Hospitals must not be allowed to operate under provisional licences indefinitely: LHC

LAHORE: The Lahore High Court (LHC) directed the government and the Punjab Healthcare Commission (PHC) to take appropriate steps to ensure that the healthcare establishments do not operate on provisional licences indefinitely and specify a timeframe within which they must get a regular licence.

The court observed allowing a healthcare establishment to operate based on a provisional licence for an indefinite period is against the object and spirit of the PHC Act.

The court observed that granting a provisional licence to any healthcare establishment does not imply that it has complied with the relevant standards and directed the Punjab government to allocate funds necessary for the enhancement of the capacity of the PHC to discharge its duties under the PHC Act.

The court passed these directions in a petition filed by Fareeha Kanwal, who complained against doctors and administration of Prime Care Hospital (PCH), Faisalabad, alleging medical negligence and malpractice.

The court observed that the general scheme of healthcare law and clinical governance requires efficiency, responsibility, and accountability at every level where healthcare is provided.

Before issuing a regular licence, the Commission must ensure that it has complied with the PHC Act, regulations, and standards and any instructions and/ or corrective orders issued by it following the survey and the inspection report, the court added.

The court observed that the PHC Act does not stipulate any time limit within which the healthcare establishment must apply for a regular licence. As a result, these establishments continue to operate indefinitely under a provisional licence.

The court said, astonishingly, even after about 5½ years of registration, the Commission has no objection to its functioning on a provisional licence if it improves its score to 70 percent.

The court observed that where the law does not prescribe a time limit for performing a duty, it must be completed within a reasonable time.

The court said that caesarean sections (C-sections) that are not medically necessary and are performed for financial gains and the consultant’s convenience are unethical and constitute professional misconduct and malpractice.

The court observed that the Commission was required to set appropriate standards to regulate this area of healthcare services but has not done it so far. The Technical Advisory Committee formed under section 10 of the PHC Act has also failed to make any recommendations, the court added.

The court; therefore, directed the PHC to develop standards to regulate healthcare services relating to C-section procedures in consultation with a technical advisory committee and other stakeholders immediately and complete all processes within 90 days.

The respondent PCH has been further directed to improve its score up to 70% within three weeks, failing which necessary action shall be taken in accordance with law, the court warned.

The court held that all consultants and healthcare establishments should submit separate reports every six months giving details of the C-sections they performed and directed the PHC to conduct a compulsory clinical audit of all healthcare establishments and consultants whose figures exceed the WHO rate. The court also directed the PHC to develop a mechanism for clinical audit of all C-sections done in the province.

Petitioner Fareeha was admitted to PCH, Faisalabad, and gave birth to a baby girl. The petitioner regained consciousness, and the tests taken revealed that she had developed paraplegia/ plexopathy and had lost control of her urine and stool.

The petitioner filed a complaint with the Commission, exonerating a consultant gynaecologist who performed a C-section on the petitioner and referred the matter to the Pakistan Medical and Dental Council (PDMC) as the case required further probe.

The Commission imposed a fine of Rs 3 lac on PCH and said that 20 percent of that amount should be paid to the petitioner.

The PCH was also directed to improve its score on the Minimum Service Delivery Standards (MSDS) table up to 70 percent within three weeks.

The PCH filed an appeal against the Commission’s order before the district judge, Faisalabad, which was dismissed.

The petitioner also partially challenged the Commission’s order. Still, the District Judge, Faisalabad, dismissed it for lack of jurisdiction, hence, filed the petition.

The court upheld the decision of the district judge. It said the fine imposed on PCH must be deposited in the fund established under section 32(1) of the PHC Act, and the petitioner cannot be compensated.

Copyright Business Recorder, 2023