 bill no 137 of  2015 the clinical establishments (registration and regulation) amendment bill, 2015 by shri ravneet singh, mp a billto amend the clinical establishments (registration and regulation) act, 2010be it enacted by parliament in the sixty-sixth year of the republic of india as follows:—short title and commencement1 (1) this act may be called the clinical establishments (registration and regulation)amendment act, 20152 in the clinical establishments (registration and regulation) act, 2010 (hereinafter referred to as the principal act), for section 7, the following section shall be substituted,23 of 2010substitution of new section for section 7namely:—5"7 the national council shall follow a consultative process with the state council or the union territory council, as the case may be, and the concerned state government for determining the standards and for classification of clinical establishments in accordance with such procedure as may be prescribed"national council to follow consultative process with the state or union territory council and concerned state governmentsamendment of section 123 in section 12 of the principal act, for sub-section (2), the following sub-section shall be substituted, namely:—10"(2) the clinical establishment providing round the clock emergency services shall undertake to provide within the staff and facilities available, such medical examination and treatment as may be required to stabilise the emergency medical condition of any individual who comes or is brought to such clinical establishment:provided that in no case an individual who comes or is brought to such clinical establishment shall be denied emergency medical treatment:15provided further that if an individual, who comes or is brought to such clinical establishment, is unable to meet the cost of emergency medical treatment, the state government concerned shall reimburse such cost to the clinical establishment at such rate and in such manner, as may be prescribed"amendment of section 134 in section 13 of the principal act, after sub-section (2), the following section shall be inserted, namely:—20 25"(3) notwithstanding anything in this act, the central government shall, while prescribing minimum different standards for classification of different categories of clinical establishments, relax such conditions of adherence to the standards for small and medium health care establishments which include clinics and small nursing homes (less than twenty beds), as it may deem appropriate, having regard to the local conditions, as determined by the state council or the union territory council, as the case may be, or the state government concerned30(4) minimum standards prescribed for small and medium health care establishments shall be same for government as well as private sector establishments and there shall be no discrimination between allopathic (modern medicine), alternate systems (ayush), yoga and sowa-rigpa establishments of similar size and facilities in terms of minimum standards shall be required to be fulfilled for registration under this act" statement of objects and reasonsthe clinical establishments (registration and regulation) act, 2010 was enacted to ensure that a quality standard is maintained by clinical establishments but the act has proved to be detrimental to the growth of nation's healthcare sector, especially the small and medium clinical establishmentshealth being a state subject and the registration of clinical establishments being done under the state government, any centralization of healthcare sector will not provide enough space to the state governments and the local authorities to build this sector in a contextual manner therefore, the state governments must be given at least equal authority to make changes in the standards and requirements for registration of clinical establishmentsin the existing legal framework, only large private sector hospitals with substantial finances are able to register themselves and provide healthcare services due to paucity of funds, the smaller and medium healthcare establishments, providing healthcare services to seventy five to eighty per cent of the population, are finding it difficult to abide by the requirements needed for registration under the act and are being pushed out of the systemseveral state governments including the governments of west bengal and tamil nadu states have refused to implement the act stating that it penalizes private clinics and the doctors similarly, various medical groups like the medicos' legal action group trust (mlag) and indian medical association (ima) have stated that the act is safeguarding the interests of large private sector hospitals onlythough the indian medical association and medicos' legal action group trust have stated that the act ensures the quality and standard in healthcare/medical services in the country, but at the same time, also leading to an inspector raj and harassment of small and medium medical establishments in the country the registration of individual practicing doctors is being cancelled nationwide due to their  inability to meet the requirements prescribed under the actmoreover, the small and medium clinical establishments which provide 24 hour medical emergency services cannot be expected to stabilize all emergencies without a mechanism for reimbursement of the cost incurred in such stabilization the need of the hour is that in prescribing the standards for clinical establishments, concession in complying with the standards be provided to smaller and medium clinical establishments in areas where people do not have physical and financial access to healthcare facilitiesthe ratio of number of doctors to per one thousand population in india is 047, which is much lower than the global average of 15 if the act is not amended suitably, this ratio will further decline and may lead to a poor healthcare service in the countrythe bill, therefore, seeks to amend the clinical establishments (registration and regulation) act, 2010 with a view to—(a) enable the state councils, union territory councils and state governments to have their say in the formulation of standards and classification of clinical establishments with regard to local conditions;(b) compensate the clinical establishments for providing emergency medical services to individuals who cannot afford the cost of the treatment in clinical establishments during emergency; and(c) provide concessions to the small and medium clinical establishments in adherence to prescribed standards for classification of clinical establishments annexure extract from the clinical establishments (registration and regulation) act, 2010 (23 of 2010)7 the national council shall follow the consultative process for determining the standards and for classification of clinical establishments in accordance with such procedure as may be prescribednational council to follow consultative process12 (1)condition for registration(2) the clinical establishments shall undertake to provide within the staff and facilities available, such medical examination and treatment as may be required to stabilize the emergency medical conditions of any individual who comes or is brought to such clinical establishments13 (1) clinical establishment of different systems shall be classified into such categories, as may be prescribed by the central government, from time to timeclassification of clinical establishment(2) different standards may be prescribed for classification of different categories referred to in sub-section (1):provided that in prescribing the standards for clinical establishments, the central government shall have regard to the local candidates———— a billto amend the clinical establishments (registration and regulation) act, 2010————(shri ravneet singh, mp)mgipmrnd—23ls(s3)—30-04-2015