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INTRODUCTION: DEFINITION: It is a study of legal powers and duties of the state to assure the conditions, for people to be healthy and limitations on the power of the state to constraint the autonomy, privacy, liberty, propriety or other legally protected interests on the individual for the protection of promotion of community health.

Characteristics: :

Characteristics: Government: Public health a primary (but not exclusive) responsibility of state. Population: Create the conditions in which communities can be health. Relationship: Between state and population who place themselves or the community at risk. Services : Deals with the provision so population based services grounded on the basis on the scientific methodologies. Coercion: Authorities possess a power to force individuals and businesses for the protection of the community.

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Act: Act means statute or law adopted (enacted by) national or state legislative or other governing body. Resolution: These are used to express legislative opinion or to regulate affairs of the governing body itself, and from ordinance or by laws of municipal corporation and regulation of administration. Rules: Rules are explicit statements that tell an employee what he or she ought or ought not to do.


CATEGORIES To and Improve and Maintain high standards in Medical Education and services: Indian medical council act, 1956 and regulations 2002 Indian Nursing council act, 1947 Dentist Act,1948 Pharmacy Act,1948 Homeopathy central council act, 1973

Categories contd...:

Categories contd... Public Registration to Assess Mortality and Enumeration of population : Registration of Births and Deaths Act, 1969 Census Act, 1948 To Prevent Public Health Problems: Epidemic Diseases Act, 1897 Prevention of Food Adulteration Act, 1954 To Achieve Maternal Health and to Empower the Women: MTP Act,1971 Maternity Benefit Act, 1961 Dowry Prohibition Act, 1961 Immoral Traffic Act, 1956 PNDT act, 1994

Categories contd...:

Categories contd... To safeguard Children and young: Juvenile Justice Act, 1986 Child Labour Act, 1986 To Rehabilitate and Provide equal opportunities to disabled and disadvantageous groups: Persons with disabilities Act,1995 Mental Health Act, 1987 To Prevent Drug Addiction and Substance Abuse and Safe Manufacturing of Drugs: Narcotic Drugs and Psychotropic Substances Act,1985 Drugs and cosmetics Act, 1940 Drugs Act,1948

Categories contd...:

Categories contd... To Protect Workers and Provide Social Security: Factories Act,1948 Mines act, 1952 ESI Act , 1948 Workmen’s Compensation Act, 1923 Environmental Legislation: Environment Act,1986 Air(Prevention and control of Pollution) Act,1981 Water (Prevention and control of Pollution) Act,1974 Atomic Energy Act, 1962 Miscellaneous: Disaster Management Act 2005


CHAPTERS DESCRIBED in INDIAN MEDICAL COUNCIL ACT, 1956 Code of medical ethics Duties of a physician * to their patients * in consultation * to the public and to paramedical profession Responsibilities to each other Unethical acts & Misconducts


CODE OF MEDICAL ETHICS Qualified in modern system of medicine only. Update knowledge and skills, CME Maintain medical records, medical certificate register Display details Observance of sanitary laws and regulations


DUTIES OF A PHYSICIAN * TO THEIR PATIENTS In case of emergency treat or refer to appropriate physician Information revealed in confidence to be kept secret Never exaggerate or minimize the gravity of a situation


DUTIES OF A PHYSICIAN * IN CONSULTATION Consultation only when justifiable, interest of patient Laboratory tests to be carried out judiciously Punctuality Never criticize referring physician Communicate opinion in writing to referring physician


DUTIES OF A PHYSICIAN * TO THE PUBLIC AND TO PARAMEDICAL PROFESSION Enlighten public regarding quarantine regulations and measures for prevention of epidemic Notify concerned authorities in accordance with laws, regulation and rules Recognize and promote practice of different paramedical services


RESPONSIBILITIES TO EACH OTHER Render service to fellow physicians and their immediate family dependents No physician or consultant shall criticize referring physician Consideration for reputation of absent physician, while treating patient


UNETHICAL ACTS & MISCONDUCTS Advertisement Association Alcoholism Abortion Human rights violation False certification Breach of confidence Not taking appropriate consent of patient Falsification of degrees Violation of guidelines while conducting research Found absent from position at place of work

Indian Medical council Act, 1956, Amendments in 2010:

Indian Medical council Act, 1956, Amendments in 2010 1. No person shall establish a medical college. 2. No medical college shall:- 1. Open a new or higher course of study or training (including a postgraduate course of study or training) which would enable a student of such course or training to qualify himself for the award of any recognised medical qualification; or 2. Increase its admission capacity in any course of study or training (including a postgraduate course of study or training), except with the previous permission of the Central Government obtained in accordance with the provisions of this section.

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3. CONSTITUTION & COMPOSITION OF THE COUNCIL I. The Central Government shall cause to be constituted a council consisting of the following members, namely:- 1. One member from each State to be nominated by the Central Government. 2. One member from each University to be elected from amongst the members of the medical faculty 3. One member from each State in which a State Medical Register is maintained, 4. Seven members to be elected from amongst themselves by persons enrolled on any of the State Medical Registers 5. Eight members to be nominated by the Central Govt. II. The President and Vice-President of the Council shall be elected by the members of the Council from amongst themselves. III. No act done by the Council shall be questioned on the ground merely of the existence of any vacancy in, or any defect in the constitution of the Council.

The Registration of Births and Deaths Act, 1969:

The Registration of Births and Deaths Act, 1969 Uniform law across the country on the registration of births and deaths Reporting and registration of all births and deaths compulsory Registrar General, India to ‘coordinate and unify’ the implementation of the Act

The Registration of Births and Deaths Act, 1969:

The Registration of Births and Deaths Act, 1969 Responsibility of the State Governments Frame rules Set up a hierarchy of state officers to manage and administer the system of registration Enforce responsibility Issue certificates

Registrar in Rural areas:

Registrar in Rural areas SHO, Police Station Chhattisgarh, Jammu and Kashmir Medical Officer in charge of PHC Assam, Haryana, Meghalaya, Orissa, Sikkim, A&N Islands, Lakshadweep Block Sanitary Inspector (with Pradhan of Gram Sabha as Sub-Registrar) West Bengal Panchayat/Village Officials All other states

Responsibility to report births/deaths:

Responsibility to report births/deaths Place of occurrence of birth/death Responsibility to report House Head of the household Hospital nursing home, etc Head of the institution Public places Police The information regarding occurrence is to be supplied within 21 days in both events of birth and death. In case of delays more than 30 days but within a year an affidavit is required from notary public with late fee i.e. One rupee per day. For registration of events beyond one years, order from class 1 officer/magistrate is necessary.


THE EPIDEMIC DISEASES ACT, 1897 The Act provides power to exercise for the control and to prevent any epidemic or spread of epidemic in the States or Country. The states may authorise any of its officers or agency to take such measures if the state feel that the public at large is threaten with an outbreak of any dangerous epidemic (Sec. 2). Person who is inspecting, is empowered to determine about the process and authority to take responsibility of all expenses incurred in compensation, travelling, temporary accommodation, segregation of infected person, etc. The state govt. can authorise the District Magistrate who can take any number of vehicles needed to carry man and equipments to and fro or transporting infected persons during an epidemic. Violation of any provision of this act is punishable under Sec 188 of IPC.

NDPS Act 1985:

NDPS Act 1985 The Act consists of 6 chapters with 83 sections. An act to : consolidate & amend the law relating to narcotic drugs, make stringent provisions for the control & regulation of operations relating to narcotic drugs & psychotropic substances, provide for their forfeiture of property derived from, or used in illicit traffic in narcotic drugs & psychotropic substances, implement the provisions of the International Conventions on Narcotic Drugs & Psychotropic Substances, & for matters connected therewith.

NDPS Act 1985- definitions:

NDPS Act 1985- definitions Addict : A person addicted to any narcotic drug or psychotropic agent. Narcotic Drug : Coca leaf, cannabis, opium, poppy straw, & includes all manufactured drugs. Manufactured Drugs: All coca derivatives, medicinal cannabis, opium derivatives, poppy straw concentrate, & any other notified narcotic substance or preparation. Psychotropic Substance : Any substance, natural or synthetic, or any natural material, or any salt or preparation of such substance/ material included in the list of psychotropic substances specified in the schedule.

Authorities & Officers:

Authorities & Officers Provision for appointment of a Narcotics Commissioner , & a NDPS Consultative Committee by the Central Govt. Chapter II A  Provision for constitution of a National Fund for Control of Drug Abuse . The Central Govt. has constituted an authority k/a the Narcotics Control Bureau with headquarters at New Delhi & 5 zonal offices to exercise the powers & functions of the Central Govt. under this act.

Prohibition, Control & Regulation:

Prohibition, Control & Regulation According to Section 8  No Person Shall : Cultivate any coca, opium poppy or cannabis plant, or Produce, possess, or consume any narcotic drug or psychotropic substance, except for medicinal or scientific purposes & in the manner & to the extent provided by the Act. There are clauses regarding the power of Central & State Govt. to permit, control & regulate the narcotic drugs & psychotropic substances, including matter of licenses.

Offences & Penalties:

Offences & Penalties Punishment for contravention in relation to poppy straw; coca plant & leaves; prepared opium, opium poppy, & opium; cannabis plant (except ganja); manufactured drugs, psychotropic substances : For 1 st offence : RI for not less than 10yrs, & Fine not less than 1 Lakh rupees For 2 nd & Subsequent Conviction : RI for not less than 15yrs, & Fine not less than 1.5 Lakh rupees. Punishment for contravention in relation to ‘ganja’ or cultivation of cannabis plant: For 1 st offence : RI which may extend to 5yrs, & Fine which may extend to 50,000 rupees For 2 nd & Subsequent Conviction : RI which may extend to 10yrs, & Fine which may extend to 1 Lakh rupees

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Punishment for contravention in relation to any controlled substance : RI which may extend to 10yrs , & Fine which may extend to 1 Lakh rupees Punishment for illegal possession in small quantity for personal consumption of any ND/ PS (Sec 27): For cocaine, morphine, heroin  imprisonment extending upto 1yr, or Fine, or Both Other  imprisonment extending upto 6 months, or Fine, or Both Death Penalty …Contd ND/ PS QUANTITY Cocaine 500 mg Morphine/ Heroin/ Codeine 1 kg Opium 10 kg Hashish 20 kg Cocaine – 125mg Heroin - 250mg Opium – 5g Charas - 5g Ganja – 500g

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Prevention of Food Adulteration Act, 1954 Food Safety & Standards Act , 2006

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Food Safety & Standards Authority The members include seven GOI officials (the rank of Joint Secretaries or above in the Ministry / Departments of Agriculture, Commerce, Consumer Affairs, Food Processing, Health, Legislative Affairs, and Small Scale Industries (who will be ex officio members) - Representatives from the Food Industry (2), Consumer Organizations (2), Eminent Food Technologists / Scientists (3), State Governments (SZ)(5), Farmers’ Organization (2) and Retailers’ Organization (1).

PFA-Act Sections:

PFA-Act Sections Sec 2(1) a-m defines What Food Adulteration is? Sec 2 (¡x) Misbranded food Sec 7 Prohibition of manufacture, sale etc of certain articles of food Sec 11 Sampling procedure Sec 14 Manufacturers, distributors and dealers to give warranty.


Contd.. Sec 14A Vendor to disclose the name of the person from whom the article was purchased Sec 15 Notification of Food poisoning Sec 16 Penalties –Subject to provisions of sub-sections 1-A Sec 19 Defenses which may or may not be allowed in prosecutions under the Act.

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Designated Officer: District-in-charge for Food Safety To issue/cancel license of Food Business Operator To receive report and samples food from Food Safety Officer. To make recommendation to Food Safety Commissioner for sanction to launch prosecutions . Food Safety Officer: For local areas To seize the samples Inspection of food processing premises Power of search, seizes, investigation, prosecutions .

Central Food Laboratories-Analytic wing:

Central Food Laboratories-Analytic wing Pune ,Ghaziabad ,Calcutta ,Mysore The Area coming under the jurisdiction of each of these Labs is reshuffled every 5yrs. CFL for Kerala as of now is Mysore. There are 81 State Food Laboratories under administrative control of States /UT.

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Substandard food: Upto Rs. 2.00 lakhs Misbranded: Upto Rs. 3.00 lakhs Misleading advertisement : Upto Rs. 10.00 lakhs Food with extraneous matter: Upto Rs. 1.00 lakhs Fail to meet the requirements as directed by FSO: Upto Rs. 2.00 lakhs Unhygienic / unsanitary preparations: Upto Rs. 1.00 lakhs Adulterant not injurious to health: Upto Rs. 2.00 lakhs Adulterant injurious to health: Upto Rs. 10.00 lakhs Unsafe food – but does not cause immediate injury : 6 months imprisonment with fine of Rs.1.0 lakh Penalties:

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Unsafe food causing non-grievous injury : 1 year imprisonment with fine of Rs. 3.00 lakh Compensation in case for injury : upto Rs.1.00 lakh Causing grievous injury : 6 years imprisonment with fine of Rs. 5.00 lakh Compensation in case for grievous injury : upto Rs.3.00 lakh Causing death : 7 years or life imprisonment and fine of Rs. 10.00 lakh Compensation in case of death : upto Rs. 5.00 lakh minimum Penalties:

MTP Act 1971: Indications :

MTP Act 1971: Indications Continuation of pregnancy constitutes risk to the life or grave injury to the physical or mental health of woman Substantial risk of physical or mental abnormalities in the fetus as to render it seriously handicapped Pregnancy caused by rape (presumed grave injury to mental health) Contraceptive failure in married couple (presumed grave injury to mental health) “In determining whether the continuance of pregnancy would involve such risk of injury to the health (as mentioned above), account may be taken of the pregnant woman’s actual or reasonable foreseeable environment”

MTP Act: Place for conducting MTP :

MTP Act: Place for conducting MTP A hospital established or maintained by Government or A place approved for the purpose of this Act by a District-level Committee constituted by the government with the CMHO as Chairperson

MTP Act amendment 2002:

MTP Act amendment 2002 Decentralizes site registration to a 3-5 member district level committee chaired by the CMO/DHO Approval of sites that can perform MTPs under the act can now be done at the district level Stricter penalties for MTPs being done in a un-approved site or by a persons not permitted by the act

Medical Abortion:

Medical Abortion MTP using Mifepristrone (RU 486) & Misoprostol approved for up to 7 weeks termination Only an RMP (as defined by the MTP Act) can prescribe the drugs Has to follow MTP Act, Rules & Regulations Can prescribe in his/her clinic, provided he/she has access to an approved place Should display a certificate from owner of approved place agreeing to provide access

Implications of amendments :

Implications of amendments Simplifies registration of sites which can be done at district level now Providers can get their sites approved for providing abortions under the MTP Act for 1 st trimester only or up to 20 weeks and thereby come under the protective cover of the MTP Act

Implications of amendments :

Implications of amendments Approved providers can provide medical abortions from their clinic, as long as they have access to an approved site Offers potential to increase number of approved sites, which would enable women to access safe abortion services Effective implementation will help to bring all abortions within legal frame work

MTP rules: what are they for?:

MTP rules: what are they for? Enable proper implementation of the provisions of the Act Ensure that MTP services are provided by qualified persons in safe and hygienic settings Help to monitor quality of services

MTP rules: what do they cover?:

MTP rules: what do they cover? Experience & training required for providers Approval of a place for terminating pregnancy under the Act Composition & tenure of District Level Committee Inspection, cancellation or suspension of approval; review Consent form

MTP rules: Who can perform?:

MTP rules: Who can perform? A medical practitioner (RMP) who has a recognized medical qualification as defined in clause (h) of section 2 of Indian Medical Council Act, 1956 Whose name has been entered in a State Medical Register and Who has such experience or training in Gynecology and Obstetrics as prescribed by Rules made under the Act

MTP rules: training requirement - 1:

MTP rules: training requirement - 1 For termination up to 12 weeks: A practitioner who has assisted a registered medical practitioner in performing 25 cases of MTP of which at least 5 were performed independently in a hospital established or maintained or a training institute approved for this purpose by the Government

MTP rules: training requirement - 2:

MTP rules: training requirement - 2 For termination up to 20 weeks A practitioner who holds a post-graduate degree or diploma in Obstetrics and Gynecology A practitioner who has completed six months house job in Obstetrics and Gynecology A practitioner who has at least one-year experience in practice of Obstetrics and Gynecology at a hospital which has all facilities A practitioner registered in state medical register immediately before commencement of the Act, experience in practice of Obstetrics and Gynecology for a period not less than three years.

Approval of a place by trimester:

Approval of a place by trimester For sites up to 12 weeks (1 st trimester) Gynecology examination/ labor table Resuscitation and sterilization equipment Drugs & parental fluids B ack up facilities for treatment of shock Facilities for transportation

Approval of a place by trimester:

Approval of a place by trimester For sites up to 20 weeks (1 st and 2 nd trimester): All requirements for up to 12 weeks + Operation table and instruments for performing abdominal or gynecological surgery Anesthetic equipment, resuscitation equipment and sterilization equipment Drugs & parental fluids notified for emergency use, notified by Government of India from time to time

Regulatory body: D L C:

Regulatory body: D L C District level MTP Committee Minimum of 3 & Maximum of 5 members including chairperson (CM H O) Composition of the committee: One medical person ( Gyne /Surgeon/ Anestheist ) One member from local medical profession; NGO & Panchayati Raj Institution of the district. At least one member shall be a woman. Tenure 2 calendar years NGO members shall not have more than 2 terms

Pre-conception and pre-natal diagnostic techniques (PCPNDT) Act:

Pre-conception and pre-natal diagnostic techniques (PCPNDT) Act Made in 1994 Regulates and prevents misuse of the diagnostic techniques. Amended again in 2003. 51


Aim Prohibition of sex selection, Regulation of pre-natal diagnostic techniques for the purposes of detecting- Genetic abnormalities or Metabolic disorders or Chromosomal abnormalities or Certain congenital malformations or Sex-linked disorders 52

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When its becomes an offence ? Service provider violating the Act. Service seeker (woman compelled to undergo the test is not punishable). Advertiser of these techniques. Complaints procedure Written complaint to Appropriate Authority. AA to act within 15 days. Delayed action to be addressed through judiciary. 53

An offence under the PCPNDT Act is cognizable, non- bailable and non-compoundable. :

An offence under the PCPNDT Act is cognizable, non- bailable and non-compoundable . First offence Subsequent offence Service provider Imprisonment (3yrs.); penalty (Rs.10000); registration cancelled (5 yrs.) Imprisonment (5yrs.); penalty (Rs.50000); registration cancelled (permanently.) Service seeker Imprisonment (3 yrs.); penalty (Rs. 50000) Imprisonment (5 yrs.); penalty (Rs. 100000); Advertiser Imprisonment (3 yrs.); penalty (Rs. 10000) 54

The Maternity Benefit Act, 1961:

The Maternity Benefit Act, 1961 Applicability to every factory or establishment in which 10 or more persons are or were employed on any day of the preceding twelve months. Eligibility for Maternity Benefit: Has to work for 80 days in the preceding 12 months immediately preceding the date of her expected delivery. Maternity benefit is paid at the rate of the average daily wage for the period of her actual absence. The average daily wage means the average of the woman’s wages payable to her for the days on which she has worked during the period of three calendar months immediately preceding the date from which she absents herself.

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Eligible for 12 weeks maternity benefit of which not more than six weeks shall precede the date of her expected delivery. Wages includes all remuneration including cash allowances, DA, HRA, Incentive bonus and the money value of any concessional value of food grains supplied but does not include any bonus other than incentive bonus, OT, gratuity, PF etc. NO employer shall knowingly employ a woman in any establishment during the six weeks immediately following the day of the delivery miscarriage or medical termination of pregnancy(MTP): No woman shall work in any establishment during the six weeks immediately following delivery, miscarriage or MTP

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Medical bonus of Rs. 250 if no prenatal confinement and psot natal care is provided by employer free of charge. 6 weeks leave with wages for tubectomy and two weeks immediately following the day of an tubectomy . One months leave with wages at the rate of maternity benefit for one month for miscarriage, MTP or tubectomy operation. Nursing breaks – Two times in the course of daily work till the child attains 15 months. Prohibition from dismissal for absence during pregnancy. However, for Misconducts, forfeiting of Maternity Benefit and Medical bonus permissible.

Child Labor Act 1986(Prohibition & Protection):

Child Labor Act 1986(Prohibition & Protection) Objectives: No child shall be employed or permitted to work in any of the following occupations: Set forth in part of ‘A’ of the schedule or in any workshop where in any of the process set forth in part ‘B’ of the schedule to this Act - PART-A 1. Transport of passengers, goods; or mails by railway 2. Cinder picking, clearing of an ash pit or building operation in the railway premise. 3. Work in a catering establishment at a railway station, involving the movement of vendor or any other employee of the establishment from one platform to another or into or out of a moving train. 4. Work relating to the construction of railway station or with any other work where such work is done in close proximity to or between the railway lines. 5. The port authority within the limits of any port.

PART B In any workshop wherein any of the following processes is carried on. :

PART B I n any workshop wherein any of the following processes is carried on. (1) Bidi -making. (2) Carpet-weaving. (3) Cement manufacture, including bagging of cement. (4) Cloth printing, dyeing and weaving. (5) manufacture of matches, explosives and fire works. (6) Mica-cutting and splitting. (7) Shellac manufacture. (8) Soap manufacture. (9) Wool-cleaning. (10) Building and construction industry.

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HOURS AND PERIOD OF WORK FOR CHILDREN: No child shall be required or permitted to work in any establishment in excess of number of hours as may be prescribed for such establishment or class of establishment. The period of work on each day shall be so fixed that no child shall work for more than three hours before he has had an interval for rest for at least one hour. No child shall be permitted or required to work between 7 P.m. and 8 a.m. No child shall be required or permitted to work overtime. No child shall be required to work in any Establishment On any day on which he already been working in another establishment.

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Weekly holidays – Every child employed in an establishment shall be allowed in each week, a holiday of one whole day, which day shall be specified by the occupier in a notice permanently exhibited in a conspicuous place in the establishment and the day so specified shall not be altered by the occupier more than once in three months.

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PENALITIES: Violations under section 3 of this act shall be punishable with imprisonment which shall not be less than 3 months which may extend to one year or with fine which shall not be less than 10000rs but which may extend to 20000rs or with both. Continuing offence under shall be punishable with imprisonment for a term which shall not be less than 6months but which may extend to 2 years. Any other violations under the Act shall be punishable with simple imprisonment, which may extend to 1 month or with fine, which may extend to 10000rs or with both.

Juvenile Justice Act:

Juvenile Justice Act The Act places children/juveniles in two categories – Juvenile in ‘ conflict with the law’ handled by State Governments/ ‘ Juvenile Boards’ Child in need of ‘ care and protection’ to be looked after by State Governments/ ‘ Child Welfare Committees’ Act to be implemented by the respective State Governments

Children in need of ‘care and protection’ are those…:

Children in need of ‘care and protection’ are those… Who are homeless, no subsistence Who reside with an abusive, violent guardian/or caregiver who has history of abuse with said child or other children Who are mentally, physically challenged, or terminally ill with no caregiver Who are victims of armed conflict, civil commotion, or natural calamity

Also…vulnerable children such as..:

Also…vulnerable children such as.. Orphan/abandoned, or run away, or missing, whose parents cannot be found Children who are being, or are vulnerable, to abuse/sexual exploitation/torture/illegal acts Children vulnerable to drug abuse and trafficking

Features of the amended JJ Act - 2006:

Features of the amended JJ Act - 2006 Greater intervention of NGOs & local authorities. Special emphasis on rehabilitation and social reintegration of the children Adoption of children simplified Registration of all child care institutions within six months of the amendments coming into force To set up special juvenile police units - A child is an individual below the age of 18 years. To set up Juvenile Justice Boards - JJBs and Child Welfare Committees – CWCs -in every district. All offences against a juvenile are cognizable offences – crimes against children identified SJPUs.

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