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India – What spurred Rs 12,000 crore medical education black market

At the time of independence there was just one private medical college, CMC Vellore, and even at the beginning of the 1980s there were only 11of them.
Rema Nagarajan | TNN | 
Recently, TOI had conservatively estimated the scale of the black economy in medical seats at about Rs 12,000 crore. How has this black market come into being? It is thanks largely to a massive expansion in private medical education in the 15 years from 1996 to 2010. Nearly 60% of the private medical seats now available were added during this period.

The expansion followed a crucial change in the Indian Medical Council Act in 1993, which gave the Medical Council of India (MCI) complete control over the process of recognising new colleges and courses. Incidentally, the 15-year period was one in which Dr Ketan Desai and his close associate Dr Kesavan Kutty Nair held sway over MCI. Desai was twice removed from the post of MCI president on allegations of corruption, though he has never been convicted on these charges.

At the time of independence there was just one private medical college, CMC Vellore, and even at the beginning of the 1980s there were only 11of them.

MCI was established in 1934 under the Indian Medical Council Act 1933, later replaced by the 1956 Act of the same name. Though conceived as an advisory body to the government on matters related to qualification and registration of medical practitioners, the council has acquired greater powers over time through amendments of the Act. The crucial one was in 1993, by which a new section 10A was introduced laying down stipulations for establishment of new medical colleges and courses of study. With this, MCI gained complete control over the process of establishing new medical colleges, and state governments, which played a larger role earlier, were reduced to just issuing no-objection certificates. This was followed by regulations brought in by the council to implement section 10A, by which curriculum and faculty requirements came under its purview and gave it the power to inspect colleges.

The years since then have seen private entrepreneurs setting up colleges as business ventures. Between 1996 and 2010, 114 private colleges were opened and their total number jumped two and half times. Thus, private colleges came to account for more than half the medical colleges in the country. In the first decade of this millennium (2000-09), 91 private colleges were opened, compared to just 62 from independence till 1999.

The 1990s also saw the rise of Dr Desai in MCI. In 1996, Desai, who had been an MCI member from 1987, became the president. This stint was cut short by the Delhi high court, which ordered his removal on charges of corruption in November 2001.

While going through the minutes of the meetings of the council, the court observed: “The president has managed and manipulated the affairs of the council in a manner that he exercises complete control… The executive committee is being used to legitimise his activities… who in turn is using his position to make illegal monetary gains…”

The court appointed retired Maj Gen SP Jhingon as administrator of MCI. He was relieved by November 2002. Even during Jhingon’s tenure as administrator, the person who headed the executive committee meeting was Dr Kesavan Kutty Nair, Desai’s associate. Dr Nair continued to head the meetings of the executive committee right through to 2007 when Desai came back to the council as a member. The executive committee, in the intervening period, included several persons known to be close to Desai, including Dr Ajay Kumar and Dr Ved Prakash Mishra.

By March 2009, Dr Desai was back as MCI president and his name for the post was proposed by Dr Rani Bhaskaran, wife of Dr Nair, and Dr Ved Prakash Mishra. Dr Kesavan Kutty Nair became the vice-president. But by April 2010, Desai was arrested yet again on charges of corruption and MCI was disbanded and replaced by a board of governors (BoG) consisting of eminent doctors nominated by the Central government.

The BoG’s stint till November 2013 coincided with the government’s renewed efforts to boost facilities for medical education in the public sector. Thirty-five government colleges adding 3,700 seats and 44 private colleges adding 5,750 seats were approved. By 2013 end, the BoG was replaced by the current council. In the last two years, 18 government colleges adding 2,150 seats and 17 private colleges adding 2,450 seats were approved.

The rush to boost medical colleges and MBBS seats in the public and private sector has been marred by persistent reports of colleges being run with inadequate faculty, facilities and even patients to provide clinical material. As many as 27 colleges, all private, were barred from taking in students in 2015-16 due to deficiencies spotted during inspections. Those in the field say these 27 are merely the tip of the iceberg and the rot is deeper and wider in private medical education.

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