New medical regulator

The Central government wants a new medical regulator, because it will directly impact people’s well-being. The Union Cabinet last week cleared a bill, aiming to wind up the Medical Council of India (MCI) and replace it with the tiol Medical Commission (NMC). Battle lines are already being drawn over this bill to be tabled in the parliamentary winter session. Two issues are likely to figure prominently in the debate — firstly, whether a regulator elected by a fraternity it is supposed to monitor can at all be effective, and secondly, can a professiol but closed user group like MCI be trusted to regulate itself in honest and transparent manner. The government appears convinced that the answer to both these questions is a resounding ‘No’’; hence the NMC bill which seeks to replace the existing Indian Medical Council Act of 1956. Over the years, the MCI has been drawing flak for its opaque and corrupt ways. Back in 2010, the Delhi High Court came down heavily on the MCI, calling it a ‘den of corruption’, ordering removal of its the then president Dr Ketan Desai, setting aside his election and asking the CBI to probe bribery allegations. The investigations revealed a corruption angle to almost every MCI activity, be it in granting affiliation to medical colleges, inspecting their infrastructure and facilities or allowing capitation fees to be charged. Crores of rupees were found extorted as bribes — the picture that came through was of a closed club of heavyweight doctors grossly misusing their office as regulators. The NDA government responded by setting up the Ranjit Roychowdhury and Hari Gautam panels in 2014 to review the working of MCI; then came a report in March 2016 by the parliamentary standing committee on health and family welfare. Devoting an entire chapter on ‘Corruption in MCI’, the report bemoaned “total system failure” in the country’s medical education and profession, recommending its sweeping overhaul.

In May 2016, the Supreme Court had harsh words for MCI, its order citing the parliamentary report that quality of medical education “is at its lowest ebb”, that medical graduates “lacked competence in performing basic health care tasks”, and that “unethical practices continued to grow” under MCI. Frowning at the government for not acting upon the report, the apex court invoked its extraordiry powers under Article 142 to set up a 3-member committee to oversee MCI’s functioning. Headed by former Chief Justice RM Lodha, this oversight committee was mandated to clear all policy decisions of MCI and issue remedial measures; it was to function till the Central government puts in place “any other appropriate mechanism”. Ironically, there are now allegations that the corruption long afflicting MCI has also infected members of the higher judiciary. In September this year, the CBI lodged an FIR, conducted raids, seized crores in cash and arrested several persons including a former Odisha High Court judge. Last month, there were high voltage scenes in Supreme Court over this MCI bribery scam, with the CBI charging that some medical colleges denied MCI approval, had later moved court and manipulated judicial orders in their favour by bribing judges. With the Supreme Court and its oversight committee taking a serious view of the scandal, the Central government’s urgency to put in place a new medical regulator soon is understandable.

According to the NMC bill, it will be a 25-member body to be selected by a search committee headed by the Union Cabinet Secretary; there will be fewer elected members in this body; its regulatory powers will be limited to establishment and recognition of medical institutes. Aspiring doctors, who enter medical studies by clearing NEET, will also have to exit through a licentiate exam before they join the profession. The Indian Medical Association (IMA) has already voiced strong opposition to this bill, contending that the MCI made up of and elected by qualified doctors — is being sought to be replaced by a body “answerable to the bureaucracy and non-medical administrators”. The government is also aiming to induct ‘non-MBBS persons’ into medical governce while allowing AYUSH (Ayurveda, Yoga & turopathy, Uni, Siddha and Homoeopathy) graduates to serve as doctors, the IMA has further alleged. Clearly, the rising debate over a new medical regulator should throw up issues like how the government plans to meet the crying shortage of doctors in the country while ensuring quality. Should altertive medicine systems be included, or should there be a more broad-based medical education that allows exit at different stages for doctors (as in Chi)? The NMC bill proposes government fee guidelines for 40% seats in private medical colleges, but what about the remaining 60%? The bill aims to give greater freedom to medical colleges in license renewal, starting PG courses and inducting more students, but will it encourage profiteering by private operators? All such questions need to be threshed out if the country is to have a clean and efficient medical regulator that safeguards patient rights. In aiming to provide a cure, the NMC bill should not turn out to be worse than the disease.