The parliamentary standing committee for the Union Ministry of Health and Family Welfare has produced a report on the Medical Council of India (MCI), which would shame all those at the helm if they were capable of such feeling. The transgressions of the regulatory body under the ministry, charged with overseeing medical education and doctors' right to practice and ethical conduct, are well known. The report has validated a lot of the relevant media coverage and, through the committee's own investigations, laid down solid fundamentals for bringing about systemic change.
Two related episodes need highlighting. The committee had received a representation from V K Babu, a doctor from Kerala, and his spouse, M V Bindu, stating that they had complained to the MCI in 2008 and 2010 that the Indian Medical Association (IMA), the doctors' body, was endorsing commercial products of private companies (PepsiCo, in one instance), which was in violation of the MCI's code of ethics. The result? He was issued show cause notices by the IMA for complaining to the press, the MCI and the ministry.
For its part, the MCI, which was reconstituted in 2013, took no action against the IMA office bearers despite its earlier ethics committee holding them guilty of violating the MCI code of ethics and recommending removal of their names from the Indian Medical Register. Instead, it also issued notices to Dr Babu and his non-medico wife asking them to appear in person before it!
When the parliamentary committee went into the matter the MCI president informed it that its ethics committee has closed the case against the whistle-blower couple. The parliamentary committee asked the MCI to complete all formalities for closing the case and report back to the committee within one month from the presentation of its report.
What else did the MCI do? The committee was "astonished" to note that MCI early this year notified an amendment to its ethics regulations, deleting the words "and professional association of doctors", thus exempting the IMA, the professional association of doctors, from the ambit of the MCI's ethics code.
The committee saw this as "nothing short of legitimising doctors' associations indulging in unethical and corrupt practices by way of receiving gifts in cash or kind under any pretext from the pharma industry or allied health industry." The committee agreed with the viewpoint of public health activists that "an action that is ethically impermissible for an individual doctor cannot become permissible if a group of doctors carry out the same action in the name of an association." The committee's conclusion: "It seems that the MCI has become captive to private commercial interests."
Not just this. The parliamentary committee also found it "intriguing that instead of intervening to thwart attempt of MCI at subverting the system, the ministry has meekly surrendered to MCI." The committee said the ministry should take immediate action to ensure that the words "and professional association of doctors" are restored in the code.
The committee is "shocked" to find that compromised individuals have been able to make it to MCI, but the ministry is not empowered to remove or sanction an MCI member even if he has been proved corrupt. Otherwise how could it happen that MCI could have at its very top a person (the then president, Ketan Desai) who was arrested on charges of corruption in 2010?
The quality of medical education is "at its lowest ebb" and the current model of medical education is not producing the right type of health professionals needed. Medical graduates lack competence in performing basic tasks like conducting normal deliveries. The committee states that "currently the MCI is an exclusive club of medical doctors" but across the world, a perspective has gained ground that self-regulation alone does not work because medical associations have "fiercely protected their turf". In countries like the UK and Australia, regulators are drawn from diverse groups. The regulator should have diverse stakeholders "such as public health experts and social scientists, health economists, health NGOs with an established reputation, legal experts, quality assurance experts, patient advocacy groups."
The oversight of professional conduct is the most important function of MCI "but it has been completely passive on the ethics dimension". Between 1963 and 2009 just 109 doctors have been blacklisted by the ethics committee of the MCI. The parliamentary committee did not want to "taint the entire medical community … but it is equally indisputable that… many unprincipled doctors and private sector hospitals have lost their moral compass and overcharge or subject their hapless patients to unnecessary surgeries and diagnostic procedures."
Other than validating a lot of what the media has been saying, the parliamentary committee has made many suggestions for reinventing regulation of medical education and ethics of doctors and other medical stakeholders. But what is the political reality on the ground? Ghulam Nabi Azad, long-term health minister under United Progressive Alliance (UPA)-II, removed the then health secretary, Keshav Desiraju, because he tried to resist the re-induction of Ketan Desai into the MCI. The electorate gave a massive verdict against the UPA and a Bharatiya Janata Party (BJP)-led government came in. Early in the day, party bigwig J P Nadda wrote to the then health minister, Harsh Vardhan, seeking removal of the chief vigilance officer of AIIMS. In a subsequent ministerial reshuffle, Mr Vardhan was removed, Mr Nadda was made health minister and at the end of the day the CVOs of both the AIIMS and the MCI were removed! Further comment is redundant.
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