THE BOMBAY NURSING HOMES REGISTRATON ACT,

1949 An Opportunity for

Improvement of Quality of Patient Care

By

Dr. Suryakant Hayatnagarkar

MAHARASHTRA THE BOMBAY NURSING

HOMES REGISTRATON ACT, 1949

An Act to provide for:

Registration and inspection of nursing homes in Maharashtra

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Definitions Provided by Law

“Local supervising authority” means

i) Muncipal Corporation-the Health officer of the concerned municipal corporation.

ii) Municipal council-the civil Surgeon of the districts in which such council is situated

iii) Cantonment – the health officer of the cantonment

iv) In the area not falling in above –district health officer of the concern Zilla parishad

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Maternity home” means any premises used, or intended to be used, for the reception of pregnant women or of women in or immediately after child birth;

“Nursing home” means any premises used or intended to be used, for the reception of persons suffering from any sickness, injury or infirmity and the provision of treatment and nursing for them, and includes a maternity home; and the expression “to carry on a nursing home” means to receive persons in a nursing home for any of the aforesaid purposes and to provide treatment or nursing for them;

“

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“Qualified medical practitioner” means a medical practitioner registered under the Bombay Medical Act, 1912, or any other law for the time being in force;

“Qualified midwife” means a midwife registered or deemed to be registered under the Bombay Nurses, Midwives and Health Visitors Act 1954 or any other corresponding law for the time being in force;

“Qualified Nurse” means a nurse registered or deemed to be registered under the Bombay Nurses, Midwives and Health Visitors Act 1954, or any other corresponding law for the time being in force;

“By-laws” means by-laws made by the local supervising authority;

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REGISTRATION

Act Provides that No person shall carry on the nursing home without

Registration Every person intending to carry on a nursing home

shall make an application for registration or the renewal of registration to the local supervising authority

A certificate of registration issued under this section shall subject to the provision of section 7, (who so ever has been convicted of an offence under this act leading to cancellation of registration.) and in force and shall be valid until 31st of March of 3rd year next following the day on which such certificate is issued and renewed, as the case may be.

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Every application for registration or the renewal of registration shall be accompanied, by such fees, as may be prescribed.

The state Government may prescribe different rate of fees for registration of nursing homes, having regard to the area in which such nursing home is situated, the number of beds therein, the number of specializations offered in such nursing home.

The LSA shall, on the receipt of an application for registration, register the applicant in respect of the nursing home named in the application and issue to him a certificate of registration in the prescribed form.

The certificate of registration issued with respect of nursing home shall be kept affixed in a conspicuous place in the nursing home

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Local supervising authority may refuse to register the applicant on the following

groundsNon-Fitness of the applicant or his agent

to carry on the nursing home. The nursing home is not under the

management of a person who is holding a degree in medical sciences and who is resident in the home.

If there is not a prescribed proportion of qualified nurses employed in the nursing home

That in the case of a maternity home it has not got on its staff a qualified midwife.

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If the area of the premises of the nursing home is less than the prescribed area.

If the number of beds available in the nursing home exceed those than prescribed.

If the nursing home is owned or is under the management of the Government Medical Officers.

Non Fitness of the premises with regard to situation, construction, accommodation, staffing or equipment

Use of the premises for any improper or undesirable purposes

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Penalty for non Registration

Imprisonment which may extend to six months

Or Fine which may extend to ten

thousand rupees Or Both(applicable all over in Maharashtra)

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Refusal or Cancellation of Registration

Subject to the provisions of this Act, theLSA may at any time cancel the

registration of a person in respect of any nursing home

OR

Refuse an application for the registration on

the ground that person has been convicted

of an offence under this Act.

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Notice of refusal or cancellation of registration

The LSA shall give not less than one calendar month’s notice of its intention and every such notice shall state the ground on which the LSA intends to cancel or refuse the registration

Provision for showing cause

Provision for appeal to State Government against such order of refusal. The decision of the State Government on any such appeal shall be final.

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Penalty for offences under Act

Whoever contravenes any of the provisions

of this Act shall be punished with fine which

may extend to 5000 and in the case of a continuing offence to a further fine of 50rupees in respect of each day on which

theoffence continues after such conviction.(Applicable all over Maharashtra)

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Inspection of nursing homes.

(1) The Health Officer of the local supervising authority at all reasonable times enter and inspect any premises which are used, or which that officer has reasonable cause to believe to be used for the purpose of nursing home and inspect any records required to be kept in accordance with the provisions of this Act:

(a) Provided that nothing in this Act shall be deemed to authorize any such officer to inspect any medical record relating to any patient in a nursing home

(b) Requiring notification to be given of any death occurring in the nursing home.

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Bye Law

The District Nursing Home Registration Board may make

bylaws not inconsistent with this

Act or rule

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Record of patients received into or of children born in the Nursing Home: -

The keeper of a Nursing Home shall keep and maintain.

(a) In the form appended to these by-laws a register of patients received into the Nursing Home;

(b) A correct alphabetical index of the names of the patients admitted to the nursing home;

(c) A daily record of health of every patient who may be suffering from acute illness;

(d) A daily record of health of every woman admitted to the nursing and Delivery and of every child born to such woman in nursing Home; and

(f) A daily and weekly record of health of other patients.

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Record of child and maternal Death

The Keeper of nursing home shall keep and maintain a register special form, of

maternal and infant deaths occurring in the nursing home, and submit monthly returns there

of to the Executive Health Officer.

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Notice of death occurring in Nursing Home

(1) If any death occurs in a nursing home, the keeper of the nursing home shall within 24 hours from the occurrence of the death given in writing the notice of such death to the Executive Health Officer of the Corporation or the Registrar of Births and Deaths for the District.

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Maintenance of register and form

Register – The local supervising authority shall maintain a register in Form ‘A’ showing the names of persons registered under section 5

Application for registration- Form ‘B’ Grant of certificate of registration – Form

‘C’ Renewal of registration - Form ‘B’

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Transfer of ownership- Immediately the transfer of the ownership or management of nursing home the transferor and the transferee shall jointly communicate the transfer affected to the LSA.

Change of address – A person registered under the Act inrespect of a nursing home shall communicate to the localsupervising authority not later that seventy-two hours aftersuch change.

Change in staff – Any change in the medical, nursing or midwifery staff together with the dates on which such changes has taken place shall be communicated to the localsupervising authority immediately and in any case, not later than three days of such change.

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Lost certificateIn the event of certificate of registrationbeing destroyed, the holder may apply to

theLSA for a fresh certificate and the LSAmay, if it thinks fit, issue such certificate upon payment of a fee of Rs. 5 A

certificateissued under this rule shall be marked “Duplicate”.

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Offences by corporations

A person committing an offence under this Act is acompany or other body corporate or an associationof persons (whether incorporated or not), every person who at the time of the commission of theoffence was a director, manager, secretary, agentor other officer or person concerned with the management there of shall, unless he proves thatthe offence was committed without his knowledgeor consent, be deemed to be guilty of such offence.

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Court Jurisdiction

No court, other than that of a PresidencyMagistrate or a Magistrate of the first

classshall take cognizance of or try any

offenceunder this Act

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Nothing is this Act shall apply to

Any nursing home carried on by Government or a local authority or by any other body of persons approved by the State Government in this behalf; and

Any asylum for lunatics or patients suffering from mental diseases, within the meaning of the Indian Lunacy Act 1912

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THE BOMBAY NURSING HOMES REGISTRATON ACT, 1949

Bombay Nursing Homes Registration Rules 1973Draft Rules for the Bombay Nursing Home

Registration Rules Submitted By CEHAT, Mumbai, June 2006

Director Health Services drafted rules in 2008.NOT APPLICABLE AT PRESENT as not yet

notified in gazette.

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CONTENTS1. Short title, extent and commencement 2. Definitions 3. Prohibition to carry on nursing home

without registration 4. Application for registration 5. Registration 6. Penalty for non-registration 7. Cancellation of registration 8. Notice of refusal or of cancellation of

registration

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CONTENTS

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

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ContentsNotifiable DiseasesBio-safety GuidelinesMinimum Standards for 10 bedded General

Nursing HomeSurgical Nursing and Maternity HomeUniversal Precautions - WHO GuidelinesBuilding Engineering Environmental

Standards

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Prohibition

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

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Prohibition

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

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Books of Records

Every nursing home shall maintain an inspection book and a complaint register (for the patients party), which shall be produced before the inspecting officer/s as and when required.

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Compliance

The Nursing Home shall adhere to the following minimum standards regarding the Functional Program of the Nursing Home.

Emergency First Aid- The basic minimum functions provided by a nursing home should include Emergency First Aid.

Co-operation in the National Health Programmers and as per notifiable diseases act/ epidemic act.

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Emergency services All emergency patients attending a nursing home, must

be attended primarily to save the life without considering the financial capability of the patient, and then, may be referred with relevant medical reports about the ailments, as early as possible to the nearest suitable referral unit. No advance payment may be demanded for such emergency care. It is also the responsibility of the patient or his/her party to pay all the dues to the nursing home. Non-payment of dues cannot become ground for refusal of emergency care for that person or for future cases.

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Routine Declarations

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

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Bio Safety

Universal bio safety guidelines and bio-medical waste treatment and disposal rules shall be followed by all nursing homes to protect environment, public and personnel employed from occupation related diseases as per the Bio-Medical Waste (Management and Handling) Rules, 1998. (See ANNEXURE II )

The general cleanliness of the premises including sanitary arrangement, furniture and Equipments must be properly maintained along with 24 hours adequate potable water supply for the beneficiaries.

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Nursing Staff Education of Nurses- With regard to

education of nurses, two categories of qualified nurses will be recognized. – Qualified Nurses- Nurses registered with the

Nursing Council would be included here. – Trained Nurses- All those who have taken a

minimum of six months nursing training in any government approved institution would be considered trained nurses, and eligible to be employed as nurses in the Nursing Homes.

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Nursing Staff Minimum number of nurses- One qualified/ trained nurse for

10 beds or part there of on every shift and if on different floors then in same proportion on different floors. Taking into account the weekly offs and leaves, this would mean totally more than 3 nurses employed per 10 beds.

Adequate efforts need to be taken to procure qualified nurses. For the time being nurses from all courses, of a minimum duration of six months, meant for training nurses, may be considered qualified nurses. Seats in government colleges for Nursing need to be increased, as also relevant courses for Nursing need to be introduced to bridge the gap.

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MINIMUM STANDARDS OF SPACE

Reception 100 sq

feet Nursing and examination 80 sq feet Consulting room each 80 sq feet Beds each bed 60 sq feet Other areas also specified

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Applicable fees

Fee Structure Rural Urban MetroUpto 10 beds 1000 1500 200011-30 beds 1500 2750 300031-100 beds 2000 3000 4000Each addl bed 20 30 40

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Patients have a right to access heath care

All nursing homes must adopt the Standard Charter of Patient's Rights (displayed at a prominent place), observe it and orient their staff for the same. It should contain all relevant provisions contained in these rules.

Patients have a right to information

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Patient Rights

All charges of the Nursing Home, like bed charges, consultation charges, operation charges, charges for diagnostic tests (If Nursing Home has a diagnostic center) must be displayed.

An information booklet in the local language must be provided to the beneficiaries. The nursing home is to offer an estimate of expenditure likely to be incurred to the in-door patients either for the whole package for investigations, treatment and management or by furnishing item-wise estimate for investigations, treatment or management, separately.

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Patient Rights

– The patient at the time of discharging from the nursing home should be provided with discharge card which should mention the diagnosis, the medical treatment given and the state of his/her health.

– If the patient chooses, he/she may seek a second medical opinion as to such diagnosis, treatment or state of health. All relevant reports must be made available to facilitate second opinion.

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Patient Rights

– All charges incurred by the patient at any stage of medical care, and all payments made by the patient should be supported by a detailed statement/receipt, which should be provided with or without a request made by the patient.

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Patient Rights

The patient must have an access to his / her clinical records at all reasonable times during admission to NH. A photocopy of the same should be available within 24 hrs when admitted to NH or within 72 hrs of making an application by patient or legal heir after discharge or death, after photocopy charges.

Patient’s have right to autonomy and participation in decision making

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Patient Rights

Patients have the right to adequate care and protection Patient has a right to personal dignity and privacy A functional grievance redress mechanism must be set up at the

nursing home and the information of the procedure should be given to the patient.

Adult and conscious patient has the right to refuse treatment if so allowed under the existing Laws.

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Notifications It shall be obligatory on the nursing home to inform to

the nearest police station about all grievous cases of injury treated in the nursing home and maintain records of all injuries examined and retain it for a period of the complete disposal of the case.

A report of Notifiable Diseases will have to be submitted within 48 hours of its diagnosis to the Director Health Services as per prescribed Form of that bureau by the Nursing Home. Notifiable disease register and a record of information given to local authorities must be maintained. A list of notifiable diseases is annexed.

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List of Notifiable Diseases

Small Pox Cholera Plague Yellow fever Scarlet fever Enteric fever (Typhoid fever) Diphtheria Typhus Tuberculosis Leprosy

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List of Notifiable Diseases

Puerperal fever: Puerperal pyrexia is considered as any febrile condition occurring in a woman whose temperature rises to 100.4’ F (38 C) or more within fourteen days after confinement or miscarriage.

InfluenzaCerebrospinal feverPoliomyelitisVirus Encephalitis / Infectious Hepatitis

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List of Notifiable Diseases

Dengue feverGastro EnteritisAIDSMeningococcal MeningitisLeptospirosisBird FluWould include any other diseases notified under

the Epidemic Diseases Act, 1897

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Our Charter

We will register all our establishments under this act immediately.

Take all necessary steps to expedite the process.Appoint qualified staff in proportion required

under the law.Renew in timely manner henceforth.

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Our Requests

Authorities may please help us to achieve our goals and not compel us to run from pillar to post to collect all the documents needed.

Authorities may please help us in not feeling guilty about small irregularities and help us fulfill the conditions.

Authorities may please help us in furthering patient’s interests which is utmost in health care.

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वि�क्रमा�दि�त्य हा� अत्य त न्य�यवि�य रा�जा� हा�त�. य� गो�ष्टी�नं तरा आपण स��

वि�क्रमा�दि�त्य�स�राखा� न्य�य करा�ल अशी� आप!क्षा� आहा!.

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What authority CMO had to order immediate closure under the law?

Will this hospital close as per order of CMO?

What will happen to patients who are undergoing treatment, surgeries or are in ICU on life support?

Who will be responsible for hardship faced by these patients?