2019 o WMA raised and supported the Dilli Chalo movement of IMA IMA is an integral part of global medical associations and should continue to lead the world in the field of medicine.

IMA Campaigns to build up the image of the medical profession

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Dr KK Aggarwal
National President IMA

Dear Colleague
To build up a strong image of the medical profession, the Indian Medical Association (IMA) is starting the following campaigns:

• MDR TB now a public health emergency as it is now a threat to community as well as health care providers. IMA: 2nd freedom struggle to end TB IMA TB Initiative: GTN, where G stands for sputum GeneXpert test for all suspected cases, T stands for trace and treat all contacts and N stands for notify (mandatory) at Nikshay http://nikshay.gov.in.
• Doctors are brand ambassadors for the society and unless they pledge their organs, the society will not follow. All doctors are requested to pledge their organs at: http://notto.nic.in/Admin/Login.aspx
• Charity begins at home. The general public will not follow preventive health advice unless doctors themselves follow the same. All IMA members are requested to get their annual checkup done once a year under the IMA campaign: Physician’s Health first. All doctors should get themselves get fully vaccinated.
• To build the community image of the profession all doctors are requested to visit a school assembly on 5th of every month and conduct a 5-minute (or more) school children health education advisory program under “IMA Aao School Chalen” project.
• All IMA members are required to report adverse reactions to drugs (serious or non-serious), devices, vaccines, herbs, blood transfusion to IMA PvPI number 9717776514 under IMA PvPI Initiative.
• All designated IMA Professors should spread the positive image of medical profession under the IMA campaign “Jiska Koi Nahi Uska IMA”.
• Each state or local branch of IMA should adopt slums/ villages / elderly homes and conduct an activity of 9th of every month under IMA Aao Gaon Chalen project
• Each state or local branch of IMA should on conduct antenatal awareness and check-up program on the 9th of every month in support of the Pradhan Mantri Surakshit Matritva Yojana.
• All state and local branches are directed to file complaints to IMA headquarters against all doctors indulging in female feticide, unethical medical practices or tarnishing the name of IMA in media or social media.
• All members should resort to digital transactions with the patients
• Past is Past: We do not want to go into controversy whether or not there were cuts and commissions in the medical practice, now onwards medical practice will be 100% ethical and doctors will charge only for consultation, skills and medical services provided.
- All IMA CMEs should have the following slide inserted before every lecture
- IMA PvPi number 9717776514
- IMA CMEs are tobacco-free, noise and air pollution-friendly,
- IMA CME lectures must cover a question each on mental health, bioethics, legal medicine and rational use of antibiotics and investigations
- Pledge organs at http://notto.nic.in/Admin/Login.aspx
- Report every TB case at nikshay.gov.in
- IMA has zero tolerance for cuts, commissions without service, female sex determination and female feticide.
- Do not criticize your colleagues in social media or news media.
- Join IMA Fast for Non-Violence on 2nd October.

Disclaimer: The views expressed in this write up are entirely my own.

IMA brings relief to Medical Profession under PNDT Act​

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Brief note on the judgment dated 17.02.16 passed by Hon’ble High Court, Delhi, in the matter of “Indian Medical Association vs Union of India: WP (C) NO. 2721/2014

On 09.01.14, the Union of India amended the PNDT Rule, vide Notification No. DL 33004/99 whereby under the amended Rules, the Qualified Doctor/MBBS/ Sonologist/ Imaging Specialist desirous of setting up a Genetic Clinic / Ultrasound Clinic / Imaging Centre is to undergo six months training imparted in the manner prescribed in the Six Months Training Rules 2014.

As the amendment in the PNDT Rules, would take away the vested rights of Qualified Doctor/ MBBS/ Sonologist/ Imaging Specialist to operate Genetic Clinic / Ultrasound Clinic / Imaging Centre and would not serve any purpose as far as scope of the PNDT Act is concerned and the same is also not in the interest of Doctors around the country, therefore, IMA took up the said issue of National Importance and challenged the same before the Hon’ble High Court of Delhi at New Delhi, vide WP (C) No. 2721/2014.

As the issue raised by the IMA was of great importance, National Issue and there was no chance for any margin of error, therefore IMA engaged Mr. Jayant Bhushan, Senior Advocate (well renowned advocate of the Country) to contest the matter.

IMA on person level of the office bearer took part in the proceedings of the said case before the Hon’ble Court and also provided help to the legal team in issue related to the medical field and were practically present in each and every hearing.

The matter was argued for 6-7 hearings and Mr. Jayant Bhushan, Sr. Adv raised the following legal issues:
(i) that prior to coming into force of the PNDT Act, even a person having a degree of MBBS, not necessarily of M.D. (Radiology) could own and operate a ultrasound machine;
(ii) that Section 2(p) of the Act also includes in the definition of sonologist or imaging specialist, every such person who holds a medical qualification recognised by the MCI, again recognising persons holding the MBBS qualification as sonologist and imaging specialist;
(iii) that there is no post-graduate qualification in ultrasonography or in imaging techniques;
(iv) that under Section 32 of the Act the power of the Central Government to make Rules extends only to make rules for minimum qualifications of persons employed at the registered genetic counseling centre, genetic laboratory or genetic clinic and not to make rules for persons employed at ultrasound clinics;
(v) that the technique of ultrasound is used for diagnostic purpose qua various organs and not only for sex determination and thus all clinics using ultrasound machines would not qualify as genetic clinics;
(vi) instance is given of specialist hospitals / clinics dealing with specific organs, say heart, lung or liver and it was contended that they also use ultrasound machine but can by no stretch of imagination be called a genetic clinic;
(vii) that the requirement, in Rule 3(3)(1)(b) as amended with effect from 9th January, 2014, of six months training can only be qua registered medical practitioners as defined in Rule 2(ee) of the Drugs and Cosmetics Rules, 1945 and cannot possibly be qua those who qualify as sonologist within the meaning of Section 2(p) of the Act;
(viii) alternatively, Rule 3(3)(1)(b) has to be confined to the genetic clinics only and cannot be extended to ultrasound clinics; all ultrasound clinics are not genetic clinics; those who have been practising as a radiologist or have been using ultrasound for tens of years cannot be asked to undergo six months training or take any test, as the same cannot take the place of their experience of decades;
(ix) The issue raised by amending the PNDT Act, are of moral issues and not legal, therefore amendment is itself bad.
(x) that the amendment of Rule 3(3)(1)(b) w.e.f. 9th January, 2014 takes away the one year experience in sonography or image scanning as existed earlier and thus Rule 6(2) of the Six Months Training Rules is bad; and,
(xi) that under Rule 8 there was/is a right of renewal of registration; the amendment w.e.f. 9th January, 2014 takes away the said right; reliance is placed on G.P. Singh’s Interpretation of Statues to urge that interpretation rendering certain words otiose, cannot be adopted and on Dr. Indramani Pyarelal Gupta Vs. W.R. Nathu AIR 1963 SC 274 laying down that the Central Government as a delegate of the legislature, without being specifically empowered can only make Rules having prospective operation and not with retrospective effect.
It is relevant to point out that Indian Radiological and Imaging Association (IRIA) petitioner in the WP (C) No. 6968/2011 argued against IMA and contended that the petition filed on behalf of IMA should be dismissed.

On the other hand, Sonologist Society of India, petitioner in the WP (C) No. 3184/2014 adopted the arguments of the IMA.

After considering the issue raised by IMA in the WP (C) No. 2721/2014 the Hon’ble High Court came to the conclusion that the PNDT Act, raised a moral issue rather than a legal issue in relation to sex determination by the doctors and any further qualification to already Sonologist/ Imaging Specialist in relation to same may not serve any purpose. The relevant para from the judgement delivered by the Hon’ble High Court is reproducing as under:-

“We are of the opinion that for the purposes of prevention of sex determination through ultrasound machines or other radiological techniques, it matters not whether the ultrasound machine is in the hands of an MBBS or an MBBS with six months training or an MBBS with one year experience who has cleared the competency test or in the hands of MD radiologist / obstetrics. The qualification of MBBS itself is a highly sought after qualification, to secure which one has to first appear in a competitive examination for admission to a medical college and thereafter has to undergo the rigours of passing the MBBS examination. By no stretch of imagination can it be said that an MBBS qualified person lacks education or understanding to be not able to comprehend the fatal consequence of female foeticide as a result of sex determination or the morality behind the same. In our opinion, to understand the said aspects, the one year experience or passing the competency test or undergoing the six months training or acquiring the post-graduate qualification, add no further to the person. To make an as educated a person as a “Doctor” understand the ill effects of sex determination and that use thereof for the purposes of female foeticide is a crime, there is no need to require him either to undergo post-graduation or a six months training or gain a one year experience or pass a competency test. By doing so, he will not be less likely to break the said law than he would be without the same. It is not as if holding a medical qualification recognised by MCI does not have any concern with the conduct/behaviour of the holder thereof. The holder thereof is required to abide by the standards of professional conduct and etiquette and code of ethics prescribed by MCI in exercise of power under Section 20A of the MCI Act. Moreover, when the holder of medical qualification is capable of being sensitised with the code of conduct/etiquette/ethics, he/she can certainly be sensitised to the issue of PNDT without being required to undergo any training/experience.”

Further, after detailed discussion before the Hon’ble High Court of the issued raised by the IMA, the Hon’ble High Court allowed/ disposed off the Writ Petition of IMA with the following declarations/directions :-

(i)   that Section 2(p) of the PNDT Act defining a Sonologist or Imaging Specialist, is bad to the extent it includes persons possessing a postgraduate qualification in ultrasonography or imaging techniques – because there is no such qualification recognised by MCI and the PNDT Act does not empower the statutory bodies constituted thereunder or the Central Government to devise and coin new qualification; – Meaning thereby as per the definition Under Section 2(p) of the PNDT Act a MBBS is a sinologist or Imaging Specialists.
(ii)  The PNDT Act/Rules does not apply to the MBBS doctor who gives a declaration that they will not be using the ultrasound machine for sex determination or pre-natal diagnostic procedure.
(iii) Rule 3(3)(1)(b) of the PNDT Rules (as it stands after the amendment with effect from 9th January, 2014) is ultra vires to the PNDT Act to the extent it requires a person desirous of setting up a Genetic Clinic / Ultrasound Clinic / Imaging Centre to undergo six months training imparted in the manner prescribed in the Six Months Training Rules.

The relevant paras from the judgment are reproduced herein under for ready reference:

“98. We accordingly dispose of these petitions with the following declarations / directions:
(i)  that Section 2(p) of the PNDT Act defining a Sonologist or Imaging Specialist,is bad to the extent it includes persons possessing a postgraduate qualification in ultrasonography or imaging techniques – because there is no such qualification recognized by MCI and the PNDT Act does not empower the statutory bodies constituted thereunder or the Central Government to devise and coin new qualification;
(ii)  We hold that all places including vehicles where ultrasound machine or imaging machine or scanner or other equipment capable of determining sex of the foetus or has the potential of detection of sex during pregnancy or selection of sex before conception, require registration under the Act;
(iii) However, if the person seeking registration (a) makes a declaration in the form to be prescribed by the Central Supervisory Board to the effect that the said machine or equipment is not intended for conducting pre-natal diagnostic procedures; (b) gives an undertaking to not use or allow the use of the same for pre-natal diagnostic procedures;,and, (c) has a “silent observer” or any other equipment installed on the ultrasound machines, as may be prescribed by the Central Supervisory Board, capable of storing images of each sonography tests done therewith, such person would be exempt from complying with the provisions of the Act and the Rules with respect to Genetic Clinics, Genetic Laboratory or Genetic Counseling Centre;
(iv) If however for any technical reasons, the Central Supervisory Board is of the view that such “silent observer” cannot be installed or would not serve the purpose, then the Central Supervisory Board would prescribe other conditions which such registrant would require to fulfil, to remain exempt as aforesaid;
(v) however such registrants would otherwise remain bound by the prohibitory and penal provisions of the Act and would further remain liable to give inspection of the “silent observer” or other such equipment and their places, from the time to time and in such manner as may be prescribed by the Central Supervisory Board; and,
(vi) Rule 3(3)(1)(b) of the PNDT Rules (as it stands after the amendment with effect from 9th January, 2014) is ultra vires the PNDT Act to the extent it requires a person desirous of  setting up a Genetic Clinic / Ultrasound Clinic / Imaging  Centre to undergo six months training imparted in the manner prescribed in the Six Months Training Rules.”

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