SURGERY BY AYURVEDIC DOCTORS- LEGAL PERSPECTIVE

Letter dt: 09/12/2020

From:  Dr. VLN Sastry, MD (Ay)(BHU)., PGDHHM., M.Sc (Psychology)., LL.B,                          Additional Director (Ayurveda)(Rtd.), Dept. of AYUSH, Govt. of United Andhra Pradesh. (E-Mail ID: <[email protected]>)

Res: Flat No. 204, Dhaani’s 9 Square Apts., Upparapally, RR District, Hyderabad- 500048 (Telangana), Mobile No: +919963634484

To: Hony. Secretary General, Indian Medical Association, IMA House, Indraprastha Marg, New Delhi- 110002

Reference:  (1)   The Gazette of India dt- 20/11/2020

                         (2)   Press Release of IMA dt- 21/11/2020

I solicit your attention on the above two references. I believe that the following information is the appropriate answer for your biased views and protest the contents of The Gazette under reference. At the outset, I strongly object your baseless press release vide reference no. 2.

1. INTRODUCTION:

                             Ayurvedic education across the nation (India) is under the control of an apex authority, the CCIM (Central Council of Indian Medicine) (now it is revised as ‘National Commission of Indian Medicine’: NCIM). It is a statutory body, constituted under IMCC Act, 1970. The existing courses are

51/2 years BAMS (Bachelor of Ayurvedic Medicine and Surgery)  degree after 10+2 with Bi.PC group. After that, 3 years post graduate course (MD Ayurveda/ MS Ayurveda); next 2 years- Ph.D (Ayurveda).

1. AYURVEDIC EDUCATION:

                                               As per the syllabus of BAMS degree, all the medical subjects of “non-clinical, para-clinical and clinical” are taught to the students covering theory, practical including clinical training in the attached teaching hospitals. Regarding the subjects of Anatomy, Physiology, pathology, General Medicine, General Surgery, ENT, Dental, Ophthalmology, Obstetrics & Gynaecology, Paediatrics etc., Ayurveda described very deeply. There are Sanskrit names specified in the ancient Ayurvedic classics for all these modern terms (ex..Shalya Tantra for Surgery, Shaalaakya Tantra for ENT, Dental & Ophthalmology; Prasuthi Tantra & Stree-roga for Obstetrics & Gynaecology etc..). As per the syllabus, for all these subjects, students are taught the  required modern concepts too by way of comparative integrated  study. (ex. Dead body dissections for Anatomy (called Shaarira-Rachana in Ayurveda), Laboratory tests for Physiology & Pathology etc.);  similarly, clinical exposure for Surgeries and Deliveries too both at Ayurvedic hospitals and modern hospitals too as per necessity. During PG studies, one becomes a specialist by mastering his/her speciality. Ph.D is as good as super speciality.

1. REGISTERED MEDICAL PRACTITIONER:

                                  To attain eligibility to practise a particular system of medicine, one has to get his/her basic professional degree qualification REGISTERED in the concerned registers maintained by State and Central governments. Then a doctor is called as” Registered Medical Practitioner”. In other words, such registration is a LICENCE to practice. MCI (Medical Council of India) is of allopathy which is analogous to CCIM. Any medical qualification obtained by any individual through any source must be recognized/approved by the respective councils. Otherwise such practitioner is construed to be a QUACK. In accordance with the Laws in vogue, qualified ayurvedic doctors should not prescribe allopathic medicines and similarly allopathic doctors should not prescribe Ayurvedic medicines. It is because the subjects PHARMACOLOGIES for both the systems are entirely different. For  BAMS graduates, there is no subject of modern pharmacology; vice versa for MBBS graduates too. Of course, there are about six states in India where the concerned state governments accorded permission to BAMS graduates to practise allopathy too, probably after getting satisfied with their pleas that they received required authentic training in modern pharmacology too. Thus, it is the prerogative and discretion of the state governments to accord such permissions by making out special statutes. Such power is vested with the Central Government too. Yet, state governments cannot go against the central government, if any conflict arises between the statutes of state and center because HEALTH is a subject matter lying in the “concurrent list” of the constitution of India. Thirdly, court of law may accord such verdicts while resolving any related disputes. Then such  validity restricts only to the extent of court’s verdict. It is high time for the state govts./ central govt. to accord necessary permission to Ayurvedic surgeons to use essential allopathic medicines connected to surgeries, by training them through short- term course, in the public interest.

1. SURGERIES IN AYURVEDA:

                                 Regarding surgeries to be done, in the recent past, CCIM with the approval of central government permitted the Ayurvedic Post-graduates (M.S-Ayurveda) to do specified surgeries-General, ENT, Eye, Dental etc. (names of the surgeries are listed in the notification ). It amounts to an authentic licence to the Ayurvedic surgeons to do that job as per necessity. Here some vacuum exists. Anaesthesia and allopathic medicines are essential for most of the surgeries. Then coordination with at least two modern doctors (one anaesthesia specialist and the other to prescribe required modern drugs necessary at pre-operative and post-operative stages.) are essential since Ayurveda falls short of the same. That necessity may not arise if Ayurvedic surgeons have licence to handle those areas too at the instance of any statute of state or central government. Otherwise, there is no wrong in hiring the required specialists from modern side, in the public interest. The modalities may vary from ‘Private Ayurvedic Nursing Homes’ to Govt. Ayurvedic Hospitals in associating with the modern specialists. It is to be noted that no law prohibits the modern specialists to associate with Ayurvedic surgeons to extend their skilled services for the of welfare of the patients because the doctors in the team confine themselves only to their services for which they have the licence.

1. PROTEST BY THE DOCTORS OF “INDIAN MEDICAL ASSOCIATION (IMA)”:

                       The above said association is of allopathic doctors and is raising venomous swords against Ayurvedic doctors and Ayurvedic system as well with a wild allegation that Ayurvedic doctors are NOT ELIGIBLE to do surgeries as permitted by the CCIM vide Gazette notification under reference 1 above and is demanding to withdraw that NOTIFICATION.

1. PROTEST IS UNJUSTIFIABLE:

                                     I, Dr. V L N SASTRY on behalf of Ayurvedic fraternity strongly CONDEMN your selfish attitude, prejudicial criticism and untenable allegations on us. At this juncture, I humbly appeal to SUCH ALLOPATHIC DOCTOR-FRIENDS WHO ARE BROAD MINDED WITH PROPER UNDERSTING ON AYURVEDA, NOT TO OPPOSE THE SAID PERMISSION TO AYURVEDIC SURGEONS and to ignore this letter thrashing the attitude of the IMA leaders (kindly don’t misunderstand this letter). Their allegations and my reply are as follows:

1. How can you do surgeries?

We the specialists are qualified and licenciated.

1. Ayurveda has not described modern surgeries:-

SUSHRUTA, ancient Ayurvedic doctor (around 2^nd century AD) is the father of surgery, a non-controversial fact , accepted by you the people also. He described a lot about innumerable surgical instruments and devices together with some procedures. Most of the present surgical equipment is the metamorphosis of the then descriptions only. Our basic language of Ayurvedic classics is Sanskrit and those are translated into English now-a-days and vice-versa is also justified. We always put efforts to develop our own techniques too.

1. Why are you adopting modern techniques & procedures?

Techniques and skill are not one’s property. Anyone can learn, acquire competency and implement unless patent rights are there backed by law. Surgery is a technique and is different from prescribing allopathic medicine. We are conscious for which we have licence and for which we don’t have.

1. What about asepsis and anti-sepsis & how can you maintain that?

Sushrutha mentioned SUCHI what you are calling asepsis and SHUDDHI what you translated as anti-sepsis. For your information, your daily habits of face wash, tongue cleaning, bath, hands wash before meals etc. are described in detail in ancient Ayurvedic classics which come under “suchi and shuddhi”. Can we allege that you copied us? Can we restrict you from your daily routine? In olden days Ayurvedic rishis used to wear DHOTIs; now can you restrict us from wearing pants? Likewise, besides Ayurvedic agents/ drugs/ medicines, we are competent to use SPIRIT etc. for which there is no ban in any LAW.

1. Ayurveda is resorting to PLAGIARISM:-

This allegation speaks your lack of wisdom. If we use Sanskrit terms for modern techniques and procedures, it does not amount to plagiarism. If we make a false claim that those things belong to Ayurveda, then it amounts to plagiarism. We are stating that we are updating Ayurveda by integrating with modern technology for the welfare of the ailing people. Can you say that the word BLOOD is of allopathy and the Hindi term KHOON is of Ayurveda? Can you restrict us from depending upon modern pathological investigations? Is it plagiarism? How silly IMA is?

1. Mixing up/Integration of Modern medicine  with Ayurveda is a retrograding step:-

         -- NO,  it’s a progressive step for the Ayurvedic practitioners since Ayurvedic classics emphasized in a SLOKA that Ayurvedists should be well conversant with the contemporary scientific knowledge. (…Ekam…shaastramadheeyaano…). If you don’t want to learn other sciences, it’s upto you. But you do not have any RIGHTS over allopathic material/knowledge or to hide it in your pockets. I draw your attention that YOU simply acquired qualification in allopathy, next became RMP and a specialist practitioner. That’s all. Is it your property? Have you got MOU (Memo of understanding) with founders of allopathy like HIPPOCRATES?

 NOTE: For FISTULAs, Ayurvedic doctors apply KSHAARA-SOOTRA (medicated thread) in place of surgery; yielding excellent results. To apply the same in high rectal fistulas, patient needs General Anaesthesia. Then we utilize the services of modern anaesthetist; patient pays the fees to him separately. How is it wrong? Can you prevent the anaesthetist from associating with Ayurvedic doctors/surgeons? For your information, once, BHU, Varanasi offered training to modern surgeons to learn the technique; several modern surgeons learnt it and practising it too. Can you say that it is unlawful? So, you don’t have rights to arrest any integration and at the same time remember that patient has every right to hire/engage the doctors of all disciplines at one place in the interest of his health care. It’s the principle being magnified by the govt. in the public interest at large.

1. WHAT’S THE PROBLEM FOR IMA IF WE PERFORM SURGERIES?

1. Are we your business  competitors?

-No, we are highly less in number and the scope of surgeries is limited; we won’t handle any major surgeries like “Cardiac By-pass or Brain operations”. Whatever it be, it’s a fundamental right of every citizen of India to undertake any business anywhere in India.

          (ii)   Do you think that we lack skill and hence damage the patients?

                  -Nobody drives the car without expertise  even though one possesses driving  licence in the pocket. If at all any damage is caused to the   patient due to insufficient skill and knowledge, that comes under ‘medical negligence’ punishable under LAW. This is equally applicable to all the doctors including modern surgeons, if negligence is proven. Secondly, patients do not accept/opt all the doctors without making a thorough verification of their proficiency, more so surgeons. Whatever it be, it’s not the outlook of IMA people; it’s the concern of patients and government.

1. Are you worrying about PUBLIC INTEREST?

-As a matter of fact, this permission itself facilitates more poor people in and around the villages to have the advantage of getting necessary treatment. Don’t you know how many modern surgeons are available to the poorer sections in the villages?

It has become an open secret how CORPORATE HOSPITALS are squeezing the public taxing them by way of unnecessary investigations, created surgeries to meet their targets. There is no basis for their unreasonable room rents, exorbitant cost of the medicines they are selling at their counters apart fromthe “Ventilators/ECMO gimmicks”. Whether IMA shows any concern about these exploitations? Therefore, Ayurvedic surgeons stand more nearer to the public interest rather than the modern surgeons.

1. Whether IMA is the better judge than Government to decide the                

necessity of permitting the Ayurvedic doctors for doing surgeries?

-Government is highly concerned with public welfare at large by considering multiple factors whereas IMA works self-centred with false ego and biased outlook. Don’t you know that 90% of the allopathic Nursing Homes/Private hospitals are utilising the services of Ayurvedic doctors as Duty Doctors? There it’s their necessity, not charity. It is also a known fact that most of the modern doctors also prescribe Ayurvedic medicines of different companies like “Himalaya, Charak, Alarsin etc.” this may be objectionable as per law but not a crime in practice. Do you mean that Government does not have vision and powers to design the health-care measures in the public interest, especially keeping in view of weaker sections? Can you show us any dental specialist, ENT specialist or Ophthalmologist doing private practice in remote villages?

1. What’s your Locus standi/cause of action- to move the court of law in this issue?

         --IMA is not losing anything, nothing lies against modern doctors/surgeons, neither the  government nor Ayurvedic surgeons resorted to any plagiarism or cheating, nobody is snatching or poaching your property rights or patent rights; no scope at all for PIL (public interest litigation).

---- The only reason for your turmoil seems to be enormous JEALOUSY/ENVIOUSNESS against Ayurvedic system and Ayurvedic doctors as well, backed by the TA philosopher ERC BERNE’-s principles: “I am OK, you are NOT OK & I am better than you” . Another reason that could be your FALSE BELIEF that IMA has property rights on ALLOPATHIC SYSTEM as if  purchased from HIPPOCRATES or IMA itself founded this system.

1. CONCLUSION:

                                 In view of what I narrated above, I advise the leaders of IMA to understand the issues coolly, realize the symbiotic benefits of integrated approach, the basic rights of the public to opt for any doctor/any system of treatment for their health care (this is the concept of NRHM scheme in vogue of central govt.:- National Rural Health Mission- making available AYUSH systems too in PHCs/Govt Hospitals ) and don’t defame the public policies of the govt. Our common goal must be public health care.

SARVE JANAAH SUKHINO BHAVANTHU

Thanking you,                                                                                                                  

(Dr. VLN Sastry)

( Courtest - Dr. VLN Sastry )