A parliamentary committee has lifted the lid from the goings on in the scam-infested country’s sole medical regulatory body, Medical Council of India (MCI), which it says is a “club” of influential medical practitioners who act without any fear of governance and regulations.
No wonder the Working Group on Tertiary Care Institutions for the 12th Five Year Plan says nearly one million Indians die every year due to inadequate healthcare facilities, 700 million people have no access to specialist care and 80% of specialists are working in urban areas.
The MCI, which is supposed to regulate and monitor the medical profession — from granting approval for setting up a medical college to allocating seats and later monitoring the conduct of doctors — has failed in its duties in setting up high standards of health care.
Massive money changes hand in granting approval for setting up a medical college and also in the inspection of functioning of these institutions which thrive on mammoth of capitation fee up to Rs 50 lakh a seat in MBBS.
All these gory details are listed in a report of a 31-member Department-related Parliamentary Standing Committee on Health and Family Welfare led by Prof Ram Gopal Yadav. The report is already before Rajya Sabha but the government is yet to take a call on it.
If the committee finds MCI hugely responsible for the prevailing pathetic state of health care and low standard of conduct among a large section of medical practitioners and hospitals, it also takes the government to task for being indifferent to the dire need for putting in place an appropriate law that should have put regulated the working of MCI, which hitherto is an unregulated body.
The composition of MCI at present “doesn’t represent professional excellence nor follows medical ethos. The current composition of the Council reflects that more than half of the members are either from corporate hospitals or in private practice."
The committee is surprised to note that even doctors nominated to MCI by state and central governments “have been nominated from corporate private hospitals which are not only highly commercialised and provide care at exorbitant cost but have also been found to be violating value frameworks."
“They indulge in unethical practices such as carrying out unnecessary diagnostic tests and surgical procedures in order to extract money from hapless patients and meet revenue targets and flouting government rules and regulations, especially about treating patients from underprivileged backgrounds," the committee expresses its anguish.
It is also “astonishing” that government succumbed “meekly” to an amendment in the regulations introduced by MCI in February last deleting the words “and professional association of doctors", thus exempting professional association of doctors from the ambit of MCI Code of Ethics Regulations, 2002. This amendment encouraged corruption among organised medical professionals. The committee says, “Exempting professional association of doctors from the ambit of Ethics Regulations is nothing short of legitimizing doctors’ associations indulging in unethical and corrupt practices by way of receiving gifts in cash or kind under any pretext from the pharmaceutical industry or allied health industry."
Terming the action of MCI as “ethically impermissible”, the high-powered panel says, “it seems the MCI has become captive to private commercial interests, rather than its integrity in public interest."
But all the questionable decisions by MCI never attracted the attention of government. The government in fact “meekly surrendered to MCI," the parliamentary panel says.
MCI has become an “exclusive club of medical doctors” as it comprises selectively chosen doctors by ignoring the legitimate expectation of diversity.
The committee has asked the Union Health Ministry to take immediate action to ensure that “the illegality committed” by MCI in granting immunity to medical bodies from ethical standards is nullified.
The evil effect of the amendment by MCI is grave. Doctors in medical institutions like hospitals and clinics “indulge in unethical practices such as carrying out unnecessary diagnostic tests and surgical procedures in order to extract money from hapless patients and meet revenue targets and flout government rules and regulations, especially about treating patients from underprivileged backgrounds”, the committee unveils the motive behind introducing suspicious amendment by MCI.
The effect is evident as 63 million people are faced with poverty every year due to health care costs alone which clearly indicates that “health care is moving away from the reach of the people in general and the poor in particular," the panel laments.
The committee also pulls up MCI for not plugging the loopholes in the system by checking corruption in enhancing the seats in medical colleges, for approval of setting up these colleges and during their inspection, which are conducted by a select few manageable inspectors every year.
Therefore, the committee favours bifurcation of the functions of MCI and recommends that different structures be created for discharging different functions.
This opaqueness in the inspections of medical colleges “give enormous scope for money to exchange hands”, the committee affirms and finds it ironical that the “evaluation of quality of teaching and training and the final product, ie the doctor, does not figure in inspection report."
The Committee also expresses shock at the fact that despite hundreds of faculty members from 183 government medical colleges being available, certain 'serial inspectors' were part of almost half the inspections conducted in the year 2014 and of the 261 inspections done during 2014, inspectors from medical colleges in Gujarat were involved in as many as 100 inspections and another 40 involved faculty from Bihar.
“Cannot be a mere coincidence but reeks of a serious scam," the committee slams the MCI and health ministry as it recommends that in order to unravel the truth, an in-depth probe may be conducted into the arbitrary appointment of inspectors in 2014 and an action taken report within three months.
It also stresses on implementation of the report by Prof Ranjit Roy Chaudhury committee which was set up by NDA government in July, 2014 that suggested reforms in the regulatory framework of medical profession.
It is imperative that a National Medical Commission (NMC) through a new Act is constituted to do away with MCI. There is need for formation of a National Advisory Council consisting of members from the State Governments, Union Territories, State Medical Councils, Medical Universities and members of NMC.