MAHARASHTRA THE BOMBAY NURSING HOMES REGISTRATON ACT, 1949

1. MAHARASHTRA THE BOMBAY NURSING HOMES REGISTRATON ACT, 1949 • Draft Rules for the Bombay Nursing Home Registration Act (Amendment) 2005 • Submitted To Dr. Prakash Doke, Director General of Health Services, Government of Maharashtra • Submitted By CEHAT, Mumbai, June 2006 • NOT APPLICABLE AT PRESENT Modern Hospital - BTS

2. CONTENTS • 1. Short title, extent and commencement • 2. Definitions • 3. Prohibition to carry on nursing home without registration • 4. Application for registration • 5. Registration • 6. Penalty for non-registration • 7. Cancellation of registration • 8. Notice of refusal or of cancellation of registration Modern Hospital - BTS

3. CONTENTS • 9. Inspection of nursing homes • 10. Income of local supervising authority • 11. Expenses of local supervising authority • 12. Penalty for offences under Act • 13. Offences by corporations • 14. Court competent to try offences under Act • 15. Indemnity to persons acting under this Act • 16. Rules • 17. By-laws Modern Hospital - BTS

4. Contents • Notifiable Diseases • Bio-safety Guidelines • Minimum Standards for 10 bedded General Nursing Home • Surgical Nursing and Maternity Home • Universal Precautions - WHO Guidelines • Building Engineering Environmental Standards Modern Hospital - BTS

5. Prohibition • No nursing home shall be operated unless it is duly registered or its registration is duly renewed and the registration in respect thereof has not been cancelled under Section 7. Modern Hospital - BTS

6. Prohibition • Provided that nothing in the section shall apply in the case of a nursing home which, is in existence at the date of the commencement of this Act, for a period of three months from such date or if an application for registration is made within that period in accordance with the provisions of rule 16 until such application is finally disposed of. Modern Hospital - BTS

7. Application of Registration / Renewal of a Nursing home • An application for registration, renewal of the registration shall be made to the Local Supervisory Authority (MCGM), in duplicate, on “Prescribed” Form in advance before the date on which the registration is to expire and shall be accompanied by the fee prescribed. Modern Hospital - BTS

8. Application of Registration / Renewal of a Nursing home • For a duplicate certificate an application should be made on a plain paper to the Local Supervisory Authority after paying the amount stipulated by the District Nursing Home Registration Board. • The Local Supervisory Authority or any person authorized on its behalf shall assign an acknowledgement number immediately if delivered at office of the Local Supervisory Authority or within 15 days if received by post. Modern Hospital - BTS

9. Refusal to registration • (a) That he, or any person employed by him at the nursing home, is not a fit person, whether by reason of age or otherwise, to carry on or to be employed at a nursing home of such a description as the nursing home named in the application; or • (b) That the nursing home is not under the management of a person who is either a qualified medical practitioner or a qualified nurse and who is resident in the home, or that there is not approver proportion of qualified nurses among the persons having the superintendence of or employed in the nursing of the patients in the home; or Modern Hospital - BTS

10. Refusal to registration • (c) That in the case of a maternity home it has not got on its staff a qualified midwife; or • (d) That for reasons connected with the situation, constriction, accommodation, staffing or equipment, the nursing home or any premises used in connection therewith are not fit to be used for a nursing home of such a description as the nursing home mentioned in the application or that the nursing home or premises are used or are to be used for purposes which are in any way improper or undesirable in the case of such nursing home. Modern Hospital - BTS

11. Penalty • Whoever contravenes the provisions of section 3, shall, on conviction, be punished with fine which may extend to five hundred rupees or, in the case of a second or subsequent offence, with imprisonment for a term which may extend to three months or with fine which may extend to five hundred rupees or with both. Modern Hospital - BTS

12. Inspection • The Health Officer of the local supervising authority or the Civil Surgeon of the district in which a nursing home is situated or any other officer duly authorized by the local supervising authority or the Civil Surgeon, may, subject to such general or special orders as may be made by the local supervising authority, at all reasonable times enter and inspect and premises which are used, or which that officer has reasonable cause to believe to be used, for the purpose of nursing home, and inspect any records required to be kept in accordance with the provisions of this Act: Modern Hospital - BTS

13. Inspection • Provided that nothing in this Act shall be deemed to authorize any such officer to inspect any medical record relating to any patient in a nursing home. • (2) If any person refused to allow any such officer to enter or inspect any such premises as aforesaid, or to inspect any such records as aforesaid or abstracts any such officer in the execution of his powers under this section, • he shall be guilty of an office under this Act Modern Hospital - BTS

14. Records • (a) Prescribing the records to be kept of the patients received into a nursing home, and in the case of the maternity home, of miscarriages, abortions or still births occurring in the nursing home and of the children born therein and of the children so born who are removed from the home otherwise than to the custody or care of any parent, guardian relative. • (b) Requiring notification to be given of any death occurring in the nursing home Modern Hospital - BTS

15. Books of Records • Every nursing home shall maintain an inspection bookand a complaint register (for the patients party), which shall be produced before the inspecting officer/s as and when required. Modern Hospital - BTS

16. Medical records- The keeper of a Nursing Home shall keep and maintain. • (a) In the form appended to these by-laws a register of patients received into the Nursing Home; (b) A correct alphabetical index of the names of the patients admitted to the nursing home; (c) A daily record of health of every patient who may be suffering from acute illness; (d) A daily record of health of every woman admitted to the nursing home for delivery and of (e) every child born to such woman in nursing home; and (f) A daily and weekly record of health of other patients. Modern Hospital - BTS

17. Notice of death occurring in Nursing Home: • (1) If any death occurs in a nursing home, the keeper of the nursing home shall within 24 hours from the occurrence of the death given in writing the notice of such death to the Executive Health Officer of the Corporation or he Registrar of Births and Deaths for the District, appointed under section 442 of the Municipal Act, within whose jurisdiction the nursing home is situated. • (2) The notice may be sent by pre-paid post or in any other effective manner Modern Hospital - BTS

18. Notice of death occurring in Nursing Home: • (a) The notice shall contain the particulars required to be entered in a register sheet under Section 451 of the Municipal Act. • (b) Within twenty-four hours of the conclusion of the inquest, if any, held on the death of any patient admitted into a nursing home, the keeper of such home shall forward a report to the Executive Health Officer of the Corporation or the Registrar of Births and Deaths for the District concerned, containing the following particulars, namely: - • (c) Date of inquest; • (d) Cause of death as found by the authority by which the inquest was held. Modern Hospital - BTS

19. Compliance • The Nursing Home shall adhere to the following minimum standards regarding the Functional Program of the Nursing Home. • Emergency First Aid- The basic minimum functions provided by a nursing home should include Emergency First Aid. • Co-operation in the National Health Programmers and as per notifiable diseases act/ epidemic act. Modern Hospital - BTS

20. Emergency services • All emergency patients attending a nursing home, must be attended primarilyto save the life without considering the financial capability of the patient, and then, may be referred with relevant medical reportsabout the ailments, as early as possible to the nearest suitable referral unit. No advance payment may be demanded for such emergency care. It is also the responsibility of the patient or his/her party to pay all the dues to the nursing home. Non-payment of dues cannot become ground for refusal of emergency care for that person or for future cases. Modern Hospital - BTS

21. Routine Declarations • Declare routinely offered facilities: The nursing home should declare on its sign boards / notice boards / informational literature about the nature of facilities routinely offered and should not ordinarily treat those patients for which facilities are not routinely available in that nursing home. Modern Hospital - BTS

22. Bio Safety • Universal bio safety guidelines and bio-medical waste treatment and disposal rules shall be followed by all nursing homes to protect environment, public and personnel employed from occupation related diseases as per the Bio-Medical Waste (Management and Handling) Rules, 1998. (See ANNEXURE II ) • The general cleanliness of the premises including sanitary arrangement, furniture and Equipments must be properly maintained along with 24 hours adequate potable water supply for the beneficiaries. Modern Hospital - BTS

23. Nursing Staff • Education of Nurses- With regard to education of nurses, two categories of qualified nurses will be recognized. • Qualified Nurses- Nurses registered with the Nursing Council would be included here. • Trained Nurses- All those who have taken a minimum of six months nursing training in any government approved institution would be considered trained nurses, and eligible to be employed as nurses in the Nursing Homes. Modern Hospital - BTS

24. Nursing Staff • Minimum number of nurses- One qualified/ trained nurse for 10 beds or part there of on every shift and if on different floors then in same proportion on different floors. Taking into account the weekly offs and leaves, this would mean totally more than 3 nurses employed per 10 beds. • Adequate efforts need to be taken to procure qualified nurses. For the time being nurses from all courses, of a minimum duration of six months, meant for training nurses, may be considered qualified nurses. Seats in government colleges for Nursing need to be increased, as also relevant courses for Nursing need to be introduced to bridge the gap. Modern Hospital - BTS

25. Patients have a right to access heath care • All nursing homes must adopt the Standard Charter of Patient's Rights (displayed at a prominent place), observe it and orient their staff for the same. It should contain all relevant provisions contained in these rules. • Patients have a right to information Modern Hospital - BTS

26. Patient Rights • All charges of the Nursing Home, like bed charges, consultation charges, operation charges, charges for diagnostic tests (If Nursing Home has a diagnostic center) must be displayed. • An information booklet in the local language must be provided to the beneficiaries. The nursing home is to offer an estimate of expenditure likely to be incurred to the in-door patients either for the whole package for investigations, treatment and management or by furnishing item-wise estimate for investigations, treatment or management, separately. Modern Hospital - BTS

27. Patient Rights • The patient at the time of discharging from the nursing home should be provided with discharge card which should mention the diagnosis, the medical treatment given and the state of his/her health. • If the patient chooses, he/she may seek a second medical opinion as to such diagnosis, treatment or state of health. All relevant reports must be made available to facilitate second opinion. Modern Hospital - BTS

28. Patient Rights • All charges incurred by the patient at any stage of medical care, and all payments made by the patient should be supported by a detailed statement/receipt, which should be provided with or without a request made by the patient. Modern Hospital - BTS

29. Patient Rights • The patient must have an access to his / her clinical records at all reasonable times during admission to NH. A photocopy of the same should be available within 24 hrs when admitted to NH or within 72 hrs of making an application by patient or legal heir after discharge or death, after photocopy charges. • Patient’s have right to autonomy and participation in decision making Modern Hospital - BTS

30. Patient Rights • Patients have the right to adequate care and protection • Patient has a right to personal dignity and privacy • A functional grievance redress mechanism must be set up at the nursing home and the information of the procedure should be given to the patient. • Adult and conscious patient has the right to refuse treatment if so allowed under the existing Laws. Modern Hospital - BTS

31. Clinical Research • Any Nursing Homes undertaking clinical research must ensure that the following conditions are fulfilled: • Any nursing home that is undertaking clinical research must ensure that it is done in compliance with ICMR guidelines. • Patient’s informed consent is obtained before involving them in any clinical research protocols. • Patients are informed of their right to withdraw from the clinical research at any stage and also of the consequences (if any) of such withdrawal. Modern Hospital - BTS

32. Penalty • Whoever contravenes any of the provisions of this Act shall, if no other penalty is elsewhere provided in this Act or the Rules for such contravening, on conviction be punished with fine which may extend to five thousand rupees and in the case of a continuing offence to a further fine of fifty rupees in respect of each day on which the offence continues after such conviction up to six months following which the registration of the nursing home would be cancelled. Modern Hospital - BTS

33. Penalty • Whoever continues to contravene the provisions of Section 3 from the Act, shall on conviction, be punished with imprisonment which may extend to six months or with fine which may extend to ten thousand rupees or with both. • On further contravention will be liable for punishment as per the act. Contravention of renewal after three years, will also invite a show cause notice, along with a fine as per Section 12 of Act. Failure to renew registration three months after show cause notice will amount to non-registration. Modern Hospital - BTS

34. Notifications • It shall be obligatoryon the nursing home to informto the nearest police station about all grievous cases of injury treated in the nursing home and maintain records of all injuries examined and retain it for a period of the complete disposal of the case. • A report of Notifiable Diseases will have to be submitted within 48 hours of its diagnosis to the DirectorHealth Servicesas per prescribed Form of that bureau by the Nursing Home. Notifiable disease register and a record of information given to local authorities must be maintained. A list of notifiable diseases is annexed. Modern Hospital - BTS

35. List of Notifiable Diseases • Small Pox • Cholera • Plague • Yellow fever • Scarlet fever • Enteric fever (Typhoid fever) • Diphtheria Typhus • Tuberculosis • Leprosy Modern Hospital - BTS

36. List of Notifiable Diseases • Puerperal fever: Puerperal pyrexia is considered as any febrile condition occurring in a woman whose temperature rises to 100.4’ F (38 C) or more within fourteen days after confinement or miscarriage. • Influenza • Cerebrospinal fever • Poliomyelitis • Virus Encephalitis / Infectious Hepatitis Modern Hospital - BTS

37. List of Notifiable Diseases • Dengue fever • Gastro Enteritis • AIDS • Meningococcal Meningitis • Leptospirosis • Bird Flu • Would include any other diseases notified under the Epidemic Diseases Act, 1897 Modern Hospital - BTS

38. Not Applicable Nothing in this Act shall apply to - • (i) any nursing home carried on by Government or a local authority or by any other body of persons approved by the Provincial Government in this behalf; and • (ii) Any asylum for lunatics or patients suffering from mental diseases, within the meaning of the Indian Lunacy Act, 1912. Modern Hospital - BTS

39. ACKNOWLEDGMENTS • CEHAT – Ms. Chandrima • AMC • BHNA • MCGM – Mr. Jairaj Pathak • Government of Maharashtra Modern Hospital - BTS