Guj govt's new SOP for PMJAY medical procedures seeks to plug system loopholes

Ahmedabad, Dec 23 (PTI) The Gujarat government on Monday issued a fresh SOP for cardiology, radiology and neonatal procedures in PMJAY-MA-empanelled hospitals to prevent malpractice and criminal activities, state Health Minister Rushikesh Patel said.
    The new Standard Operating Procedures were issued weeks after two Pradhan Mantri Jan Arogya Yojana (PMJAY) beneficiaries died following botched angioplasty procedures at a private hospital in Ahmedabad.
    The probe showed that Khyati Multispeciality Hospital had organised free check-up camps in villages to convince PMJAY cardholders to undergo angioplasty despite no medical necessity. They were shown in the "emergency" category to expedite government approval, after which the hospital claimed payments under the Central scheme.
    "The new SOP has been framed keeping in mind various aspects, leaving no scope for any malpractices or criminal activities by private hospitals empanelled under the PMJAY scheme in Gujarat," Patel said.
    The fresh guidelines mandate hospitals treating cardiology patients under the PMJAY-MA (Pradhan Mantri Jan Arogya Yojana-Mukhyamantri Amrutam) scheme to upload CD/videography of angiography and angioplasty at the pre-authorisation stage.
    In case of emergency, this CD/videography will have to be uploaded after treatment.
    For oncology, hospitals have to upload a certificate from a tumour board, consisting of a joint panel of medical, surgical, and radiation oncologists, to ensure that the treatment plan has been decided as per the patient's need.
    The SOP stated that the treatment under PMJAY will be allowed for uterine or vaginal cancer which requires brachytherapy, a type of radiation therapy, at only those hospitals having the mandated facility. A tie-up system with other hospitals will not be allowed in case of brachytherapy, it said.
    Hospitals have to ensure that a full-time paediatrician is available for neonatal care and that the number of nursing staff will be proportionate with the number of patients' beds, it said.
    "The state government is determined not to tolerate activities that compromise the lives of patients at the cost of humanity," Patel said, adding that the guidelines cover cardiology, radiology, neonatal, and total knee replacement (TKR)/ total hip replacement (THR) services.
    Patel said only those cardiology centres can be designated as cardiology clusters which have full-time cardiologists and cardio-thoracic surgeons to ensure the best decision for the beneficiary patients.
    Additionally, such hospitals have to ensure that a full-time cardiac anaesthetist and physiotherapist are working with them. In special cases, centres providing only cardiology services will be able to perform angioplasty when emergency treatment is essential, he said.
    Necessary amendments have also been made in the radiation packages to ensure the flexibility of selecting the appropriate treatment and packages in radiation therapy for cancer treatment, the health minister said.
    The SOP mandates capturing CBCT (Cone Beam Computed Tomography System) images in kilowatts in Image Guided Radiation Therapy, he said.
    "Hospitals will have to mandatorily maintain records by following the quality control standards for the radiotherapy machine," he added.
    The minister said the guidelines for neonatal care have been prepared after considering various representations, especially treatment given to children in NICUs.
    "To ensure quality treatment for children in the Neonatal Intensive Care Unit (NICU), hospitals will have to install CCTV cameras while keeping in mind the privacy of mothers," he said.
    Additionally, the Taluka Health Officer will visit NICUs regularly and submit a report to the state authority, Patel said, adding that an online visit module portal will become operational soon.
    "Full-time paediatricians have been made mandatory for hospitals with a neonatal specialty so that children get round-the-clock treatment. As per the norms and standards of the scheme guidelines for pediatric hospitals, nursing staff will also have to be kept according to the number of the patient beds," he added.
    The government had earlier prepared a new SOP for TKR/THR (Total Knee Replacement/Total Hip Replacement) under the PMJAY scheme.
    A total of 75 hospitals affiliated under the PMJAY scheme have been fined Rs 3.51 crore for violation of SOP for treatment of TKR, the minister said.
    "More than 14 (PMJAY) hospitals were suspended, de-panelled, and penalised for malpractices till 2024 on complaints related to the violation of the guidelines and treatment. A fine of approximately Rs 18 crore has also been imposed,' he added.
    Seven persons underwent angioplasty, a procedure that widens blocked or narrowed coronary arteries to improve blood flow to the heart, at Khyati Multispeciality Hospital on November 11, following which two of them died, prompting Vastrapur police to register three FIRs the next day.
    Police so far arrested eight persons, including a director of the hospital, a visiting cardiologist, the CEO, a marketing director and a marketing executive.

(This story has not been edited by THE WEEK and is auto-generated from PTI)