By Express News Service – KOCHI

The panel was set up earlier this month after the government had in October suggested a body headed by Rangarajan to decide the structure of the premium rescheduling policy whose final decision would be implemented by the highways ministry after Finance Minister P Chidambaram’s approval.

Officials said concessionaires had argued that a decline in traffic along highways had put them under stress because of which construction and debt servicing were proving difficult. The committee and the highways ministry now wants to check whether traffic has declined and if this could lead to any stress.

“The NHAI is surveying the traffic across 47 highway stretches. The data collected will then be sent to a consultant which will study past and present traffic data to analyse the trends and its findings will be sent to the highways ministry. Based on this, the committee is likely to make a decision on what parameters could be used to determine stress,” an official said.

There was some confusion over the stretches to be included, an official said, explaining the delay in the survey even as the request came in early this month. Since 2012-13, the highways ministry and NHAI have been struggling to find takers for multiple public-private partnership (PPP) projects. The government could award only 1,116-km last fiscal against the target of 9,500 km and only one PPP project has been awarded this year.

The highways ministry, which has put its plans for awarding PPP projects this year on hold till the market scenario improves, expects to kick-start several stalled projects with its premium restructuring proposal.

Source-http://articles.economictimes.indiatimes.com

The unique part of Nav Bharat Nagarik Manch’s agitation on Wednesday morning was inspection of files under Section 4 of the Right to Information (RTI) Act. Nav Bharat Nagarik Manch held a demonstration in front of the NHAI office before procuring documents under RTI. Nav Bharat members DVR Rao, Commander Ravindra Pathak (retd), Raja Narsimhan, Mahesh Tele, Omkar Virkar, Dhananjay Oval, Akash Jadhav, Mrs Sonawane, Hrushikesh Patankar and Prashant Salunke held the demonstrations. We wanted to procure following documents after the horrendous Neera River bridge tragedy of 2^nd November, which killed four young ad professionals from Pune after their car plunged into the river in the absence of a crash barrier at the tip of the bridge:

1.     Correspondence between NHAI and Reliance Infra (or whatever are the names of the sub contractors) regarding action on the repair of the Neera River bridge after submission of the Inspection Report of Neera Tragedy by your Safety Consultants, sometime last week.
2.     Correspondence between NHAI, Pune and the central authority of NHAI/Union Ministry of surface, road and transport, regarding repair of the Neera Bridge to make it safe, post the November 2 tragedy.
3.     Correspondence of the last one year, from NHAI Pune office to Reliance Infra pertaining to the condition of the highway road constructed by Reliance Infra in the 300 km odd Maharashtra portion of the stretch of the Mumbai-Bangalore highway
4.     Photographs taken out by NHAI regarding the condition of the Maharashtra stretch of the Mumbai-Bangalore stretch which is under operation, maintenance and security of Reliance Infra
5.     Documents pertaining to action taken by NHAI against Reliance Infra in the past one year for shoddy work.
6. Unlike Section 6 of the RTI Act, where you need to write a formal application and pay Rs10 in cash or through IPO for a central government office, no formal application is required to inspect files under Section 4. 
7. Yet, this writer sent a previous intimation to Rajesh Kaundal, Project Director, NHAIstating: “I wish to bring to your notice that a citizen desiring to inspect the documents containing information covered under Section 4 of the Right to Information Act, 2005, need not make any formal requisition under Section 6 of the Act because these documents should have already been published by the public authority so that citizens have ‘minimum resort to the use of this Act to obtain information’’
8. The contract given to Reliance Infra is clearly covered under `permits and authorisations’ and hence is covered under Section 4. I intend to exercise my right as a citizen to inspect these documents in your office with my colleagues during our peaceful protest today at your office between 11 am and 1 p m.  Please note that it is not necessary for me under the Act to give such notice before inspection of documents covered under Section 4 of the Act.  However, being a responsible citizen, I thought it appropriate to intimate you beforehand.’’
Despite this, Mr Kaundal replied to my email request stating: “Section 4 (1)(b) is designed to ensure that public authorities disclose certain information which are important to the public voluntarily at every level of operation. Please log on to www.nhai.org for the information published by NHAI.”
“For any other information requested in specific, it is requested to submit application to PIO with requisite fee so that the same can be made available to you within the stipulated time period including inspection of the documents for extraction of the information if required by you. In case of any difference of opinion, it is requested to contact CPIO on the following address:- VS Darbari, GM (Coord) & CPIO, National Highways Authority of India, No.G-5 & 6, Sector – 10, Dwarka, New Delhi – 110 075.Contact No.011-25074100 (Extn : 1520).  Email : [email protected].’’
The writer wrote back stating: “The information I have asked for comes under Section 4 of the RTI Act. However, it is not put up on your website, as far as I searched. In the absence, of you not having uploaded it in the public domain, that is uploaded on www.nhai.org, I, as a citizen, is allowed physical inspection of files in your office.’’
However, no amount of explanation convinced Mr Kaundal, when this writer met him in the office. He insisted that I file an application under Section 6 of the RTI Act and he has no problem about providing me information immediately. Since he assured me of immediate inspection of files, I relented. However, I am filing a complaint to the Information commissioner today, for not providing me information under Section 4.
It is so exasperating that, even after seven years of the implementation of the RTI Act, neither do most public authorities suo motu upload information under Section 4 on their respective websites and hesitate to allow physical inspection of files by citizens.
Amongst the several documents I procured, the following one is very worrying, as the contractor now says all major bridges from Dehu Road to Satara need crash barriers for safety but insists that the NHAI must pay for the repairs. And therein lies the ping-pong game of NHAI Pune sending this request to the Delhi office.
The details are as follows:

PS Toll Roads Pvt Ltd, the subsidiary agency of Reliance Infra has sent a letter to Project Director, NHAI on 25^th November, stating that raising and strengthening of the Median wall (wall in between the two bridges) to the height of the crash barrier, is required for all the six major bridges between Dehu Road and Satara and not only for the Neera River bridge. This was revealed through the documents procured under RTI Act by Vinita Deshmukh and other members of Nav Bharat Nagarik Manch, from the NHAI office at Warje.

The major bridges which need urgent repairs, in the light of the terrible tragedy of 2^ndNovember, where four ad professionals died, have been identified by the contractor as Pawana Bridge, Mula Bridge, Mutha Bridge, Krishna River Bridge, Venna River Bridge and Neera River Bridge. Repairs have also been recommended for a series of culverts and small bridges.

The letter written by Nagendra Rai, officer of the PS Toll Roads Pvt Ltd to Mr Kaundal,  admits that all the major bridges and some of the culverts are ‘unsafe’ for commuters. The letter states, “you are aware that gap between all existing minor/major bridges and slab culvert is not properly closed by cras barrier or extending medial wall up to the level of crash barrier and same is leading to unsafe situation for the traffic.”

Nav Bharat Nagarik Manch is shocked that there is no urgency shown regarding the repair of the Neera Bridge despite the most horrendous tragedy earlier this month.

Instead, the NHAI Pune has washed its hands up stating that such a decision can be taken only by the Delhi office of NHAI. The reason being the statement in the letter in which Rai states, “As per schedule B of Concession Agreement, no scope is defined for improvement/strengthening of the median walls for all existing major/minor bridges and slab culverts.”

This in effect means, that the Reliance Infra’s subsidiary agency, PS Toll Roads Pvt Ltd, is asking NHAI to provide the funds. NHAI Pune in turn says they are not the authority and so the letter has been sent to Delhi.

In the end, Nav Bharat Nagarik Manch is appalled that the final victims are citizens. It has begun the process of procuring documents under RTI to file a public interest litigation (PIL).

(Vinita Deshmukh is the consulting editor of Moneylife, an RTI activist and convener of the Pune Metro Jagruti Abhiyaan. She is the recipient of prestigious awards like the Statesman Award for Rural Reporting which she won twice in 1998 and 2005 and the Chameli Devi Jain award for outstanding media person for her investigation series on Dow Chemicals. She co-authored the book “To The Last Bullet – The Inspiring Story of A Braveheart – Ashok Kamte” with Vinita Kamte and is the author of “The Mighty Fall”.)

Source-http://www.moneylife.in

Years ago, Charlie, a highly respected orthopedist and a mentor of mine, found a lump in his stomach. He had a surgeon explore the area, and the diagnosis was pancreatic cancer. This surgeon was one of the best in the country. He had even invented a new procedure for this exact cancer that could triple a patient’s five-year-survival odds–from 5 percent to 15 percent–albeit with a poor quality of life. Charlie was uninterested. He went home the next day, closed his practice, and never set foot in a hospital again. He focused on spending time with family and feeling as good as possible. Several months later, he died at home. He got no chemotherapy, radiation, or surgical treatment. Medicare didn’t spend much on him.

It’s not a frequent topic of discussion, but doctors die, too. And they don’t die like the rest of us. What’s unusual about them is not how much treatment they get compared to most Americans, but how little. For all the time they spend fending off the deaths of others, they tend to be fairly serene when faced with death themselves. They know exactly what is going to happen, they know the choices, and they generally have access to any sort of medical care they could want. But they go gently.

Of course, doctors don’t want to die; they want to live. But they know enough about modern medicine to know its limits. And they know enough about death to know what all people fear most: dying in pain, and dying alone. They’ve talked about this with their families. They want to be sure, when the time comes, that no heroic measures will happen–that they will never experience, during their last moments on earth, someone breaking their ribs in an attempt to resuscitate them with CPR (that’s what happens if CPR is done right).

Almost all medical professionals have seen what we call “futile care” being performed on people. That’s when doctors bring the cutting edge of technology to bear on a grievously ill person near the end of life. The patient will get cut open, perforated with tubes, hooked up to machines, and assaulted with drugs. All of this occurs in the Intensive Care Unit at a cost of tens of thousands of dollars a day. What it buys is misery we would not inflict on a terrorist. I cannot count the number of times fellow physicians have told me, in words that vary only slightly, “Promise me if you find me like this that you’ll kill me.” They mean it. Some medical personnel wear medallions stamped “NO CODE” to tell physicians not to perform CPR on them. I have even seen it as a tattoo.

To administer medical care that makes people suffer is anguishing. Physicians are trained to gather information without revealing any of their own feelings, but in private, among fellow doctors, they’ll vent. “How can anyone do that to their family members?” they’ll ask. I suspect it’s one reason physicians have higher rates of alcohol abuse and depression than professionals in most other fields. I know it’s one reason I stopped participating in hospital care for the last 10 years of my practice.

How has it come to this–that doctors administer so much care that they wouldn’t want for themselves? The simple, or not-so-simple, answer is this: patients, doctors, and the system.

To see how patients play a role, imagine a scenario in which someone has lost consciousness and been admitted to an emergency room. As is so often the case, no one has made a plan for this situation, and shocked and scared family members find themselves caught up in a maze of choices. They’re overwhelmed. When doctors ask if they want “everything” done, they answer yes. Then the nightmare begins. Sometimes, a family really means “do everything,” but often they just mean “do everything that’s reasonable.” The problem is that they may not know what’s reasonable, nor, in their confusion and sorrow, will they ask about it or hear what a physician may be telling them. For their part, doctors told to do “everything” will do it, whether it is reasonable or not.

The above scenario is a common one. Feeding into the problem are unrealistic expectations of what doctors can accomplish. Many people think of CPR as a reliable lifesaver when, in fact, the results are usually poor. I’ve had hundreds of people brought to me in the emergency room after getting CPR. Exactly one, a healthy man who’d had no heart troubles (for those who want specifics, he had a “tension pneumothorax”), walked out of the hospital. If a patient suffers from severe illness, old age, or a terminal disease, the odds of a good outcome from CPR are infinitesimal, while the odds of suffering are overwhelming. Poor knowledge and misguided expectations lead to a lot of bad decisions.

But of course it’s not just patients making these things happen. Doctors play an enabling role, too. The trouble is that even doctors who hate to administer futile care must find a way to address the wishes of patients and families. Imagine, once again, the emergency room with those grieving, possibly hysterical, family members. They do not know the doctor. Establishing trust and confidence under such circumstances is a very delicate thing. People are prepared to think the doctor is acting out of base motives, trying to save time, or money, or effort, especially if the doctor is advising against further treatment.

Some doctors are stronger communicators than others, and some doctors are more adamant, but the pressures they all face are similar. When I faced circumstances involving end-of-life choices, I adopted the approach of laying out only the options that I thought were reasonable (as I would in any situation) as early in the process as possible. When patients or families brought up unreasonable choices, I would discuss the issue in layman’s terms that portrayed the downsides clearly. If patients or families still insisted on treatments I considered pointless or harmful, I would offer to transfer their care to another doctor or hospital.

Should I have been more forceful at times? I know that some of those transfers still haunt me. One of the patients of whom I was most fond was an attorney from a famous political family. She had severe diabetes and terrible circulation, and, at one point, she developed a painful sore on her foot. Knowing the hazards of hospitals, I did everything I could to keep her from resorting to surgery. Still, she sought out outside experts with whom I had no relationship. Not knowing as much about her as I did, they decided to perform bypass surgery on her chronically clogged blood vessels in both legs. This didn’t restore her circulation, and the surgical wounds wouldn’t heal. Her feet became gangrenous, and she endured bilateral leg amputations. Two weeks later, in the famous medical center in which all this had occurred, she died.

It’s easy to find fault with both doctors and patients in such stories, but in many ways all the parties are simply victims of a larger system that encourages excessive treatment. In some unfortunate cases, doctors use the fee-for-service model to do everything they can, no matter how pointless, to make money. More commonly, though, doctors are fearful of litigation and do whatever they’re asked, with little feedback, to avoid getting in trouble.

Even when the right preparations have been made, the system can still swallow people up. One of my patients was a man named Jack, a 78-year-old who had been ill for years and undergone about 15 major surgical procedures. He explained to me that he never, under any circumstances, wanted to be placed on life support machines again. One Saturday, however, Jack suffered a massive stroke and got admitted to the emergency room unconscious, without his wife. Doctors did everything possible to resuscitate him and put him on life support in the ICU. This was Jack’s worst nightmare. When I arrived at the hospital and took over Jack’s care, I spoke to his wife and to hospital staff, bringing in my office notes with his care preferences. Then I turned off the life support machines and sat with him. He died two hours later.

Even with all his wishes documented, Jack hadn’t died as he’d hoped. The system had intervened. One of the nurses, I later found out, even reported my unplugging of Jack to the authorities as a possible homicide. Nothing came of it, of course; Jack’s wishes had been spelled out explicitly, and he’d left the paperwork to prove it. But the prospect of a police investigation is terrifying for any physician. I could far more easily have left Jack on life support against his stated wishes, prolonging his life, and his suffering, a few more weeks. I would even have made a little more money, and Medicare would have ended up with an additional $500,000 bill. It’s no wonder many doctors err on the side of overtreatment.

But doctors still don’t over-treat themselves. They see the consequences of this constantly. Almost anyone can find a way to die in peace at home, and pain can be managed better than ever. Hospice care, which focuses on providing terminally ill patients with comfort and dignity rather than on futile cures, provides most people with much better final days. Amazingly, studies have found that people placed in hospice care often live longer than people with the same disease who are seeking active cures. I was struck to hear on the radio recently that the famous reporter Tom Wicker had “died peacefully at home, surrounded by his family.” Such stories are, thankfully, increasingly common.

Several years ago, my older cousin Torch (born at home by the light of a flashlight–or torch) had a seizure that turned out to be the result of lung cancer that had gone to his brain. I arranged for him to see various specialists, and we learned that with aggressive treatment of his condition, including three to five hospital visits a week for chemotherapy, he would live perhaps four months. Ultimately, Torch decided against any treatment and simply took pills for brain swelling. He moved in with me.

We spent the next eight months doing a bunch of things that he enjoyed, having fun together like we hadn’t had in decades. We went to Disneyland, his first time. We’d hang out at home. Torch was a sports nut, and he was very happy to watch sports and eat my cooking. He even gained a bit of weight, eating his favorite foods rather than hospital foods. He had no serious pain, and he remained high-spirited. One day, he didn’t wake up. He spent the next three days in a coma-like sleep and then died. The cost of his medical care for those eight months, for the one drug he was taking, was about $20.

Torch was no doctor, but he knew he wanted a life of quality, not just quantity. Don’t most of us? If there is a state of the art of end-of-life care, it is this: death with dignity. As for me, my physician has my choices. They were easy to make, as they are for most physicians. There will be no heroics, and I will go gentle into that good night. Like my mentor Charlie. Like my cousin Torch. Like my fellow doctors.

Ken Murray, MD, is Clinical Assistant Professor of Family Medicine at USC.

*Photo courtesy of patrick.ward04.

Source-http://www.zocalopublicsquare.org

NEW DELHI: Many highway developers, including GMR and GVK, are set to get major relief in next one week as the PM-appointed C Rangarajan committee is likely to recommend reduction and deferment of premium to be paid to NHAI.

The panel is likely to suggest that for six-laning of highway projects, at least 25% reduction in annual premium payment to NHAI during construction period and about 50% during subsequent years. The panel was constituted to come out with a formula to defer the premium payment towards later part of the concession period to make projects viable for developers.

In case of four-laning of projects, the developers don’t have to pay premium during the construction period. During operation and maintenance period, they have to pay minimum 50% of the committed annual premium.

For both six-laning and four-laning of highway projects, during operation and maintenance period, annual cash flow surplus subsequent to fulfilling debt servicing and other obligations, will have to be used mostly towards premium payment. The objective is to ensure that NHAI gets the entire premium at least three years before the contract period ends, said a source.

Developers were complaining about difficulties in premium payment due to slowdown in traffic amid a weak economy. Many projects, which were awarded could not take off, while many on-going projects were getting stuck. The committee felt that a reduction and deferment of premium payment in the initial period and increasing the amount in the later, when both traffic growth and collection of toll are expected to go up, will help the developers.