A report by a parliamentary committee on health has indicted the Medical Council of India for corruption and recommended replacing it with a National Medical Commission
By Dinesh C Sharma
During the hearing of a case involving Medical Council of India (MCI) president Dr Ketan Desai in 2001, a bench of the Delhi High Court had commented that “MCI is a den of corruption”. Since then, Desai has been in and out of jail, three central governments have changed, several health ministers have come and gone, many expert panels have given their reports on the functioning of the medical regulator and ordinances have been issued suspending elected office bearers. But despite all these, nothing has been able to change the way the MCI functions.
A self-regulatory body
MCI is supposed to be a self-regulatory body of medical professionals mandated to take care of undergraduate medical education, licensing of new medical colleges, expansion of existing ones, maintaining Indian Medical Register and dealing with medical ethics, including cases of medical negligence. Given the fact that medical education has become a thriving business as private colleges mushroom under political patronage, MCI over the years has emerged as a centre of illicit and unethical activities. It has remained blind to unethical medical practices and cases of gross negligence by doctors as MCI panels overlooking these aspects are dominated by vested interests.
It is in this backdrop that the Parliamentary Standing Committee on Health, chaired by Ram Gopal Yadav, has submitted its report that deals exclusively with the functioning of MCI.
Addressing failures
The report has established how the Council has repeatedly failed in fulfilling its mandate over the decades. The failure is on all fronts. In the absence of a curriculum that produces doctors suited to working in rural health services and urban slums, the medical education system has got disconnected with the health needs of the country. The result: poor doctor-patient ratio and skewed distribution of medical colleges.
The Council has also been unsuccessful in maintaining uniform standards of medical education both at the undergraduate and post-graduate levels. The menace of high capitation, which the Council has not effectively addressed, has led to devaluation of merit in medical admissions. The system of granting recognition, de-recognition and inspections of medical colleges is opaque. In addition, the Council has failed to instill respect for a professional code of ethics in medical professionals and take disciplinary action against doctors found violating the code of ethics.
Expert opinion
Dr Kunal Saha, Founder, People for Better Treatment
“Presence of individuals who are not members of the medical community in MCI and state medical councils would avoid the obvious conflict of interests present today in the doctor-only medical councils across India. However, the process of selection of such members should be honest and transparent.”
Dr Arun Gupta, Convener, Alliance Against Conflict of Interest
“If a truly independent board of ethics comes into reality, it would certainly be helpful to clear dirty stuff in medicine that is going on. They would need to set up mechanisms for prevention and management of conflict of interests as one of the steps, among others, to define what is ‘unethical.’”
Dr K K Aggarwal, Secretary General, Indian Medical Association
“Regulators have to be independent. Indian Medical Association is against government-nominated regulators controlling Medical Council of India. In a democratic country, elective body is the right answer.”
Drastic Solutions
The parliamentary panel has suggested a drastic solution to this mess—disbanding MCI in its present form and replacing it with a National Medical Commission and associated bodies to look after different aspects like accreditation of medical colleges, medical ethics, etc. The first step in reforming medical education and practice should be to repeal the Indian Medical Council Act of 1956 under which MCI was established. “The situation has gone far beyond the point where incremental tweaking of the existing system or piecemeal approach can give contemplated dividends. That is why the committee is convinced that MCI cannot be remedied according to existing provisions of Indian Medical Council (IMC) Act, 1956 which is certainly outdated. If we try to amend or modify the existing Act, ten years down the line we will still be grappling with the same problems that we are facing today,” the committee has observed.
The biggest lacuna of the IMC Act, according to the committee, is self regulatory nature of MCI which has reduced it into “an exclusive club of medical doctors” as IMC Act does not call for diversity of backgrounds in the members. Drawing upon the experience of other countries, it has emerged that self-regulation alone does not work because medical associations fiercely protect their turf. “Any group consisting entirely of members from the same profession is unlikely to promote and protect public interest over and above their own self-interest and therefore check-and-balance mechanisms are required,” the committee observed while recommending the inclusion of non-medical members (like public health experts, social scientists, health economists, civil society members) in regulatory body. It is in favor of a government-nominated regulator—instead of an elected body as in the case of MCI.
Promote ethical conduct
Another major recommendation is to establish a separate Board of Medical Ethics for promotion of ethical conduct by medical practitioners. Such a body may be modeled after the General Medical Council or the UK and the Australian Medical Council which have separate mechanisms for governance of ethical practice by doctors. The proposed Board should plan for continuing renewal of codes of ethics, their dissemination through various channels. At present, MCI is free to make changes in its ethics rules, like the recent change that excludes associations of doctors from its purview.
Instead of reinventing the wheel with regards to reforming the regulatory system, the parliamentary panel has endorsed the recommendations made by the last expert panel headed by Ranjit Roy Chaudhury who expired recently. The expert committee was constituted by the central government in July 2014 to suggest reforms in the regulatory framework of medical profession. In its report submitted in February, 2015, the panel had recommended the formation of a National Medical Commission (NMC) through a new Act. The NMC is supposed to have four arms—Undergraduate Board of Medical Education and Training, Postgraduate Board of Medical Education and Training, National Assessment and Accreditation Board and National Board for Medical Registration. In addition, it should have a National Advisory Council consisting of members from state governments, union territories, state medical councils, medical universities and members of NMC. The parliamentary committee has endorsed these recommendations and asked the health ministry to introduce a new comprehensive Bill in parliament to implement all the recommendations at the earliest.
Earlier attempts to reform MCI have failed due to political reasons and opposition from states. In 2011, the government introduced the National Commission for Human Resources for Health (NCHRH) Bill in the Rajya Sabha. It was referred to a standing committee which suggested several changes, including greater say for states, in its report presented to parliament in November 2012. But the health ministry did not act on it, and two years later, the Ranjit Ray Chaudhury panel was set up.
Hopefully this time around, there will be some action.