Monday, January 17, 2011

MINUTES OF MEETING HELD ON 09 DEC 10 AT KOTA HOUSE

NFDC AGENDA FOR DISCUSSIONS WITH ECHS 09 DEC 2010

Issue of 3 Months Medicines and Longer

1. We were informed by CNS, COP, CPS and Capt, AL Narayan Director, ECHS (Navy) that “MDECHS has informed that AG/Army HQ had a meeting recently with DGMS (Army) & MDECHS regarding issue of medicines for three months to Veterans. AG has directed DGMS (Army) to resume issue of three months medicines to ECHS members on medical officer’s prescription. The policy letter on the subject is being promulgated to the environment shortly. But medicines are not being issued on the ground. It will avoid work load on Polyclinics, Doctors, Reception and Medicine issue counters. More than 60% members in ECHS are on CT.

2. Long Term Issue of Medicines. Veterans are being denied medicines when proceeding out of the country etc for longer periods despite showing air tickets and passports to the officer in charge (ECHS Polyclinic NOIDA).We feel we should be issued medicines for such long absences as there is no addl cost to the exchequer and medicines are the legitimate dues of the patient. shareefahmad.khan@gmail.com

In Cases of Emergency Base / R&R / Service Hospitals’ must Accept Veterans.

3. Officers staying in vicinity of Base hospital & R&R and needing medical attention be seen at these hospitals in cases of emergency, rather turning down without attending and life is lost/ condition deteriorates.
Case. On 17 Sep Mrs Chitra Pandey was not attended to by the Lt Col Anup the DMO at R&R at about 1630 hrs with her platelets at 18K and severe headache. Repeated requests and pleading with Base Hosp for reference to empaneled hospital were not accepted. She was treated at R&R on 12 Sep 10 for high fever,105.6 degrees. Later she was rushed to Fortis, Rockland and Max Hospital but no beds were available. Her condition worsened and family went through pain. OiC Lodhi Road Col Dhingra is well aware of this incident. His timely assistance helped getting Chitra, admitted to Sant Permanad Hospital, Civil lines PM 17 Sep 2010 only thru good personal networking. Armed Forces channel have become more bureaucratic.

Lodi Road Issues
4. A large number of retired officers are being served by Lodhi Road Polyclinic however the only and good medical specialist namely Manoj Aron was replaced. Available GPs are inexperienced and very slow. It takes a couple of hours for one's turn to come and the place is always over crowded. There is one old X-ray equipment without any radiologist. This results into R&R not accepting the X Ray report without radiologist's findings and the patient has to be X Rayed again with additional trips to R&R or Base Hospital This is taxing. You are requested to consider appointing at least two Medical specialists at the earliest.
5. The third MO has just come after months of a single MO and the second Med Specialist has not been there for many months and only up to 1300 hrs Cdr. (retd) Keshoram

6. Lodi Road Clinic is not authorized to refer cases to the empanelled Hospitals directly but has to refer all cases to the Base Hospital which in turn depending on the occupancy/facilities refer the case to the Empanelled hospitals. For the large number of ECHS members residing in East Delhi the Base Hospital is on the other extremity of the city and over 30-35 kilometers. Considering Delhi’s traffic and the age of the ECHS members, driving this distance is most trying to say the least. It is suggested that ECHS Lodi Road be authorized to refer cases directly to RR Hospital, the RR hospital in turn may further refer the case to the empanelled hospital in case the capacity/facility in RR does not exist.

7. Adequate and serviceable diagnostic equipment is not available. For example, the dental XRay machine took over a year to repair. We had to get XRays done privately.
NOIDA Specific Issues
8. Referral for Dental cases in Noida is made only to AFDC, which is overloaded with patients and difficult to get an appointment. Alternatively one has to go to some empanelled Dental Clinic in Janakpuri which is 40 Kms from Noida. Suggestion is to allow patients to be referred to some good empanelled hospitals’ in Noida. It takes 6m to 1 year to get dentures made. V.S.Vishnoi

9. Non availability of specialists e.g. ENT, Cardiologist etc.

10. Non availability of Medical Staff for X-ray, physiotherapy. There is also is an acute shortage of space for Medicine Store and medical staff. The equipment including instruments in Dental Centre Noida needs to be repaired/ replaced so that the doctors can do justice. At times even proper Lighting and filling material are not available. If we compare the facilities with R & R/ AFDC, ECHS Noida will be rated ‘sub-standard’

11. Funds for local purchase – need to be doubled.

12. The Doctors don’t have a stethoscope, thermometer, BP instrument, torch and instrument to check the throat etc. These must be provided to all doctors.
Mumbai’s Issues
13. There is no Civil hospital on the panel of ECHS in Mumbai and INHS Asvini is overcrowded. This a major problem and an issue for those living in the suburbs. chaman_chawla2000@yahoo.com
General Issues
14. ECHS Lodi Road Clinic is not authorized to refer cases to the empanelled Hospitals directly but has to refer all cases to the Base Hospital which in turn depending on the occupancy/facilities refer the case to the Empanelled hospitals. For the large number of ECHS members residing in East Delhi the Base Hospital is on the other extremity of the city and over 30-35 kilometers. Considering the Delhi traffic and the age of the ECHS member driving this distance is most trying to say the least. It is suggested that ECHS Lodi Road be authorized to refer cases directly to RR Hospital, the RR hospital in turn may further refer the case to the empanelled hospital in case the capacity/facility in RR does not exist.
15. A Veteran had an Ortho problem and visited ECHS on Saturday. He was referred to the Base Hospital Ortho Surgeon who sees outpatients only on Tuesdays and Fridays. He started his journey at 0700hrs and could manage to reach the Base hospital at 0845. On reporting to counter for registration he was informed that Ortho Surgeon is on leave. On further enquiry as to when the Ortho Surgeon will be on duty, he was informed " not this week". There are many who suffer similarly. We need a workable solution Avtar Singh
16. Issue of possibly fake / spurious medicines has been brought to the notice of OI/c the Clinic and the same was also given in writing for pursuing the matter further. The OI/c and MO i/c concurred that the medicine in question was spurious/fake. The matter needs to be pursued.
H Sahney,
17. At times very old and infirm Veterans, some over 90 years old have problems and they are not in a position to take the car ride to a hospital. We need to devise ways to provide support in such cases.
18. There is no Polyclinic support available on Sundays and holidays and this totals some 70 plus days in a year and this issue needs to be addressed. Similarly, since many Veterans’ take a second job after retirement, therefore Sundays may be made half working days and staff granted compensatory leave on a working day. Dr. Satish Kulhari
19. Military Hospitals shutting doors to the ESM and sufficient private super specialty hospitals not keen on getting to be empanelled to the ECHS.
20. Need to review the requirement of TAC (temp att cert) to be able to get medicines for than 7 days and of course, the concept of parent polyclinic. Col PK Garg
21. The official ECHS website needs to be redesigned to make it member friendly where information should be available conveniently. It should have provision for giving feed back / suggestions / complaints and date of up-dating of the site should be displayed. Complaints may also be received on the net. All members should be given the facility to get their email ID registered so that any future policy change or information can be communicated to those who have registered for the facility seamlessly by email.
22. CGHS have the following facilities, which could be considered for induction in ECHS besides bringing in, other improvements given below in the comparison between CGHS and ECHS :-
(a) CGHS Doctors are available on shift during off working hours to attend to patients after working hours. In the present ECHS system a patient can go to empanelled Hospitals only if they are critically ill as per list promulgated. If the illness does not fall within the promulgated list we have to go private doctor and pay the fees from our pocket.
(b) CGHS Doctors visit residence of patients if they are unable to go the clinics because of nature of sickness, very old age or other reasons.
23. ECHS doctors refuse to sign, Driving Licence renewal medical form, RTO insists that these should be signed by a Govt Doctor. Please request ECHS to help us in this.
24. Examination of the list of ECHS Empanelled Hospitals in NCR and other Regions shows that the MOA with a large number of Hospitals has expired in June 2010. It is possible that some of these may have been renewed but this information has not been updated on the Army ECHS website. It is suggested that the list of empanelled hospitals in the Army/Navy website be regularly updated so that the ECHS members can make an informed choices Further it is also suggested that the contact persons telephones- of the respective hospitals be also put on the website and updated at the time of renewal of the MOA. Vijay S Mathur VAdm (R)
25. ECHS does not keep catheters of various sizes despite application made. This may also be considered.
Common Issues – Vision Statement and Need For Setting Standards by ECHS
26. There is a very urgent need for the promulgation of a Vision statement and ‘Standards’ to be achieved in all spheres including standards of cleanliness and hygiene, waiting times, facilities at the Policlinics, distance of polyclinic from residence, reaching out to those in the hinterland etc.. Arrangement to see doctors with prior appointments rather than waiting in long queues also needs to be incorporated in this document.
27. There is considerable concern on the poor standard of cleanliness, especially the bathrooms-----they really stink and the unhygienic atmosphere in the waiting halls on a daily basis.
SALIENT DIFFERENCES BETWEEN CGHS AND ECHS
AND NEEDING TO BE BRIDGED
CGHS ECHS
1. Both serving as well as Only retired person are members
retired person are members

2. Open 24 hours Open only during working hours
3. Open on Sundays and holidays Closed on Sundays and Holidays

4 Situated extensively through the Only two in Delhi and only one at selected
length and breadth of the country, in towns
Cities and towns

5 Has a number of support Only one at each city and
Hospitals in Delhi and big cities

6 Referral to empanelled Referral to empanelled hospital
Hospital allowed for all ailments. restricted to some ailments.

7 NA drugs available through No such arrangement yet
selected chemist shops

8 Polyclinic situated within Polyclinic situated at much
5 kms distance in Delhi more than 15 kms

9. 24 hours service available for Patient has per force to go to Base/service
minor ailments such as fever and hospital after ECHS working hours and
not needing hospitalization Sundays/ holidays

10. No discrimination on priority Priority to serving over retired personnel.
between serving and retired persons
at support(civil) hospitals.
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NFDC Brief on Discussions Held with CPS and MD,ECHS

1. The meeting was held as scheduled, at Kota House on 9 Dec 10 with CPS, Vice Adm SPS Cheema in the Chair. MD ECHS with his staff and Officers in Charge of all Polyclinics in the NCR were present. From our side, VAdm SP Govil, Vice Adm AC Bhatia, Cmde H Sawhney, Cdr KC Bansal, Cdr. HK Nag, Cmde Ranjit Rai, Cmde RR Tandon, Cdr N Mahajan, Capt Pran Parashar, Cmde VK Thakur and VAdm Harinder Singh attended.
2. There has been some delay in promulgating these minutes as we were waiting for the official record of discussions. As some members of NFDC want a feed -back, a summary of the discussions is given in the succeeding paragraphs.
3. The meeting was very useful and productive in bringing out the problems being faced by the veterans. The veterans explained their basic requirements to help in creating a better understanding of their requirements and with the aim of closing the gap between the two sides. The Official team was very frank and extremely positive on the way ahead and assured us that the system would show all round improvement in the next few months.
4. Issue of Medicines for 3 Months and Longer. It was brought out that there was a contradiction between the orders issued by the Service Hqrs and those issued by the erstwhile DGAFMS. The latter was unwilling to see the point of view of the veterans. The officers-in charge confirmed that they were willing to issue medicines for longer periods provided their demands are met in full; the former DGAFMS had opposed this also. ECHS and service Hqrs will try and improve the supply of medicines. Members proceeding abroad will also be able to draw medicines for longer periods once adequate supplies were available. The issue of some fake medicines finding their way to the Veterans was also noted for action. Local purchase powers, though revised recently were still inadequate. Problems are also compounded as each service is following its own procedures leading to variations between the Polyclinics. These procedure are also being standardized.
5. Third Party Administrators. The proposal for Third Party Administrators (TPAs) has already been approved for the CGHS and will be introduced in to ECHS very shortly. These administrators will attend to reimbursements and clearances of bills to hospitals and individuals. The TPAs will cut out the Civil/Military interface. Similarly the empanelment of Pharmacies to issue medicines on the lines of CGHS will ensure a continuous supply of medicines directly to the patients, though this system may take some time. In the meantime the Military supply channels are being improved.
6. Lodi Road Issues. MD,ECHS acknowledged that there were many shortcomings and agreed to make up some of the shortages of personnel, maintenance and equipment. Making up the shortage of the junior staff may not happen in a hurry as there were not many volunteers due to the poor pay structure. There was general agreement that the Lodi Rd clinic had shown distinct improvement recently, though much still needed to be done. The MD also pointed out that the rush should even out, once the three additional polyclinics in Delhi get operational. However, he added that there were difficulties as far as accommodation for these clinics was concerned. One of the Clinics is expected to be located in Chankyapuri.
7. Referrals. Veterans from Delhi are unlikely to get the facility of being referred directly to empanelled hospitals, due to Govt regulations and also the likelihood of setting up a Veterans' Hospital in the NCR, for which a case is being progressed.
8. NOIDA Specific Issues. There was a broad consensus that Noida Polyclinic was generally running well, though much more still needed to be done. MD agreed to make up shortages of equipment, medicines and funds at the earliest. Also,\more space would be available for the clinic once the adjacent building was made available and both buildings renovated and modernized. He was unable to provide a referral facility for Dental care as none of the local clinics were volunteering and he requested NFDC Members to try and cajole local dentistry clinics to join up. Members' help is solicited towards this end.
9. ECHS Facilities at Jalvayu Vihar. It was urged that some ECHS facilities be located at the MI Room in Jal Vayu Vihar MI Room (Sectors 21 and 25) for the benefit of the veterans residing there. MD ECHS stated that as per their plans, once the renovation of the Sector 37 polyclinic is taken in hand, part of ECHS would be relocated to the Sector 25 MI Room.
10. Polyclinic Support. There is no polyclinic support outside working hours, on Sundays and holidays, for the aged and infirm who cannot make it to the Polyclinic and the need for TACs. MD informed that there is no bar whatsoever to Veterans going to empanelled hospitals for illnesses that they may consider essential and urgent for treatment and we should use this facility that already exists. A suitable system to provide OPD support is also being discussed by ECHS and will be promulgated after approval. ECHS will work towards the goal of providing support outside working hours and also publish its vision statement, as requested by us. TACs are not essential and the need will cease once the new ECHS Cards are issued, possibly within a month. The fact that they are given medicines for a shorter period is because of shortage of medicines with the Polyclinics whose priority is to satisfy the needs of their dependents first. However, this situation should improve once the supply of medicines improves.
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ECHS BRIEF GIVEN BY ECHS AT THE MEETING
ECHS was started on 01 Apr 2003 based on felt need of a large population of ex-servicemen across the country. This scheme modeled on the lines of CGHS provided comprehensive medical cover to the members for all known diseases. Prior to 1963 there was no provision for Medicare to ex-servicemen. In 1963, the govt. permitted limited medical facilities to the ex-servicemen. Limitation was based on local availability of facility and medicines. Local purchase of medicines for treating ex-servicemen was not allowed since the concession was based on local spare capacity utilisation within existing budgetary allocations for serving soldiers. Only ex-servicemen and their spouse / widows were permitted this 'gratis' Medicare with exclusions of diseases like cardiac ailments, renal failures, cancer, TB, leprosy, psy illness and paraplegia. Military Hospitals covered places where only 20% of ex-servicemen had settled. Therefore only very limited number of patients could actually get medical attention by the AFMS.
ECHS was therefore the most notable welfare scheme ever launched in India for ex-servicemen. The members of ECHS became entitled to comprehensive Medicare covering all known diseases. ECHS marked Govt's commitment to providing full budgetary support to the healthcare of ex-servicemen and their families. Not only ex-servicemen and their spouse / widows, ECHS covered entitled parents and children. ECHS beneficiaries became entitled to treatment not only in service hospitals, they could also be referred to select private hospitals for best possible Medicare and to ensure that service hospitals are not overloaded. Apart from 106 ECHS Polyclinics in military stations, 121 Polyclinics were established in non-military stations where a large majority of retired soldiers had settled down. These Polyclinics were provided with doctors, physicians, paramedics and at some places even gynecologists to provide full fledged OPD facility to the members. Diagnostic aides like X-Ray and path lab has also been provided at the polyclinics.
ECHS membership has now crossed 11 Lakh with a total of over 34 Lakh beneficiaries. Smart cards have been issued to the members to establish irrefutable proof of the identity through biometrics.
As the scheme progressed and advanced towards stabilisation, the large and expanding beneficiary base necessitated review and reforms. Main challenge of the scheme was how to handle increasing OPD load at the Polyclinics with skeletal contractual staff authorisation, how to decongest the high-pressure Polyclinics and service
hospitals, how to prevent infirm patients running from pillar to post for getting entitled Medicare and reimbursements and how to extend the reach of ECHS to remote areas with considerable ex-servicemen population.
The free and frank no holds barred discussions during the Chandimandir ECHS Seminar of Jul 2009 based on theme-'The Way Ahead', marked a turning point for ECHS and facilitated much needed reforms. Reformed referral policy liberalized procedure for treatment in private hospitals and paved way for decongesting service hospitals (Army, Command and Zonal), removed local restrictions on referrals and opened non-empanelled dialysis centres for beneficiaries. Direct referrals by remote Polyclinics were permitted to empanelled super-speciality hospitals of nearby cities. This enabled the outstation patients to directly access outstation multi-speciality hospitals without being referred through high-pressure Polyclinics of larger cities like Delhi, Chandigarh, Bangalore, Kolkata, and Pune etc. This provision also helped in preventing congestion at the Polyclinics of these cities.
Another issue facilitated during the Chandimandir Seminar was mutual decision by the Services and the ex-servicemen's bodies to work in partnership for resolving problems of members and for improving the services under the Scheme. Voluntary service by the members has been notable at Secunderabad Polyclinic where right from registration of sick report to assistance in construction of additional accommodation, member volunteers are doing wonderful works. The 'Secunderabad Model' is there for others to emulate and take a notch higher.
After persistent efforts of the Armed Forces, the Govt has approved the expansion of ECHS to open 199 additional ECHS Polyclinics. This will enable benefits to ex-servicemen in districts where their population is up to 1500. Remote areas where the ECHS population is up to 800 would also be covered. Anomaly of denial of ECHS membership to Nepal Domiciled Gorkha ex-servicemen was removed when the Govt. approved their membership for treatment in India. It is now intended to seek establishment of Polyclinics in Nepal. This would bring the NDGs ex-servicemen settled in Nepal at par with their counterparts in India.
Certain other improvements in the scheme being actively pursued with the Govt. are:-
-Enhancement of powers of competent financial authorities to enable early consideration of Medicare bills.
-Improving supply of medicines and consumables through two means. The first, through the proposal of outsourcing the pharmacy services to reputed manufacturers and suppliers and the second through enhancing the financial limit of local purchase of medicines by Officer-in-charge of the Polyclinics. Provision is also being sought for reimbursement of purchase of non-available medicine to the members.
-Improving quality of OPD services at the Polyclinics by seeking authorisation of deficient category of essential staff like radiologists, radiographers, physiotherapists, pharmacists, dental assistants / hygienists and clerks. Presently the Armed Forces are spending approx Rs 5 Crore annually for this purpose.

-There are about 6.5 Lakh ECHS hospitalizations each year. Hospital bill clearance takes much longer than the stipulated period of 60 days in absence of dedicated staff / organisation for this purpose. Therefore bill processing by Third Party Administrators is intended to replace the present adhoc processing system.. This would not only reduce load from the Station HQs but also enable the hospitals to receive reimbursements within three weeks of bill submission.
-Empanelment of private hospitals for providing cashless treatment to ECHS beneficiaries is an ongoing process. However, this process takes unduly long due to delayed submission of completed proceedings of Board of Officers convened for this purpose. In some cases, this process takes nearly two years. Govt. is now considering utilizing the services of National Board of Accredition for Hospitals and Healthcare providers (NABH). This step is expected to reduce the empanelment period to approx a month.
While the formal Govt. nod for much needed improvements in ECHS is awaited, certain other steps have been taken by the Armed Forces for meeting the enhanced aspirations of the beneficiaries. Providing telephonic appointments with the Polyclinic doctors in afternoons is a small step, which has added to clientele satisfaction. ECHS staff at various high-pressure stations has also been advised to set up extension counters in localities with high member density so that ECHS benefits, especially medicines are available in their neighborhood. This step would also help in decongesting the Polyclinics.
It has been realized that such a large health scheme cannot be effectively managed without using technology. Therefore, automation of Polyclinic processes and networking of all Polyclinics is underway on Public Private Partnership model.
Recently a study on ECHS and CGHS was conducted by the Indian Council for Research on International Economic Relations. The survey undertaken under this study revealed the members preference for ECHS as against offered health insurance scheme. 93% beneficiaries preferred ECHS to health insurance.
ECHS is a flagship welfare scheme of the Govt. for the welfare of ex-servicemen. Approximately Rs 1000 Crore is being spent by the Govt. for meeting the health care needs of the veteran soldiers and their families of the three services and the Indian Coast Guard. The Armed Forces are continuously endeavouring to improve the quality and reach of this scheme, which is now on the threshold of a major expansion.
Ten ECHS hospitals are planned at Delhi Cantt, Chandigarh/Panchkula, Jalandhar Cantt, Lucknow, Kolkata, Jaipur/Jodhpur, Secundrabad, Pune, Kochi and Bangalore. ECHS hospital at Delhi Cantt will be established first followed by other cities. These hospitals will be of are 500 beds facility in 25 acre area with a capital and revenue budget of 250 Crore and 135 Crore respectively.
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INTEGRATED HEADQUARTERS MINISTRY OF THE DEFENCE (NAVY)
ECHS OFFICE
MINUTES OF MEETING HELD ON 09 DEC 10 AT KOTA HOUSE
MDECHS INTERACTION WITH PRESIDENT NFDC


1. The following were present :-

Vice Admiral SPS Cheema, CPS - Chairman
Maj Gen A Srivastava, MDECHS
Cmde MVS Kumar PDESA
Captain AL Narayan Director ECHS(Navy)
Vice Admiral Harinder Singh (Retd) President NFDC
Cmde VK Thakur (Retd) Secy NFDC
Oi/Cs of ECHS Polyclinics Lodhi Road, Gurgaon, Noida, Faridabad and Ghaziabad (Hindon)
Approx 20 retired Naval Officers of NCR/ Delhi

2. CPS has welcomed the members for the meeting especially president Navy Foundation Delhi Charter and MDECHS.


AGENDA POINTS


ITEM I & II - ISSUE OF THREE MONTHS MEDICINES AND
LONG TERM ISSUE OF MEDICINES


3. Status. We were informed by CNS, COP, CPS and Capt, AL Narayan Director, ECHS (Navy) that “MDECHS has informed that AG/Army HQ had a meeting recently with DGMS (Army) & MDECHS regarding issue of medicines for three months to Veterans. AG has directed DGMS (Army) to resume issue of three months medicines to ECHS members on medical officer’s prescription. The policy letter on the subject is being promulgated to the environment shortly. But medicines are not being issued on the ground. It will avoid work load on Polyclinics, Doctors, Reception and Medicine issue counters. More than 60% members in ECHS are on CT. Veterans are being denied medicines when proceeding out of the country etc for longer periods despite showing air tickets and passports to the officer in charge (ECHS Polyclinic NOIDA).We feel we should be issued medicines for such long absences as there is no additional cost to the exchequer and medicines are the legitimate dues of the patient.

4. Discussion. The issues of medicines is the total responsibility of DGAFMS. Necessary funds from ECHS for example for this financial year an amount of Rs. 360 Crore have been placed with DGAFMS. However, AFMSDs functioning under DGAFMS are supplying only 10% of the required medicines. The remaining 90% are being supplied through the existing Local Purchase procedure as is being done for serving personnel in Military Hospitals. A case has also been taken up for review of financial powers of Oi/C polyclinics for local purchase by Oi/C polyclinic including military polyclinics Rs. two lac for ‘A’ and ‘B’ type polyclinics and Rs. one lac for ‘C’ and ‘D’ type polyclinics. Not withstanding the above, MDECHS has intimated that policy letter on the subject for issue of three months medicines exists in ECHS but DGAFMS has issued a overriding directive that medicines will be issued for only one month and more importantly the Oi/C of polyclinics have informed that the stock being held does not permit them to issue three months medicines and that is the reason why polyclinics are unable to issue three months medicines to ECHS members. However, MDECHS has intimated that Navy could make necessary arrangements at Commands / Naval Hospitals levels so that medicines could be issued for three months. As far as Delhi / NCR is concerned MDECHS would again take up the issue with DGAFMS for resolving this issue of medicines.

5. Decision. MDECHS has been requested to take up the issue of three months medicines with DGAFMS and thereafter promulgate the policy letter.

Action By : MDECHS


ITEM III - IN CASES OF EMERGENCY BASE / R&R / SERVICE HOSPITAL
MUST ACCEPT VETERANS

6. Status. Officers staying in vicinity of Base hospital & R&R and needing medical attention be seen at these hospitals in cases of emergency, rather turning down without attending and life is lost/ condition deteriorates.

7. Discussion. The military hospitals will accept cases of emergency for providing medicare subject to availability of facility / beds. Refusal to attend to medical emergencies is against medical ethics. Any case of this nature would be brought to the notice of concerned DGMS / DGAFMS.

8. Decision. MDECHS has been requested to take up the issue of medicare in Base / R&R with DGAFMS and thereafter promulgate the policy letter.

Action By : MDECHS

LODHI ROAD ISSUES

ITEM IV & V - APPOINTMENT OF SUITABLE MEDICAL OFFICERS / RADIOLOGIST

9. Status. A large number of retired officers are being served by Lodhi road Polyclinic however the only and good medical specialist namely Manoj Aron was replaced. Available GPs are inexperienced and very slow. It takes a couple of hours for one's turn to come and the place is always over crowded. There is one old X-ray equipment without any radiologist. This results into R&R not accepting the X Ray report without radiologist's findings and the patient has to be X Rayed again with additional trips to R&R or Base Hospital This is taxing. You are requested to consider appointing at least two Medical specialists at the earliest. The third MO has just come after months of a single MO and the second Med Specialist has not been there for many months and only up to 1300 hrs.

10. Discussion. MDECHS has intimated that necessary steps will be taken to ensure good medical specialists are appointed at the polyclinic. He also further intimated that he would consider posting of two medical specialists by re appropriating. The issue of Radiologist will be resolved once the additional manpower sanction is obtained from MOD.

11. Decision. MDECHS has been requested to authorise two medical specialists to Lodi Road Polyclinic and expedite obtaining additional manpower sanction from MoD for authorising Radiologist.
Action By : MDECHS

ITEM VI - REFERRAL TO PRIVATE EMPANELMENT HOSP DIRECTLY BY
LODHI ROAD POLYCLINIC

12. Status. Lodi Road Clinic is not authorized to refer cases to the empanelled Hospitals directly but has to refer all cases to the Base Hospital which in turn depending on the occupancy/facilities refer the case to the Empanelled hospitals. For the large number of ECHS members residing in East Delhi the Base Hospital is on the other extremity of the city and over 30-35 kilometers. Considering Delhi’s traffic and the age of the ECHS members, driving this distance is most trying to say the least. It is suggested that ECHS Lodi Road be authorized to refer cases directly to RR Hospital, the RR hospital in turn may further refer the case to the empanelled hospital in case the capacity/facility in RR does not exist.

13. Discussion. MDECHS has agreed to this point to consider favorably and that the suitable policy letter will be promulgated at the earliest subject to confirming non availability of facilities / beds.

14. Decision. Executive orders in this regard have since been issued by the Central Organisation ECHS.


Action By : MDECHS


ITEM – VII - AVAILABILITY OF EQUIPMENTS IN OPERATIONAL STATUS

15. Status. Adequate and serviceable diagnostic equipment is not available. For example, the dental XRay machine took over a year to repair. We had to get XRays done privately.

16. Discussion. This issue will be addressed expeditiously as required. The issue of stocking personal catheters at polyclinics will be taken up with DGAFMS / concerned SEMO.

17. Decision. MDECHS has been requested to take up the issue with DGAFMS for necessary action.

Action By : MDECHS


NOIDA SPECIFIC ISSUES

ITEM VIII - REFERRAL FOR DENTAL IN NOIDA TO JANAKPURI

18. Status. Referral for Dental cases in Noida is made only to AFDC, which is overloaded with patients and difficult to get an appointments. Alternatively one has to go to some empanelled Dental Clinic in Janakpuri which is 40 Kms from Noida. Suggestion is to allow patients to be referred to some good empanelled hospitals’ in Noida.

19. Discussion. Since the Janakpuri dental clinic is 40 Km away and the local dental clinics are not coming forward for empanelment due to low rates or for other reasons, the Chairmen requested the retired fraternity to use their good social network and ensure the local dental clinics come up for empanelment as the new 2010 ECHS rates are on the higher side. ECHS is also planning to create own dental laboratory adjunct to the polyclinics for meeting the denture requirement. ECHS has been authorized 58 procedures like CGHS.

20. Decision. Retired fraternity has been requested to use their influence for getting suitable dental centres in Noida for empanelment under ECHS.

Action By : MDECHS


ITEM IX - NON AVAILABILITY OF SPECIALISTS – ENT, CARDIOLOGIST

21. Status. Non availability of specialists - ENT, Cardiologist.

22. Discussion. MDECHS explained that Polyclinics are meant to provide general OPD cover including physician and gynae. For Specialist / super specialist cover, patients are referred to service / empanelled facilities.

23. Decision. MDECHS has intimated that Polyclinics are meant to provide general OPD cover including physician and gynae. For Specialist / super specialist cover, patients are referred to service / empanelled facilities.

Action By : Oi/C Polyclinics (Delhi / NCR)


ITEM X - STATUS OF DENTAL POLYCLINIC

24. Status. Non availability of Medical Staff for X-ray, physiotherapy/. There is also is an acute shortage of space for Medicine Store and medical staff. The equipment including instruments in Dental Centre Noida needs to be repaired/ replaced so that the doctors good do Justice. At times even proper Lighting and filling material is not available. If we compare the facilities with R & R/ AFDC, ECHS Noida will be rated ‘sub-standard’

25. Discussion. Oi/C Noida Polyclinic was requested to ensure that the complaints of dental centre are addressed aggressively at the earliest.

26. Decision. MDECHS has been requested to ask Oi/C Noida Polyclinic to ensure that the complaints of dental centre are addressed aggressively at the earliest.

Action By : Oi/C Polyclinic Noida

ITEM XI - FUNDS FOR LOCAL PURCHASE NEED TO BE INCREASED

27. Status. Funds for local purchase – need to be increased.

28. Discussion. This issue is pending with Mod and once the approval is received the Oi/C Polyclinic both at the military and non military will have power of 2 lakh in ‘A’ and ‘B’ Type of polyclinic and 1 lakh in ‘C’ and ‘D’ type of polyclinic.

29. Decision. MDECHS has been requested to promulgate the policy letter after approval from MoD.

Action By : MDECHS


ITEM XII - DOCTORS MEDICAL EQUIPMENTS

30. Status. The Doctors don’t have a stethoscope, thermometer, BP instrument, torch and instrument to check the throat etc. These must be provided to all doctors.

31. Discussion. Oi/C Noida Polyclinic has been requested to ensure at the earliest that the doctors are provided medical equipment like Stethoscope, Thermometer, BP instrument, torch and instrument to check the throat etc at the earliest. Oi/C polyclinic has intimated that this was a lapse because doctors posted to the polyclinic are more than the authorised strength but he said that he would ensure that these instruments are made available to all the doctors at earliest.

32. Decision Oi/C Noida Polyclinic has been requested to provide medical equipment to all the doctors of Noida Polyclinic.

Action By : Oi/C Polyclinic Noida


MUMBAI ISSUES

ITEM XIII - NO PVT. EMPANELMENT HOSPITAL AND INHS ASVINI IS OVERLOAD

33. Status. There is no Civil hospital on the panel of ECHS in Mumbai and INHS Asvini is overcrowded.

34. Discussion. More private hospitals are not coming up for empanelment under ECHS because they have enough loads on direct cash payment basis and ECHS is on credit basis. One more polyclinic is being set up in Navi Mumbai which should reduce the load of OPD at Asvini.

35. Decision One more polyclinic is being set up in Navi Mumbai which should reduce the load of OPD at Asvini.

Action By : Dir ECHS(N)


GENERAL ISSUES

ITEM XIV - REPEAT POINT OF POINT 6

ITEM XV - AVAILABILITY OF ORTHO FACILITY IN BASE HOSP

36. Status. A Veteran had an Ortho problem and visited ECHS on Saturday. He was referred to the Base Hospital Ortho Surgeon who sees outpatients only on Tuesdays and Fridays. He started his journey at 0700hrs and could manage to reach the Base hospital at 0845. On reporting to counter for registration he was informed that Ortho Surgeon is on leave. On further enquiry as to when the Ortho Surgeon will be on duty, he was informed " not this week". There are many who suffer similarly.

37. Discussion. Ortho facility in Base hosp can be availed only subject to availability of facility / beds. The ECHS members are entitled to visit any empanelled hospital for treatment in case of non availability of facility in Base Hospital and intimate the polyclinic the next day alternately if the emergency is such he could visit any of hosp including non empanelled and seek reimbursement.

38. Decision. MDECHS has intimated that ECHS members are entitled to visit any empanelled hospital for treatment in case of non availability of facility in Base Hospital.

Action By : ECHS Members


ITEM XVI - ISSUE OF FAKE / SPURIOUS MEDICINES

39. Status. Issue of possibly fake / spurious medicines has been brought to the notice of OI/c the Clinic and the same was also given in writing for pursuing the matter further. The OI/c and MO i/c concurred that the medicine in question was spurious/fake. The matter needs to be pursued.

40. Discussion. MDECHS has intimated that he would bring this to the notice of DGAFMS and remedial action initiated to avoid recurrence.

41. Decision. MDECHS has been requested to take up the issue with DGAFMS for necessary action to avoid recurrence.

Action By : MDECHS

ITEM XVII - REPEAT POINT OF POINT 7
.

ITEM XVIII - TRANSPORT FOR AGED VETERANS

42. Status. At times very old and infirm Veterans, some over 90 years old have problems and they are not in a position to take the car ride to a hospital. We need to devise ways to provide support in such cases.

43. Discussion. MDECHS has intimated that it is not possible to provide car to the ECHS Member to the hospital with the existing infra structure of transport. However should there be medical requirement due to the status of the patient the ambulance at the polyclinic will be provided to transfer the patient to the referred hospital.

44. Decision. MDECHS has intimated that it is not possible to provide car to the ECHS Member to the hospital with the existing infra structure of transport. However should there be medical requirement due to the status of the patient the ambulance at the polyclinic will be provided to transfer the patient to the referred hospital.


Action By : Oi/C Polyclinics(Delhi / NCR)


ITEM XIX - POLYCLINICS ROUND THE CLOCK

45. Status. There is no Polyclinic support available on Sundays and holidays and this totals some 70 plus days in a year and this issue needs to be addressed. Similarly, since many Veterans’ take a second job after retirement, therefore Sundays may be made half working days and staff granted compensatory leave on a working day.

46. Discussion. During non consultation period / holidays, patients are free to get treatment from empanelled hospitals in emergency. Suitable policy instructions are intended to be issued enabling essential treatment at empanelled hospitals on holidays / non-working hours.

47. Decision. MDECHS has been requested to issue the policy letter regarding enabling essential treatment at empanelled hospitals on holidays / non-working hours.

Action By : MDECHS


ITEM XX - MILITARY HOSPITALS SHUTTING DOORS TO ESM AND PRIVATE SUPER SPECIALTY HOSPITAL NOT EMPANELLING

48. Status. Military Hospitals shutting doors to the ESM and sufficient private super specialty hospitals not keen on getting to be empanelled to the ECHS.

49. Discussion. MDECHS has intimated that he would take up this issue with DGAFMS to provide medicare subject to availability to facility / beds. With the implementation of 2010 CGHS rates which are higher, the private super specialty hospitals would be keen to come under ECHS.

50. Decision. MDECHS has been requested to take up this issue with DGAFMS and thereafter promulgate the policy letter.


Action By : MDECHS


ITEM XXI - TAC CERTIFICATE


51. Status. Need to review the requirement of TAC (temp att cert) to be able to get medicines for than 7 days and of course, the concept of parent polyclinic.

52. Discussion. The TAC certificate requirement is relevant because of the status of the data base of members expected to the polyclinics however with the online of computerization / automation this issue will be addressed favourably for the purpose of issue of medicines of more than seven days if not for obtaining costly individual equipment like hearing aids / medical equipment etc.

53. Decision. The TAC certificate requirement is relevant because of the status of the data base of members expected to the polyclinics however with the online of computerization / automation this issue will be addressed favourably for the purpose of issue of medicines of more than seven days if not for obtaining costly individual equipment like hearing aids / medical equipment etc.

Action By : MDECHS


ITEM XXII - WEBSITE USER FRIENDLY / E-MAIL ID REGISTRATION

54. Status. The official ECHS website needs to be redesigned to make it member friendly where information should be available conveniently. It should have provision for giving feed back / suggestions / complaints and date of up-dating of the site should be displayed. Complaints may also be received on the net. All members should be given the facility to get their email ID registered so that any future policy change or information can be communicated to those who have registered for the facility seamlessly by email.

55. Discussion. MDECHS has intimated that this will be implemented.

56. Decision. MDECHS has been requested to implement this at the earliest and promulgate to all concerned.

Action By : MDECHS


ITEM XXIII - CGHS DOCTORS WORKING HOURS / VISITING RESIDENCE OF PATIENT

57. Status. CGHS have the following facilities, which could be considered for induction in ECHS besides bringing in, other improvements given below in the comparison between CGHS and ECHS :-

(a) CGHS Doctors are available on shift during off working hours to attend to patients after working hours. In the present ECHS system a patient can go to empanelled Hospitals only if they are critically ill as per list promulgated. If the illness does not fall within the promulgated list we have to go private doctor and pay the fees from our pocket.

(b) CGHS Doctors visit residence of patients if they are unable to go the clinics because of nature of sickness, very old age or other reasons.

58. Discussion. MDECHS has intimated that CGHS does not open all dispensaries during off working hours. They only provide some high pressure dispensaries with minimal medical facilities. This issue can be considered once we have sanction for additional staff from MoD.

59. Decision. MDECHS has been requested to consider the issue after the sanction for additional staff from MoD is obtained and promulgate to all concerned thereafter.

Action By : MDECHS


ITEM XXIV - DOCTORS TO SIGN DRIVING LICENCE RENEWAL FORMS

60. Status. ECHS doctors refuse to sign, Driving Licence renewal medical form, RTO insists that these should be signed by a Govt Doctor. Please request ECHS to help us in this.

61. Discussion. MDECHS has intimated that he would promulgate the policy letter on the subject directing doctors to sign the Driving Licence renewal form and if required the necessary approval from RTO will be obtained, so that their signatures are acceptable.

62. Decision. MDECHS has been requested to promulgate the policy letter on the subject so that ECHS doctor's signature are acceptable for driving licence renewal medical form.

Action By : MDECHS

ITEM XXV - VALIDITY OF MOA WITH PRIVATE EMPANELMENT HOSPITALS

63. Status. Examination of the list of ECHS Empanelled Hospitals in NCR and other Regions shows that the MOA with a large number of Hospitals has expired in June 2010. It is possible that some of these may have been renewed but this information has not been updated on the Army ECHS website. It is suggested that the list of empanelled hospitals in the Army/Navy website be regularly updated so that the ECHS members can make an informed choices Further it is also suggested that the contact persons telephones- of the respective hospitals be also put on the website and updated at the time of renewal of the MOA.

64. Discussion. MDECHS has intimated that this request will be complied and ensure that the list of private empanelment hospitals with valid MOA will be hosted on website to enable ECHS members to make their choice of treatment.

65. Decision. MDECHS has been requested to update the list of private empanelment hospitals to enable ECHS members to make their choice of treatment.

Action By : MDECHS


COMMON ISSUES

ITEM XXVI - VISION STATEMENT AND NEED FOR SETTING STANDARDS BY ECHS / APPOINTMENT BY TELEPHONE

66. Status. There is a very urgent need for the promulgation of a Vision statement and ‘Standards’ to be achieved in all spheres including standards of cleanliness and hygiene, waiting times, facilities at the Policlinics, distance of polyclinic from residence, reaching out to those in the hinterland etc etc. Arrangement to see doctors with prior appointments rather than waiting in long queues.

67. Discussion. MDECHS has intimated that vision statement and standard for ECHS has already been promulgated and a copy of the same could be obtained from ECHS Central Organisation. Arrangements to meet doctors on appointment on telephone in the afternoons has already been implemented.

68. Decision. Director ECHS (N) is requested to obtain the vision statement from MDECHS and forward to NFDC.

Action By : Director ECHS (N)


ITEM XXVII - CLEANLINESS OF TOILETS AT POLYCLINIC

69. Status. There is considerable concern on the poor standard of cleanliness, especially the bathrooms, they really stink and the unhygienic atmosphere in the waiting halls on a daily basis.

70. Discussion. This is a cause of concern and that Oi/C polyclinic must ensure that standard of cleanliness in the toilets at polyclinic is of highest standard in spite of constraints of water / cleaning labourers problems.

71. Decision. Oi/C Polyclinics have been requested to take necessary action regarding cleanliness of toilets of polyclinics if required by obtaining the necessary assistance from station commanders with respect to constraints of availability of water / safaiwalas.

Action By : Oi/C Polyclinics – Delhi / NCR

CONCLUDING REMARKS


72. There being no other points, the meeting was over.

73. In conclusion, CPS requested MDECHS to resolve the issues raised during the meeting for clientele satisfaction as medicare is most important need for the veterans.

74. These minutes issue with the approval of the Chairman.






(AL Narayan)
Capt (IN)
Director ECHS(N)


SO/CNS SO/COP SO/CPS

SO/DGMS(NAVY) SO/MDECHS PDESA

SECY NFDC

OI/C POLYCLINICS.
BASE HOSPITAL (DELHI CANTT), LODHI ROAD,
GURGAON, NOIDA, FARIDABAD, GHAZIABAD (HINDON)