This is an important update for Physiotherapists:
National Council for Clinical Establishments under the Chairmanship of Director General of Health Services, Government of India in consultation with various stakeholders has prepared draft minimum standards for various categories of Clinical Establishments for implementation of the Clinical Establishments Act.
Requesting all Physios to take part in this cause to uplift our Profession.
(This mail contains 3 attachments)
ESIC Model Hospital(Ministry of Labour and Employment, Govt of India),
Rajaji Nagar, Bangalore-560010
Dr. Anil Kumar, CMO(AK)
Room No.506 ‘D’ Wing,
5th Floor, Nirman Bhawan,
( Objection: This definition, paraclinical word and referral system are not in accordance with any reference , either National or International Standard. Points regarding the definition are mentioned in this draft)
(Suggestion: Physiotherapy is a Separate Clinical Establishment as per the current Clinical Establishment Act of the Central Government and State Governments. An individual Physiotherapy Clinic/Centre should be included in Clause 2.1. Points regarding the Clinical Establishment of Physiotherapy Clinic/Centre are mentioned in this draft)
(Suggestion: The State Existing Councils in India, The Maharashtra State OTPT Council & Delhi Council for Physiotherapy & Occupational Therapy have given autonomous and Independent practice status for Physiotherapists with Job nature of Assessment , Diagnosis and Treatment .The same Criteria should be followed in the Clinical Establishment Act)
10.2 Assessment and plan of care: The physiotherapist card/slip of every registered patient must bear the minimum following legibly at every visit: Working diagnosis as provided by the treating medical doctor who has referred the patient, Relevant history and examination findings, Plan of care listing the exercises and physical modalities, Signature and date of the physical therapist, A review and re-prescription from the treating medical doctor after three weeks for continuing plan of care.
( Objection: The treatment is determined by the Physiotherapist who is a qualified Professional according to the current Clinical Establishment Acts and the existing state Councils of India. 3 Weeks is not sufficint duration in case of patients with Paraplegia, hemiplegia, Cerebral palsy etc. Kindly refer the Ministry of Social Justice & Empowerment’s letter No. 9-3/CCD/2007 dated 15/05/2008 , Subject: Handling of Children with disabilities and referral which states that “Most of the doctors are not trained for rehabilitation of Persons with disabilities, they often try to treat their disabilities even when medical or surgical interventions are not required. In the process, most critical period of six years of life is lost which is most important period to train & rehabilitate the child with disability to utilize the residual capacity of the impaired organs. Consequently , it is too late for such children to respond to the rehabilitation therapies even by most qualified & skilled rehabilitation professionals like Physiotherapists etc.
Chief Commissioner has taken notice of the complaints from parents, Rehabilitation professionals , NGO’s etc . and has directed that appropriate instructions may be issued by Medical Council of India and Indian Medical Association through print and electronic media to the effect that the doctors not trained on rehabilitation should restrict their treatment of children with disabilities to their medical illness/disease or else action be initiated against such practices under relevant section of MCI. They should refer such children to the qualified rehabilitation Professionals to ensure that they get appropriate rehabilitation/therapeutic assistance well in time. The court of the Chief Commissioner for persons with disabilities shall be constrained to initiate action under Section 59 of the Persons with Disabilities Act, 1995 against the Doctors who may persist with such practices.
Supporting Points for Modifications of Points 1, 2.1 , 6.1 &10.1
1. Delhi Council for Physiotherapy & Occupational Therapy Bill 1997 : “Physiotherapy” means physiotherapeutic system of medicine which includes examination, treatment, advice and instructions to any persons preparatory to or for the purpose of or in connection with movement dysfunction, bodily malfunction, physical disorder, disability, healing and pain from trauma and disease, physical and mental conditions using physical agents including exercise, mobilization, manipulation, mechanical and electrotherapy, activity and devices or diagnosis, treatment and prevention.
2. Maharashtra State OTPT Council: "Physiotherapy" means a branch of modern medical science which includes examination, assessment, interpretation, physical diagnosis, planning and execution of treatment and advice to any person for the purpose of preventing, correcting, alleviating and limiting dysfunction, acute and chronic bodily malfunction including life saving measures via chest physiotherapy in the intensive care units, curing physical disorders or disability, promoting physical fitness, facilitating healing and pain relief and treatment of physical and psychosomatic disorders through modulating physiological and physical response using physical agents, activities and devices including exercise, mobilization, manipulations, therapeutic ultrasound, electrical and thermal agents and electrotherapy for diagnosis , treatment and prevention.
Maharashtra State has Documented Physiotherapy as an Individual profession and has passed " Maharashtra Council for Paramedical sciences & Technologies" for Paramedics. Physiotherapy and Paramedical councils are two different councils
3. Government of India- Quality Council of India , Survey Report & Recommendations Of Clinical Establishments
All the below Acts/Rules (Karnataka Private Medical Establishments Act,2007 /The Karnataka Private Medical Establishments (amendment) act, 2012 , The Andhra Pradesh Private Medical Care Establishments (Registration andRegulation) Act, 2002 ,The Bombay Nursing Homes Registration Act, 1949, The Delhi Nursing Homes Registration Act, 1953,
Manipur Homes and Clinics registration Act, 1992, The Nagaland Health care Establishments Act, 1997, The Arunachal Pradesh Health and Establishment Act, 2002, The Orissa Clinical Establishments (Control and Regulation) Act, 1990, The Punjab State Nursing Home Registration Act, 1991, The Tripura Clinical Establishment Act, 1976, The West Bengal Clinical Establishments Act, 1950, The Jammu and Kashmir Nursing Homes and Clinical Establishments (registration and licensing) act, 1963, Madhya Pradesh Clinical Rules, 1973 / Madhya Pradesh Upcharya Griha Tatha Rajupchar Sanbabdu Sthapama Adhiniyam, 1973 ) state that
Physiotherapy Clinic is documented in as a Separate type of Establishment as an Out Patent Service under the direct supervision of a properly qualified expert and hence in reference with the above definition of “Clinical establishment”, the Physiotherapist should be able to offer services facilities requiring diagnosis, treatment or care for illness, injury, deformity, abnormality etc in the field of Physiotherapy.
A survey was proposed by the Ministry of Health & Family welfare, Govt. of India. It was conducted in collaboration with Quality Council of India (NABH) & Indian Medical Association (HQ). The aim was to carry out survey in all the districts of the 4 states and 7 Union Territories so as to help QCI in defining the minimum requirements for different types of Clinical establishments” for implementation of the Clinical Establishment Act 2010.
Draft Minimum Standards: QCI was given task of developing draft minimum standards for consideration of National Council. Preliminary standards on 15 categories were developed and shared with members and States for feedback. After incorporating survey findings and feedback, draft of minimum standards for 35 categories have now been received from QCI.
The documentation about Physiotherapy in this survey clearly defines and documents Physiotherapy as an Individual Clinical Establishment. The findings on Physiotherapy are documented below :
(i) Physiotherapy Definition: The treatment of disease, bodily defects, or bodily weaknesses by physical remedies, as massage, special exercises, etc., rather than by drugs.
(ii) Physiotherapy Centres/Physiotherapy Clinics are mentioned as a Separate facility
(iv) Physiotherapy Clinics are Categorized as Individual Practitioners Clinic with 2 Clinics in Himachal Pradesh, 13 Clinics in Pondicherry ,28 Clinics in Delhi
(vi) Equipments: ElectroTherapy: Traction Unit Cervical Lumbar, Interferential Therapy, Shortwave Diathermy, Cold Packs, Muscle Stimulator with Electro Diagnostic, CPM, Hot Pack Unit, Laser, Wall Ladder, TENS, Parafin Wax Bath, Muscle Testing (Reference:http://
Exercise Therapy: Wall Ladder, Shoulder Wheel, Dumbbells Weight Cuffs, Thera Bands Thera Tubes, Spirometer, Tilt Board, Swiss ball, Vibrator for Chest Physiotherapy, Treadmill
(vii) Core Group Recommendations:
“Most of the doctors are not trained for rehabilitation of Persons with disabilities, they often try to treat their disabilities even when medical or surgical interventions are not required. In the process, most critical period of six years of life is lost which is most important period to train & rehabilitate the child with disability to utilize the residual capacity of the impaired organs. Consequently , it is too late for such children to respond to the rehabilitation therapies even by most qualified & skilled rehabilitation professionals like Physiotherapists etc.
Chief Commissioner has taken notice of the complaints from parents, Rehabilitation professionals , NGO’s etc . and has directed that appropriate instructions may be issued by Medical Council of India and Indian Medical Association through print and electronic media to the effect that the doctors not trained on rehabilitation should restrict their treatment of children with disabilities to their medical illness/disease or else action be initiated against such practices under relevant section of MCI. They should refer such children to the qualified rehabilitation Professionals to ensure that they get appropriate rehabilitation/therapeutic assistance well in time. The court of the Chief Commissioner for persons with disabilities shall be constrained to initiate action under Section 59 of the Persons with Disabilities Act, 1995 against the Doctors who may persist with such practices”.
7. Public Notice by Government of NCT of Delhi:
This differentiates Physiotherapists from paaramedcals.
( Reference: Clause 9.39Thirty-First report on Paramedical and Physiotherapy Central Councils Bill-2007)
The Patna high court directed the state government to frame rules to implement the Clinical Establishment (Registration and Regulation) Act, 2010, in the state. Hearing a PIL filed by Veteran's Forum for Transparency in Public Life, a division bench of Justice Navin Sinha and Justice Shailesh Kumar Sinha directed the government to frame the rules by January 31, 2014. "If it is not so done, principal secretary, health department, shall be present in person and show cause," the court ordered. The Act was enacted for registration and regulation of the clinical establishments with a view to ensuring minimum standards of facilities and services. Bihar adopted the Act in July, 2011, but the rules to implement it have not been framed yet, petitioner's counsel Dinu Kumar submitted. According to the Act provisions, a clinical establishment is supposed to maintain records of outpatient, inpatient, operation theatre, labour room, MTP, case-sheets, laboratory register, discharge summary, complaint register, number of beds, system-wise and speciality-wise in the establishment, rates of different services, et cetera. Additional advocate general 14 P N Shahi informed the court through a counter affidavit that the rules are being drafted and the State Council and District Regulation Authority will be constituted soon. However, the court termed it "evasive" for not having proper dates and ordered the state to frame the rules, to constitute a state council for clinical establishments and district registration authority by January 31 and submit a report before it by February 3, 2014.
(Reference: Thirty-First report on Paramedical and Physiotherapy Central Councils Bill-2007)
Clause 8.2 “Physiotherapy being considered a discipline distinct from paramedical disciplines finds a specific mention in the title (Paramedical and Physiotherapy Central Councils Act, 2007)”
13. World Health Organization (WHO) and International Labor Organization (ILO)
1. Definition of Physiotherapist by World Health Organization which emphasizes on assessment and formulating a treatment plan independently by Physiotherapists.
"Physiotherapists assess, plan and implement rehabilitative programs that improve or restore human motor functions, maximize movement ability, relieve pain syndromes, and treat or prevent physical challenges associated with injuries, diseases and other impairments. They apply a broad range of physical therapies and techniques such as movement, ultrasound, heating, laser and other techniques. They may develop and implement programmes for screening and prevention of common physical ailments and disorders"
The World Health Organization (WHO) has classified physiotherapists in professional group (ISCO Code 2264) and paramedical professionals have been classified in a separate entity ( ISCO code 2240).
WHO Link: http://www.who.int/hrh/
Physical therapists are qualified and professionally required to:
-undertake a comprehensive examination/assessment of the patient/client or needs of a client group
-evaluate the findings from the examination/assessment to make clinical judgments regarding patients/clients
-formulate a diagnosis, prognosis and plan
-provide consultation within their expertise and determine when patients/clients need to be referred to another healthcare professional
-implement a physical therapist intervention/treatment programme
-determine the outcomes of any interventions/treatments
-make recommendations for self-management.
Thanking you in advance.
ESIC Model Hospital(Ministry of Labour and Employment, Govt of India),
Rajaji Nagar, Bangalore-560010