The Clinical Establishment Act- How will it affect the practising dentist

The Clinical Establishment Act 2010 became effective in Feb 2012 through an extraordinary gazette notification and is today applicable in 4 states with at least three more poised to adopt the same. There is no doubt that this is a landmark legislation which very few people in the dental profession noticed. One of the reasons is that, dentistry as an important clinical branch of health care has been grossly under represented. The DCI has represented the meeting of the national Council in two of its four meetings through its secretary. The minutes of the meetings are available on the website of the body ( 1). Scanning through the minutes it is surprising to see that while all the branches have strongly voiced their opinions, dentistry has not spoken out a single sentence (as per the recorded minutes).  It must be said that the National Council has made an exhaustive list of the regulations required for starting and running of clinics. In fact the requirement for a dental clinic is rather well formatted. It is divided into Dental Center for a single dentist practice and a Dental Hospital for those with inpatient facility. The Dental Hospital requirements are a little difficult to fulfill- at least for the new practitioner starting in a metro city! Dr Anmol Kalha is the member from the Dental Profession and we hope that dentistry is well spoken for. The State Council will be the implementing authority through its district officers. The District registering committee will be nominated by the Collector and will have three members including a senior police officer and a representative from the profession. It is at this level that one can expect problems if any for the practicing dentist. The inspectors are nominated by the District authority.

Since most of the States have yet to adopt the Act, it may be some time before all dentists face the nuts and bolts of regulation. We sincerely hope that it will not be a source of harassment for an already struggling profession. On the other hand regulating practice may eliminate quackery to a large extent. More importantly it will ensure safety for the public.

I thought I will touch upon a few of the requirements and comment on them so that eminent persons who will eventually represent us will be able to get an idea about how laws are likely to affect the common dental practitioner. I was recently told by someone that impossible guidelines like an OPG in every clinic etc were suggested. On reading the clinical requirements, it is clear that these were exaggerations. It is titled as Standard No CEA/ Dental Hospital-38 and 39 for Dental Hospitals and Dental Centers respectively. This is unusual because the Code of Ethics Regulation prevents Dental Clinics from being called Hospitals. That may change because the new code of Ethics is almost ready as per information from the DCI.

In any case the new requirements will cover all dental clinics including single person run establishments and exceptions are only for the armed forces. The format available on the website (2) is comprehensive and covers all specialties. The norms for infection control, cleanliness and safety (including bio and radiation safety) are quite rational and practical. However there appears to be some need for pragmatism in the space requirements. It says that for Dental Hospitals 30% of carpet area should be reception and circulation. 30% of carpet area for one Chair is expected to be 6 sq meters of carpet space (i.e 18x18= 324 Sq Ft). In addition 30% carpet area should be for ancillary purposes including sterilization, toilet etc. This means that a clinic should have a minimum of 1000 Sq Ft for one chair. For every extra chair there must be an additional 60% or 600 Sq Ft. I will leave it to the reader to decide if this is practical in a city like Mumbai. It does not say where the patients will be admitted. On the other hand Dental Centers need only 60 Sq Ft for a chair and 35 Sq feet for reception etc. The 60Sq ft will be a little tight if a patient needs to be shifted after a syncope. I do not understand why one needs 5 times more space around a chair in the hospital category! There are several other small glitches including a number of inspections for bio safety, lift safety, drug expiry etc. While I think it is necessary, I am not sure how many dentists will be comfortable with buying Oxygen and other gases and all monitoring systems and equipment. Another difficult task will be the employment of ‘qualified’ assistance (diploma recognized by state dental council) and providing minimum wages according to the labor laws. Some requirements like waste disposal etc are definitely important. Some others may need tinkering. Some other requirements may worry dentists and doctors. One is expected to put a price list for procedures for patients to see and the rates are decided by the competent authority, not the dentist. I am not sure if this will work for health care.

My biggest issue with the construct of the legislation is the absence of the IDA inputs, whereas the IMA, Ayurveda, Unnani, Yoga and Homeopathy associations (not just councils) are very well represented. How in the world are they going to implement ground level regulation without technical inputs from the dental profession- particularly practicing dentists!

While you chew on that information, you can go to the very informative website and troll through all the sections at  http://clinicalestablishments.nic.in/En/1066-national-council-members.aspx.

1.       http://clinicalestablishments.nic.in/En/1066-national-council-members.aspx

http://clinicalestablishments.nic.in/WriteReadData/449.pdf