Healthy policies: Sindh govt must not let Amal Umer Bill fail like those before it

Private hospitals will follow law or face punitive action, says Information adviser Wahab

KARACHI: The Sindh Assembly passed on Monday the Sindh Injured Persons' Compulsory Medical Treatment (Amal Umer) Bill, making it mandatory for all hospitals to provide medical aid and treatment to any injured person without waiting for 'medico-legal formalities'.

While the new law, which would come into effect after it has been ratified by the Sindh governor, has been lauded by the civil society and members of the medical fraternity, some fear that it would meet the same fate as its predecessors in the absence of an effective mechanism for its implementation.

"This has been our longstanding demand," said Dr Qaiser Sajjad, the secretary-general of the Pakistan Medical Association (PMA). "We have been saying all along that emergency treatment should be free at all healthcare centres, regardless of whether they are public or private," he added.

Lauding the initiative, Dr Sajjad said that the PMA had also suggested the provincial government to appoint at least two medico-legal officers in each town of the metropolis. "You see, if there is an incident in Malir, the patient has to be rushed to the Jinnah Postgraduate Medical Centre. In many cases, the patient dies before reaching the hospital," he said.

According to Dr Sajjad, the Sindh Injured Persons' Compulsory Medical Treatment Bill was legislated as a result of the efforts of Amal Umer's parents. "We should all thank the parents for their efforts," he said.

The government woke up to the need of such a law after the killing of 10-year-old Amal Umer, during a police shootout with robbers in Defence Housing Authority in August last year. The child had later died due to the alleged negligence of the hospital she was rushed to. The law states that it would be the duty of a hospital to provide compulsory medical treatment to the injured person on a priority basis.

Dr Tipu Sultan, the chairperson of the Sindh Healthcare Commission agreed. "We had suggested these measures to them [Sindh government] a long time ago," he said. "It is inhumane to deny treatment to any injured person based on the premise that it is a medico-legal case."

What about implementation?

Some fear that the law, much like its predecessors will not see the light of day. They point to the 'Sindh Injured Persons (Medical Aid) Bill 2014', which also mandated hospitals to treat all patients without waiting for police clearance.

The chief minister's adviser on law and information, Barrister Murtaza Wahab, however, has a different perspective. "Laws are not implemented when there are no provisions for punitive action," he said, referring to the older law.

This time, the Sindh government seems to have thought it through. When the Amal Umer Bill comes into effect, the owners or administrative staff of hospitals that deny treatment could be penalised Rs0.5 million or sentenced to prison for up to three years.

Who will pay?

There is, however, another caveat that could become an obstacle to the implementation of the law. The Amal Umer Bill states that the provincial government will bear the expenses of the treatment if the injured person is unable to pay. How this would be possible without a budgetary allocation for the current fiscal year remained a question mark. "Laws should be made for the public benefit, not just for advertisement," said Dr Sajjad.

Asked about the funding mechanism, Wahab said the provincial government would likely use the chief minister's discretionary funds for the purpose. "The hospital would submit the bill to the health department, which would verify it and then move a summary to the chief minister, who would then approve it," he explained. The process would be cumbersome, he admitted, but private hospitals would have no choice but to implement the government's decision. He added that it would take another month for the law to come into effect.

Dr Sultan had an even better proposal. "The private hospitals should not even demand payment for the smaller invoices," he suggested. "Consider this as community service - for the same community from which they make so much money," he reasoned.

The healthcare commission's chairperson added that the government would pay the bills like it had promised, lest they were forged or over-invoiced. "As long as they are genuine bills, the government has promised to pay them and it will."

Published in The Express Tribune, January 30^th, 2019.