MUST READ ARTICLE: Indian Medical Council (Amendments) Bill, 2013: No prescription for a corruption-free healthcare system Friday, September 6, 2013 by Dr Kunal Saha The recent introduction of the Indian Medical Council (Amendments) Bill, 2013 (‘Bill 2013’) in the Parliament has ignited a heated debate in some quarters of the medical community. While some doctors with political connection may find this Bill as a great opportunity to climb up the ladder to the Medical Council of India (MCI), others are deeply perturbed with the proposed Bill for more reason than one. Ironically, most physicians practicing around the country perhaps are still unaware about what are at stake in this significant piece of the new medical legislation. Interestingly, while members of the Rajya Sabha are still debating on the proposed Bill 2013, the union health ministry has already initiated the process of “election” and “nomination” of new doctor-members from different states to constitute the next MCI by passing an Ordinance, “Indian Medical Council (Amendment) Ordinance, 2013” earlier this year. But most state medical councils (SMCs) and health universities that have the primary responsibility to elect doctors as members for the next MCI have remained reticent about the MCI election process. In fact, barring a few exceptions, most SMCs and health universities have shown little or no interest to conduct an open and transparent MCI election, which must include all registered doctors practicing modern medicine. One has to wonder why these medical establishments are not keen to inform all physicians about this important MCI election being held in accordance to the Bill 2013. Unfortunately, there is no prescription in the proposed Bill that can bring hope of a cure for the ailing medical system in India. The Bill 2013 is merely an “old wine in a new bottle” which makes one point abundantly clear that unscrupulous doctors and medical colleges with financial affluence and political connection that have been plundering our healthcare delivery system for a very long time have little to fear from the changes in law proposed in this Bill. Nobody should be oblivious of the underlying facts of the genesis of Bill 2013, which started in 2010 with the revelation of a deep-rooted corruption inside the MCI. The Bill 2013 has proposed to amend the Indian Medical Council Act, 1956 (‘IMC Act, 1956’) which was enacted more than half a century ago with the primary aim to provide a platform for the maintenance of an uniform standard of medical education and to regulate ethical practice by doctors across India. The IMC Act, 1956 provided rules for the establishment of MCI as the central authority for control of medical education with exclusive power to approve or disapprove medical colleges and to take disciplinary action against the delinquent physicians for their unethical and negligent acts. The IMC Act, 1956 also stipulated formation of state medical council (SMC) that would issue licenses to bona fide medical graduates allowing them to practice modern medicine in the state. But what actually prompted the central government to introduce the new Bill 2013 to propose an amendment in the 57-year old laws made under the IMC Act, 1956? The answer to this important question may still be vivid in our memory as it started just a little more than three years ago when one Dr Ketan Desai, then president of MCI, was caught red-handed (through a sting operation) by the Central Bureau of Investigation (CBI) on 22nd April, 2010 while taking bribe from a private medical college allegedly in exchange of granting the MCI recognition. This was not the first time that the same Dr Desai came to the limelight for being involved with a shameful conduct as the top medical man in the country. In a writ petition (PIL) (LPA No. 299-301/2001; Union of India vs. Harish Bhalla & Others), Delhi High Court dubbed MCI as a “den of corruption” and ordered Dr Desai to be removed from his post of MCI president on corruption charges in 2001. But Dr Desai made a remarkable return to the top of MCI when he was elected “unopposed” as the MCI president once again in a general body meeting held on 1st March, 2009 where nearly one hundred MCI members from across the nation took part but none opposed Dr Desai for the coveted post of MCI president despite his besmirched background. Rest is a dark history of Indian medicine as Dr Desai was arrested by the CBI in 2010 while still occupying the top post in MCI. Dr Desai’s arrest by the CBI was highly publicized by the national and international media, which also brought endless ignominy to all doctors of the Indian origin. Under mounting public pressure, the union health ministry was eventually forced to dissolve the full body of elected members of MCI in May 2010. For the past more than three years, MCI has been functioning under a ‘Board of Governors’ (BOG), established through an Ordinance with few hand-picked doctors chosen by the government. The sordid saga of Dr Desai undoubtedly put the health ministry in an embarrassing situation. But the undisputed fact remains that Dr Desai’s incredible return as the MCI president in 2009 (with full support from every MCI member) and his eventual fall from the grace in 2010 took place under the same health ministry headed by Mr Ghulam Nabi Azad who is still the union health minister. The health ministry has since been under relentless pressure to re-establish a democratically elected body of the MCI. The Bill 2013 was introduced by the UPA government seemingly to establish a new MCI by changing the old provisions of the IMC Act, 1956, to cleanse the healthcare system and to prevent unscrupulous medicos gaining entry to the MCI. In fact, the Bill 2013 has been touted by the government as a major benevolent Act to regain public trust on doctors and to stem the rot in the healthcare system. And as expected, several apparently populist provisions have been craftily included in this Bill. For example, the new Bill has proposed that president/vice-president of MCI may not hold office for more than two terms (Section 3.2). But nothing in the Bill 2013 can prevent the same doctor to return to the post of MCI president/vice-president after taking a break as an ordinary member for a single term. What difference would it make if a depraved president like Dr Desai occupies the post of MCI president for two terms and then step aside for a single period only to regain the post of MCI president? Other gimmicks clearly aimed at hoodwinking ordinary people are also included in the proposed Bill 2009, for e.g. the term of president/vice-president (Section 7.1) or regular member (Section 7.2) has been reduced by one-year time (from 5 years to 4 years) but with absolutely no restriction on the re-election (and re-nomination) of the same member over and over again. These trifling changes are clearly designed only for political purposes, which cannot have any impact on removing corruption from the MCI. Perhaps the biggest gimmicky change proposed in the Bill 2013 is the introduction of Section 30A.2f which provides the power to remove MCI president/vice-president or any regular member from his office if: “…in the opinion of the Central Government, (the MCI member) has so abused his position as to render his continuance in office detrimental to the overall public interest”. The specific language used in this provision was framed clearly to counter allegation against inclusion of any dissolute doctor in the MCI (e.g. Dr Desai). But the proposed provision falls flat on its face for a number of reasons because it leaves several lacunae for corrupt medicos to easily infiltrate the MCI. First, this law does nothing to prevent a doctor who has already been convicted or who is known to be involved with immoral activities from becoming a member or even president of MCI. In fact, if a new MCI body is established today in accordance to the Bill 2013, Dr Ketan Desai would be a member and possibly president of MCI once again without any problem whatsoever because the new provision has merely stated that a member/president/vice-president may be removed from MCI in future if he is found to have abused his official position in MCI. Despite the undisputed fact that Dr Desai had previously abused his position as MCI president for which he was arrested by CBI and removed from MCI in 2010, there is no bar for him to be elected as a new MCI member or even president of MCI again. In fact, if a new MCI is formed today, Dr Desai would be a member because he is also the lone member elected from the medical faculty in Gujarat University Senate and according to Section 3.1(b) of the Bill 2013, doctor elected from each University Senate would also be a member of MCI. Further, the proposed law under Section 30A.2f has also stipulated that a member may be removed from MCI but only if “in the opinion of the Central Government” it is found that the member has abused his official position. Why the Central Government should be the lone judge to decide whether any MCI member may have abused his official position when many of these members were “nominated” and not “elected” by the government? This reminds the age-old axiom of letting “fox guarding the hen house”. The health ministry always remained as a silent spectator when Dr Desai was condemned for serious charges of corruption and bribery. Dr Desai was removed from his post of MCI president in 2001 by Delhi High Court and in 2010, he was terminated from MCI after he was arrested and charged under the Prevention of Corruption Act by CBI. The health ministry did absolutely nothing to prevent Dr Desai from abusing his official position either in 2001 or 2010. Ironically, the Central Government has also proposed no change in the Bill 2013 to curb doctors with tainted background from being elected or nominated as a member of MCI. In fact, with reports of gross mismanagement and corruption inside the health department appearing regularly in the news, the health ministry has no credibility left in the eyes of the ordinary people today. Moreover, Rule 10 of “Central Civil Services Rules, 1965” has stipulated that a person working in any government agency would be suspended if he remains under police custody for a period of more than 48 hours and also during pendency of criminal proceedings in the court against him. A doctor-member should be removed from MCI if he is facing criminal trial or if he has been put behind bar for a period more than 48 hours. The proposed law in the Bill 2013 that a member may be removed from MCI only when he is found guilty in the opinion of the Central Government is another self-serving devious ploy by the health ministry to shield the corrupt medicos. It is a common knowledge that corruption in healthcare has thrived with declining standard of medical education with rapid proliferation of shoddy private medical colleges in the recent years. MCI holds exclusive authority for the control of medical education including giving recognition to new medical colleges and to allow/disallow increase in the number of graduate and postgraduate seats in existing medical colleges across India. Many private medical colleges have been able to obtain green signal from MCI even without adequate infrastructure and medical faculties in the recent past. These private medical colleges are built with the primary motive to make huge financial profit through exorbitant “capitation fee” and other unethical means from the aspiring medical students. The owners and shareholders of these spurious private medical colleges have frequently obtained MCI recognition through external political influence or by bribing the officials/members of MCI. The recent arrest of Dr Desai by CBI bears a glaring proof of such deplorable activities by high-rank MCI members. Doctors who own private medical colleges should never be allowed to become the MCI members in order to avoid possible conflict of interests. Unfortunately, there is no provision in the Bill 2013 to exclude doctors who are involved with running the business of private medical colleges from becoming members of MCI. In fact, the number of members to be elected to MCI has been sharply increased under Section 3(1)b of the proposed Bill 2013 that has stipulated that 1 doctor would be elected to MCI for every 10 medical colleges including the private medical colleges. Proprietors of some private medical colleges have already been elected as MCI members in some states under the new provision of the Bill 2013. According to published reports, four doctors including one Dr G Bhaskar Rao were elected from the NTR Health University in Andhra Pradesh in August 2013 as MCI members under Section 3(1)b. Dr Rao is not only the owner and chairman of GSL Medical College, a private medical college in Andhra Pradesh, he is also the president of ‘Private Medical Colleges Association’, a group devoted to promote interests of the private medical colleges in India. Should someone like Dr Rao who clearly has a possible conflict of interest to act in favour of private medical colleges be allowed as a member of MCI that has the sole authority not only to recognize new private medical colleges but also to approve or disapprove increase in the number of graduate and postgraduate seats in the existing private medical colleges? Ironically, a new, populist provision has also been included in the Bill 2013 under Section 30A-2e which stipulates that a member should be removed from MCI if he has “acquired such financial or other interest as is likely to affect prejudicially the exercise of his functions as such president, vice-president or other member”. Obviously, individuals like Dr Rao would be ineligible to work as MCI members because of their direct association with a private medical college with seemingly unsavoury “financial or other interest” which is likely to affect their function in MCI. And yet, there was no bar for Dr Rao to get himself elected as a member for the next MCI under the provisions of the Bill 2013. Perhaps the greatest damage that the proposed Bill 2013 may inflict on the society is its direct threat to democracy in the medical community of India. The Bill 2013 has proposed to significantly increase the number of MCI members from different states who are elected not by their doctor-peers in the state but by the few members of each University Senate most of whom hail from non-medical and sometimes non-academic divisions of the school. The Bill 2013 has proposed that each University Senate may elect 1 doctor-member for MCI for every 10 medical colleges (Section 3.1b). With numerous private medical colleges burgeoning all over the nation under a liberal recognition policy by the previous MCI, a large number of additional members would be elected for the next MCI from many states mostly by the non-medical voters of the Senate who possibly have little or no knowledge about the character or competency of the doctors contesting MCI election. Even if the number of MCI members had to be increased due to the proliferation of new medical colleges, why not let the registered doctors elect the most competent among their peers just the way members of SMCs are elected in India? Further, it cannot be justified to have equal representation in MCI from a large, reputed government medical college with hundreds of students compared to a small, private medical college under a “deemed” university built primarily to make financial profit. Also, instead of the large number of registered physicians, allowing a handful of Senate members to elect MCI members is more likely to be influenced by unwarranted external factors including bribery and corruption. Apart from increasing the number of “elected” MCI members from private medical colleges, the Bill 2013 has also proposed to increase the number of MCI members to be “nominated” by the Central Government. The newly proposed Section 3(1)aa in the Bill 2013 has stipulated that one member from the Union Territories will be “nominated” to the MCI by the Central Government although the criteria for such nomination of doctors are not mentioned anywhere in the Bill. Why the government did not allow fellow doctors to elect their representative to MCI through a democratic process even if additional members had to be included from the Union Territories? There is little dispute that political influence might play a key role for obtaining “nomination” from the government to be a member of MCI under this new provision of law. By increasing the number of “nominated” position in the MCI under the Bill 2013, the health ministry has undoubtedly done a big favour to the Central Government to reap more political bargaining power in the coming years. In sum, the proposed Bill 2013 is nothing but a colossal political gimmick in the name of transformation of the broken healthcare system in India. This Bill was created to quell the increasing public outrage against maladministration and corruption in the central medical regulatory system. Although the Bill 2013 has emanated primarily from the premature disbandment of the last MCI following the precipitous arrest of then MCI president Dr Ketan Desai, which also exposed the deep-rooted corruption in the MCI, there is no genuine attempt in this Bill to deter the corrupt practices indulged by many Machiavellian medical leaders in the past. While the shrewd legal brains in the health ministry may not have failed to include some populist provisions in this Bill to delude ordinary citizens, a closer look to the proposed changes can leave no room for any doubt that the creators of the Bill 2013 had no intention to build an honest and transparent MCI. On the contrary, several new provisions have been inserted in this Bill in the most clandestine manner that are likely to embolden the debauched members of the medical community to join and rule MCI as they did in the past. Instead of bringing any meaningful changes to rebuild public trust and to help the hapless patients of India, the proposed Bill has unquestionably provided more power in the hands of the inept health ministry to further manipulate the existing medical system. Unfortunately, this Bill is also likely to hurt countless number of honest and caring Indian doctors who also wanted true reform of the broken medical system. While the Bill 2013 is likely to face stiff challenges from the opposition parties in the Parliament, one should not expect any improvement in the healthcare delivery system, which is already rotten to its core, if this Bill eventually becomes the law of the land. Dr Kunal Saha, MD, PhD Professor and Private Consultant in HIV/AIDS President, People for Better Treatment (PBT) indiamedicaltimes/2013/09/06/guest-article-indian-medical-council-amendments-bill-2013-no-prescription-for-a-corruption-free-healthcare-system-by-dr-kunal-saha/?fb_comment_id=fbc_332744006861356_10236420_332950650174025#f3dfce2d3a3b3ba
Posted on: Sat, 07 Sep 2013 05:21:38 +0000
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