Q: What ails medical education in India? A: MCI

Mushrooming private medical colleges have lowered standards and follow unethical practices. On top of that, MCI is accused of arm-twisting them and minting money

pankaj

Pankaj Kumar | September 5, 2014


The MCI should introduce a common entrance test, impose the prescribed fee structure and put an end to capitation fee if it is serious about its role.
The MCI should introduce a common entrance test, impose the prescribed fee structure and put an end to capitation fee if it is serious about its role.

Could thickness of partition walls in a college building or the library not stocking ‘sufficient’ number of journals be a reason for a college to be denied permission to admit students? As it turns out, it could be.

The medical council of India (MCI) has denied 46 medical colleges permission and, consequently, reduced the number of medical students in this academic year by 4,100.

[Also read: Graduates with MBBS-level degrees from foreign varsities allege discrimination in India]

As per estimates, the ratio of doctors and the Indian population is a dismal 1:1,700. According to the World Health Organisation (WHO), there should at least be one doctor for every 1,000 people in any country. For that, India needs to train at least 4 lakh more people to become doctors by 2020.  

After repeated pleas to the MCI went unheard, the colleges approached the health ministry, which, in turn, moved the supreme court on July 30. The ministry appealed the apex court for modification of time schedule for granting approvals to new colleges and renewal of permission to existing seats in old colleges. But the MCI contested it hotly, citing the ‘gravity of irregularities’. The government move, as a result, ended in a defeat in court.

The union health minister, Dr Harsh Vardhan, acknowledged that the inspection reports were about minor problems with air-conditioning, library not stocking sufficient journals (at a time when all journals of repute are available on the internet, for free or for a fee), or about thickness of partition walls in buildings, and, of course, shortage of faculty. But though most colleges say they had made amends, the MCI, they allege, was yet to acknowledge it.

Dr KV Babu: from whistle-blower to accused

According to medical code of ethics, a doctor “should expose, without fear or favour, incompetent or corrupt, dishonest or unethical conduct on the part of members of the profession”. Kerala-based Dr KV Babu was only following the tenet in letter and spirit when he lodged a complaint with the medical council of India (MCI) about the unethical practice followed by the Indian medical association (IMA) in endorsing private products.

According to the minutes of IMA meetings, its endorsement committee had a discussion over endorsement of products and they decided to endorse Quaker oats, Tropicana juices of Pepsico and Odomos cream, gel and lotion of Dabur. In lieu of these endorsements, Pepsico and Dabur paid the IMA '1.38 crore and '69 lakh, respectively, for three years.

After several complaints followed by deliberations, the government-appointed chairman of the MCI concluded, in 2008, that it was indeed unethical on IMA’s part to endorse brands. The chairman further ordered removal of the names (president, secretary and all other executives of the IMA) of those found guilty from the Indian Medical Register for six months. The MCI chairman also directed letters of censure to be issued to all members of the IMA executive committee on the endorsement issue. Then health minister Ghulam Nabi Azad had informed the Lok Sabha about the orders.

In December 2010 the ethics committee of the MCI also found Dr Ajay Kumar, president of the IMA in 2008, guilty of professional misconduct for being party to the decision to endorse brands. Ironically, Dr Kumar is now a member of the same MCI ethics committee. The earlier order of the ethics committee was reversed soon after MCI was reconstituted in November 2013 and Dr Kumar became a member of the MCI and its ethics committee.

Recently, whistle-blower Dr Babu, along with his non-medico wife Bindu, was summoned by the MCI for registering the “false complaint”. The MCI, it may be noted, has no jurisdiction over non-doctors. Also, the MCI itself had earlier admitted that it had no jurisdiction over the IMA but only over individual doctors.

Dr Babu, it seems, is being harassed for upholding the medical code of conduct.


“The MCI should have desisted from bureaucratic attitude and college managements should have been given time to rectify problems and those who have complied should have been heard. Ultimately, students will be the losers,” said the health minister. “It would have been in national interest to permit colleges on the basis of conditional letters, as there is no point in punishing students.”

The health minister said the situation would have been worse had he not pushed for the clearance of 10,000 MBBS seats, which was in jeopardy in early June.

So, why is the MCI bent on not giving these colleges a go-ahead?

It seems the 44 colleges mentioned on the health ministry website (plus two others whose names have not been  mentioned but have been confirmed by sources) that have been denied permission are victims of politics – almost all of them either got recognition as a medical college or were permitted to increase student intake after the council was dissolved in May 2010.
Following the arrest of former MCI president Ketan Desai in a graft case in April 2010 – he was accused of accepting bribe in lieu of permission for a Patiala-based private medical college – a government-appointed board of governors ran the institute till November 9, 2013 when the MCI board was reconstituted, allegedly putting Desai loyalists in charge.

For instance, Lord Buddha Koshi Medical College and Hospital, Saharsa, and Malla Reddy Institute of Medical Sciences in Vijayawada have been denied permission for a third batch of 100 and 150 seats, respectively. Their inception year was 2012.

Similarly, Indian Institute of Medical Sciences & Research, Jalna, in Maharashtra, BGS Global Institute of Medical Sciences in Bangalore and Sardar Rajas Medical College in Kalahandi, Odisha, have been denied permission for 100, 150, and 100 seats, respectively. Again, all three were set up in 2013.

Annapoorna Medical College of Salem, Tamil Nadu, and Sri Muthukumaran Medical College, Chennai, are among other institutions that have been denied fourth and fifth batches. Their inception date: sometime after April 2010.

That’s why some of the private colleges have moved the court and pleaded that despite compliance, they have not been given a second chance.

Infrastructure, or the lack of it, has been cited as the main reason for reduction of seats in private colleges. But the same reason doesn’t hold for government colleges, which got due permission, possibly fearing uproar in parliament by MPs of the Samajwadi Party, Left parties and Mamata Banerjee’s Trinamool Congress. Thus, government colleges of Uttar Pradesh and West Bengal got permission on the basis of a conditional letter, whereas most private colleges were denied even a second inspection to check for compliance.
Governance Now possessses MCI’s letters to several government colleges to whom conditional permission has been granted despite their lack of infrastructure.

An institution such as Government Medical College & Super Facility, Azamgarh, Uttar Pradesh, has been allowed to continue despite possessing less than half the required number of teachers (short by 52 percent) and resident doctors (54 percent shortage). Similarly, Manyavar Kanshi Ram Government Allopathic Medical College, Jalaun, UP, has 38 percent faculty shortage and resident doctor shortage of 34 percent. Similar shortage of faculty (48 percent) and resident doctors (58 percent) was shown in the case of Kannauj Government Medical College.

Doctor Woe

0.6 per 1,000 is the present doctor-population ratio, according to union health ministry data

0.8 per 1,000 is the target by 2025.

1-doctor-for-1,000 population target cannot be met before 2031.

6,91,633 physicians India had during the 11th Plan

8,48,616: physicians expected by 2017 (for 12th Plan)

45,500: the availability of MBBS seats as against 33,500 four years ago

22,800 is the number of PG seats from 13,800 four years ago

19 state government-owned medical colleges were upgraded last year under the Pradhan Mantri Swasthya Surakasha Yojana

6 new AIIMS were announced last year to increase availability of doctors in the country


MCI inspection had found severe shortage of staff and faculty also in institutes such as Mahamaya Rajkiya Allopathic Medical College in Ambedkarnagar, BRD Medical College in Goarakhpur, and Lala Lajpat Rai Medical College in Meerut. However, these colleges were given letters of permission on condition of complying with the norms. The 43 private (and three government) medical colleges have, on the other hand, been derecognised for 2014-15 academic session for precisely the same reasons.

“Law does not permit differentiation between private and government colleges. If there are deficiencies and a conditional letter has been offered, then it should be offered to both (sets of institutions) by following the same yardstick,” said Dr Prem Kumar, former additional secretary of MCI.

“The actual reason (for denying permission to these colleges) is not the deficiencies. It is mainly to send a message among private colleges and opponents that all decisions taken in the last three years can be reversed,” said a top functionary of MCI who did not want to be named. “The recent steps have been taken to prove to the (health) minister that MCI is an autonomous and elected body and it will not be bullied by the union minister.”

Similar sentiments were echoed by Dr Kunal Saha, who is fighting to cleanse medical education and the profession in India. “If you see the inception date of these private colleges, you will find that most of them opened between 2010 and 2013. That’s why they are paying the price, because it is no more a secret that Dr Desai is running the council through remote control,” said Dr Saha, chairman of People for Better Treatment. “Even the names of the colleges that have been denied permission make it clear that the denial of permission is not merely because of poor infrastructure. It could just be a reason on paper, but the actual reason seems to be different.” [Desai’s licence to practice medicine was cancelled when he was caught red-handed by the CBI. The decision was not revoked as long as the board of governors ran the council. After the reconstitution of the council, however, the move got revoked. Dr Saha has now challenged it in court.]

Dr Mukesh Yadav, a forensic doctor and chairman of Quality of Medical Education, concurred: “The MCI is a perfect place to wield influence over politicians. And private colleges are the tools, as they are used to amass money or to please political masters in respective states. If the MCI is truly serious about improving medical education then it should have taken steps to introduce a common entrance test, strictly impose the prescribed fee structure, and put an end to capitation fee.”

Dr Yadav also said, “This is an arm-twisting tactic...to increase political support. The strategy is to complicate the matter and multiply problems and then make all college owners run to the political masters. It has nothing to do with quality. Otherwise, why is KV Babu being harassed?”

Dr Babu was in news recently because he and his non-medico wife have been (or were) summoned by the MCI for complaining against some of the previous members of Indian medical association (IMA) who are now MCI members (see box).
Interestingly, the previous council (headed by the board of governors nominated by the government) had issued a notice to the same erring officials, but the day the new council was reconstituted a majority of old members who were active during Dr Desai’s tenure came back to the council. Worse still, they reversed the decisions of the board. Now, the complainant has become an accused and the accused are sitting on his jury.

Health activist Dr Meera Shiva underscores the problem: “We all are against the mushrooming of private medical colleges because it has lowered the standards and increased unethical practices. But the root cause of these problems is the regulatory body whose work should be to regulate the standards. “Instead, it is always in news for arm-twisting and minting money.” 

This story first appeared in Magazine Vol 05 Issue 15(01-15 Sept 2014)

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