Safety has been one of the biggest concerns in the Indian Railways system. While the number of accidents have gone down over the last few years, the number still remains over 100 accidents a year. In light of the recent train accidents in Uttar Pradesh (UP), we present some details around accidents and safety in the Indian Railways.
Causes of rail accidents
The number of rail accidents has declined from 325 in 2003-04 to 106 in 2015-16.[1] The number of rail accidents as per the cause are shown in the graph below. In 2015-16, majority of the accidents were caused due to derailments (60%), followed by accidents at level crossings (33%).1 In the last decade, accidents caused due to both these causes have reduced by about half. According to news reports, the recent railway accidents in UP were caused due to derailment of coaches.
Derailments
Between 2003-04 and 2015-16, derailments were the second highest reason for casualties.2 The Standing Committee on Railways, when examining the safety in railways, had noted that one of the reasons for derailments is defect in the track or coaches. Of the total track length of 1,14,907 kms in the country, 4,500 kms should be renewed annually.2 However, in 2015-16, of the 5,000 km of track length due for renewal, only 2,700 km was targeted to be renewed.2 The Committee had recommended that Indian Railways should switch completely to the Linke Hoffman Busch (LHB) coaches as they do not pile upon each other during derailments and hence cause lesser casualties.2
Un-manned level crossings
Un-manned level crossings (UMLCs) continue to be the biggest cause of casualties in rail accidents. Currently there are 14,440 UMLCs in the railway network. In 2014-15, about 40% of the accidents occurred at UMLCs, and in 2015-16, about 28%.2 Between 2010 and 2013, the Ministry fell short of meeting their annual targets to eliminate UMLCs. Further, the target of eliminating 1,352 UMLCs was reduced by about 50% to 730 in 2014-15, and 820 in 2015-16.2 Implementation of audio-visual warnings at level crossings has been recommended to warn road users about approaching trains.2 These may include Approaching Train Warning Systems, and Train Actuated Warning Systems.2 The Union Budget 2017-18 proposes to eliminate all unmanned level crossings on broad gauge lines by 2020.
Casualties and compensation
In the last few years, Railways has paid an average compensation of Rs 3.03 crore every year for accidents (see figure below).[2]
Note: Compensation paid during a year relates to the cases settled and not to accidents/casualties during that year.
Consequential train accidents
Accidents in railways may or may not have a significant impact on the overall system. Consequential train accidents are those which have serious repercussions in terms of loss of human life or injury, damage to railway property or interruption to rail traffic. These include collisions, derailments, fire in trains, and similar accidents that have serious repercussions in terms of casualties and damage to property. These exclude cases of trespassing at unmanned railway crossings.
As seen in the figure below, the share of failure of railways staff is the biggest cause of consequential rail accidents. The number of rail accidents due to failure of reasons other than the railway staff (sabotage) has increased in the last few years.
Accidents due to failure of railway staff
It has been noted that more than half of the accidents are due to lapses on the part of railway staff.2 Such lapses include carelessness in working, poor maintenance, adoption of short-cuts, and non-observance of laid down safety rules and procedures. To address these issues, conducting a regular refresher course for each category of railway staff has been recommended.2
Accidents due to loco-pilots2,[3]
Accidents also occur due to signalling errors for which loco-pilots (train-operators) are responsible. With rail traffic increasing, loco-pilots encounter a signal every few kilometres and have to constantly be on high alert. Further, currently no technological support is available to the loco-pilots and they have to keep a vigilant watch on the signal and control the train accordingly.2 These Loco-pilots are over-worked as they have to be on duty beyond their stipulated working hours. This work stress and fatigue puts the life of thousands of commuters at risk and affects the safety of train operations.2 It has been recommended that loco-pilots and other related running staff should be provided with sound working conditions, better medical facilities and other amenities to improve their performance.2
Actions taken by Railways with regard to the recent train accident
According to news reports, the recent accident of Utkal Express in UP resulted in 22 casualties and over 150 injuries.[4] It has also been reported that following this incident, the Railways Ministry initiated action against certain officials (including a senior divisional engineer), and three senior officers (including a General Manager and a Railway Board Member).
The Committee on Restructuring of Railways had noted that currently each Railway zone (headed by a General Manager) is responsible for operation, management, and development of the railway system under its jurisdiction.[5] However, the power to make financial decisions does not rest with the zones and hence they do not possess enough autonomy to generate their own revenue, or take independent decisions.5
While the zones prepare their annual budget, the Railway Board provides the annual financial budget outlay for each of them. As a result of such budgetary control, the GM’s powers have been reduced leaving them with little independence in planning their operations.5
The Committee recommended that the General Managers must be fully empowered to take all necessary decisions independent of the Railway Board.5 Zonal Railways should also have full power for expenditure and re-appropriations and sanctions. This will make each Zonal Railway accountable for its transport output, profitability and safety under its jurisdiction.
Under-investment in railways leading to accidents
In 2012, a Committee headed by Mr. Anil Kakodkar had estimated that the total financial cost of implementing safety measures over the five-year period (2012-17) was likely be around Rs one lakh crore. In the Union Budget 2017-18, the creation of a Rashtriya Rail Sanraksha Kosh was proposed for passenger safety. It will have a corpus of Rs one lakh crore, which will be built over a five-year period (Rs 20,000 crore per year).
The Standing Committee on Railways had noted that slow expansion of rail network has put undue burden on the existing infrastructure leading to severe congestion and safety compromises.2 Since independence, while the rail network has increased by 23%, passenger and freight traffic over this network has increased by 1,344% and 1,642% respectively.2 This suggests that railway lines are severely congested. Further, under-investment in the sector has resulted in congested routes, inability to add new trains, reduction of train speeds, and more rail accidents.2 Therefore, avoiding such accidents in the future would also require significant investments towards capital and maintenance of rail infrastructure.2
Tags: railways, safety, accidents, finances, derailment, casualty, passengers, train
[1] Railways Year Book 2015-16, Ministry of Railways, http://www.indianrailways.gov.in/railwayboard/uploads/directorate/stat_econ/IRSP_2015-16/Year_Book_Eng/8.pdf.
[2] “12th Report: Safety and security in Railways”, Standing Committee on Railways, December 14, 2016, http://164.100.47.193/lsscommittee/Railways/16_Railways_12.pdf.
[3] Report of High Level Safety Review Committee, Ministry of Railways, February 17, 2012.
[4] “Utkal Express derailment: Four railway officials suspended as death toll rises to 22”, The Indian Express, August 20, 2017, http://indianexpress.com/article/india/utkal-express-train-derailment-four-railway-officers-suspended-suresh-prabhu-muzaffarnagar-22-dead-4805532/.
[5] Report of the Committee for Mobilization of Resources for Major Railway Projects and Restructuring of Railway Ministry and Railway Board, Ministry of Railways, June 2015, http://www.indianrailways.gov.in/railwayboard/uploads/directorate/HLSRC/FINAL_FILE_Final.pdf.
The National Medical Commission (NMC) Bill, 2017 was introduced in Lok Sabha in December, 2017. It was examined by the Standing Committee on Health, which submitted its report during Budget Session 2018. The Bill seeks to regulate medical education and practice in India. In this post, we analyse the Bill in its current form.
How is medical education and practice regulated currently?
The Medical Council of India (MCI) is responsible for regulating medical education and practice. Over the years, there have been several issues with the functioning of the MCI with respect to its regulatory role, composition, allegations of corruption, and lack of accountability. For example, MCI is an elected body where its members are elected by medical practitioners themselves, i.e. the regulator is elected by the regulated. In light of such issues, experts recommended nomination based constitution of the MCI instead of election, and separating the regulation of medical education and medical practice. They suggested that legislative changes should be brought in to overhaul the functioning of the MCI.
To meet this objective, the Bill repeals the Indian Medical Council Act, 1956 and dissolves the current Medical Council of India (MCI) which regulates medical education and practice.
Who will be a part of the NMC?
The NMC will consist of 25 members, of which at least 17 (68%) will be medical practitioners. The Standing Committee has noted that the current MCI is non-diverse and consists mostly of doctors who look out for their own self-interest over larger public interest. In order to reduce the monopoly of doctors, it recommended that the MCI should include diverse stakeholders such as public health experts, social scientists, and health economists. In other countries, such as the United Kingdom, the General Medical Council (GMC) responsible for regulating medical education and practice consists of 12 medical practitioners and 12 lay members (such as community health members, and administrators from the local government).
How will the issues of medical misconduct be addressed?
The State Medical Council will receive complaints relating to professional or ethical misconduct against a registered doctor. If the doctor is aggrieved by the decision of the State Medical Council, he may appeal to the Ethics and Medical Registration Board, and further before the NMC. Appeals against the decision of the NMC will lie before the central government. It is unclear why the central government is an appellate authority with regard to such matters.
It may be argued that disputes related to ethics and misconduct in medical practice may require judicial expertise. For example, in the UK, the GMC receives complaints with regard to ethical misconduct and is required to do an initial documentary investigation. It then forwards the complaint to a Tribunal, which is a judicial body independent of the GMC. The adjudication and final disciplinary action is decided by the Tribunal.
What will the NMC’s role be in fee regulation of private medical colleges?
In India, the Supreme Court has held that private providers of education have to operate as charitable and not for profit institutions. Despite this, many private education institutions continue to charge exorbitant fees which makes medical education unaffordable and inaccessible to meritorious students. Currently, for private unaided medical colleges, the fee structure is decided by a committee set up by state governments under the chairmanship of a retired High Court judge. The Bill allows the NMC to frame guidelines for determination of fees for up to 40% of seats in private medical colleges and deemed universities. The question is whether the NMC as a regulator should regulate fees charged by private medical colleges.
A NITI Aayog Committee (2016) was of the opinion that a fee cap would discourage the entry of private colleges, therefore, limiting the expansion of medical education. It also observed that it is difficult to enforce such a fee cap and could lead medical colleges to continue charging high fees under other pretexts.
Note that the Parliamentary Standing Committee (2018) which examined the Bill has recommended continuing the current system of fee structures being decided by the Committee under the chairmanship of a retired High Court judge. However, for those private medical colleges and deemed universities, unregulated under the existing mechanism, fee must be regulated for at least 50% of the seats. The Union Cabinet has approved an Amendment to increase the regulation of fees to 50% of seats.
How will doctors become eligible to practice?
The Bill introduces a National Licentiate Examination for students graduating from medical institutions in order to obtain a licence to practice as a medical professional.
However, the NMC may permit a medical practitioner to perform surgery or practice medicine without qualifying the National Licentiate Examination, in such circumstances and for such period as may be specified by regulations. The Ministry of Health and Family Welfare has clarified that this exemption is not meant to allow doctors failing the National Licentiate Examination to practice but is intended to allow medical professionals like nurse practitioners and dentists to practice. It is unclear from the Bill that the term ‘medical practitioner’ includes medical professionals (like nurses) other than MBBS doctors.
Further, the Bill does not specify the validity period of this licence to practice. In other countries such as the United Kingdom and Australia, a licence to practice needs to be periodically renewed. For example, in the UK the licence has to be renewed every five years, and in Australia it has to renewed annually.
What are the issues around the bridge course for AYUSH practitioners to prescribe modern medicine?
The debate around AYUSH practitioners prescribing modern medicine
There is a provision in the Bill which states that there may be a bridge course which AYUSH practitioners (practicing Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy) can undertake in order to prescribe certain kinds of modern medicine. There are differing views on whether AYUSH practitioners should prescribe modern medicines.
Over the years, various committees have recommended a functional integration among various systems of medicine i.e. Ayurveda, modern medicine, and others. On the other hand, experts state that the bridge course may promote the positioning of AYUSH practitioners as stand-ins for allopathic doctors owing to the shortage of doctors across the country. This in turn may affect the development of AYUSH systems of medicine as independent systems of medicine.
Moreover, AYUSH doctors do not have to go through any licentiate examination to be registered by the NMC, unlike the other doctors. Recently, the Union Cabinet has approved an Amendment to remove the provision of the bridge course.
Status of other kinds of medical personnel
As of January 2018, the doctor to population ratio in India was 1:1655 compared to the World Health Organisation standard of 1:1000. The Ministry of Health and Family Welfare stated that the introduction of the bridge course for AYUSH practitioners under the Bill will help fill in the gaps of availability of medical professionals.
If the purpose of the bridge course is to address shortage of medical professionals, it is unclear why the option to take the bridge course does not apply to other cadres of allopathic medical professionals such as nurses, and dentists. There are other countries where medical professionals other than doctors are allowed to prescribe allopathic medicine. For example, Nurse Practitioners in the USA provide a full range of primary, acute, and specialty health care services, including ordering and performing diagnostic tests, and prescribing medications. For this purpose, Nurse Practitioners must complete a master’s or doctoral degree program, advanced clinical training, and obtain a national certification.
