(June 1, 2010, Special to ‘Financial Chronicle’)

by Praful Bidwai

Take the case of the Medical Council of India, whose president Ketan Desai has been arrested for flagrant bribe-taking. The MCI, a statutory institution, is meant to play a dual role: registering doctors and regulating their conduct; and recognising medical colleges, inspecting their infrastructure and approving their curricula. That this role, vital to our critically important, yet neglected, healthcare sector, was entrusted to a body mired in professional misconduct and rank bribery is a terrible comment on the medical profession and the self-regulation approach.

Desai, who headed the MCI from 1996 to 2001, and then again 2009 onwards, would charge Rs 2 crores or more to recognise a medical college. The Central Bureau of Investigation has just tracked properties worth Rs 40 crores owned by him and his wife.

In fact, strong evidence of Desai’s corruption in college registration and admissions had emerged 10 years ago, through a writ petition in the Delhi High Court challenging his appointment. This was based on MCI records and the unexplained receipt of Rs 65 lakhs in bank drafts in the names of Desai’s wife, daughters and himself. The Court ruled that Desai had misused his position. “We cannot allow an unscrupulous and corrupt person to function as the president of the MCI.”

Yet, the government and the CBI didn’t further investigate Desai thanks to his enormous political clout based on connections with ministers and bureaucrats involved in the intense manipulation of nominations to the MCI. Many doctors in New Delhi and the state capitals who treat politicians and bureaucrats are enormously powerful. Some use this power to favour to friends and relations; yet others, to get into the MCI and make money.

Logically, the MCI should be composed of professionals from all the fields with a stake in its functions. Its membership should be determined by expertise in particular areas, understanding of India’ specific healthcare needs, diversity of disciplines, pedagogical experience, knowledge of teaching hospitals, etc.

Instead, the MCI has turned into a political body to which some doctors are nominated by the government, and others elected by their colleagues. Its electoral contests tend to be fierce, noisy and well-lubricated by money.

The keenest contestants in the MCI elections are ambitious doctors in search of a high political profile and power without responsibility. There is intense regional- and national-level manipulation, haggling, and exchange of millions of rupees for each seat on the MCI and the state councils. Those elected naturally want to recover their “investment” through bribes.

This system is extremely corrosive of the ethical practice of medicine and good medical education, and will produce sub-standard, unscrupulous physicians and third-rate hospitals. But it has prevailed because the medical profession as a whole has prospered as never before and acquired all the disgusting characteristics of crass greed-driven consumerism.

Doctors are among India’s wealthiest people and have gained the most from the rampant privatisation of healthcare and mushrooming of capitation-fee colleges. Unethical practices are widespread in the medical profession. These are among the most obnoxious features of neoliberalism and state withdrawal from health services. This has corrupted what was once a noble profession and turned doctors into mercenaries. The MCI reflects this in its crassest form.

This warrants serious introspection on the part of the medical profession and policymakers and a thorough reorganisation of the MCI. The Council must be bifurcated into two bodies. The first should register doctors, and stipulate professional standards and criteria for a doctor’s fitness to continue to stay on the MCI register. There are many doctors who have learnt nothing about medicine for decades, are too old to practise, or have moved on to other professions. They should be de-registered. The Council should periodically issue clear statements on professional standards and codes of ethics, and monitor doctors’ compliance.

The second council, dealing with medical education, should include a broad spectrum of stakeholders besides doctors, and must set model curricula and best-practice protocols for affordable medical care.

Both councils should consist of members who are not “politically elected” but selected after proper scrutiny and interviews by a credible board composed of accomplished doctors from different disciplines, with a publishing and public service record; eminent citizens; representations of patients, paramedics and disabled groups; and social workers and political leaders with an established interest in healthcare-related issues and so on. The MCI’s restructuring should begin immediately.

Meanwhile, Desai should be prosecuted and punished in an exemplary fashion in the long-term interest of the public and the medical profession.—end--