Dark clouds over doctors’ policeman VALUE FOR MONEY
Alot that is wrong with the Indian medical profession has been bared for all to see across the world through a Reuters investigation into the controversy surrounding Ketan Desai. He is set to take over as the president of the World Medical Association (WMA) next year but the global body was not aware that two criminal cases were pending against him when he was elected to the position. The Indian Medical Association (IMA) wrongly informed the WMA that all charges against him had been dropped — but that related to a charge dating back to 2001. In both the pending cases, relating to 2009 and 2010, Dr Desai has been accused by the CBI of entering into a criminal conspiracy to help two medical colleges increase the number of students they can take in. This was when he was the president of Medical Council of India (MCI) which regulates medical education.
Dr Desai’s name hit the headlines in particular when he was arrested in 2010 after purportedly being caught by the CBI, which laid a trap, for accepting a bribe of ~2 crore. He was thereafter incarcerated, removed as head of the MCI and his licence to practice taken away. He is well connected and says he has been relentlessly pursued by malicious and false allegations. WMA functionaries appeared to have been naïve in accepting the clean chit given by IMA to Dr Desai when negative information about him was there in the public domain.
As for the Indian authorities, their transgression is in allowing the regulation of medical education and the profession (ethical standards are supervised by the MCI) to be in the doldrums for years. How far the government of the day bent over backwards to help Dr Desai can be gauged from the fact that in early 2014 health secretary Keshav Desiraju was abruptly transferred. This was followed by a public outcry which alleged that his fault was to oppose the reinduction of Dr Desai into the MCI, from which he had been made to exit after being arrested on charges of bribery.
What is worse is that any hopes for an improvement in regulation after the installation of the National Democratic Alliance (NDA) government appear to be receding, going by more recent happenings. The chief vigilance officer (CVO) of the MCI, H K Jethi, was removed from his position after he recommended that three members of the ethics committee of MCI be investigated for misleading WMA into believing that all CBI investigations against Dr Desai had been withdrawn.
Not just one but another CVO, Sanjiv Chaturvedi (he has just received the Magsaysay award for his record of public service), of the All India Institute of Medical Sciences, was shifted out of his position by Harsh Vardhan, the first health minister of the NDA government. Among the representations that influenced this decision was one by J P Nadda, BJP national general secretary and MP. The irony is that Mr Vardhan was himself removed from his position later and the same Mr Nadda has taken over as the new health minister!
It is therefore idle to expect that much will come out of the announcement by Mr Vardhan, on taking over as Union health minister, that his ministry was drawing up a panel of reputed medical practioners and consumer law experts to suggest ways of bringing in greater transparency and accountability in medical practices. It is doubtful if much would have happened on this front if he was still around in the ministry; the circumstances of his departure make any improvement even less unlikely.
The leading legal activist and one time active member of the Aam Aadmi Party, Prashant Bhushan, openly alleged in early 2014 that under the patronage of three important people – the then Union health minister Ghulam Nabi Azad, Uttar Pradesh chief minister Mulayam Singh Yadav and the then Gujarat chief minister Narendra Modi – a “medical mafia” had taken over MCI. Such was the strength of the mafia that ideological differences between the respective political parties had been sunk in supporting Dr Desai’s return to MCI after his earlier suspension. The Gujarat chief minister is of course now the prime minister!
Unethical practices in healthcare stem from two sources. One is medicine and medical device companies offering gratification under various forms to doctors as part of their marketing activities and the other is doctors themselves proactively engaging in certain practices. A report in the Times of India says that the voluntary code disallowing the former is likely to be made mandatory and, of course, a section of the pharmaceutical industry is opposing this.
As for the latter, MCI has formulated and enforces the code of ethics for medical practitioners. This code, under “unethical acts”, lists the receiving and giving of gifts and commission for referring, recommending or procuring a patient for treatment. Complaints regarding professional misconduct can be brought before the MCI or the state medical councils which can take disciplinary action. Unnecessary diagnostic tests, inflated medical bills and consideration exchanged in lieu of these remain rampant. This is not surprising as the rot begins at the top with the policeman itself.