The report covers a range of issues but the most damaging section was what is being labeled as the “whistle blower affair”, and tackles the question: can an activity that is considered unethical for individual medical practitioners become ethical for an association of doctors?
On 26 October 2007, an “endorsement committee” of the IMA resolved that the IMA should endorse Quaker Oats, Odomos and Tropicana fruit juices. The deal was worth an estimated Rs 2.25 crores. The National President was authorized to sign the endorsement deal after it was passed at the Orissa meeting of the Central Working Committee (CWC) in April 2008. An IMA member complained against this unethical decision to the IMA in May 2008 and the MCI in June 2008. The MCI Ethics Committee after repeated reminders declared in June 2009, that the IMA was not under its jurisdiction. Meanwhile the decision for endorsement was ratified and the IMA went ahead. A complaint to the MoHFW followed, which directed the MCI to review its decision. Numerous letters later, including an RTI application to the CIC, the MCI finally decided in 2009, that associations did fall under the purview of the MCI. The IMA CWC in 2009 meanwhile decided that no further endorsement deals should be signed, but existing agreements continued.
Repeated requests for disciplinary action followed and involved the NHRC. Eventually in November2010, the MCI reconfirmed the unethical nature of such endorsements and served a show-cause notice to Dr Dharam Prakash who signed the deal. Ghulam Nabi Azad announced in Parliament the names of Drs Samaram and Dharam Prakash that had been removed from the medical register for 6 months and 61 members on the IMA censured. This decision was stayed by a court order, whilst at the same time the MCI ratified its decision on disciplinary action, extended the period of erasure to 1 year and included three more doctors. In 2011, Dr K.V. Babu, the whistle blower was sent a show cause notice by the IMA for expulsion from the organization. Letters followed fast and furious between the IMA and its branches, MCI and MoHFW. Eventually MPs Brinda Karat and P. Rajeev intervened. In 2014, the MCI amended 6.8 of its Ethics Rules and Regulations, and removed professional associations of doctors from its purview. This decision was gazetted by the MCI on February 1, 2016. After further furious exchanges, the matter was eventually put before the Standing Committee which submitted its report entitled “92nd Report MCI”, March 8, 2016.
The report expressed “severe astonishment” over the February 1 notification of Medical Council of India. The PSC slammed MCI over deleting the words “and professional association of doctors” by amending clause 6.8 of the MCI Code of Ethics Regulations, 2002, thereby allowing professional associations to be exempted from the MCI code of ethics. Such exemption they said is nothing short of legitimizing 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. It endorsed the generally held common sense public viewpoint 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,” adding that it was unable to “uncover any rational reason as to why the MCI has taken such a retrograde decision. It seems that the MCI has become captive to private commercial interests, rather than its integrity in public interest.”
The committee also criticized the MoHFW for its “inaction against the MCI over the issue” thereby meekly surrendering to the MCI. It called for adherence to regulations and “immediate action in the matter to ensure that the illegality committed in terms of violation of ethical standards of 2002 Regulations, either by an individual doctor or a group of doctors in the form of an association is not kept out of the jurisdiction of MCI and the words “and professional association of doctors” are restored to clause 6.8 of the MCI Code of Ethics Regulations 2002 so that no immunity, whatsoever, is accorded to any association or society of doctors.”
The PSC also gave relief to the whistleblower, Dr Babu K.V, by directing the Ethics Committee to expedite the completion of all formalities concerning closing of the case against him and “convey compliance within 1 month”.
The PSC further castigated the MCI on various other issues. It called for restructuring the MCI, to remove the bias against larger public health goals as it is presently an “exclusive club” of medical doctors from corporate hospitals and private practice. The Council membership, as well as the Ethics Committee, it recommended, should represent a cross section of society such as public health experts, health economists, health NGOs, patient advocacy groups, etc. It noted that medical education in India is increasingly depersonalized and has failed to instill humane values of care, concern, courtesy and compassion creating an ever widening gap between the medical education system and the healthcare system. It remains to be seen whether this report will bring precipitate the much required course correction or get consigned to the dustbin of history like so many others.
(Dr Gladstone D’Costa is the Chairman, Accreditation Committee and member, Executive Committee, Goa Medical Council.)
