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| Will replacing the MCI help? |
| Business Standard / New Delhi Jun 02, 2010, 00:39 IST |
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The regulator hasn’t distinguished itself and its ex-chief is being probed for financial irregularities involving recognition of a college - the question is whether a panel reporting to the government is a good substitute.
 K Srinath Reddy
President, Public Health Foundation of India
The MCI failed to enforce ethical standards across the profession, and power got concentrated in a few persons — self-regulation didn’t work
In 2005, the National Commission on Macroeconomics and Health, co-chaired by the then health and family welfare minister and the finance minister, observed: “The Medical Council of India (MCI) and State Medical Councils as well as the Nursing Council of India (NCI) have failed to carry out the mandate provided to them for regulating the profession and raising the standards of medical education and enforcing them; it is essential that the MCI/NCI Act be amended to allow for civil society representation in the Council.”
The replacement of the MCI office-bearers with an ad hoc body of eminent persons responds to the long-felt need to reform and reconfigure a wayward council that was doing a disservice to the country’s medical education and health-care system. The Ketan Desai imbroglio brought the council’s malaise to public attention in such an unsavoury manner that the government felt compelled to act through an ordinance.
The MCI was established as a professional organisation in 1933. On being replaced by the Indian Medical Council Act in 1956, it was mandated to maintain the Indian Medical Register; streamline and guide the conduct of the modern MBBS course; prescribe ethics for the medical profession; regulate the practice of modern medicine and act as an expert advisory body to the government. Post-graduate medical education was explicitly excluded from its regulatory purview. A cursory examination of the council’s record over the past two decades shows that it has woefully failed to meet this mandate, while transgressing into areas beyond its prescribed powers.
The existing registers of medical practitioners by no means give an accurate count of doctors currently living, residing and practising in the country. We do not know whether the medical practitioners registered five decades ago have passed away, migrated or retired. More importantly, the MCI has failed to link medical education to the country’s health-care requirements.
At present, medical graduates are numerically insufficient, qualitatively deficient and maldistributed into urban aggregates. The MCI employed antiquated criteria for recognition, to constrain and control the growth and expansion of medical colleges. Serious concerns have been raised over the council’s probity in permitting favoured institutions to get away with lax standards.
The power of the MCI became concentrated in the hands of an executive that used a flawed electoral system to perpetuate its power. The much vaunted claim of self-regulation by an informed and vigilant professional elite remained an empty boast, while the executive concentrated power in its president who brooked no challenge. The MCI began to regulate postgraduate medical education too — something that was beyond its statutory mandate. As the capitation fee and corruption quotient for postgraduate seats far exceeded the high premiums for undergraduate seats in private medical colleges, this extended ambit of regulatory authority raised concerns about the legitimacy of intent and integrity of the process. Meanwhile, the standards of both undergraduate and postgraduate education have varied quite widely across the country, with no provision for a common national qualifying examination.
The MCI has also dismally failed to enforce ethical standards across the profession. The crass commercial nature of medical practice, from individual practitioners to corporate hospitals, needs to be explained. Even the basic ethical norm that the profession should not resort to advertising is flouted with impunity. How many unethical practitioners have been disciplined by the MCI?
Finally, it must be recognised that medical education has to be closely aligned to the needs of the health-care system. The country needs to be provided with essential health-care services, and it is the duty of the government to ensure this. The MCI did not permit the creation of new cadres such as nurse practitioners and nurse obstetricians. Also, the content of our undergraduate medical education courses must become more closely aligned to primary health-care needs rather than being attuned to tertiary care practice.
The governance of medical education cannot be the privileged domain of a profession, much less so when self-regulation has abysmally failed. The interests of patients, who are in the need of well-trained and ethical doctors, and the responsibility of the government to ensure that medical education responds appropriately to health-care needs, must transcend the pride and pique of some doctors who have taken offence to a very legitimate state intervention.
 Vinay Aggarwal
Former Secretary-General, Indian Medical Association
Replacing the MCI with a body that will function under the health ministry will take away the independence of a medical education regulatory mechanism
Though medical professionals would like to see corrupt people punished, dissolving the Medical Council of India (MCI), a statutory body, is a dangerous move as the country would lose an independent regulatory mechanism.
There are two issues here: Corruption and the intent of the government. If corrupt practices are discovered, then, by all means, you need to fix responsibility and punish the accused. However, the facts of this case show that the government has not been able to prove the alleged charge of corruption, but it is in a hurry to dissolve a statutory body to gain better control over medical education.
Look at the bare bones of this case: The MCI president is caught allegedly taking a bribe. However, there is no proof, except for statements from a middleman that the money found on him was meant for the MCI president. Statements about intercepted phone calls are made to establish a link.
The Central Bureau of Investigation (CBI) takes over the case and declares that it is a much bigger racket. Almost 40 days have passed since the CBI issued its statements or filed a chargesheet in the court. No other arrests have been made during this period. The entire episode passed through unfortunate, exemplary media trial also. There are about 300 medical colleges in India. Many of them have members of Parliament and other politicians on their boards. During this period of investigation, has no other politician been found to be involved?
We should not forget that the MCI, eventually, is only a recommendatory body. Final decisions are taken by the Union health ministry. Investigations are silent on this or any incriminating evidence revealed in relation to the health ministry officials.
Now, let us look at the structure of the MCI. It is a 160-member body of nominated and elected medical professionals across the country. Many of them are vice-chancellors of various medical universities. This number also includes eight persons nominated by the central government. Many others are nominated by state governments. Dissolving the entire body means casting aspersions on the conduct of all the members and all medical professionals in general.
It seems that the government has made up its mind to dissolve the MCI and take control. Did the government dissolve the Securities and Exchange Board of India (Sebi) when a major racket was unearthed?
As the next best step, the government has decided that a six-member body will be taking over the MCI. This body, which will function directly under the health ministry, will effectively take away the independence of a medical education regulatory mechanism. Politicians and bureaucrats have taken over a professional body.
This is not the first time that the government has made such a move. In 2005, the then Union health minister, Anbumani Ramadoss, tried unsuccessfully to bring in a legislation to dissolve the MCI and set up another council under the control of the health ministry. The Indian Medical Association, along with other professional bodies, opposed this move.
Nevertheless, the legislation was drafted and placed before the Cabinet for approval to bring in an ordinance. The Prime Minister’s Office referred this Bill to a standing committee of Parliament on health. The standing committee rejected it on the ground that any regulatory body should be devoid of government control or it would lose its independent regulatory mechanism.
The case against the former president of the MCI has too many loopholes. We, as civil society members, want to know the truth and also why the entire medical profession has been blamed. Has the move been made because of an ongoing conflict between the two central government ministries — education and health — over who should govern higher medical education? A recent statement by Union Health Minister Ghulam Nabi Azad, that medical education would continue to be with the Union health ministry, only exposed that tension.
If the government was so seriously committed to weeding out corruption, it would have first addressed the root causes. There is an acute shortage of medical seats. It should immediately go about addressing this issue and increase the number of medical colleges, which will also address the issue of shortage of doctors. Over 2 lakh students compete for about 20,000 medical college seats each year.
It is important that the MCI retains its independence and is run by independent and nominated members.
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