INDIAN MEDICAL ASSOCIATION

IMA NEWS An Official Publication of Indian Medical Association (HQs)

Vol. 63 No. 02 February 2024 Pages : 01 to 32 Price : 5/- www.ima-india.org

Meeting with Director General Health Services Covid Martyrs Day -

Covid Martyrs Day - Kerala regarding AMR and NExT Mehsana

Release of Health Manifesto in the Meeting of

Parliamentarians Meeting of State Presidents & Secretaries of East Zone

On an invitation from Shri Ashish Bhargava IAS, Director General, the National President Dr R
V Asokan and Hony Secretary General Dr Anil Kumar Nayak met him in his chamber on
12.02.2024. Shri Ashish Bhargava requested the help of IMA in sensitizing doctors on
prescription habits to avoid drugs not permitted for athletes. He requested for best practices
that may be followed while handling a case of a sports person. He referred to WADA World
Anti Doping Agency’s prohibited list of substances and methods.
IMA PARLIAMENTARIANS MEET
From the pen of National President, IMA
Be prepared
Eternal vigilance is the price in democracy. Doctor community in India is aggrieved on several
counts. Justice has eluded us. We have remained soft targets for long.

The time to ght back and resist is now. The only way to do that is to reach out to the last IMA
member and bring everyone on board. We have released our Charter of demands. These are
a fraction of our frictions with the establishments. They are not comprehensive though.

When the election beagle sounds for the Parliament do not spare anyone whom you can inuence. Bring to
the fore the soft power of the fraternity. No longer we will be dictated to. No one will rule over us without our
consent.

Fight back with the two tools we have given you. The Health Manifesto is for the nation. The Charter of
Demands is for the profession. Both are living documents which will be constantly updated.
IMA has a presence in all the districts of the country. We have sub district penetration in most of them. Now
that is our strength; envy of even political parties. Let the elephant know its strength. Stand up against
injustice. Stand up to save the purity of the profession. Our time is now. Go out into the eld. Play the game of
democracy.

Arise Awake and Resist

Organise or Perish
Long Live IMA !
Dr. R.V. Asokan
National President, IMA

Greetings from IMA Headquarters!

I extend heartfelt gratitude to all for constantly supporting IMA's mission and maintaining its
esteemed reputation.

February proved to be an eventful month with numerous activities at IMA Headquarters and
across various state and local branches.

With Parliamentary Elections drawing near, our efforts in political liaisoning have intensied. A meeting was
convened with Hon'ble Members of Parliamentarians on February 7, 2024, at Hotel Le - Meridien, New
Delhi. The objective was to address critical health concerns and present the IMA Health Manifesto to sensitize
MPs about pressing healthcare issues. I'm pleased to share that representatives from various parties attended
the meeting. MPs were briefed about IMA's Aao Gaon Chalen Project and the villages adopted by IMA and its
branches, along with the nation's health needs. I express gratitude to the liaisoning team for their dedication
to the success of the Hon'ble Members of Parliament Meet.

The Health Manifesto has been sent to Presidents & Secretaries of all State branches with a request to engage
local MPs and disseminate the document, possibly in regional languages. State Presidents & Secretaries are
urged to conduct Leadership training Meets for their local branch leaders.

Additionally, IMA has issued Charter of Demands, we request our leaders to present the same to the local
candidates of their areas and advocate for healthcare needs.

To strengthen MSN and JDN, an email has been sent to all State branches to establish direct connections

www.ima-india.org February 2024 3 3

 between Medical colleges and Local branches, aiming to enhance membership.
Responding to requests from State/local branches, the extension in HFC rates has been prolonged until
February 29, 2024. I trust you have capitalized on this opportunity and expanded your membership. Kindly
forward the status of your membership to IMA HQs.
Notication for the 231st CWC meeting has been circulated to all members, with State branches urged to
provide the names of Alternate members by March 31, 2024.
Our State and local branches are the backbone of IMA. They are pivotal in disseminating and acting upon
initiatives proposed by HQs. Discussions during Zonewise meetings of State Presidents & Secretaries
centered on state-specic issues and collaboration with IMA HQs. I urge State leaders to percolate these
decisions to their Local branches.
Efforts to rebuild the Existing Building of IMA HQs have been ongoing since 2015 due to its deteriorating
condition. Following discussions in various CWCs/CCs, it was decided to reconstruct the building with
modern facilities. The unanimous decision to demolish the current building and erect a new one signals our
commitment to rejuvenating IMA HQs for its Centenary Year in 2028. Financial contributions from leaders,
individuals, state, and local branches are indispensable for this endeavor. Let's generously donate towards
this shared goal, aiming to fund the project internally.
The revitalized IMA Aao Gaon Chalen Project, launched nationwide on June 25, 2023, urges each local
branch to adopt a village and engage in regular activities. Please forward village adoption activity reports
and photographs to IMA HQs for documentation.
Continuing our Organ Donation Awareness efforts initiated in August 2023, I urge everyone to promote
organ donation and encourage individuals to pledge their organs posthumously, thereby saving lives.

Let's unite in upholding the dignity of our profession and fortifying our beloved organization.
Long Live IMA!
Dr. Anilkumar J. Nayak
Honorary Secretary General, IMA

19.02.2024
URGENT: HEALTH MANIFESTO AND LEADERSHIP MEETING FOR PARLIAMENTARY ELECTIONS

To
The State President & Secretary
All the IMA State Branches
Greetings from Indian Medical Association, Hqs.
We acknowledge the help and cooperation of all the state branches for the past 7 weeks. We have been able
to meet with each other individually and severally in Delhi. We could also put together a meeting of the MPs
successfully. The most important event in the country this year happens to be the Parliamentary elections. This
is a great opportunity for IMA at all levels to intervene in Health issues as well as highlight the issues
confronting the medical profession.

Accordingly, IMA HQs has come out with the Health manifesto to be used by IMA State and Local branches.
We are herewith forwarding the Health Manifesto drafted through a consultative process. Several experts
have contributed in its preparation. You can peruse the document and appreciate its breadth and depth. It is

4 February 2024 www.ima-india.org 39

desired that the state branches of IMA print as many copies as required. The State President and State
Secretary may kindly make a translation of the initial few pages written by the National President and Hony
Secretary General into vernacular as their contribution with their photos and names. It is desired that every
state branch conduct a leadership meeting for atleast 5 hours in equipping and training all the local branch
Presidents and Secretaries in this regard. A leadership meeting consisting of state office bearers, senior state
leaders and local branch Presidents and secretaries may be convened in the first fortnight of March.

This intimation is to enable you to plan your meetings accordingly. The Health Manifesto is for the nation and
the people. A charter of demands and the general structure of the leadership meeting are under preparation.
This will be sent to you in the following days. The purpose of the exercise is to empower the local branch
leaders to interact with the candidates of all political parties highlighting the Health needs of the country and
the demands of the medical profession.

This nationwide exercise for the Health of the people and the demands of the profession will be the most
powerful intervention that IMA can bring out. We request all the State Branches to align with IMA HQs in
making it a great success. We are available over phone or WhatsApp or email for clarification.

30.01.2024

DEMANDING THIRD ROUND OF NEET SS COUNSELLING - REG.

To,
Dr. B. N. Gangadhar
Chairman,
National Medical Commission

Respected Sir,

Further to our letter dated 29-01-24 and subsequent to the Record of Proceedings in Writ Petition no, 32/24,
we reiterate our plea to hold the third round of NEET Super Specialization counseling to address the critical
issue faced by meritorious candidates who have qualified for the all India quota in the NEET-SS 2023-2024
entrance examination, who in spite of their qualifications, have encountered limitations in securing seats in
better institutions and pursuing courses of their choice due to the unavailability of a third round of
counseling. The Honorable Court was also insistent that there should not be any dilution of merit while
allowing the students to resign their selected seats and the vacant seats to be included in the mop-up round.
In keeping with natural justice and in fairness in allotment of seats we believe that denying eligible
candidates the chance to upgrade to vacant seats while allowing less meritorious candidates to occupy them
will dilute meritocracy's essence. In light of these circumstances, we urge the NMC to consider conducting a
third round of counseling for NEET super specialization courses to facilitate the allocation of vacant seats to
eligible candidates who have secured seats in the first and second rounds of counselling but would wish the
opportunity to upgrade to better seats through third round of counselling.

Such a step by NMC would not only prevent dilution of merit but also avoid further filing of petitions. We trust
that the NMC will take proactive steps to address the concerns raised by the NEET SS aspirants.

Dr. R V Asokan, National President, IMA Hqs.

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 STRENGTHENING IMA MEDICAL STUDENTS NETWORK AND JUNIOR DOCTORS NETWORK:
REQUEST FOR COLLABORATION.
The State President/Secretary
All State Branches of IMA
Dear Doctor,
This is to inform you about our initiative to bolster the Indian Medical Association (IMA) Medical Students Network (MSN)
and Junior Doctors Network (JDN) by establishing direct connections between medical colleges and local branches
across the country.
Enclosed with this email is a list of medical colleges in your state along with corresponding local branches. We kindly
request your assistance in connecting these branches with the respective medical colleges. Your knowledge of the
geographic status of the state will greatly facilitate this process and help us maximize membership in the IMA MSN and
JDN.
The horizontal connect between the mother local branch and the MSN unit in the local medical college is the umbilical
cord with IMA. It is requested that the state branch take initiative to facilitate the appointment of a coordinator in every
mother local branch exclusively for MSN activities.
Additionally, we kindly ask you to connect the branch details provided in the Excel sheet with the Branch President and
Secretary and send it back to us at hsg@ima-india.org and np@ima-india.org at your earliest convenience.
(Note: To see the enclosures, kindly check your mail. IMA has sent this email to you on 19/02/2024)
31.01.2024
EXECUTIVE ORDER ON CRIMINAL PROSECUTION OF DOCTORS
Shri Amit Shah Ji
Honourable Union Minister for Home
Respected Sir,
IMA thanks the Government of India for raising awareness on how doctors are being implicated in criminal cases.
Medical community is grateful for being exempted from the enhanced punishment for negligence as originally
proposed in clause 106 of Bhartiya Nyaya Samhitha. It is also a relief that section 88 of IPC has been retained as Section
26 of Bhartiya Nyaya Samhitha.
Medical professionals are constrained to take a calibrated risk many a time in critical situations. Therefore, it becomes
difficult to define gross negligence.
Provided that a RMP to be held guilty of criminal medical negligence, it must be of such a high degree as to be ‘gross’,
supported by expert opinion, otherwise, it may be presumed a medical accident, the reason of which cannot be
conclusively determined.’(2005)6SCC1Jacob Mathew Vs. State of Punjab.
In this juncture Indian Medical Association requests your good self to issue a Government order from the Union Home
department providing further clarifications on provisions under Section 26 and Section 106 of BNS for the benefit of
investigating officers.
1. Whenever a complaint of criminal negligence is taken up by the investigating officer provisions of section 26 of BNS
shall take precedence. Provisions of section 106 should be considered only when the officer is satisfied of the
recklessness or gross negligence.
2. When the investigating officer is satisfied that section 106 cannot be excluded he may follow the procedures as
enunciated by the judgement of the Supreme Court of India Jacob Mathew Vs State of Punjab.
Three documents in this line are submitted for perusal and consideration. The executive order may protect doctors being
harassed under criminal law.
We would be grateful for a favourable directive to the police officers of the country.
Dr. R V Asokan, NP IMA Dr. Anilkumar J. Nayak, HSG IMA
6 February 2024 www.ima-india.org
www.ima-india.org February 2024 3 7
8 February 2024 www.ima-india.org
C.No.4923431/Crime 4(3)/2023
Office of the Director General of Police /
Head of Police Force,
Tamil Nadu, Chennai-4.
Dated, 21.06.2023
Circular Memorandum
Sub: Police – Registration of cases against doctors – Proper
procedure – Instructions issued - Reg.
-o0o-
Attention of all officers is invited to the above subject.

2. Instances have come to notice that criminal cases are registered in Police Station u/s 304 (A) IPC - which is
culpable homicide not amounting to murder - for negligence against the Medical Practitioners on the
complaint of the family members of the deceased or the discharged patients. Such extreme action is
unjustified as it causes damage to the reputation of the medical practitioner. It also demoralises the entire
health care fraternity, who take care of the health of people.

3. It may be borne in mind that, complications during treatment especially surgery are likely to happen
independent of the procedures and in spite of the best efforts taken by the doctors in good faith.
4. The Hon'ble Supreme Court of India and the Hon'ble High Court have issued guidelines time and again
in this regard to the effect that the doctors shall be held criminally responsible only if a prima facie case is
made out and after getting an expert opinion from a qualified doctor, preferably a Government doctor of
adequate qualification and training.
5. Extract of important guidelines of the Hon'ble Supreme Court of India

are given hereunder:

i) A simple lack of care, an error of judgement or an accident, is not proof of negligence on the part of a
medical professional.
ii) So long as a doctor follows a practice acceptable to the medical profession of that day, he cannot be held
liable for negligencemerely because a better alternative course or method of treatment was also
available.
iii) Simply because a more skilled doctor would not have chosen to follow or resort to that practice of
procedure which the accused followed.

iv) It is not possible for every professional to possess the highest level of expertise of skills in that branch
which he practices.

v) A highly skilled professional may be possessed of better qualities, but that cannot be made the basis or
the yardstick for judging the performance of the professional proceeded against on indictment of
negligence.
vi) Simply because a patient has not favourably responded to a treatment given by a physician or a surgery
has failed, the doctor cannot be held liable.
vii) Human body and medical science both are too complex to be easily understood. To hold in favour of
existence of negligence, associated with the action or inaction of a medical professional, requires an in-
depth understanding of the working of a professional as also the nature of the job and or errors
committed by chance, which do not necessarily involve the element of culpability.

viii) The investigating officer and the private complainant cannot always be supposed to have knowledge of
medical science so as to determine whether the act of the accused medical professional amounts to rash

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 or negligent act within the domain of criminal law under section 304-A IPC.

ix) A private complaint may not be entertained unless the complainant has produced prima facie evidence
before the Court in the form of a credible opinion given by another competent doctor to support the
charge of rashness or negligence on the part of the accused doctor.

x) The investigating officer should, before proceeding against the doctor accused of rash or negligent act or
omission, obtain anindependent and competent medical opinion preferably from a doctor in
Government service qualified in that branch of medical practice who can normally be expected to give
an impartial and unbiased opinion applying Bolam's test to the facts collected in the investigation..
xi) A person is not liable in negligence because someone else of greater skill and knowledge would have
prescribed different treatment or operated in a different way; nor is he guilty of negligence if he has acted
in accordance with a practice accepted as proper by a responsible body of medical men skilled in that
particular art, even though a body of adverse opinion also existed among medical men.
xii) A mere deviation from normal professional practice is not necessarily evidence of negligence. Let it also
be noted that a mere accident is not evidence of negligence. So also an error of judgment on the part of a
professional is not negligence per se.
xiii) No sensible professional would intentionally commit an act or omission which would result in loss or
injury to the patient.

6. The Government of Tamil Nadu has also issued guidelines to be followed strictly while registering case
against the Medical Practitioners, vide G.O.(Ms) No.220 Health and Family Welfare (21) Department,
dated, 04.07.2008, which reads as follows :

“A private complaint may not be entertained unless the complainant has produced prima facie evidence
before the Court in the form of a credible opinion given by another competent doctor to support the charge
of rashness or negligence on the part of the accused doctor. The investigation officer should, before
proceeding against the doctor accused of rash or negligent act or omission, obtain an Independent and
competent medical opinion, preferably from a doctor in Government service qualified in that branch of
medical practice who can normally be expected to give an impartial and unbiased opinion applying Bolam's
test to the facts collected in the investigation. A doctor accused of rashness or negligence, may not be
arrested in a routine manner, simply because a charge has been levelled againsthim, unless his arrest is
necessary for furthering the investigation or for collecting evidence or unless the investigation officer feels
satisfied that the doctor proceeded against would not make himself available to face the prosecution unless
arrested, the arrest may be withheld.”

7. Therefore, it is reiterated that whenever a complaint of death due to negligence on the part of Medical
Practitioners is received, the investigating officers should

a) Make thorough enquiry and collect all oral and documentary evidences.
b) Obtain the opinion of another competent Government doctor preferably from the Medical College
Hospital.
c) Obtain Legal opinion if a criminality under 304(A) is made out with the available evidences.
d) The doctor accused of rashness or negligence, shall not be arrested in a routine manner.
e) The CoPs and SPs should personally review and weigh the evidences before registration of case.
f) An express report on registration of cases, facts and circumstances with details of evidence of the case
shall be sent to the DGP/HoPF within 24 hours of registration of case.
8. Acknowledge the receipt of the circular memorandum.
Sd/- XXXXXX
Director General of Police/HoPF
Tamil Nadu.
To
All Unit Officers

10 February 2024 www.ima-india.org

 Dr. R. Gunasekaran Dr. Suresh Gutta Dr. Ashok Sharda Dr. Shivkumar Utture
National Vice President National Vice President National Vice President National Vice President

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12 February 2024 www.ima-india.org
 IMA'S CONCERNS IN HEALTH AND POLICY POSITIONS
Universal Health Care (UHC)
IMA recognizes Universal Health Care (UHC) as an entitlement to Health security.
The state has an obligation to provide appropriate medical care but also to address
all the health determinants including drinking water and sanitation. The entitlement
should be for a basic Health package for every citizen in primary, secondary and
tertiary care. Universal Health care should be ensured primarily by the public sector supplemented with strategic
purchase from the private sector. Universal Health Care should move from an aspirational goal to an entitled
provision.
Health Financing
IMA advocates a tax-based system of Health financing. Contributory Health insurance offers incomplete coverage
and restricted services. General revenues should be the source of UHC. Increased allocation of financial resources
for Health is the most important component. The allocation varying from 1.1 to 1.6 % GDP together by the various
Governments is one of the lowest in the world. Moreover, the expenditure incurred on Health determinants like
drinking water, sanitation should be provided for separately. Thus, the minimum allocation for Health alone
should be around 2.5% of the GDP. Despite numerous policy pronouncements prioritizing health, the
governments in India at the Centre and state levels have historically underfunded the public health sector, resulting
in poor health outcomes and rising inequity in access to health care. India's overall health spending (public and
private) is currently estimated to be 3.8% of its GDP, lower than the LMIC average of health spending share of GDP
of around 5.2%. India's health system is overwhelmingly financed by out-of-pocket (OOP) expenditures incurred
by households (around 63% of all health spending) (NHSRC, 2018b; RBI, 2019). Government funding, provided
by both the Central and state governments, currently constitutes approximately one-third of all health spending,
with states accounting for nearly two-thirds of total government health expenditure. Sustained underfunding of
public sector facilities, and the rapid growth of private sector has contributed to rising OOP costs on health care for
households. Of this, a significant share, almost two-thirds of OOP expenses, are for purchasing outpatient care,
especially medicines. Because households bear the burden of the high OOP health expenses in India, more than
55 million people are impoverished each year on account of expenses for ill health.
Accreditation is better option
The advice of the Planning commission committee to choose accreditation for healthcare institutions as the choice
for regulation was ignored. The Clinical Establishment Act in the current form is proving to be a burden on small
and medium hospitals. Cases of misuse of power are being reported. If registration and quality are the aims the
goals will be better served by insisting on accreditation rather than regulation. There is a strong case for exemption
of small and medium hospitals from the clutches of the current CEA.
Anti-Microbial Resistance
AMR is emerging as a major threat in the communicable diseases front and has to be tackled with urgency. Anti-
Microbial resistance (AMR) is global, regional, and national priority. It increases morbidity and mortality, and
results in economic losses. The rates of AMR in the 3 sectors – human, food animal, and environment - have been
rising disproportionately in India in the past decades.
The responsible use of antibiotics is a fundamental and effective strategy in containing AMR; however, misuse,
overuse, and inappropriate use of these medications contribute significantly to the development and spread of
antibiotic-resistant bacteria. AMR containment needs a multi-stakeholder response to raise AMR awareness,
training, and capacity development of health professionals, strengthening of infection prevention and control,
operational research, and surveillance of AMR, as well as antimicrobial consumption/use and healthcare
associated infections.
IMA can play a pivotal role in promoting behavioral change through continuous medical education, peer support,
and fostering of responsible anti-microbial use within the healthcare community, and reduction of spread of
infections in health care settings.
Quality of Drugs and related issues
The Mashelkar Report of 2003 noted, “The problems in the regulatory system in the country were primarily due to
inadequate or weak drug control infrastructure at the State and Central level, inadequate testing facilities,
shortage of drug inspectors, non-uniformity of enforcement, lack of specially trained cadres for specific regulatory
areas, non-existence of data bank and non-availability of accurate Information. There is much less quality control
www.ima-india.org February 2024 3 13
 on the manufacture of medication except perhaps among those recognized as GMP (Good Manufacturing
Practice) companies. Quality assurance of the drugs manufactured in the country is a top priority. Similarly, GST on
drugs and medical equipment levied at 5% to 18% needs a reconsideration considering the fact drugs form the
substantial portion of out-of-pocket expenditure.
IMS - Indian Medical Services
The COVID pandemic has exposed the vulnerability of the healthcare system in our country. It has also brought to
fore the grave paucity of professionalism in health management right from the Sub-District Office level. As such,
this mandates towards an acute need for change in the health administration of the country. IMA has proposed to
the Government to revive the Indian Medical Services discontinued in 1948. An All-India cadre of doctors would
be more sensitive to the needs of the patients and clinicians. It is pertinent to note that 'Law and Order' is a state
subject in the schedule appended to the Constitution of India but there is an All India Indian Police Service which is
in vogue.
National Medical Commission
1,08,915 MBBS graduates come out of 706 medical colleges of India posing huge challenge for quality
maintenance in our medical colleges. IMA desires that NMC should rise to the expectations and trust invested in it.
NMC should be sensitive to the issues of young doctors, their career and unemployment. Moreover, the National
Medical Commission Act, 2019 needs to be amended to suitably incorporate a provision thereunder for
supporting medical education through accruable developmental funds in tune with the provision included at
Section 12(B) of the University Grants Commission Act, 1956 governing Higher Education so as to make National
Medical Commission a Commission in the truest and realistic sense by vesting it with financial disbursement
authority.
In order to invoke quality centricity in all levels of medical education a robust and outcome based analytical
accreditation system through Autonomous Accreditation and Ranking Board of the NMC needs to be rolled out
immediately in the teeth of recognition granted to it by World Federation of Medical Education vide its Notification
dated 20th September, 2023 for a period of 10 prospective years and avail much desired Global parity in the
context of the material reality that India turns out to be the largest producer of trained health manpower.
It is also mandated that institutionalized mechanism in the form of Academic Staff Colleges for full time faculty
development programme through structured refresher courses for medical education needs to be evoked for
fulfilling international parlance on the said count.
Healthcare violence
Violence on Doctors and Hospitals is a national shame. 23 State legislations have been ineffective due to absence
of a Central Law.
The Central Government deemed it fit to bring amendments to the Epidemic Diseases Act 1897 during Covid
period. Airport and Airline staff are protected by a Central Law. Hospitals should be declared as safe zone. Doctors
and nurses deserve to be protected during normal times as well and certainly deserve to be treated as equivalent to
airline staff.
Health Manifesto
In a Parliamentary democracy the only way to raise our concerns is to sensitise the common man and create a
public opinion. Health of the nation deserves to be an important election issue and IMA strives to streamline its
concerns into a Health Manifesto. IMA rededicates itself to the health of our people and to work with the
Government to achieve affordable Universal Health Care for everyone.
Priorities
 Tax funded universal healthcare with basic package for all citizens.
 Direct funding of Government Hospitals and human resources with strategic purchase from private sector.
 5% GDP resources to be allotted by the Governments to Health.
 Re-envision PMJAY to cover outpatient care and cost of drugs.
 Direct Benefit transfer, copayment and reimbursement models will sustain Health insurance model.
Dr. R. V. Asokan Dr. Anilkumar J. Nayak
National President, IMA Hony. Secretary General, IMA

(Excerpts from IMA Health Manifesto)

14 February 2024 www.ima-india.org

www.ima-india.org February 2024 3 15
 CHARTER OF DEMANDS

16 February 2024 www.ima-india.org

 NOTIFICATION FOR 231ST MEETING OF THE CENTRAL WORKING COMMITTEE OF IMA TO BE
HELD ON 13TH & 14TH, APRIL 2024 AT CHENNAI, TAMIL NADU
To,

 All members of the Central Working Committee, IMA

 Ex-officio members of Central Working Committee, IMA
Dear Doctor,

It is notified that the 231st meeting of the Central Working Committee of Indian Medical Association is
scheduled to be held on 13th & 14th, April, 2024 (Saturday & Sunday) at Chennai.
VENUE: MGM Beach Resort, Beside MGM Dizzee World, 1/74, SH 49, ECR-603112, Chennai.

Please note that one night accommodation will be arranged for you for attending the above meeting. (13th
night)
Accommodation will be provided only to those participants who confirm their participation alongwith their
travel itinerary to IMA HQs latest by 10th March, 2024.
TA will be reimbursed as per IMA Rules and only as per fares prevalent as on 5th March, 2024.

13th April, 2024

12:00 noon to 1:00 pm Lunch

1:00 pm to 7:00 pm Central Working Committee Meeting

8:00 pm onwards Dinner

14th April, 2024

7:00 am to 9:00 am Breakfast

9:00 am to 1:00 pm Central Working Committee Meeting

1:00 pm to 3:00 pm Dinner

If a Regular CWC Member is unable to attend the meeting, an alternate CWC Member may attend in his/her
place. In that case, the official information should be sent to IMA HQs. on or before March 31st, 2024. The
information of Alternate CWC members received after March 31, 2024 shall not be considered for the
privileges of voting and T.A.

Contact Person of IMA Hqs:

Dr. Shitij Bali
Honorary Finance Secretary, IMA Hqs.
Mobile: +91 9910755660
Email Id: shitij.bali@yahoo.com
Dr. Anilkumar J. Nayak
Honorary Secretary General

www.ima-india.org February 2024 3 17

 31.01.2024
EMAIL FROM IMA REGARDING DRAFT CRIMINAL LAW (AMENDMENT) BILL, 2024
To,
Shri Amit Shah ji
Honourable Union Minister for Home
Government of India
New Delhi
Respected Sir,
Greetings from Indian Medical Association (Hqs.)!

IMA is grateful to the benevolence shown by your goodself on the floor of the Parliament declaring the
intention of the Government to protect the doctors from murder charges. In pursuance of our earlier
submissions, we hereby submit certain proposals of amendments to the existing BNS for purposes of doctors
being handled as appropriate to their sensitive relationship with the patient. Kindly consider this request of
the medical fraternity of India and oblige.

Dr R V Asokan Dr Anilkumar J Nayak

National President, IMA Hony. Secretary General, IMA

18 February 2024 www.ima-india.org

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20 February 2024 www.ima-india.org
www.ima-india.org February 2024 3 21
 Dr. K M Abul Hasan Dr. Shalabh Gupta
Chairman, IMA JDN Chairman, IMA MSN

No to NExT

22 February 2024 www.ima-india.org

www.ima-india.org February 2024 3 23
 02.02.2024
INDIAN MEDICAL ASSOCIATION'S COMMENTS ON THE ISSUE OF LIVE SURGERY BROADCAST
To,
Dr. (Prof.) Yogender Malik
Member (EMRB)
National Medical Commission
Dear Sir,
Indian Medical Association expresses the following opinion in regards to your invitation to provide
comments on the issue of live surgery broadcast.
While we acknowledge and share concerns about the potential risks and ethical considerations, it is crucial
to recognize the valuable aspects of live surgical demonstrations in the medical field before we turn to the
cons.
Importance of Live Surgery for Educational Purposes:
 Real-time Learning Experience for doctors in training: Live surgical broadcasts provide a real-time
learning experience for medical professionals, allowing them to witness and understand the intricacies of
surgical procedures as they happen. This is of value for doctors in training like residents. For surgeons
already in the practice it has very limited value because the surgeries taken up for live surgery do not
provide any challenging learning experience to somebody who is already conversant with the techniques.
Surgical skill cannot be transferred through videos.
The role of wet labs and simulators in the situation of skill transfer cannot be over emphasized.
 Skill Transfer: Live surgeries contribute to the skill transfer process for new procedures and devices. Even
for such demonstrations the effect of recorded surgery with multiple playbacks and voice offers is
extremely important.
What is to be opposed?
Live surgical broadcasts done by champion surgeons for commercial advertising and entertainment,
promoted by surgical manufacturers on patients in third-party institutions and beamed live to surgical
conferences.
Why is it to be opposed?
 Inferior Educational Value: Such broadcasts are not as effective as pre-recorded surgical videos for
training and teaching purposes. The risk involved in such broadcast or higher and therefore they are a
poorer modality for teaching.
 Patient Risk: Live surgical broadcasts are a marketing and advertising activity that puts the patient at risk.
The operating surgeon is often not familiar with the conditions of the third-party institute. The choice of the
surgeon is often dictated by the company and the operating surgeon comes by the morning flight only to
go back by the evening one after the conference.
 Limited Patient Interaction: The patient is kept for surgery, and the treating doctor meets them for the first
time outside the operation theatre. The operating surgeon and treating physician might be different,
leading to compromises in the patient's care.
 Post-Surgery Follow-up Challenges: Surgeons conducting live broadcasts might leave the patient to be
followed up by the third-party institution, causing potential challenges in continuity of care.
 Commercial Influence: Companies paying large sums of money for such activities often dictate which
surgeons are promoted, compromising the objectivity of the medical procedure. As a result of this
commercial influence they have become advertising avenues for champion surgeons, companies and
even hospital chains.

24 February 2024 www.ima-india.org

 Quality of Care Concerns: There is a lack of regulation regarding the quality of care provided to the
patients in these situations. Claims made during live surgical broadcasts are not subject to peer review.
 Ethical Concerns: Ethically of, the principle of non-maleficence is compromised (primum non nocere or
first do no harm medical ethics is compromised and even equity principle is often violated as patients
selected for such activities are often less economically capable and susceptible to inducements.
What is not to be opposed?
 Pre-recorded Surgical Videos: These offer better educational value, are peer-reviewable, and allow for
editing or disclaimers for unscientific claims.
 Streaming Inside the Institute: Streaming activities within the institute, where patients are treated by
surgeons from their own institutions, should be regulated to maintain privacy. Streaming for learning or
training purposes should not be permitted in conferences.
 Simulated Training and wet labs: In the era of simulated training, live broadcasts for training purposes
are not justified, as simulation produces behavioural change which simple demonstrations cannot
achieve.
Regulatory Proposals:
 Strict Regulation: Live surgical procedures should be strictly regulated and permitted only if there is no
commercial or pecuniary benefit involved.
 Strong Scientific Review Process and a Registry: To ensure that adequate and complete records are
maintained and there is tracking of complications. To ensure that the patients can get redress in case any
untoword incident happens.
 Well Defined and Recorded Methodology for Management of complications along with a plan of such
management should be made available to this registry for implementation in case of complications.
 Videographed Informed Consent: The informed consent process by the operating surgeon should be
videographed and placed on third-party servers with a time stamp.
 Use for New Procedures or Devices Only: Live surgery should be permitted only when demonstrating a
new procedure or device, not for routine surgical procedures.
 Insurance Adequacy Monitoring: Professional and hospital indemnity insurance, along with
compensation for the patient, should be monitored by a regulatory authority.
 Stringent NMC Regulations: The NMC should implement stringent regulations in consultation with IMA
to prevent the use of such events as advertising opportunities.
Hence it is necessary to formulate protocols which should be regulated by Statutory bodies:
1) Patients should be admitted in the department of medical college/hospital where the surgeon is
attached. Stress for the surgeon is reduced as the surgery takes place in a known and familiar
environment.
2) No high risk patient should be selected for Live Demonstration of Surgery.
3) Surgeons should be highly reputed in their field and preferably associated with institutions as senior
consultant.
4) The surgeon should be available to the institution pre-operative before Live Demonstration of Surgery
and post-operative period after the procedure is performed so that he can ensure care of the patient
during preoperative period as well as immediate postoperative period.
5) Surgery should be performed in an operation theatre at the Institution where the surgeon is routinely
working and familiar with the environment.
6) The operation theatre should have all equipment and drugs for Safe Surgery and also for handling any

www.ima-india.org February 2024 3 25

 medical emergency.
7) An expert who can explain each and every step in the procedure, video recording of which is to be
streamed, should be selected for giving commentary during live demonstration of surgery and answer
questions raised by the delegates. This saves the time and concentration of the surgeon can fully focus on
the surgery.
8) Any new equipment being demonstrated during live streaming of surgery must have procured FDA
certification indicating its safety for use on the patients.
9) The procedure which is demonstrated should be essential for treatment of the patient and have proven
data to show that it is essential in reducing suffering from disease or disorder from which the patient is
suffering.
10) Patient counselling should be done by the surgeon who is conducting the live demonstration of surgery
himself, and the patient should be aware that the procedure will be demonstrated using live video
streaming to trainee surgeons.
11) The patient must be told all risks associated with the procedure Itself along with additional risk because
of live streaming of video recording in the language of the patient and Consent should be obtained
accordingly in writing.
12) The patient should be permitted to withdraw his permission any time before commencement of surgery,
and there should not be any compulsion of undergoing the procedure.
13) No charges should be recovered from the patients who agree to undergo live demonstration of surgery
for training of the young surgeons.
14) Professional associations of the doctors of various specialties and super specialties should develop their
own specific guidelines.
15) In case of any mishap, the patient or his relative should be provided compensation by all stakeholders
jointly and severally as determined.
16) All surgeons and assistants performing the live surgeries must be registered with the SMC/ NMC.
17) Live surgery broadcast to the general public should be discouraged and avoided.
Medical professionals who do not adhere to these guidelines will be considered as violation of professional
ethics and appropriate action shall be initiated against such registered medical practitioners by the SMC/
NMC
Conclusion
In conclusion, while recognizing the educational value of live surgical demonstrations, it is imperative to
acknowledge that their role for doctors in training is limited. The educational objectives achieved through live
broadcasts can often be replicated by pre-recorded surgical videos, which carry a lower risk and can be
subject to rigorous peer review. The call for stringent regulation and monitoring of live surgical broadcasts is
not an endorsement of an outright ban but a necessary step to ensure patient safety and prevent their misuse
for advertising purposes.
The National Medical Commission and the Indian Medical Association can collaborate to establish and
enforce robust guidelines that safeguard patients' rights and uphold the principles of ethical medical practice.
It is crucial to strike a balance where advancements in medical education are fostered without compromising
patient safety.
Incidentally we would point out that such recommendations to regulate live surgery broadcast should not be
confined to private hospitals alone. They should apply to public sector as well. Statutory institutions including
the NMC as well as the state Medical Councils should also abide by the same.
Dr. R. V. Asokan Dr. Anilkumar J. Nayak
National President, IMA Hony. Secretary General, IMA

26 February 2024 www.ima-india.org

 04.02.2024

REQUEST TO CONSIDER WAITLISTED WOMAN CANDIDATES IN AMC SSC 2023 MERIT LIST, FOR THE
VACANT 158 SEATS WHICH ARE LEFT BY MALE CANDIDATES.
To

Shri Rajnath Singh

Honourable Minister for Defence
Government of India

Respected Sir,
Greetings from Indian Medical Association !
I am writing to you on behalf of the Indian Medical Association (IMA), representing the concerns and interests
of the medical community.
We appreciate the efforts taken by the Ministry of Defence and DGAFMS in conducting the AMC SSC
Interviews 2023 to fill the vacancies in the Armed Forces Medical Services (AFMS). However, we have come
across disparity in the allocation of vacancies between male and female candidates, which has raised
concerns. According to the official notification published by DGAFMS in October 2023, a total of 650
vacancies were announced, out of which 585 positions are reserved for male candidates and a mere 65
positions are kept for woman candidates. It is disheartening to note this lack of gender balance.
We would like to bring to your attention that for 585 vacancies kept for male candidates, only 427 males have
been given place in the merit list for Army Medical Corps(AMC), including those considered fit as well as unfit
(applied for AMB). There is no male candidate in the waiting list as per the result published on 5th January
2024, which leaves 158 seats vacant.
In an ideal scenario, even if all the above 427 male candidates are considered fit and join for services, there
are still these 158 seats remaining vacant to be filled as there are no male candidates in the waiting list.
Meanwhile, there are 65 seats for woman candidates, and there is a waiting list for woman candidates till
rank 161 as per the published results.

In light of this situation, we earnestly request your kind consideration to redistribute these remaining
vacancies to the woman candidates who have appeared for the AMC SSC Interview 2023 and are in the merit
list waiting eagerly to join the services. Keeping in view of The Article 15 of the Constitution of India, we
request you to not let the highly meritorious woman doctors of the country, be denied a chance to serve the
nation only because of their gender. We believe that equal access to opportunities for all individuals,
regardless of gender, is not only a matter of fairness but also essential for the growth and effectiveness of our
defence forces.

We request you to kindly give careful consideration to our plea and take necessary action to address this
issue. We are confident that your intervention in this matter will help create a more inclusive and equitable
environment within the AFMS.

Encl. for your kind perusal Final merit list AMC SSC 2023 as published by DGAFMS on 5th January 2024 as
no. 42190/SSC/2023/DGAFMS/DG-1A.

Dr. R V ASOKAN
National President, IMA

Copy to: Dr Anilkumar J Nayak, Honorary Secretary General, IMA

www.ima-india.org February 2024 3 27

 IMA PARLIAMENTARIANS MEET

28 February 2024 www.ima-india.org

 ACTIVITIES OF NATIONAL PRESIDENT & SECRETARY

www.ima-india.org February 2024 3 29

 COVID MARTYRS DAY ON 30TH JANUARY 2024

12 February 2024 www.ima-india.org

 We aim to eliminate TB
from India by 2025

WorldTBDay
Hon’ble PM Modi said during the 102nd episode of
'Mann Ki Baat.' 24th
March
2024

Dr. Ketan Desai

Dr. R V Asokan Past President Dr. Anilkumar J. Nayak
WMA, MCI & IMA

INDIAN
MEDICAL
ASSOCIATION
 R.N.I No. : 14447/1967 Postal Registration No. DL-(C)-01/1385/2024
Date of Publication 7-8th of the same month Posted at LPC Delhi RMS Delhi - 110006
Date of Posting 28-29 Same Month

Dr. Ketan Desai

Chief Patron
Past President, WMA, MCI & IMA

IMA Dream Project

Aao Gaon Chalen

Let’s give health to every Indian
All branches are requested to adopt one village

Dr. R. V. Asokan Dr. Anilkumar J. Nayak Dr. Shitij Bali Dr. Bipin M. Patel Dr. V. K. Monga
National President Chairman, IMA Standing Committee Convenor, IMA Standing Committee
for Aao Gaon Chalen for Aao Gaon Chalen

Printed by Dr. Anilkumar J. Nayak and Published by Dr. Anilkumar J. Nayak on behalf of Indian Medical Association
(Name of Owner) Indian Medical Association and Printed at M/s. Print Master Enterprises, LLP, 134,
GF, Patparganj Indl. Estate and published at IMA House, Indraprastha Marg, New Delhi - 110002
Place of publication: IMA House, Indraprastha Marg, New Delhi - 110 002
Telephone : +91-11-2337 0009, 2337 8680
Mail : hsg@ima-india.org Website : www.ima.org
Editor : Dr. Anilkumar J. Nayak