What the country urgently needs is a thorough clean-up of all medical education and regulatory bodies at the state and central levels

File photo from 2010 of former Medical Council of India president Ketan Desai

The Vyapam scam in Madhya Pradesh has exposed the underbelly of medical education and its criminalisation in India. The brazenness with which entrance exams and recruitments have been conducted was only possible due to collusion of sections of all instruments of the State – politicians, the judiciary and bureaucracy – with businessmen, medical professionals and even journalists. Senior members of the medical profession have been actively involved in this scam with monetary exchange of an order that may never be known.

After a lengthy silence, the national media is now reporting extensively on the scam and much of the debate has focused on the misrule of the Bharatiya Janata Party government in the state. In our view, however, Vyapam is not restricted to Madhya Pradesh. The scam is pervasive and could well cover many other states ruled by other political parties. Governments in other states are not above board in matters relating to the recognition and licensing of medical colleges, conducting entrance tests, and collecting capitation fees and bribes for admission and award of degrees. The extensive corruption in medical education represents both a political and an institutional crisis.

The authority of the Medical Council of India, which is the apex regulatory body for medical education, has been systematically undermined due to the flouting of rules for monetary gain. The MCI and the State Medical Councils play an important role in setting and implementing guidelines for the curriculum, entrance exams, ethical standards and practices of doctors. However, in practice, the MCI has reneged on its responsibility to enforce standards. It has been widely reported that an important reason for this failure was the deep-seated corruption in the MCI over which Dr. Ketan Desai, former council president, and members of the board presided.

One of us, Rama Baru, was a member of the Ethics Committee of the MCI a few years ago and we are thus privy to information about malpractices and CBI chargesheets against Ketan Desai and several private medical colleges in south India.

In fact, our knowledge of corrupt practices in the MCI dates back to 2001 when Desai was charged with misuse of office and the Delhi High Court ordered his removal from the post, opining that:

“The allegations of [the] petitioner against Dr. Ketan Desai regarding minting money stands established. He has misused his position as President of the MCI. He is using the office for making illegal monetary gains for himself and his family members. Prima facie a case for prosecution of Dr. Ketan Desai on charges of corruption under the Prevention of Corruption Act is clearly made out”.

Despite this indictment he continued to remain in office.

 In 2009, Desai managed to get elected unopposed as MCI president. In 2010, the Central Bureau of Investigation charged him with accepting a bribe of over Rs. 2 crore for granting recognition to a private medical college in Punjab. Soon after his arrest, the CBI also raided his home in Gujarat and filed additional charges for having “disproportionate wealth” estimated at around Rs. 1,800 crores. Subsequent to this, Desai’s medical registration was cancelled by the MCI. This received media attention and there was pressure from civil society that led to the dissolution of the MCI by the government. The Centre then appointed a seven member committee to oversee the functioning of MCI, as an interim arrangement before fresh elections could be held.

It is during this period that the Ethics Committee heard several cases of fraud in the recognition of private medical colleges and the conduct of entrance exams in several states. The Ethics Committee had recommended the de-recognition of these colleges and punishment for the erring doctors. Many of these recommendations were ratified by the Board of Governors but others were not acted upon due to the dissolution of the interim Board.

A dodgy election

In October 2013, the Centre announced the constitution of the new MCI with a representative body. However, even though Ketan Desai’s licence has remained derecognised since 2010, he managed to nominate himself from the Gujarat State Medical University. When questioned he said, ‘that the MCI has no jurisdiction or authority to suspend the registration of any doctor registered with any state medical council’. The elections were conducted on December 11, 2013 for the post of president, vice president and executive/post graduate committee members and the new MCI was constituted.

The way in which these elections were conducted amounted to manipulation by a small mafia of doctors who had a hold over the MCI and State Medical Councils. A writ petition filed by Dr. Kunal Saha, President of an NGO called People For Better Treatment (PBT) pointed out that all major officers of the council were elected unopposed. These members were close associates of Desai. It is well known that a day before the election, Desai hosted a party. Most of the nominated members who were close to him attended the party. He printed a list of members for the major posts and explained who will nominate who’s name (“proposers”) and those who will support these nominations (“seconders”) for the next day’s election. A formal complaint was made by a newly elected member (Balbir S. Tomar) that the process of election was a fraud. The Hindu reported that Tomar “had said that the MCI lacked a formal and ethical structure for nominating its members. The nomination procedure in the MCI got over in just 10 minutes against the officially stipulated procedure that requires two days of deliberations.”

It is relevant to note that Ketan Desai had the support of several politicians cutting across all political parties, including the top leadership of the Samajwadi Party, Congress Party and Bharatiya Janata Party. As a result, when Keshav Desiraju, a distinguished and upright IAS official who was he Union Health Secretary at the time, took the view that the pending CBI charges against Desai made him ineligible for contesting the MCI elections, he was transferred by the then Congress-led UPA government.

It has also been reported that the Central Vigilance Officer, Harish Kumar Jethi, who was appointed in 2013, requested repatriation to his parent department, citing reasons of harassment and lack of co-operation from the president and several officials of the MCI in his efforts to deal with corruption. When Dr Harshvardhan was appointed Union Health Minister by Narendra Modi in May 2014, he showed some resolve in seeking to clean up the MCI but he was soon dropped from the cabinet. While the ‘tobacco lobby’ was accused of seeking the minister’s removal, it is entirely possible that the ‘medical mafia’ may have contributed to his ouster.

The Vyapam scam has opened a Pandora’s Box that the MCI has tried hard to shut. While this scam, including the death of several people connected with medical education, both private and government, should be investigated on its own terms, it should encourage concerned citizens, the medical profession and the government to undertake a thorough review and reform of medical education and of its regulatory bodies, both at the state and Central levels.

Rama Baru is a Professor at the Centre of Social Medicine and Community Health, JNU
Archana Diwate is a Research Scholar at the Centre of Social Medicine and Community Health, JNU