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Madurai: The Madurai bench of Madras High Court recently reiterated that a claim for medical reimbursement cannot be rejected merely because the treatment was undertaken in a non-networking hospital.

“The issues regarding the settlement of the medical claim are no more res-integra in respect of the treatment undertaken in a non-network hospital. Several orders have been passed by the Courts to settle the medical reimbursement claim and not to reject the same merely on the ground that the hospital is not falling under the list of network hospitals,” noted the HC bench comprising Justices SM Subramaniam and V Lakshminarayanan.

Such observations were made by the HC bench while considering a plea challenging the order of rejection to settle the medical reimbursement claim of the petitioner issued by the Director of Health and Rural Services.

The petitioner, a State pensioner, is a member of the Medical Health Scheme. He held the post of Chief Administrative Officer in the Principal District Court, Pudukkottai and consequently retired from the post in 2010. He regularly pays the subscription fees under the Medical Health Scheme.

While undergoing surgery for a left renal tumour (Cancer), the petitioner was admitted as an in-patient at BRS Hospital, Chennai. During his stay at the hospital, he spent a sum of Rs 1,24,576 towards medical expenses.

Following this, he submitted an application seeking medical reimbursement. However, his petition for medical claim reimbursement was rejected by the Director of Health and Rural Services on the ground that he undertook treatment in a non-network hospital. Referring to this, the authorities held him ineligible for medical reimbursement claim.

Also Read: AYUSH treatment on par with Allopathic treatment for Reimbursements: HC

Challenging this order, the petitioner approached the High Court bench and demanded reimbursement for the money he spent on his treatment. On the other hand, the counsel for the Government submitted that the medical claim will be settled only in the event of taking treatment in a network hospital. The counsel further pointed out that the hospital, in which the petitioner was treated, is not a network hospital, and therefore, the rejection was in order.

However, the court referred to several orders passed by the Courts and pointed out,

“Several orders have been passed by the Courts to settle the medical reimbursement claim and not to reject the same merely on the ground that the hospital is not falling under the list of network hospitals.”

In respect of the petitioner’s case, the bench noted that there was no dispute in the genunity of the treatment taken by the petitioner. The bench further observed,

“In the present case, the genunity of the treatment taken by the petitioner has not been disputed. Once the treatment is found to be genuine, there is no reason to reject the medical claim of the petitioner.”

With this observation, the bench issued direction to the government authorities to settle the claim for medical reimbursement. The order stated, “In view of the facts and circumstances, the impugned order passed by the 2nd respondent dated 02.04.2018 is set aside. The 7th respondent is directed to settle the eligible medical reimbursement claim of the petitioner under the scheme within a period of six (6) weeks from the date of receipt of a copy of this order and the respondents 1 to 6 shall ensure that the payment is made by the 7th respondent within the time stipulated by us in this order.”

To view the order, click on the link below:

https://medicaldialogues.in/pdf_upload/madras-hc-medical-reimbursement-227700.pdf

Also Read: Hospital charging amounts exceeding approved rates, state can’t deny medical reimbursement

Chronic obstructive pulmonary disease (COPD) is globally the third leading cause of death, causing 3.23 million deaths in 2019.

Most feasible way to measure oxygen saturation is by pulse oximetry (SpO2). The Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines recommend evaluation with arterial blood gas (ABG) analysis if SpO2 is ⩽92%.

This recommendation has not been evaluated in stable outpatients with COPD undergoing testing for Long-Term Oxygen Therapy (LTOT) to evaluate whether the performance of SpO2 compared with ABG analysis of PaO2 and arterial oxygen saturation (SaO2) to detect severe resting hypoxemia in patients with COPD a team of researchers conducted a study.

The study published in Annals of American Thoracic Society, reports that SpO2 alone may have a high false-negative (FN) rate for detecting severe resting hypoxemia in COPD patients being assessed for long-term oxygen therapy (LTOT). The GOLD recommends reflex measurement of PaO2 through ABG analysis. This is crucial, particularly for active smokers, and it is advisable to use a cutoff higher than SpO2 ⩽92%.

Researchers conducted a Retrospective analysis of paired SpO2 and ABG values from stable outpatients with COPD who underwent LTOT assessment in a single center. They calculated false negatives (FNs) as an SpO2 >88% or >89% in the presence of pulmonary hypertension with a PaO2 ⩽55 mm Hg or ⩽59 mm Hg in the presence of pulmonary hypertension. Test performance was assessed using receiver operating characteristic (ROC) analysis, intraclass correlation coefficient (ICC), test bias, precision, and accuracy root-mean-square (Arms). An adjusted multivariate analysis was used to evaluate factors affecting SpO2 bias.

The key findings of the study are

• A total of 518 patients were included, the prevalence of severe resting hypoxemia was 74 (14.3%), with 52 missed by SpO2 (FN, 10%), including 13 (2.5%) with an SpO2 > 92% (occult hypoxemia).

• FNs and occult hypoxemia in Black patients were 9% and 1.5%, respectively, and were 13% and 5%, respectively, among active smokers.

• The correlation between SpO2 and SaO2 was acceptable (ICC = 0.78; 95% confidence interval, 0.74–0.81); and the bias of SpO2 was 0.45%, with a precision of 2.6 (−4.65 to +5.55%) and Arms of 2.59.

• These measurements were similar in Black patients, but in active smokers, correlation was lower and bias showed greater overestimation of SpO2.

• ROC analysis suggests that the optimal SpO2 cutoff to warrant LTOT evaluation by ABG analysis is ⩽94%.

In conclusion, “SpO2 as the only measure of oxygenation carries a high FN rate in detecting severe resting hypoxemia in patients with COPD undergoing evaluation for LTOT. Reflex measurement of PaO2 by ABG analysis should be used as recommended by GOLD, ideally at a cutoff higher than an SpO2 ⩽92%, especially in active smokers.”

Reference: Brian Garnet , Rodrigo Diaz-Lankenau , Elie Jean et al ; Accuracy of Pulse Oximetry for Long-Term Oxygen Therapy Assessment in Chronic Obstructive Pulmonary Disease; Ann. Of Am. Thor. Soc. DOI:https://doi.org/10.1513/AnnalsATS.202209-837OC

Bengaluru: The State Government authorities of Karnataka have asked the medical graduates from the 2017 batch, who completed their MBBS course from government-quota seats, to join the one-year compulsory rural service. 

Many of these students are either busy with work or pursuing higher studies. However, as per the rules, if any student does not fulfill the rural service requirements will be slapped with a Rs 10-lakh penalty.

Around 4,170 students are eligible to attend the counselling for rural services this year. TOI adds that for the first time, the State has allowed merit-based exemptions for students based on their MBBS scores.

A notification in this regard has been issued on December 11. The concerned notification is applicable for the MBBS students who were admitted in Government medical colleges and under the government quota seats in private medical institutes during the academic year 2017-2018. Consequently, they graduated after completing their internship in the year 2023.

Also Read: Karnataka Govt proposes restricting compulsory service only for GMC graduates

As per the latest media report by the Times of India, several students are upset over the delayed posting for compulsory rural service. However, the officials in the Health and Family Welfare Department have claimed that the delay was caused because of an amendment that was brought in recently. 

Earlier this year, in October, the State Government announced that rural service rules would be relaxed to the extent of staff availability in the hospitals. Referring to this, an official from the State Health Department informed TOI, “Initially, we did not have enough posts for all students. Then, the amendment to the compulsory service law had to be brought in to restrict the number of students depending upon the posts. The notification was issued as soon as the amendment was made.”

The Daily adds that the notification that was issued under the Karnataka Compulsory Selection of Candidates for Admission to Government Seats in Professional Education Institutions Rules 2006 mentioned that to fill up the available vacancies, online counselling will be held. For the first time, merit-based exemptions will be made applicable for rural service.

Therefore, this year, the candidates who will appear in the counselling for the rural service will have the flexibility to either select a preferred location for one year of service or apply for a merit-based exemption from the same.

Following this, the online counselling system will allocate either the exemption or the location, based on the merit of the candidate. This shall be done based on the MBBS scores provided by the Rajiv Gandhi University of Health Sciences to the department. Therefore, students who have high ranks will get the first chance of getting an exemption.

The MBBS students will have 198 options regarding the preferred service location. Those candidates, who will not register for the online counselling process or who will fail to report to duty will have to pay a penalty of Rs 10 lakh. 

Generally, the exemptions are for students admitted to NMC/RGUHS-approved higher courses and who must undergo one-year compulsory service in a government hospital after completing their PG/DNB/fellowships. Apart from them, women on maternity leave will get a late-commencement exemption for up to one year.

Medical Dialogues had previously reported that earlier this month, the Karnataka Government introduced a bill specifically aiming to replace an ordinance that eliminates the mandatory one-year rural service requirement for medical college graduates in the state.

The bill, tabled by Health Minister Dinesh Gundu Rao, proposes amendments to sections 3, 4, and 5 of the Karnataka Compulsory Services by Candidates Completed Medical Courses Act, 2012.

According to the statement of objects and reasons provided in the bill, the amendment seeks to exempt candidates chosen for central or state government services from the obligation to serve in rural areas.

Previously, under the Karnataka Compulsory Service by Candidates Completed Medical Courses Act, all MBBS, postgraduate, and super-speciality graduates were required to spend one year working in government healthcare institutions in rural areas as junior residents.

Also Read: Proposal to eliminate compulsory rural service for medical graduates moved in Karnataka Assembly

Bengaluru: AstraZeneca Pharma India Ltd. has signed a memorandum of understanding (MoU) with Roche Diagnostics India to improve diagnostics for breast cancer patients with a key focus to streamlining HER2 diagnostics with newer advancements in the field.

Solan: Despite clearing the Foreign Medical Graduate Examination (FMGE) in July of this year, Foreign Medical Graduates in the state are facing delays in the internship allotment process.

The state has eight medical colleges located in Shimla, Tanda, Hamirpur, Nahan, Mandi, Chamba, Bilaspur, and Solan and the FMGs are eagerly waiting to join the mandatory internship programme which is a must for practising in India.

FMGs in the state are facing delays even though some states like Gujarat, Tamil Nadu, and Jharkhand have already initiated their counselling schedules, with the process expected to conclude by the end of the month.

Also read- More Than 400 FMGs In Tamil Nadu Waiting To Join Internship, Urge Health Ministry To Expedite Allotment Process

The graduates argue that since they have already passed the screening test, they have proven their worth and should be allowed to avail internship opportunities as soon as possible.

“As per the NMC existing policy, 7.5 per cent of seats are reserved for foreign medical graduates and as per the guidelines, they will be asked to apply when the internship starts in January,” Dr Vinod Kashyap, Registrar of State Medical Council told The Tribune

Some states, such as Gujarat and Jharkhand, have released seat matrices and started the internship process for FMGs in November. However, FMGs in this particular state are still awaiting similar opportunities.

The FMGs in the state have not received any response from the State Medical Council, adding to the uncertainty and frustration among the graduates.

An FMG, Ajay Thakur, who recently met Health and Family Welfare Minister Dr Shandil here last week, told the daily, “I received my scorecard and passing certificate last month and am awaiting internship allocation in the medical colleges of the state.”

The graduates further added, “Some states such as Delhi were implementing policies that exclude students from other states from availing internships there. This has left the students hailing from the state with limited options but to seek internships from the medical colleges in the state.”

Recently, the National Medical Commission (NMC) has stated that Foreign Medical Graduates (FMG) who had a break in their final year and returned to India due to the Covid pandemic or the Russia-Ukraine war and have finished their coursework online, will be required to complete a mandatory one-year clinical clerkship. Afterwards, they will be eligible for the Compulsory Rotating Medical Internship (CRMI) or clinical medical rotatory internship.

Medical Dialogues team recently reported that the Undergraduate Medical Education Board (UGMEB) of the National Medical Commission (NMC) has released several Frequently Asked Questions (FAQs) related to various issues concerning Foreign Medical Graduates (FMGs). 

Also read- NMC Releases FAQs Related To Issues Faced By Foreign Medical Graduates, Check Details