Why one-third of hospitals will close by 2020

According to the American Hospital Association, in 2011 approximately 5,754 registered hospitals
existed in the U.S., housing 942,000 hospital beds along with 36,915,331 admissions. More than 1 in
10 Americans were admitted to a hospital last year.
Hospitals make a substantial imprint on local economies. In many communities, hospitals represent
one of the largest employers and economic drivers. Of the total annual American health care dollars
spent, hospitals are responsible for more than $750 billion.
Despite a history of strength and stature in America, the hospital institution is in the midst of massive
and disruptive change. Such change will be so transformational that by 2020 one in three hospitals
will close or reorganize into an entirely different type of health care service provider. Several
significant forces and factors are driving this inevitable and historical shift.
First, America must bring down its crippling health care costs. The average American worker costs
their employer $12,000 annually for health care benefits and this figure is increasing more than 10
percent every year. U.S. businesses cannot compete in a globally competitive market place at this
level of spending. Federal and state budgets are getting crushed by the costs of health care
entitlement programs, such as Medicare and Medicaid. Given this cost problem, hospitals are
vulnerable as they are generally regarded as the most expensive part of the delivery system for
health care in America.
Second, statistically speaking hospitals are just about the most dangerous places to be in the United
States. Three times as many people die every year due to medical errors in hospitals as die on our
highways 100,000 deaths compared to 34,000. The Journal of the American Medical Association
reports that nearly 100,000 people die annually in hospitals from medical errors. Of this group,
80,000 die from hospital acquired infections, many of which can be prevented. Given the above
number of admissions that means that 1 out of every 370 people admitted to a hospital dies due to
medical errors. So hospitals are very dangerous places.
It would take about 200 747 airplanes to crash annually to equal 100,000 preventable deaths.
Imagine the American outcry if one 747 crashed every day for 200 consecutive days in the U.S. The
airlines would stand before the nation and the world in disgrace. Currently in our non-transparent
health care delivery system, Americans have no way of knowing which hospitals are the most
dangerous. We simply take uninformed chances with our lives at stake.
Third, hospital customer care is abysmal. Recent studies reveal that the average wait time in
American hospital emergency rooms is approximately 4 hours. Name one other business where
Americans would tolerate this low level of value and service.

Fourth, health care reform will make connectivity, electronic medical records, and transparency
commonplace in health care. This means that in several years, and certainly before 2020, any
American considering a hospital stay will simply go on-line to compare hospitals relative to infection
rates, degrees of surgical success, and many other metrics. Isnt this what we do in America,
comparison shop? Our health is our greatest and most important asset. Would we not want to
compare performance relative to any health and medical care the way we compare roofers or carpet
installers? Inevitably when we are able to do this, hospitals will be driven by quality, service, and cost
all of which will be necessary to compete.
What hospitals are about to enter is the place Americans, particularly conservative Americans
cherish: the open competitive market. We know what happens in this environment. There are
winners and losers.

A third of hospitals now in existence in the United States will not cross the 2020 finish line as
winners.
Inevitably when we are able to do this, hospitals will be driven by quality, service, and cost all of
which will be necessary to compete.

The problem with reimbursement being tied to patient satisfaction is that often appropriate
medical care is confused with SERVICE. I've been a nurse for over twenty years. Our
hospital pays hundreds of thousands of dollars for patient surveys that tell us patients see
themselves as customers. Patients want instant service in the Emergency Room for an
earache or a cough- they have no appreciation for the fact that the reason they came in is
NOT an emergency. Patients want their call light answered in 3 rings even if they want their
purse from the chair next to the bed, AND there is a family member right there. Patients
want their IV or blood draw done with one stick even though they are obese and/or
dehydrated. Patients want their linen changed everyday even if it is not soiled. Patients
want their food to be delish -they have no concept of the restrictions the dietary department
has to address to provide food to so many people with diverse dietary restrictions. Patients
want a good outcome when they have been methodically destroying their own health for
over 30 years with cigarettes, alcohol,drugs,food,and a sedentary lifestyle. People want a
perfect baby when they have had no prenatal care,poor nutrition, a drug habit, alcoholism,
and a multitude of untreated sexually transmitted disease. In short there is a disconnect
between medical care and service-between what is possible and what is not. I don't think a
patient should not get good SERVICE but there is a difference between appropriate medical
care and SERVICE. We are pinched to give both! Tying reimbursement to outcomes is also
a tough issue when someone who is obese, smokes, and drinks has a poor outcome
Another important issue is that many of the patients present in a hospital are there to be
treated from a certain problem and many times the problem or the treatment itself whether

surgical or medical will decrease their innate immunity making the patients more prone to
dealy infections even from bacteria that would not cause infection in a healthy individual
Doctors are not gods. Sometimes nature wins. It is natural that there is a concentration of
deaths in hospitals. There is a concentration of sick people in hospitals
educate the public about why the ER is there and what constitutes a legitimate need for the
ER. I'm sorry that your throat hurts sometimes, but we have to care for the man having the
heart attack or the elderly woman who fell and broke her hip first. We triage people when
they come in to make sure we at handling the most critical patients first.

Medico Legal Issues - Index

Accepted Medical Practice | Accidents / Mishaps / Mistakes | Advertisement / Signboards | Advising
investigations / diagnostic procedures |Blood Banks | Blood transfusion | Collecting samples for investigations /
Diagnostic procedures | Communication with patients |Confidentiality - General Precautions | Consent Alternative / Extension during treatment / surgery / procedure / intervention | Consent - Blood
transfusion | Consent - Emergencies | Consent - Form | Consent - General Precautions | Consent - General
precautions | Consent - Medical termination of pregnancy | Consent - Minors / Incompetent patients (Proxy
consent) | Consent - Refusal to consent / Compulsory treatment | Consent - Risk information | Consent Surgery / Procedure / Intervention | Consent Form | Courts and Legal Proceedings |Courts and legal
proceedings | Death certificates | Diagnosis | Doctors giving evidence in witness box - General Precautions |
Documentation & Medical Records - General Precautions | Documentation & Medical Records Stationery | Documentation & medical records - Writing | Drugs | Emergencies - Appointing substitutes / On-call
physicians / Locums | Emergencies - Appointing substitutes / on-call physicians / Locums | Emergencies Brought-dead / Death-before-diagnosis cases | Emergencies - Complications during treatment |Emergencies Complications during treatment / surgery / procedure / intervention | Emergencies - Death of patients under
treatment |Emergencies - Engaging another obstetrician | Emergencies - General precautions | Emergencies Postmortem | Emergencies - Refusal to treat at the outset | Emergencies - Terminating treatment
midway | Emergencies - Transferring patients | Emergencies Death-on-table| Emergencies
Euthanasia | Emergency Patients - General Precautions | Emergency Patients - General
precautions | Emergency Patients - Hospitals | Emergency Patients - Outside expertise | Examining
Patients | Examining patients | Fees | Hematologists | History of Patients | History of patients | Hospitals Admitting patients | Hospitals - Discharge against medical advice | Hospitals - Discharging patients | Hospitals General Precautions | Hospitals - Infrastructure / Equipments | Hospitals - Intensive Care Units | Hospitals Nursing / Staff | Hospitals - Nursing home regulations (statutory compliance) | Hospitals - Operation
Theaters | Hospitals - Patients care | Hospitals - RMOs / Consultants | Hospitals - RMOs
/Consultants | Insurance | Law on Medical Negligence | Law on medical negligence | Maternity Hospitals /
Wards | Maternity Hospitals / Wards - General Precautions | Maternity hospitals / Wards | Medical Certificates General Precautions | Medical Records - Access / Ownership | Medical Records - Access and
ownership | Medical Records - Bed-head ticket |Medical Records - Computerized | Medical Records - Discharge
card | Medical Records - Discharge card / summary / ticket | Medical Records - General Precautions | Medical
Records - Hospitals | Medical Records - Internal / External | Medical Records - Preserve / Provide /
Produce | Medical Records - Surgery / Procedure / Intervention | Medical records - General precautions | Medical
records - Surgery / Procedure / Intervention | Pathology Laboratories / Imaging Centers General
Precautions | Pathology Laboratories / Imaging centers |Precautions - General | Precautions - General
Precautions | Precautions - Unusual | Prescription | Professional colleagues / peers |Prognosis | Qualifications /
Expertise / Skills | Referral / Consultations / Second opinion - Precautions for referring doctors | Referral /
consultations / second opinion - Precautions for consultants | Referral / consultations / second opinion Precautions for referring doctors |Statutory compliance | Surgery / Procedure / Intervention Anaesthesia | Surgery / Procedure / Intervention - Anesthesia | Surgery / Procedure / Intervention - General
Precautions | Surgery / Procedure / Intervention - General precautions | Surgery / Procedure / Intervention Intra | Surgery / Procedure / Intervention - Post | Surgery / Procedure / Intervention - Pre | Treating / Managing
patients | Unusual Precautions| Updating knowledge / Continuing Medical Education (CME) | Withdrawing from

patients | Written intimation to police |

Out of total 13692 odd hospitals in the country, 1/3rd

hospitals are in rural areas and 2/3rd are located in urban
areas.
The govt owns 2/3rd of all such hospitals comprising 35%
of countrys total bed component.
Private sector owns only 1/3rd of hospitals but number of
beds constitutes 60% of total hospital beds.
Largest share (60-80%) of health resources goes to
hospitals.
A global survey in the 6 regions of the World Health
Organization (Leadership Summit IHF-2003) reveals
Public sector hospitals in developing countries like India
lacks funds, understaffed, poorly managed in
developing countries and relatively true even in
developed country.
Human Resource Management in areas like skill
development, competencies and accountability are far
from satisfactory not only in developing countries but also
in economically advanced countries.

TITLE 77: PUBLIC HEALTH

CHAPTER I: DEPARTMENT OF PUBLIC HEALTH
SUBCHAPTER b: HOSPITALS AND AMBULATORY CARE FACILITIES
PART 250 HOSPITAL LICENSING REQUIREMENTS
The General Assembly's Illinois Administrative Code database includes only those rulemakings
that have been permanently adopted. This menu will point out the Sections on which an
emergency rule (valid for a maximum of 150 days, usually until replaced by a permanent
rulemaking) exists. The emergency rulemaking is linked through the notation that follows the
Section heading in the menu.

SUBPART A: GENERAL PROVISIONS

Section 250.100 Definitions

Section 250.105 Incorporated and Referenced Materials

Section 250.110 Application for and Issuance of Permit to Establish a Hospital

Section 250.120 Application for and Issuance of a License to Operate a Hospital

Section 250.130 Administration by the Department

Section 250.140 Hearings

Section 250.150 Definitions (Renumbered)

Section 250.160 Incorporated and Referenced Materials (Renumbered)

SUBPART B: ADMINISTRATION AND PLANNING

Section 250.210 The Governing Board

Section 250.220 Accounting

Section 250.230 Planning

Section 250.240 Admission and Discharge

Section 250.245 Failure to Initiate Criminal Background Checks

Section 250.250 Visiting Rules

Section 250.260 Patients' Rights

Section 250.265 Language Assistance Services

Section 250.270 Manuals of Procedure

Section 250.280 Agreement with Designated Organ Procurement Agencies

Section 250.285 Smoking Restrictions

Section 250.290 Safety Alert Notifications

SUBPART C: THE MEDICAL STAFF

Section 250.310 Organization

Section 250.315 House Staff Members

Section 250.320 Admission and Supervision of Patients

Section 250.330 Orders for Medications and Treatments

Section 250.340 Availability for Emergencies

SUBPART D: PERSONNEL SERVICE

Section 250.410 Organization

Section 250.420 Personnel Records

Section 250.430 Duty Assignments

Section 250.435 Health Care Worker Background Check

Section 250.440 Education Programs

Section 250.450 Personnel Health Requirements

Section 250.460 Benefits

SUBPART E: LABORATORY

Section 250.510 Laboratory Services

Section 250.520 Blood and Blood Components

Section 250.525 Designated Blood Donor Program

Section 250.530 Proficiency Survey Program (Repealed)

Section 250.540 Laboratory Personnel (Repealed)

Section 250.550 Western Blot Assay Testing Procedures (Repealed)

SUBPART F: RADIOLOGICAL SERVICES

Section 250.610 General Diagnostic Procedures and Treatments

Section 250.620 Radioactive Isotopes

Section 250.630 General Policies and Procedures Manual

SUBPART G: GENERAL HOSPITAL EMERGENCY SERVICES

Section 250.710 Classification of Emergency Services

Section 250.720 General Requirements

Section 250.725 Notification of Emergency Personnel

Section 250.730 Community or Areawide Planning

Section 250.740 Disaster and Mass Casualty Program

Section 250.750 Emergency Services for Sexual Assault Victims

SUBPART H: RESTORATIVE AND REHABILITATION SERVICES

Section 250.810 Applicability of Other Parts of These Requirements

Section 250.820 General

Section 250.830 Classifications of Restorative and Rehabilitation Services

Section 250.840 General Requirements for all Classifications

Section 250.850 Specific Requirements for Comprehensive Physical Rehabilitation

Services

Section 250.860 Medical Direction

Section 250.870 Nursing Care

Section 250.880 Additional Allied Health Services

Section 250.890 Animal-Assisted Therapy

SUBPART I: NURSING SERVICE AND ADMINISTRATION

Section 250.910 Nursing Services

Section 250.920 Organizational Plan

Section 250.930 Role in hospital planning

Section 250.940 Job descriptions

Section 250.950 Nursing committees

Section 250.960 Specialized nursing services

Section 250.970 Nursing Care Plans

Section 250.980 Nursing Records and Reports

Section 250.990 Unusual Incidents

Section 250.1000 Meetings

Section 250.1010 Education Programs

Section 250.1020 Licensure

Section 250.1030 Policies and Procedures

Section 250.1035 Domestic Violence Standards

Section 250.1040 Patient Care Units

Section 250.1050 Equipment for Bedside Care

Section 250.1060 Drug Services on Patient Unit

Section 250.1070 Care of Patients

Section 250.1075 Use of Restraints and Seclusion

Section 250.1080 Admission Procedures Affecting Care

Section 250.1090 Sterilization and Processing of Supplies

Section 250.1100 Infection Control

Section 250.1110 Mandatory Overtime Prohibition

Section 250.1120 Staffing Levels

Section 250.1130 Nurse Staffing by Patient Acuity

SUBPART J: SURGICAL AND RECOVERY ROOM SERVICES

Section 250.1210 Surgery

Section 250.1220 Surgery Staff

Section 250.1230 Policies & Procedures

Section 250.1240 Surgical Privileges

Section 250.1250 Surgical Emergency Care

Section 250.1260 Operating Room Register and Records

Section 250.1270 Surgical Patients

Section 250.1280 Equipment

Section 250.1290 Safety

Section 250.1300 Operating Room

Section 250.1305 Visitors in Operating Room

Section 250.1310 Cleaning

Section 250.1320 Postanesthesia Care Units

SUBPART K: ANESTHESIA SERVICES

Section 250.1410 Anesthesia Service

SUBPART L: RECORDS AND REPORTS

Section 250.1510 Medical Records

Section 250.1520 Reports

SUBPART M: FOOD SERVICE

Section 250.1610 Dietary Department Administration

Section 250.1620 Facilities

Section 250.1630 Menus and Nutritional Adequacy

Section 250.1640 Diet Orders

Section 250.1650 Frequency of Meals

Section 250.1660 Therapeutic (Modified) Diets

Section 250.1670 Food Preparation and Service

Section 250.1680 Sanitation

SUBPART N: HOUSEKEEPING AND LAUNDRY SERVICES

Section 250.1710 Housekeeping

Section 250.1720 Garbage, Refuse and Solid Waste Handling and Disposal

Section 250.1730 Insect and Rodent Control

Section 250.1740 Laundry Service

Section 250.1750 Soiled Linen

Section 250.1760 Clean Linen

SUBPART O: OBSTETRIC AND NEONATAL SERVICE

Section 250.1810 Applicability of Other Provisions of this Part

Section 250.1820 Obstetric and Neonatal Service (Perinatal Service)

Section 250.1830 General Requirements for All Obstetric Departments

Section 250.1840 Discharge of Newborn Infants from Hospital

Section 250.1845 Caesarean Birth

Section 250.1850 Single Room Postpartum Care of Mother and Infant

Section 250.1860 Special Programs (Repealed)

Section 250.1870 Labor, Delivery, Recovery and Postpartum Care

SUBPART P: ENGINEERING AND MAINTENANCE OF THE PHYSICAL PLANT,

SITE, EQUIPMENT, AND SYSTEMS HEATING, COOLING, ELECTRICAL,
VENTILATION, PLUMBING, WATER, SEWER, AND SOLID WASTE DISPOSAL

Section 250.1910 Maintenance

Section 250.1920 Emergency electric service

Section 250.1930 Water Supply

Section 250.1940 Ventilation, Heating, Air Conditioning, and Air Changing Systems

Section 250.1950 Grounds and Buildings Shall be Maintained

Section 250.1960 Sewage, Garbage, Solid Waste Handling and Disposal

Section 250.1970 Plumbing

Section 250.1980 Fire and Safety

SUBPART Q: CHRONIC DISEASE HOSPITALS

Section 250.2010 Definition

Section 250.2020 Requirements

SUBPART R: PHARMACY OR DRUG AND MEDICINE SERVICE

Section 250.2110 Service Requirements

Section 250.2120 Personnel Required

Section 250.2130 Facilities for Services

Section 250.2140 Pharmacy and Therapeutics Committee

SUBPART S: PSYCHIATRIC SERVICES

Section 250.2210 Applicability of other Parts of these Regulations

Section 250.2220 Establishment of a Psychiatric Service

Section 250.2230 The Medical Staff

Section 250.2240 Nursing Service

Section 250.2250 Allied Health Personnel

Section 250.2260 Staff and Personnel Development and Training

Section 250.2270 Admission, Transfer and Discharge Procedures

Section 250.2280 Care of Patients

Section 250.2290 Special Medical Record Requirements for Psychiatric Hospitals and
Psychiatric Units of General Hospitals or General Hospitals Providing Psychiatric Care.

Section 250.2300 Diagnostic, Treatment and Physical Facilities and Services

SUBPART T: DESIGN AND CONSTRUCTION STANDARDS

Section 250.2410 Applicability of these Standards

Section 250.2420 Submission of Plans for New Construction, Alterations or Additions to

Existing Facility

Section 250.2430 Preparation of Drawings and Specifications--Submission Requirements

Section 250.2440 General Hospital Standards

Section 250.2442 Fees

Section 250.2443 Advisory Committee

Section 250.2450 Details

Section 250.2460 Finishes

Section 250.2470 Structural

Section 250.2480 Mechanical

Section 250.2490 Plumbing and Other Piping Systems

Section 250.2500 Electrical Requirements

SUBPART U: CONSTRUCTION REQUIREMENTS FOR EXISTING HOSPITALS

Section 250.2610 Applicability of Subpart U

Section 250.2620 Codes and Standards

Section 250.2630 Existing General Hospital Requirements

Section 250.2640 Details

Section 250.2650 Finishes

Section 250.2660 Mechanical

Section 250.2670 Plumbing and Other Piping Systems

Section 250.2680 Electrical Requirements

SUBPART V: SPECIAL CARE AND/OR SPECIAL SERVICE UNITS

Section 250.2710 Special Care and/or Special Service Units

Section 250.2720 Day Care for Mildly Ill Children

SUBPART W: ALCOHOLISM AND INTOXICATION TREATMENT SERVICES

Section 250.2810 Applicability of Other Parts of These Requirements

Section 250.2820 Establishment of an Alcoholism and Intoxication Treatment Service

Section 250.2830 Classification and Definitions of Service and Programs

Section 250.2840 General Requirements for all Hospital Alcoholism Program

Classifications

Section 250.2850 The Medical and Professional Staff

Section 250.2860 Medical Records

Section 250.2870 Referral

Section 250.2880 Client Legal and Human Rights

Section 250.APPENDIX A Codes and Standards (Repealed)

o Section 250.EXHIBIT A Codes (Repealed)
o Section 250.EXHIBIT B Standards (Repealed)
o Section 250.EXHIBIT C Addresses of Sources (Repealed)

Section 250.ILLUSTRATION A Seismic Zone Map

Section 250.TABLE A Measurements Essential for Level I, II, and III Hospitals

Section 250.TABLE B Sound Transmission Limitations in General Hospitals

Section 250.TABLE C Filter Efficiencies for Central Ventilation and Air Conditioning
Systems in General Hospitals (Repealed)

Section 250.TABLE D General Preassure Relationships and Ventilation of Certain

Hospital Areas (Repealed)

Section 250.TABLE E Piping Locations for Oxygen, Vacuum and Medical Compressed
Air

Section 250.TABLE F General Pressure Relationships and Ventilation of Certain Hospital

Areas

Section 250.TABLE G Insulation/Building Perimeter

Re : List of statutory requirements for hospitals Posted By V.Parangiri Date : 23-Sep-10

03:04 AM Reply
Licenses and regulations Building Permit (From the Municipality) No objection certificate from the
Chief Fire Officer "License under Bio-Medical Management and Handling Rules, 1998 (Note:
Check whether the external agency is authorized to dispose all bio medical wastes of the
hospital, a copy of their license to be available with the hospital, also check whether a MOU
between the agency and the hospital is available)." No objection certificate under Pollution
Control Act. Radiation Protection Certificate in respect of all X-ray and CT Scanners from BARC.
Excise permit to store spirit Permit to operate lifts under the Lifts and Escalators Act.(if applicable)
Narcotics and Psychotropic substances Act. "Vehicle Registration Certificates (Note: For all
hospital vehicles.)" "Atomic energy regulatory body approvals. (Note: For the structural facility of

radiology dept, TLD badges etc)" Boilers Act, 1923(If applicable) "MTP Act, 1971 (Note: MTP
stands for Medical termination of pregnancy. To be displayed in the Gynaec & Obs dept) "
"License for the Blood Bank (Note: To be displayed in the Blood Bank)" Transplantation of Human
Organs Act 1994(If applicable) "PNDT Act, 1996 (Note: PNDT stands for Prenatal diagnostics
test. To be displayed in the Radiology dept that this is followed. )" Dentist Regulations, 1976
Drugs & Cosmetics Act, 1940 Electricity Act, 1998 ESI Act, 1948 (For contract employees)
Environment Protection Act, 1986 Fatal Accidents Act 1855 Guardians and Wards Act, 1890
"Indian Lunacy Act, 1912 (Note: Applicable only if a Psychiatry dept is there in the hopsital)"
"Indian Medical Council Act and Code of Medical Ethics, 1956 (Note: Whether doctors, spcialists
are registered with MCI and Tamilnadu Medical Council)" "Indian Nursing Council Act 1947 (Note:
Whether nurses are registered with NCI). Also check whether pharmacists are registered with
Pharmacy Council of India.)" Insecticides Act, 1968 Lepers Act Maternity Benefit Act, 1961
Minimum wages act, 1948 (For contract employees) National Building Code Persons with
Disability Act, 1995 Pharmacy Act, 1948 Protection of Human Rights Act, 1993 Registration of
Births and Deaths Act, 1969 SC and ST Act, 1989 Urban Land Act, 1976. Right to information Act
Contents
1.

1 Building Permit (from the Municipality).

2.

2 No objection certificate from the Chief Fire Officer

3.

3 Bio-medical Management and handling Rules, 1998.

4.

4 No objection certificate under Pollution Control Act.

5.

5 Radiation Protection Certificate in respect of all X-ray, Cath lab and CT Scanners from BARC.

6.

6 Atomic energy regularity body approvals.

7.

7 7. Excise permit to store Spirit.

8.

8 8. Income Tax PAN.

9.

9 9. Permit to operate lifts under the Lifts and Escalators Act.

10.

10 10. Narcotics and Psychotropic substances Act and License.

11.

11 11. Sales Tax Registration Certificate.

12.

12 12. Vehicle registration certificates for Ambulances.

13.

13 13. Retail and Bulk drug license (Pharmacy).

14.

14 14. Wireless operation certificate from Indian post and telegraphs. (If applicable).

15.

15 15. Air (prevention and control of pollution) Act, 1981 and License.

16.

16 16. Arms Act, 1950. (if guards have weapons).

17.

17 17. Boillers Act, 1923.

18.

18 18. Cable television networks Act, 1995.

19.

19 19. central sales tax Act, 1956.

20.

20 20. Consumer protection Act, 1986.

21.

21 21. Contract Act, 1982.

22.

22 22. Copyright Act, 1982.

23.

23 23. Customs Act, 1962

24.

24 24. Dentist regulations, 1976.

25.

25 25. Drugs and cosmetics Act, 1940.

26.

26 26. Electricity Act, 1998.

27.

27 27. Electricity rules, 1956.

28.

28 28. Employees provident fund Act, 1952.

29.

29 29. ESI Act, 1948.

30.

30 30. Employment exchange Act, 1969.

31.

31 31. Envirnment protection Act, 1986.

32.

32 32. Equal remuneration act, 1976.

33.

33 33. Explosives Act, 1884.

34.

34 34. Fatal accidents Act, 1855.

35.

35 35. Gift tax Act, 1958.

36.

36 36. Hire Purchase Act, 1972.

37.

37 37. Income Tax Act. 1961.

38.

38 38. Indian Lunacy Act, 1912.

39.

39 39. Indian Medical Council Act and Code of Medical Ethics, 1956.

40.

40 40. Indian Nursing Council Act, 1947.

41.

41 41. Indian penal code, 1860.

42.

42 42. Indian trade unions Act, 1926.

43.

43 43. Industrial disputes Act, 1947.

44.

44 44. Insecticides Act, 1968.

45.

45 45. lepers Act.

46.

46 46. Maternity benefit Act, 1961.

47.

47 47. MTP act, 1971.

48.

48 48. Minimum wages Act, 1948.

49.

49 49. National building code.

50.

50 50. National holidays under shops Act.

51.

51 51. Negotiable instruments Act, 1881.

52.

52 52. Payment of bonus Act, 1965.

53.

53 53. Payment of gratuity Act, 1972.

54.

54 54. Payment of wages Act, 1936.

55.

55 55. Persons with disability Act, 1995.

56.

56 56. Pharmacy Act, 1948.

57.

57 57. PNDT Act, 1996.

58.

58 58. Prevention of food adulteration Act, 1954.

59.

59 59. Protection of human rights Act, 1993.

60.

60 60. PPF Act, 1968.

61.

61 61. Registration of births and deaths Act, 1969.

62.

62 62. Sale of goods Act, 1930.

63.

63 63. Tax deducted at source Act.

64.

64 64. Sales tax Act.

65.

65 65. SC and ST Act, 1989.

66.

66 66. license for the blood bank.

67.

67 67. Companies Act, 1956.

68.

68 68. Constitution of India.

69.

69 69. Insurance Act, 1938.

70.

70 70. Transplantation of human organs Act 1994 and license (If applicable).

71.

71 71. Workers compensation Act, 1923.

72.

72 72. Urban land Act, 1976.

73. 1 Building Permit (from the Municipality).

74. 2 No objection certificate from the Chief Fire Officer

75. 3 Bio-medical Management and handling Rules, 1998.
76. 4 No objection certificate under Pollution Control Act.
77. 5 Radiation Protection Certificate in respect of all X-ray, Cath lab and CT Scanners from BARC.
78. 6 Atomic energy regularity body approvals.
79. 7 7. Excise permit to store Spirit.
80. 8 8. Income Tax PAN.
81. 9 9. Permit to operate lifts under the Lifts and Escalators Act.
82. 10 10. Narcotics and Psychotropic substances Act and License.
83. 11 11. Sales Tax Registration Certificate.
84. 12 12. Vehicle registration certificates for Ambulances.
85. 13 13. Retail and Bulk drug license (Pharmacy).
86. 14 14. Wireless operation certificate from Indian post and telegraphs. (If applicable).
87. 15 15. Air (prevention and control of pollution) Act, 1981 and License.
88. 16 16. Arms Act, 1950. (if guards have weapons).
89. 17 17. Boillers Act, 1923.
90. 18 18. Cable television networks Act, 1995.
91. 19 19. central sales tax Act, 1956.
92. 20 20. Consumer protection Act, 1986.
93. 21 21. Contract Act, 1982.

94. 22 22. Copyright Act, 1982.

95. 23 23. Customs Act, 1962
96. 24 24. Dentist regulations, 1976.
97. 25 25. Drugs and cosmetics Act, 1940.
98. 26 26. Electricity Act, 1998.
99. 27 27. Electricity rules, 1956.
100.28 28. Employees provident fund Act, 1952.
101.29 29. ESI Act, 1948.
102.30 30. Employment exchange Act, 1969.
103.31 31. Envirnment protection Act, 1986.
104.32 32. Equal remuneration act, 1976.
105.33 33. Explosives Act, 1884.
106.34 34. Fatal accidents Act, 1855.
107.35 35. Gift tax Act, 1958.
108.36 36. Hire Purchase Act, 1972.
109.37 37. Income Tax Act. 1961.
110. 38 38. Indian Lunacy Act, 1912.
111. 39 39. Indian Medical Council Act and Code of Medical Ethics, 1956.
112. 40 40. Indian Nursing Council Act, 1947.
113. 41 41. Indian penal code, 1860.

114. 42 42. Indian trade unions Act, 1926.

115. 43 43. Industrial disputes Act, 1947.
116. 44 44. Insecticides Act, 1968.
117. 45 45. lepers Act.
118. 46 46. Maternity benefit Act, 1961.
119. 47 47. MTP act, 1971.
120.48 48. Minimum wages Act, 1948.
121.49 49. National building code.
122.50 50. National holidays under shops Act.
123.51 51. Negotiable instruments Act, 1881.
124.52 52. Payment of bonus Act, 1965.
125.53 53. Payment of gratuity Act, 1972.
126.54 54. Payment of wages Act, 1936.
127.55 55. Persons with disability Act, 1995.
128.56 56. Pharmacy Act, 1948.
129.57 57. PNDT Act, 1996.
130.58 58. Prevention of food adulteration Act, 1954.
131.59 59. Protection of human rights Act, 1993.
132.60 60. PPF Act, 1968.
133.61 61. Registration of births and deaths Act, 1969.

134.62 62. Sale of goods Act, 1930.

135.63 63. Tax deducted at source Act.
136.64 64. Sales tax Act.
137.65 65. SC and ST Act, 1989.
138.66 66. license for the blood bank.
139.67 67. Companies Act, 1956.
140.68 68. Constitution of India.
141.69 69. Insurance Act, 1938.
142.70 70. Transplantation of human organs Act 1994 and license (If applicable).
143.71 71. Workers compensation Act, 1923.
144.72 72. Urban land Act, 1976.

All of them might not be applicable to all the Hospitals:

Building Permit (from the Municipality).
Click here for Land Rules from Nagpur Improvement
Trust :http://echt.co.in/yahoo_site_admin/assets/docs/LDR_nagpur.249191908.pdf

Click here for Nagpur Municipal Corporation

Rules :http://59.90.39.15:8081/NMCEIP/rules_byelaws/MAHITICHA%20ADHIKARUPDt.pdf

Click for Procedures of Obtainning Building Permit Chapter

2.9: http://www.urbanindia.nic.in/publicinfo/byelaws/Chap-2.pdf

No objection certificate from the Chief Fire Officer

Click here for Approval and NOC Document : http://www.maharashtrafireservices.org/fire_approval.htm

Bio-medical Management and handling Rules, 1998.

Click link to see Rules,1998 :http://www.kerenvis.nic.in/legislation/Biomedical%20Waste
%20_Management%20and%20Handling_%20Rules,%201998.pdf

No objection certificate under Pollution Control Act.

Click link : FAQ's - Maharashtra Pollution Control Board

Click for Biomedical Waste Management : http://mpcb.gov.in/biomedical/bmw.phpC

Click for Formate of Form : http://mpcb.gov.in/images/Combied-consent-form-New_1.pdf

Radiation Protection Certificate in respect of all X-ray, Cath lab and CT Scanners from BARC.
click for form
Click here for safety requirements
http://www.aerb.gov.in/t/xray/GSR-388.pdf

Atomic energy regularity body approvals.

Click here for Approval Form : http://www.aerb.gov.in/T/forms/regforms/radiography/forms/Enclosure-8.pdf
Click here for Consenting Process : http://www.aerb.gov.in/cgi-bin/consents/consents.asp#Type
%20Approval
Click here for useful LINKS FOR INSTITUTIONS &
ORGANISATIONS : http://www.aerb.gov.in/cgi-bin/hotlinks/ulinks.asp

7. Excise permit to store Spirit.

8. Income Tax PAN.

Click here for Infromation about PAN : http://www.incometaxindia.gov.in/pan/overview.asp
Click link for Form for allotment of
PAN : http://law.incometaxindia.gov.in/DITTaxmann/IncomeTaxRules/pdf/Form49aE.PDF

9. Permit to operate lifts under the Lifts and Escalators Act.

Clicl here for Bombay Lift Act 1939
:http://mahenergy.gov.in/acts/the_bombay_lifts,_act,_1939/contents_of_lift_act/bla3.htm

Click here for Application forms for Lift : http://www.mahapwd.com/electrical/inspection.htm#FormA

10. Narcotics and Psychotropic substances Act and License.

Click for ACT (Narcotics and psychotropic substances Act )
http://www.gina.gov.gy/gina_pub/laws/Laws/cap3511.pdf

Click here for Indian Government Rules and

Regulations : http://www.medindia.net/indian_health_act/narcotic-drugs-and-psychotropic-substancesact-1985-procedure.htm Indian

RelealthIndian Laws and Regulations Related to

HealthIIndian
11. Sales Tax Registration Certificate.
Click here for Centeral Sales Tax ( Registration and Turnover )Rule
1957 :http://www.dvat.gov.in/dvatonline/docs/CST_Act_1957.pdf

Click here for Various Forms of Centeral Sales Tax : http://cg.nic.in/comtax/forms/cstform1.pdf

Click here for Form " C " Profarma : http://mahavat.gov.in/mahavat/download_center/upload/00319Form

%20C.pdf

Click here for Sales Tax related Quation's clarification

Maha.Govt.: http://finance.indiamart.com/taxation/salestax.html

Click here for Instruction sheet for e-Application for

Registration,Maharashtara : http://125.21.254.72/mahavat/regthis.html

Click here for e-Registration of Maharashtra Sales Tax : http://www.mahavat.gov.in/ERegistration/

Click Following link for Goa Govt's. SalesTax - Registration,Forms,

Queries:http://www.goagovt.nic.in/charter/files/sales_tax/index.htm#forms

12. Vehicle registration certificates for Ambulances.

13. Retail and Bulk drug license (Pharmacy).

14. Wireless operation certificate from Indian post and telegraphs. (If applicable).

15. Air (prevention and control of pollution) Act, 1981 and License.
Click here for Act : http://envfor.nic.in/legis/air/air1.html
Click here for Maharashtra Pollution Board's
Link : http://mpcb.gov.in/citizenchart/images/pdf/Template3.pdf

16. Arms Act, 1950. (if guards have weapons).

Click here : http://www.indianlawcds.com/cr1/Armsact1959.htm

17. Boillers Act, 1923.

Click here : http://dipp.nic.in/boiler/ibact.htm

18. Cable television networks Act, 1995.

Click here : http://tdsat.nic.in/books/THE%20CABLE%20TELEVISION%20NETWORKS%20(Regulation)
%20Act.doc

19. central sales tax Act, 1956.

Click here : http://www.dvat.gov.in/dvatonline/docs/CST_Act_1956.pdf

20. Consumer protection Act, 1986.

Click link to see Act : http://ncdrc.nic.in/1_1.html

21. Contract Act, 1982.

Click here to see the Law
http://en.wikipedia.org/wiki/Privity_of_contract

22. Copyright Act, 1982.

Click here for " copy right act "
http://copyright.gov.in/Documents/CopyrightRules1957.pdf

23. Customs Act, 1962

Click here to see the Act : http://exim.indiamart.com/act-regulations/customs-act-1962.html

24. Dentist regulations, 1976.

Click link tosee : http://125.16.62.44/intranet/eip/legislation/uploads/DENTISTS%20ACT%201948.pdf

25. Drugs and cosmetics Act, 1940.

Click link to see : http://cdsco.nic.in/html/Copy%20of%201.%20D&CAct121.pdf

26. Electricity Act, 1998.

Click link to see Electricity Act, 1998. : http://www.delhitransco.gov.in/stu_rules.htm

27. Electricity rules, 1956.

Click link to see Electricity rules, 1956 : http://chandigarh.gov.in/engg_web/pages/IErules1956.pdf

28. Employees provident fund Act, 1952.

Click here to see the Act : http://www.epfindia.com/for_employees.htm

Click here to see Legal Provisions of the ACT : http://www.epfindia.com/legel_provision.htm

29. ESI Act, 1948.

Click link to see Act : http://esicdelhi.org.in/chp3.php

30. Employment exchange Act, 1969.

Click here : http://www.vakilno1.com/bareacts.htm

31. Envirnment protection Act, 1986.

Click here : http://envfor.nic.in/legis/env/env1.html
32. Equal remuneration act, 1976.
Click here : http://pblabour.gov.in/pdf/acts_rules/equal_remuneration_act_1976.pdf

33. Explosives Act, 1884.

Click here : http://peso.gov.in/PDF/Explosive_%20Act_1884.pdf
34. Fatal accidents Act, 1855.
Click here : http://www.vakilno1.com/bareacts/Laws/The-Indian-Fatal-Accidents-Act-1855.htm

35. Gift tax Act, 1958.

Click here : http://www.incometaxindia.gov.in/Gift%20tax%20act.asp

36. Hire Purchase Act, 1972.

Click here : http://www.vakilno1.com/bareacts/hirepurchase/hirepurchaseact.htm

37. Income Tax Act. 1961.

Click here : http://www.pdfound.com/pdf/income-tax-act-1961.html

38. Indian Lunacy Act, 1912.

Click here : http://sdobishnupur.gov.in/Acts%20and%20Rules/Dictionery/0935.pdf

39. Indian Medical Council Act and Code of Medical Ethics, 1956.
Click here : http://www.mciindia.org/know/rules/ethics.htm

40. Indian Nursing Council Act, 1947.

Click here : http://www.indiannursingcouncil.org/indian-nursing-council-act-1947.asp

41. Indian penal code, 1860.

Click here : http://districtcourtallahabad.up.nic.in/articles/IPC.pdf

Click here for another Link : http://www.vakilno1.com/bareacts/IndianPenalCode/indianpenalcode.htm

42. Indian trade unions Act, 1926.

Click here for Link : http://pblabour.gov.in/pdf/acts_rules/trade_unions_act_1926.pdf

Click here for another

Link : http://labour.delhigovt.nic.in/act/details_acts/trade_union_act_1926/trade_union/intro.html

43. Industrial disputes Act, 1947.

Click here : http://labour.delhigovt.nic.in/act/html_ida/ida_1947_index.html

44. Insecticides Act, 1968.

Click here : http://cibrc.nic.in/insecticides_act.htm

45. lepers Act.

Click here : http://sdobishnupur.in/Acts%20and%20Rules/Dictionery/1205.pdf

46. Maternity benefit Act, 1961.

Click here : http://pblabour.gov.in/pdf/acts_rules/maternity_benefit_act_1961.pdf

Click here for Rules and Regulations Link : http://www.medindia.net/indian_health_act/maternity-benefitact-1961-introduction.htm

47. MTP act, 1971.

Click here : http://mohfw.nic.in/MTP.htm

48. Minimum wages Act, 1948.

Click here : http://pblabour.gov.in/pdf/acts_rules/minimum_wages_act_1948.pdf

Click here for Minimum Wages InIndia : http://www.paycheck.in/main/officialminimumwages

49. National building code.
Click here : http://construction.indianetzone.com/1/national_building_code.htm

Click here for Rules and Regulation link : http://construction.indianetzone.com/1/acts_regulations.htm

50. National holidays under shops Act.

Click her for Bombay shop and establishment Act 1948 :http://www.karmamgmt.com/act_bs.asp

Click here for National Holidays : http://www.indianpublicholidays.com/2009/11/list-of-holidays-in-india2010/

51. Negotiable instruments Act, 1881.

Click here : http://chddistrictcourts.gov.in/THE%20NEGOTIABLE%20INSTRUMENTS%20ACT.pdf

Click here for Link : http://www.dateyvs.com/gener10.htm

Click here for another Link: http://www.indianlawcds.com/BANKING/NIA1881.htm

52. Payment of bonus Act, 1965.

Click here : http://pblabour.gov.in/pdf/acts_rules/payment_of_bonus_act_1965.pdf

53. Payment of gratuity Act, 1972.

Click here : http://labour.delhigovt.nic.in/act/payment_gratuity.html

54. Payment of wages Act, 1936.

Click here : http://pblabour.gov.in/pdf/acts_rules/payment_of_wages_act_1936.pdf

Click here for another Link : http://vakilno1.com/bareacts/paymentofwagesact/paymentofwages.htm

55. Persons with disability Act, 1995.

Click here : http://nhrc.nic.in/Publications/Disability/Annexure-1.html

Click here for another Link : http://www.disabilityindia.org/pwdacts.cfm

56. Pharmacy Act, 1948.

Click here http://www.punjabmedicaleducation.org/data/pharmacy/new%20act.pdf

Click here to see 2nd link of the Act : http://www.pci.nic.in/contents.htm

57. PNDT Act, 1996.

Click here : http://mohfw.nic.in/titlepage.htm

Click here for another Link : http://mohfw.nic.in/THE%20PNDT%20ACT%20(PRINCIPAL

%20ACT)1994.htm

58. Prevention of food adulteration Act, 1954.

Click here : http://mohfw.nic.in/pfa%20acts%20and%20rules.pdf

Click here for another

Link : http://www.medindia.net/indian_health_act/the_prevention_of_food_adulteration_act_1954/list-ofacts.htm

59. Protection of human rights Act, 1993.

Click here : http://nhrc.nic.in/Publications/HRActEng.pdf

Click here for another Link : http://nhrc.nic.in/hract.htm

60. PPF Act, 1968.

Click here : http://www.indiapost.gov.in/POSBActs/PPF_ACT.pdf

Click here for PPF Scheme Link : http://www.indiapost.gov.in/POSBActs/PPFRules1968.pdf

61. Registration of births and deaths Act, 1969.

Click here : http://www.delhi.gov.in/DoIT/DES/Registration/ACT.pdf

Click here for another Link : http://www.tn.gov.in/acts-rules/hfw/birth_death_act_e.pdf

62. Sale of goods Act, 1930.

Click here : http://www.dateyvs.com/gener12.htm

63. Tax deducted at source Act.

Click here for IT Gao region : http://www.incometaxbangalore.org/taxinfo/tdschart.htm

64. Sales tax Act.

Click here for CENTRAL SALES TAX ACT,
1956 : http://www.dvat.gov.in/dvatonline/docs/CST_Act_1956.pdf

Click here for Sales Tax Department Gov. Maharashtra

Link : http://www.mahavat.gov.in/mahavat/index.jsp

65. SC and ST Act, 1989.

Click here : http://www.hrln.org/hrln/index.php?option=com_content&view=article&id=254:sc-a-stprevention-of-atrocities-act-1989&catid=53:know-your-rights-&Itemid=92
66. license for the blood bank.

67. Companies Act, 1956.

Click here : http://www.vakilno1.com/bareacts/companiesact/companiesacts.htm

Click for Link of Company Law : http://www.dateyvs.com/inventry.htm

68. Constitution of India.

Click here : http://lawmin.nic.in/coi/coiason29july08.pdf

Click here for another Link : http://indiacode.nic.in/coiweb/welcome.html

69. Insurance Act, 1938.

Click here : http://gicouncil.in/TheInsuranceAct1938.pdf

\
70. Transplantation of human organs Act 1994 and license (If applicable).
Click here for ACT : http://www.mohanfoundation.org/tho/thobill3cont.asp

Click here for THO Rules and New FORMS Link : http://www.mohanfoundation.org/tho/tho_rule-form1a.asp

Click here for Registration of Hospital for THO

Link : http://www.mohanfoundation.org/tho/tho_rules4.asp#7

Click here for FORM-11 required for Registration of Hospital for THO
Link : http://www.mohanfoundation.org/tho/tho_rule-form11.asp

71. Workers compensation Act, 1923.

Clicl here for LAW : http://lawcommissionofindia.nic.in/51-100/Report62.pdf

Click
here : http://nihfw.org/NDC/DocumentationServices/Legislations/THEWORKMENSCOMPENSATION.html

72. Urban land Act, 1976.

Click here : http://urbanindia.nic.in/legislations/sub_legis/ulcra_1976.pdf

Click here for another Link : http://www.lawzonline.com/bareacts/urban-land-ceiling-and-regulationact/urban-land-ceiling-and-regulation-act.html

Angry relatives attack Maxx Care Hospital in

Nagpur over death of their kin
Quite unruly scenes were witnessed at the Maxwell Hospital near Borgaon on Saturday
when angry relatives of a deceased gate crashed into the hospital, damaged the
furniture and pelted stones in the premises. A doctor was reportedly injured in the
ruckus

Angry relatives of dead patient damage hospital

Relatives of a patient who died in a private hospital in Rasipuram late on Sunday night staged a road
blockade with the dead body. They also allegedly broke a few glass window panes and chairs before
calm was restored.

Anger and Angst in Hospitals Where

Doctors Die

A disgruntled patient stabbed three doctors including Wang on October 25 at the No. 1 People's
Hospital in Wenling, in the eastern province of Zhejiang. Wang, who headed the hospital's ear, nose
and throat department, died from his wounds. The patient had been unhappy about a nasal surgery.
Wang was fourth doctor killed in a hospital by angry patients, their relatives or associates since
2009. In addition, more than a dozen doctors, nurses and other medical workers have been attacked
on the job in recent years with fists, knives and in at least one case an axe.
Violence and threats of violence have shaken professionals in the nation's hospitals. The Ministry of
Health recently said more than 70 percent of all hospitals reported incidents of verbal threats or
physical attacks against professional staffers in recent years.

RIGHTS OF THE PATIENT

Right to considerate and respectful care.
Right to information on diagnosis, treatment and medicines.
Right to obtain all the relevant information about the professionals involved in the
patient care.
Right to expect that all the communications and records pertaining to his/her case
be treated as confidential
Right to every consideration of his/her privacy concerning his/her medical care
programme.
Right to expect prompt treatment in an emergency
Right to refuse to participate in human experimentation, research, project affecting
his/her care or treatment.
Right to get copies of medical records
Right to know what hospital rules and regulations apply to him/her as a patient and
the facilities obtainable to the patient.
Right to get details of the bill.
Right to seek second opinion about his/her disease, treatment,etc

Set Up a Hospital
Thinking about starting a hospital of your own? Heres just what the doctor ordered
By Dr. Mukesh Daftary

4 May 2010

Many of us began our lives in one, and most of us have visited one under both happy and unpleasant
circumstances. No doubt, hospitals are an indispensable part of peoples lives everywhere. This makes
the healthcare industry a lucrative area to step into.
In India, healthcare is the second-fastest growing sector right now, after retail. Many corporate houses are
considering or have already diversified into this sector by setting up their own hospitals.
Since the process of setting up a hospital involves so many processes, sub-processes and finance, it is
imperative to prepare a detailed feasibility study report before you get started. Most people misunderstand

the FSR as a tool for obtaining finance from institutions. On the contrary, it is a tool that would clearly
answer the five questions that form the basis of every good hospital:
Why am I doing it? Is it for the good of the people and the nation, or for my own financial interests?
When should I start out? Timing is important; make sure you start out at a time thats most appropriate
for bringing up a hospital.
Where should I set it up? Proper location is also extremely important. If there are existing hospitals in a
particular area, its best not to start another one there. Also, the area you select should be easily
approachable and have transportation facilities.
What kind of hospital will it be? Do you want to start a speciality or general hospital? Equipment and
products need to be procured accordingly.
How will I go about it? Broadly outline the steps for building the hospital and having all the services in
place.
If you are toying with this idea yourself, it is important to first ask yourself a few basic questions. Setting
up a hospital is a complex mix that includes proper building design, permissions, finance, advisors and
consultants.
PERMITS
Land and construction
The first thing to figure out is land. Keeping the approachability and transportability in mind, one should
ideally look for non-agricultural land and it should be designated for hospitals. You can obtain this
information from the land records of the local authorities or municipal corporations. In case the land is not
designated for hospitals, you will have to notify the local authorities about the change of users.
To start construction, you will need certain documents, such as the land title deed, corporate or company
details, permission from the local authority to use land space for construction, building permit, tax
identification card and the architects plan. The architects plan must be approved by the local authorities
before construction can commence. A certificate of no objection also needs to be procured from the local
authorities.
On obtaining electricity supply and setting the tiles, you can get a completion certificate from the
authorities after the premises has been inspected. An occupation certificate is issued after all clearances
are obtained.
Electricity
A hospitals load requirement is calculated based on the lighting, air-cooling and medical equipment
usage. These can be assessed with the help of the architect or hospital consultant. The permission is to
be obtained from the local electric supply board.
Water
The water requirement for a hospital can vary vastly from project to project, depending on whether it is a
primary, secondary, tertiary or special care hospital. However, for a ballpark figure, your hospital will
require approximately 100 liters of water per bed per day. This includes everything from a patients water
requirements to hospital maintenance. Permission has to be obtained from the local authorities.
Sewerage and sanitation
For the installation of tanks, pipelines and the likes, you need to obtain permission from the local
authorities.

Bio-medical waste
Large hospitals need to have incinerators installed for disposing bio-medical waste, such as body parts or
tissues. As incinerators usually take up between 500 to 1,000 square feet of space, smaller hospitals
cannot afford to have them installed. Therefore, they need to register themselves with municipal
corporations for waste disposal.
Fire department approval
This is necessary for large hospitals.
Health certification
In most cities, the local authority will certify a healthcare facility only after all beds and equipment have
been installed. This involves a nominal fee.
FINANCE
Obtaining finance for setting up a hospital or healthcare center is not difficult, as success rates in this
industry is usually quite high. Banks are relatively easy targets for this sector.
ADVISORS & CONSULTANTS
In the process of setting up a hospital, you will need to enlist the services of these professionals:

Architects
Hospital design consultants
Structural engineers
Electricity consultants
Water and sanitation consultants
Fire prevention consultants
DEPARTMENT-WISE PLANNING
Choosing medical equipment vendors:
- Equipment planning, department-wise
- Budgeting
- Vendor identification
- Vendor selection
- Purchase
- Installation
- Signing annual maintenance contracts
Human resource functions:
- Making a requirement matrix, department-wise
- Making HR available
- Interview and selection
- Assessing financial implication
Types of doctors or consultants:
- Resident medical officers
- Full-time consultants
- Part-time consultants
- Visiting consultants

- Nursing staff
Automation and engineering services:
- Air-conditioner
- Air handling unit
- Plumbing
- Electricity maintenance
- Medical gas pipelines
- Civil works
Computerization:
- Hardware
- Software (Hospital Management Information System)
Systems and protocols:
- Nursing protocol
- Admissions protocol
- Infection control protocol, etc.
You would also need to plan for:
- Stores and pharmacy
- Hi-tech equipment selection, installation and training
- Setting up super-speciality departments

Some examples of unrealistic expectations of patients would include:

o
o
o
o
o

wanting to discuss several major problems, all in one standard consultation

prescription to be given without a consultation

ability to call the physician 24 h a day for any problems and

thinking that the physician will always know the exact diagnosis at first consultation and
start treatment immediately

POPULAR ARTICLES
Interior design in healthcare: is it recognised as the speciality it deserves?
Hospital data analytics a cure to a big problem
Transforming medical equipment planning
The impact of medical records storage on hospital design and infrastructure plans
Getting your own clinic up and running

Examples of unrealistic expectations we have seen

include:

you will have time to discuss three major problems in a

standard consultation

you will prescribe them an S8 medication because they ask for

it

you will immediately know the exact diagnosis and treat it

that day

you will divulge medical details about other family members

you will provide a repeat script without seeing them

the skin excision will not leave a scar

they can call you 24 hours a day

5 Challenges Building a Hospital

When it comes to the culture of a hospital, nothing is as important as the employees who work for it and aim to
provide excellent patient care. When it comes to a hospital's balance sheet, particularly the physical assets, nothing is
as important as the actual hospital and other ancillary buildings
1. Accessing affordable capital.
2. Selecting an approach and facility design that optimizes costs.
3. Forecasting future needs.
4. Adopting green building strategies.
5. Engaging and gaining support from medical staff, civic leaders and the public early on.

ACTS APPLICABLE TO NURSING HOMES:When runs a nursing home, following acts are applicable to nursing homes :-

1.) Minimum Wages Act : Applicable to all nursing homes.

2.) Payment of Bonus Act : Applicable to nursing homes having 10 or more employees.
3.) Provident Fund Act : Applicable to nursing homes having 10 or more employees.
4.) Payment of Gratuity Act : Applicable to nursing homes having 20 or more employees.
5.) Industrial Disputes Act : Applicable to all nursing homes.
6.) Shop and Establishment Act : Applicable to all nursing homes.
Top

Minimum Wages Act :Under this act, wages payable at present are as follows :
1.) Sweepers, ward boys, Ayahs, peons, X-ray boys, Rs. 2300 plus DA ward servants, cook-mates, kitchen-mates
etc.
2.) Semi-skilled untrained Nurses, untrained Technicians etc.Rs. 2400 plus DA
3.) Qualified Nurses etc.Rs. 2500 plus DA

At present DA is Rs. 284 for the period Jan., 2000 to June, 2000.

Part time workers can be employed and paid corresponding percentage of full time wages.

Daily wages employee's pay has to be calculated by dividing total pay by 26.

Once a week off is to be given to each employee.

Overtime wages are to be paid at double the regular wages.

An employee should not work more than 9 hours a day or 48 hours a week.

Spread over work or break duty should not exceed 12 hours.

Minimum wages do not make any provision for earned leave. However, Shop & Establishment Act does provide
21days yearly leave with wages for an employee who has worked more than 240 days in a calendar year. At present
the Shops & Establishment Act is applicable to nursing homes but dispensaries and consulting rooms are exempt
from it by the recent Orissa High Court judgement. However, there is a very strong case for private nursing homes to
challenge the Shops & Establishment Act if individually prosecuted and chances of getting exemption by legal course
are very good for nursing homes owned / run by professionals.
Top

Other Acts :1.) Provident Fund Act, if applicable, and employer has to contribute 6 % and deduct 6 % from the employee and
credit the amount to Provident Fund.

2.) Bonus is to be given at 8.33 % of the wages of the employee.

3.) Gratuity is to be paid if an employee has worked for 5 years at the rate of 15 days' wages per year of service at
the rate of last pay drawn.
Top

Maintenance of Registers
Following registers are to be maintained by a nursing home :1.) Wages cum attendance register of the staff.
2.) Indoor admission register.
3.) Delivery patients' register.
4.) MTP & sterilisation records register.
5.) Operation theatre register.
6.) Admitted patients daily records register.
7.) Alphabetical index register.
Nurses employed should be qualified and their qualification registered under BPNA. This is one of most difficult
requirements for nursing homes at present and may be almost difficult to fulfil if authorities implement it strictly

Patients and their attenders

They have very high expectations about quality and time

taken for improvement of patient. They want complete
and quick improvement. Some of them will be in an
emotionally charged state, especially, anxious about the
diagnosis and prognosis of patients illness
(Chandrashekharan, 1999). This leads to persistent
enquiries with the doctors which is irritating. Attenders
expect to be periodically updated about patients

condition. After having paid huge amounts for the

treatment attenders are worried about the proper
implementation of treatment. In the unfortunate event of
death of the patient, grief in relatives is expressed as
anger (Jaiswal, 2004). Real or perceived negligence on
part of doctor leads to anger by relatives.

Doctors Behaving Badly? They Say It

Happens All The Time
If results from national survey can be believed, more than 2 in 3 U.S. doctors witness other
physicians disrupting patient care or collegial relationships at least once a month. More than 1 in
10 say they see it every day.

A 14-page white paper put out by the ACPE cited these examples:

A doctor who was being monitored because of a long history of

rudeness again yelled at a nurse, resulting in "a significant medication error
and harm to a child."

A prominent surgeon's habit of degrading comments aimed at nurses

and support staff eventually resulted in "shoving and pushing...in the OR."

A male doctor created "an intolerable work environment for a female

physician" through "condescending, bullying" and refusing to acknowledge
her supervisory role.

Three-quarters of survey respondents say they're concerned about

disruptive behavior by fellow physicians. Virtually all say it affects patient
care.
A little over a quarter of doctor-respondents admitted they had been guilty of
disruptive behavior at one time or another. The most common reasons,
respondents say, are workload and behaviors learned in medical school.

More than half the doctors surveyed say they've witnessed other physicians
yelling, flinging insults, refusing to cooperate with other health care
personnel and refusing to follow established rules.
Less frequent but not uncommon: Discriminating against colleagues or
patients (24%), inappropriate jokes (40%), profanity (41%) and spreading
malicious rumors (21%).
Least common, but disturbing, were cases of throwing things (14%),
retaliating against perceived slights (13%), substance abuse (14%) and
physical violence (3%).

Registered nurses are hard to find. The American Nurses Association reports that
by the year 2020, America could find itself short of health care industry demands by
more than 1 million nurses
3

Wilson Churchill had said First we shape our buildings, thereafter they shape us . This is certainly
true of the hospital building.

Introduction
Hospitals are amongst the largest and most complex of all modern institutions. Hospital architecture is a part of this
complexity. Unlike other organizations, which may be built in various ways, hospital building has lesser choices. It
differs from other building types in the complexity of functional relationship that must exist in the various parts of a
hospital. Apart from providing the right environment for patients and care providers, it should also be sensitive to the
needs of the visitors including patients families. A number of hospitals are ideally constructed to deliver the present/
future requirements of healthcare. It is an essential requirement to examine the emerging issues, analyse the
challenges, appreciate the emerging trends and study the various strategic options available for designing, planning
and constructing a hospital.

Emerging Issues
The emerging issues related to hospital architecture are mainly linked to the changing role of the hospitals. The main
changes that have occurred in the healthcare delivery system are as follows.

Enhanced patients expectations: The patients have become more quality conscious as well as price
sensitive. They expect clinical, administrative and supportive services as well as design of facilities to be contusive
to their requirements.

Epidemiological and demographic changes: There has been a cascading pattern in the incidence of
lifestyle diseases and geriatric related healthcare problems.

Emphasis on ambulatory / daycare: Hospital stay is gradually being programmed for high dependency
impatient care and for other cases more emphasis is on shorter stay.

Enhanced standards: There has been an up gradation standards and norms in the delivery of healthcare in
almost all aspects.

Changing function of hospitals: Hospitals are an evolving system. Hospitals apart from curing the sick
have the added functions of maintenance and prevention of health, biomedical research and providing community
outreach services. Focus has shifted from treating illness to creating wellness.

Health Insurance: Health insurance is gradually permeating as an important facet of healthcare delivery
system. The providers of insurance and healthcare as well as the recipients view the hospital as an important hub
for healthcare delivery.

Advancement in Medical Sciences: Advancement in medical sciences dictate/change the paradigm of

healthcare delivery. Trends and dimensions in molecular biology, pharmaceuticals and surgical interventions have
changed medical management outcomes. New diagnostic and therapeutic modalities require special controlled
environment, energy requirements and other engineering services
Go for Green Hospitals: The emphasis of healthcare architecture must be on improving the quality of the
environment for patients and health care providers. The hospitals should be environment friendly. Some of the
parameters which may be considered are:

Designed to make best use of passive solar energy.

Utilization of renewable sources of energy such as solar, wind and biogas

Proper waste disposal

Go organize.

Use materials utilized in hospital building should be noon toxic and non allergic

Use of natural light by construction of a truism

Ventilators.
Visualize the Hospital of the Future: In the future that more common hospital functions will move close to patients
and only a few specific specialized functions will be concentrated at other places. The concentration of specialized
facilities and dispersal of other hospital function will influence the building design and planning as well as facilities to
support the continually changing hospital function. A number of smaller facilities will be required at several locations
to accommodate the dispersed functions and larger facilities at an early accessible location to accommodate the
concentrated functions. When the amount of intervention becomes higher or the impact of the intervention becomes
lower, request for dispersion function grows. Since function will be continually be transferred to the decentralized
health facilities as new function are introduced in the specialized centers, flexibility and expandability in the building
design at both centers in a necessity3.

Not only medical professionals but also

various private medical institutions are usually
apprehensive in dealing with these, for,
according to them, an MLC (Medico-legal Case)
implies lot of disputes, unwanted burden,
rough speaking police officials, inordinate

hours in the court, unrelenting defense

counsels, etc. Because of this fear-factor , they
either try to avoid the cases or try to get rid of
them as soon as possible. With these improper
understanding about implications of the cases,
they invite mistakes, deliberation, which may
land them in trouble.
Table- 1: Awareness status regarding medico-legal Case Management

Table-2: Status of various medico-legal procedures of medico-legal Case

Management

Table-3: Awareness Status about various documentation proceude in MLC

Management

Table-4: Status of specific problem medico-legal Case Management

Sr. No. Particular of subject matter/ issues

number of cases 119

Awareness Response Total

Aware Partly Aware Not Aware No response

1. Medico-legal Cases 66 (55.46%) 49 (41.18%) 01 (0.84%) 03 (2.52%)
2. Promptness in examination of victim of sexual
assaults
45 (37.82%) 31 (26.05%) 33 (27.73%) 10 (8.40%)
3. Death certification in MLC 43 (36.13%) 31 (26.05%) 37 (31.09%) 08
(6.72%)
4. Evidence Preservation in MLC 39 (32.77%) 37 (31.09%) 24 (20.17%)
19 (15.97%)
5. Medico-legal severity of injury 36 (30.25%) 43 (36.13%) 28 (23.53%)
12 (10.08%)
6. Importance of Identity in MLC 33 (27.73%) 39 (32.77%) 31 (26.05%)
16 (13.45%)
7. Criminal Abortion Cases 27 (22.69%) 31 (26.05%) 49 (41.18%) 12
(10.08%)
8. Awareness of Law related to medical Practice 44 (36.97%) 23 (19.33%)
38 (31.93%) 14 (11.77%)
9. Real causes of Negligence complaints 46 (38.66%) 39 (32.77%) 23
(19.33%) 11 (9.24%)
10. Awareness regarding the provisions of PCPNDT Act 45 (37.82%) 37
(31.09%) 24 (20.17%) 13 (10.92%)

11. Importance of good medical record 32 (26.89%) 42 (35.29%) 29

(24.37%) 16 (13.45%)
12. Rights of the patients 25 (21.08%) 41 (34.45%) 39 (32.77%) 14
(11.77%)
Average percentage

33.69% 31.02% 24.93% 10.36%

Sr. No. Particular of subject matter/ issue Awareness Response /Total

number of cases 119
Aware Partly Aware Not Aware No response
1. Injury report/ Register/MLC Register 67 (56.30%) 36 (30.25%) 11
(9.24%) 05 (4.20%)
2. Ideal Medico-legal record Keeping 25 (21.01%) 41 (34.45%) 34
(28.57%) 19 (15.97%)
3. Recording of Dying Declaration/ Deposition. 34 (28.57%) 39 (32.77%)
35 (29.41%) 11 (9.24%)
4. MLC Investigation 38 (31.93%) 44 (36.98%) 29 (24.37%) 08 (6.72%)
5. Poisoning cases 37 (31.09%) 33 (27.73%) 36 (30.25%) 13 (10.92%)
6. Negligence in MLC Cases 41 (34.45%) 29 (24.37%) 32 (26.89%) 17
(14.29%)
Average percentage 33.89% 31.09% 24.79% 10.22%
Sr. No. Particular of subject matter/ issue

Awareness Response Total

number of cases 119

Aware Partly Aware Not Aware No Response

1. MLC Cases File? 36 (30.25%) 39 (32.77%) 29 (24.37%) 15 (12.61%)

2. MLC Record Keeping? 25 (21.01%) 41 (34.45%) 34 (28.57%) 19
(15.97%)
3. MLC Investigations? 38 (31.93%) 44 (36.98%) 29 (24.37%) 08 (6.72%)
4. Asses of Medical Records? 34 (28.57%) 26 (21.85%) 46 (38.66%) 13
(10.92%)
5. Safety of Medical records? 33 (27.73%) 29 (24.37%) 43 (36.13%) 14
(11.77%)
Average percentage 27.90% 30.08% 30.42% 11.60%
Sr. No. Particular of subject matter/ issue Problemin (%)
1. No significant History of MLC? 76%
2. Household Accidents? 67%
3. Illegal pregnancy/criminal abortion? 63%
4. Patient of MLC case absconds? 59%
5. Attendant absconds? 57%
6. Cases in which Dying Declaration/Deposition required? 51%
7. Financial Crisis of patient? 50%
8. Non-cooperation of IO? 43%
9. Problem related to preservation evidence material? 43%
10. Attitude and behavior of IO/Agency? 41%

11. Patient insisting/refusing for MLC Cases? 39%

12. Forensic medicine/Autopsy? 29%
13. Court/Witness? 27%
14. MLC Patient died at higher center? 23%

Are stairs and hallways well lit?

Are exits well marked?

Do the hallways have handrails?

Do rooms and bathrooms have grab bars and call buttons?

Are there safety locks on the doors and windows?

Are there security and fire safety systems?

Is there an emergency generator or alternate power source?

Is the floor plan logical and easy to follow?

Does the facility smell fresh and clean?

Are residents bathed and well groomed?

Do the staff members respond quickly to calls for help?
Is there fresh water available in the rooms?
Does the food look and smell good?
Are the residents offered choices of food at mealtimes?
Are residents rights posted?
Do the staff members knock before entering a residents room?
Are the doors shut when the staff members dress and bathe a
resident?
Is the facility an easy place for family and friends to visit?

research on the misbehavior of nursing assistants.

They have classified misbehavior into four categories:
1.

Production deviance includes behaviors that waste time and resources.

1.

Property deviance involves either theft or destruction of facility or residents property.

2.

Normative deviance generally involves talk that hurts or belittles others.

3.

Personal aggression mostly involves hitting, fighting, or sexual harassment.

4.
These behaviors on the part of nursing assistants cost hospitals and nursing homes large amounts of
money. Moreover, they represent a very real legal liability can the facility prove in court that it
exercised due diligence to prevent misbehavior that has bad consequences for residents?
Misbehavior by nursing assistants can have catastrophic consequences for any nursing facility. It is
important that management be able to show that they have exercised every possible precaution to
prevent such things from happening. While such precautions do not guarantee that misbehavior will
not happen, they will limit its frequency, severity and legal consequences. An ounce of prevention is
always worth a pound of cure.

staff failed to understand the appropriate response to various medical symptoms; no clear policy
existed for managing pressure sores; and one patient's anticoagulant state could not be
assessed when industrial action meant that transport to take him to hospital was not available-and several changes in drug treatments were recommended. The problems that were identified
were mainly due to poor communication between the home and general practitioners and
hospitals and to the lack of guidance policy on common issues that arise in long term care. Such
a policy could be produced by health authority staff, general practitioners, and representatives of
nursing homes.
medical malpractice by doctors in India Reason Patients have to trust before give their body to doctors[GOD].
Patients don't have control of buying medicines and pathology lab test and operation and treatment
medical instrument
becuase doctors write name of the brand of products
There is no way to keep track of others experience of patients with a common doctor.
We need to know doctors commission network - Currently doctor connected with which pharma
companies - Currently doctor connected with which pathology labs. - Currently Doctor connected
with which other doctors. - Currently Doctor connected with which hospitals. - Currently Doctor
suggesting compulsory tests. - Currently Doctor suggesting forceful operation - Doctor threaten to
patients.[yes/no/sometime] - Doctor misbehave to patients.[yes/no] - Doctor don't give appropriate
attention.

Location: In hospital business, you need a good location as people can easily get health facility from your
hospital. So, before start your hospital, you should always think about the location. You should always
choose such location where at the argent time, people will get the health care and they will get proper
treatment from your hospital. Your location will be such place where the patients will communicate
comfortably. Your hospital road will be broad as ambulance and other cars may easily go with your
patients. So, you should always very conscious about the choosing location of your hospital business.

A nursing home is a wonderful business opportunity especially for those that love to take care of people.
However, it is also a challenge to set up because of the many requirements that you have to comply with.

Safety Equipment for Nursing Home Business

Residents of a nursing home cannot easily react or notice right away the circumstances that warrant
emergency action. Simply put, old people cannot run right away if there is a fire building up inside their

rooms. Sometimes, people with dementia do not notice emergency situations at all and cannot cry for
help. Because of this, you need to install specific emergency equipments.
To ensure the safety of your residents you would need to install smoke detectors that will detect the
presence of fire early on. You would also need to install fire extinguishers that your staff can use in case
of fire. Besides safety equipment, you would have to drill your employees in a pre-arranged emergency
procedure so that they can react appropriately and bring your residents to safety. Fire exits should also be
designated in order to facilitate rapid evacuation in case of emergency.

Nursing Home Myths and Realities

Myth

Reality

Medicaid does not pay for the service you

want.

Medicaid residents are entitled to the same service

as other residents.

Only staff can determine the care you

receive.

Residents and family have the right to participate in

developing a care plan.

Staff cannot accommodate individual

schedules.

A nursing home must make reasonable

adjustments to honor residents' needs and
preferences.

You need to hire private help.

A nursing home must provide all necessary care.

Restraints are required to prevent the

resident from wandering away.

Restraints cannot be used for the nursing home's

convenience or as a form of discipline.

Family visiting hours are restricted.

Family members can visit at any time of day or

night.

Therapy must be discontinued because

the resident is not progressing.

Therapy may be appropriate even if resident is not

progressing; Medicare may pay even without
current progress.

You must pay any amount set by the

nursing home for extra charges.

A nursing home may only require extra charges

authorized in the admission agreement.

The nursing home has no available space

for residents or family members to meet.

A nursing home must provide a private space for

resident or family councils.

The resident can be evicted because he or

she is difficult or is refusing medical
treatment.

Being difficult or refusing treatment does not justify

eviction.

Sources: Adapted from E. Carlson, "Twenty Common Nursing Home Problems and the Laws to
Resolve Them," Clearinghouse Review Journal of Poverty Law and Policy, Jan./Feb. 2006 39(9
10):51933.