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Letter to CJ Bombay HC by a Psychiatrist to intervene in ‘ Medical MalPractice’ case

Copy of Dr  Vani’s letter to Hon CJ Mumbai Highcourt

From,
Dr Vani Kulhalli
204 Shyamakamal C
Agrawal Market
Vile Parle East
Mumbai-57

To,
Honorable Chief Justice
High Court of Mumbai
Mumbai.

Subject- Petition to intervene in the matter of Dr Bawaskar vs P M Medical Centre, Pune

currently being handled by the Maharashtra Medical Council (MMC)

Respected Sir,

I am a Psychiatrist practicing in Mumbai for the last 10 years. I have seen the
harm done to the community by ‘cut-practice’ and believe that it is a horrible
form of corruption that should be immediately stopped. In this regard, I had
filed RTI applications to the Medical Council of India and Maharashtra Medical
Council in 2012 (enclosure). Although the Indian Medical Council Regulations of
2002 mentions cut-practice as illegal, there is no mention of the procedures to
establish the misconduct or the quantum and nature of punishment. I was also
surprised that the Councils had not even thought of setting up a group/
committee to deliberate in this matter in the several decades of their
existence!

All members of the current MMC are doctors or beaurocrats. They are not well versed
in judging misdemeanors of this (financial and ethical) nature. Their role in
this case will be limited to merely hear the case and settle it.  Secondly, they are mostly busy doctors doing
the council work in honorary capacity and cannot spare the time or energy required.
Thirdly, being doctors it will not be easy for them to be objective in the
respect of a practice that has spread its tentacles over most of the medical
community. Sometimes fraternal ties make it difficult to give out proper
decisions. Therefore, I have serious doubts about the competence and credibility
of MMC to handle this case.

The procedure used for settling this case will only involve hearing both parties. No
investigation will be done to establish the facts of the case. For example,
simply checking other cases handled by the diagnostic centre will be able to
tell us whether it routinely reimbursed ‘professional charges’ to doctors for
the favour of referring patients (in other words, did cut practice). So the
question of a misunderstanding arising in this particular case only, will not
arise. I fear that this type of investigative approach will not be taken for
the reasons stated above. The whole purpose of the complaint and the intention
of the complainant to cleanse medical practice will be lost.

A patient goes to his doctor in pain and desperation, with a hope not only of
treatment but also of empathic guidance and support. If the doctor is motivated
by empathy and informed by scientific facts, this patient can get what he
needs. This is a basic human right. There is no law that forbids the doctor
from framing and then claiming his/ her fees for this service. That amount may
be high or low, as per the doctor’s judgement. Inspite of this, it is my personal
experience that all patients pay the fees asked of them. Then what is the need
to fool the patient into paying through cut-practice network?

Thus cut-practice is not motivated by lack of
income alone. It is the work of a perverse mind motivated by a criminal intent.
This is perpetrated by group of individuals who seek to defraud the patient and
are unconcerned with the risk that the patient is exposed to, in undergoing
unnecessary tests and surgeries.  Therefore,
it should be classified as a premeditated criminal activity done with the
astute planning of an intelligent but sick mind. All sections of society and
every profession have such members. In the medical community, they are
represented by professionals who believe cut-practice is their entitlement.
This makes it necessary to punish the holders of such malafide intent to
protect humanity.

Further,it gives unfair advantage those doctors who are corrupt and can be justly
termed as an ‘illegal trade practice’. A group of such doctors form a cartel
and edge out other doctors.  The doctor or hospital who bribes corners a large clientele

and this affects the morale of non- corrupt doctors.   It is now known that such persons are able to
get income tax benefits as paying ‘referral charges’ has been ruled as a
legitimate business expense. The doctor who refers the patients need not use
his/ her skills as a doctor as the income from kickbacks frequently exceeds
income from hard work and is home-delivered by a ‘P R O’.  (Public Relations Officer)

A person who pays a bribe to get some work done does it for himself, is aware
that he is paying, is aware why he paying it, is aware to whom he is paying and
at least some of the times, has the choice not to pay. The hapless patient has
no idea that he/ she has been taken for a ride by the doctors with whom he/ she
trusted his life.  The very nature of
cut-practice makes it impossible for the victim to take precautions. The victim
will never be able to get redress even if he becomes aware; a strong sense of
fraternity will prevent any doctor from being a witness and there are no other
witnesses in this crime. Therefore cut practice is the worst form of corruption
and it denies the patient his basic human rights. And that is why Dr Bawaskar’s
case is of extreme importance. For the first time, we have a doctor willing to
go on record and remedy the practice and he has followed the proper procedure.

According
to me cut-practice is a crime against humanity. It is so well organized; I wish
the doctors should be booked under MCOCA or some such similar law. I feel it is
an economic offence against the state, where the recipients of kickbacks are
not paying the proper taxes due to invisible transactions whereas the kickback
generators are evading tax in the name of business expense. There is artificial
inflation of medical costs as the kickbacks amount to anything between 40-60%
of medical expenses.  It is destroying
the moral fabric of medical community by making the wrong people rich and
successful. Cut practice is an insidious and horrible practice that hits out at
the very base of humanity. I have now seen the worrying trend of specialist
doctors doing general practice only for the sake of cashing in on this
cut-practice trend.

I
plead to your Kind Lordship to take cognizance of the extreme importance of
this case. A rare case such as Dr Bawaskar’s, is a once in the life time
opportunity to give out a strong message of zero tolerance to
cut-practice.  Cut- practice is a serious
crime. I and others like me, think that it is a matter in the public interest and
does not have sufficient stature or competence to
deliberate on a matter of such national and human importance. It is our humble
plea that the case should be handled by an August and eminently competent body
such as the Honorable High Court itself. The case should be investigated by a
proper agency such as Police or Economic Offences Wing and case pleaded by
proper lawyers. The Honorable Court may deem fit to suo moto issue relevant
guidelines or at least appoint a observer of proven integrity to monitor and
report to the Honorable High Court and His Kind Lordship about the proceedings
in this case.

Enclosures
Contents of application to Medical Council  of India and Maharashtra Medical
Council  under RTI Act 2005
With
Highest Hope from You, Sir
Sincerely,
Dr
Vani B Kulhalli

Maharashtra doctor files case over cut backs

 TNN Jul 7, 2013, 04.34AM IST
(The complainant first wrote…)

 

MUMBAI: Complaints against the medical profession’s unhealthiest procedure – the practice of giving cuts and commissions – has at long last reached the law-makers.
A doctor from rural Maharashtra, who was shocked to get a cheque of Rs 1,200 “for professional services” from a diagnostic chain, has filed a case against cut practice with the Maharashtra Medical Council (MMC), a quasi-judicial body governing the working of the medical profession. The first hearing in the case was held on Saturday.

The complainant, Dr H S Bawaskar who runs a hospital at Mahad in Raigad district, first wrote a letter in April to the Medical Council of India (MCI), which, in turn, directed the complaint to the state branch.

Cut practice is a term used to describe a commission that a doctor from another doctor, hospital or diagnostic gets for referring a patient for consultation, surgery or diagnostic test.

In March, Dr Bawaskar referred a patient named Sunita Veer from Mahad for a CT scan. “I told her she could go anywhere for a scan,” he told TOI. The patient got a scan done at N M Medical Centre located in Sancheti Hospital, Pune.

Following this, Dr Bawaskar got a cheque for Rs 1,200 from N M Medical Centre. “When I enquired about the cheque with the centre, I was told that it is a payment towards professional fees for referring my patient to them,” said Dr Bawaskar.

He wrote a protest letter to the Pune centre and asked it to return the money to the patient instead. The money was subsequently given to the patient.

On Saturday, Rahil Shah, CEO of N M Medical Centre, told TOI that the matter came to their notice only the day before. “It was sudden. At the council meeting on Saturday, we explained that there has been a misunderstanding. The council then said it would deliberate on the matter and decide,” Shah said.

The MCI’s code of ethics for doctors prohibits any rebates and commission to doctors. “The medical profession is already under attack for corrupt practices. The documents attached are aproof of giving kickbacks to doctors/persons sending cases to such centres as a systematic arrangement. This is openly paying a commission or kickback or cut to ensure that the institute gets an assured flow of cases to feed their centre,” said Dr Bawaskar.

MMC chairperson Dr Kishor Taori confirmed that the council was looking at the complaint filed by Dr Bawaskar. “We will listen to the other side as well before giving our judgment,” he told TOI.

But Dr Bawaskar says that his protest isn’t against one institute or centre. “Over the years, many diagnostic centres have tried to offer me commission. One centre in Panvel sent me a note of Rs 500 that I promptly mailed back to them,” he said. In Raigad district, he said, diagnostic centres have different rates for his patients. “My patients pay Rs 2,300 for a scan while patients of other doctor pay Rs 2,700,” he said.

Nashik-based public health specialist Dr Shyam Ashtekar, who has written in support of Dr Bawaskar’s complaint to the MMC, said that cut-backs hit patients hard. “Cost of care, as a result of cut practice, goes up by 30-40% for the patient. Moreover, hospitals or diagnostic chains are forced to conduct extra and unnecessary procedures,” he said. He alleged that hospital software have inbuilt provision to allow for commissions and cutbacks.

 

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