A representation submitted to the West Bengal Clinical Establishment Regulatory Commission (WBCERC) by the Association of Private Hospitals and Nursing Homes has placed a larger governance question before the state: can healthcare regulation protect patients while recognising the sharply different capacities of large corporate hospitals, secondary-care centres and small nursing homes?
Representatives of small and medium clinical establishments from across West Bengal submitted the proposal on Monday, according to the Times of India. Their central demand is that the state should move away from uniform compliance requirements and adopt a tiered framework based on the scale and function of each facility. The submission is therefore not only a plea against penalties. It is an argument for designing regulation around how healthcare is actually distributed across urban, semi-urban and rural settings.
The Association has proposed three categories. Tier 1 would cover tertiary corporate institutions, Tier 2 secondary multi-specialty centres, and Tier 3 basic surgical or maternity units. The representation argues that applying the same mandates to all three types of establishment could place smaller facilities at a disadvantage. The report does not specify which existing mandates would be altered or how the commission would calculate compliance requirements for each tier, but the proposed classification points to a persistent administrative challenge: regulation must be consistent in its objectives while being proportionate in its implementation.
That distinction matters because smaller facilities often form part of the first layer of care outside major metropolitan hospitals. The representation describes the pressure on primary and secondary-care providers as both administrative and financial. If compliance costs, documentation requirements or penalties are designed primarily around tertiary institutions, smaller centres may face higher operating pressure without necessarily delivering the same range of services. If they withdraw services or become financially unsustainable, patients could be pushed towards fewer and larger hospitals. The supplied report does not establish that such closures or withdrawals have occurred, but it identifies the risk that the association wants the regulator to address.
The proposal also seeks a different process for dealing with technical clinical-negligence allegations. APHNH has requested that such allegations be examined by an independent Peer Review Committee made up of active practising specialists before prima facie findings or interim penalties are issued. The association cited Supreme Court verdicts in support of this demand.
This request exposes the difficult balance between two forms of accountability. Patients need a credible mechanism to raise complaints and obtain protection when care fails. Hospitals, meanwhile, argue that complex clinical decisions should be assessed by qualified specialists rather than through procedures that may not fully account for medical circumstances. A peer-review mechanism could add technical scrutiny, but its credibility would depend on how members are selected, whether conflicts of interest are managed, whether patients can present evidence, and whether the process adds to or delays existing remedies. None of those operating details is set out in the reported representation.
The financial section of the submission connects regulation to the functioning of public health insurance schemes. Providers have asked for reforms in Swasthya Sathi and the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana, or AB-PMJAY. Their proposals include unbundling complex treatment packages so that hospitals can be reimbursed for pre-existing comorbidities, unexpected surgical complications and life-support interventions such as dialysis or mechanical ventilation.
The significance of this demand lies in the way packaged payments interact with real patients. A treatment episode may not follow a predictable sequence, particularly when a patient has multiple conditions or requires intensive care. If a package does not adequately account for additional interventions, the hospital and the public scheme can disagree over liability and payment. The representation seeks a mandatory 30-day statutory settlement window for undisputed claims and a monthly tripartite dispute-resolution mechanism involving state health authorities, insurers and hospital representatives.
For patients, the payment system is often invisible until it becomes a barrier. Delayed or disputed reimbursements may be experienced at the hospital counter as requests for clarification, delays in discharge or uncertainty over whether a procedure will be covered. The report does not provide figures on pending claims, settlement times or the number of patients affected in West Bengal. It does, however, show that providers see claim administration as part of the state’s healthcare infrastructure rather than as a separate commercial issue.
The submission also addresses the integrity of medical supply chains. APHNH has called for a closed chain of custody for high-risk consumables, including intravenous fluids, blood products, cold-chain biologics and implants. Such a system would be intended to preserve sterility and batch traceability from procurement to use. In an environment where a product failure or contamination event can be difficult to investigate after the fact, the ability to identify the source and movement of a medical item is an important regulatory function.
At the same time, the association has sought formal written waivers when families choose to purchase routine oral medicines from outside the hospital. It argues that hospitals should not remain liable for risks arising from external procurement when families make that choice after being informed. The proposal raises a question about how responsibility should be divided among hospitals, pharmacies, patients and suppliers. A waiver may record consent, but the representation as reported does not establish what safeguards or disclosure standards would accompany such a process.
Workplace safety is another part of the submission. The organisation has urged WBCERC to reinforce zero-tolerance policies against vandalism and violence under the West Bengal Medicare Service Persons and Medicare Service Institutions (Prevention of Violence and Damage to Property) Act. It wants aggrieved parties directed towards formal statutory dispute channels rather than confrontations inside medical facilities.
This demand places hospital safety within the same regulatory conversation as patient rights. Violence can disrupt care, endanger staff and other patients, and damage essential property. But formal dispute channels must also remain accessible and responsive if they are to provide a credible alternative to confrontation. The report records the association’s request but does not include a response from patient groups, public-health organisations or WBCERC on how enforcement and grievance redressal should be balanced.
The representation’s final cluster of demands concerns administration and inspection. APHNH highlighted more than 350 NABH-accredited facilities in the state and asked for streamlined licensing incentives, joint district inspection teams that include association representatives, and a ban on unauthorised non-regulatory personnel or videographers during hospital visits to protect patient privacy.
These requests reveal the institutional complexity of healthcare oversight. A regulator must inspect facilities independently, but inspection systems also need technical knowledge and predictable procedures. Including association representatives could improve operational understanding, while also raising questions about independence and conflict management. Similarly, protecting patient privacy during inspections is a legitimate concern, but any restriction on recording or access would need to be clearly limited to authorised processes and consistent with accountability requirements.
The broader issue is whether West Bengal’s clinical-establishment regime can become more differentiated without becoming weaker. Tiered regulation, specialist peer review, faster claims settlement, traceable supplies and safer facilities address different parts of the same system. A hospital is not regulated only through licensing. Its performance is also shaped by reimbursement rules, procurement controls, staffing, inspection practices and the legal process for handling complaints.
The reported representation does not amount to a policy change. It is a set of proposals submitted to WBCERC, and the report does not state that the commission has accepted them or announced a timetable for action. The next important developments will therefore be the commission’s response, any consultation with patient representatives and insurers, and the details of any framework that distinguishes facility categories while preserving uniform standards for safety, transparency and patient protection.
