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Subir Roy: Who will police the doctors’ policeman?

The new union minister for health, Harsh Vardhan, has some good news for all by declaring that his ministry is drawing up a panel of respected medical practioners and consumer law experts to suggest ways of bringing in greater transparency and accountability in medical practices.

This is vital in a poor country where people meet an inordinately high amount of their medical expenses (59.4 per cent) out of their own pockets. If public healthcare is highly non-functional, then private healthcare has to be properly regulated. The moves come after a TV channel, through a sting operation, revealed that doctors were routinely getting a commission – sometimes as much as 30-50 per cent – for prescribing costly diagnostic tests.

What is less inspiring is that the minister has asked the Medical Council of India (MCI), which is the policeman in this regard, to call an emergency meeting of its ethics committee to address this issue. The problem is that the MCI, as it now stands, inspires little confidence. It was in active controversy earlier this year over an attempted return by its former president Ketan Desai, who had lost his post and his doctor’s licence in 2010 when he was caught taking a bribe to favour a particular medical college. The then health secretary, who tried to prevent his return to the MCI, was removed from the post, provoking a public outcry.

Most recently, the MCI has asked a couple – a whistle-blower doctor and spouse – who had complained to it against the Indian Medical Association (IMA), the medical practioners’ lobby, to appear before it for “false reports” against the Kerala chapter of the IMA.

The whistle-blower’s complaint was against IMA officebearers and members who had decided to endorse commercial products, against the MCI’s code of ethics. The central council of the IMA had in a 2008 meeting decided to endorse commercial products of PepsiCo and Dabur India for fees totalling Rs 2 crore. Earlier this year, the then health minister, Ghulam Nabi Azad, had told the Lok Sabha that the MCI ethics committee had decided to remove the names of the president and secretary of the IMA from the Indian Medical Register for six months and issue letters of censure to all executive committee members of the IMA on the endorsement issue.

Now, the supreme irony is that the IMA president in 2008, Ajay Kumar, who was thus censured for the endorsement decision, is now a member of the MCI’s ethics committee (six months are over and it is presumably business as usual) before which the whistle-blower couple was asked to appear! That is not all. On the matter of moving against the IMA, the MCI has argued that its writ runs over individual practitioners, not their associations. After having washed its hands of the IMA because it is a private body, the MCI has now gone one step further. It is claiming that it cannot even censure IMA officebearers who were a party to the endorsement decision.

While corruption in India and in general and in healthcare in particular is well known, the lid was blown off it internationally by an article in the BMJ (formerly the British Medical Journal) earlier this year by David Berger, who wrote about what he saw while working as a volunteer doctor in a charitable hospital in the Himalayas. This prompted the journal to write an editorial that said: “India has a lack of external accountability and oversight of both public and private health sectors … Those in much better paid private [medical] sector jobs are incentivised to generate business for their employers by overinvestigation and overtreatment of patients who are at their mercy both medically and financially.”

How to set things right? Samiran Nundy, a senior specialist at the Sir Ganga Ram Hospital in Delhi and one of the coauthors of the editorial, told Rema Nagarajan of The Times of India that the MCI, currently an “exclusive club of doctors”, has to be restructured with half the members from lay people, such as teachers and representatives of patients’ groups. The previous government’s promise to bring the MCI under an overarching body remains unfulfilled. Regular audits of procedures and interventions, now non-existent, are a must. Computerisation of medical records, containing not just prescriptions but patient history, is another must.

One reason for the present system is the spread of corporate healthcare. “Working in the corporate sector is a nightmare,” adds Dr Nundy. They offer “crores” as salary, but that is “reviewed” in six months to see “if the doctor is able to bring in the money expected”. Salaries can go down by 30 per cent after such reviews and some are even forced to leave “because they could not deliver the profits expected”.



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