A campaign to take on corrupt medical practice

We work in community health, and three members of our group have been running small nursing homes in the rural areas of Nashik district. Nashik is a booming city, 200 km from Mumbai and has the latest medical university of Maharashtra state.

In October last year, we had sent a patient to a leading private hospital in Nashik for emergency care. The patient, Ms Mangala Gangurde, was suffering from pre-eclampsia and hails from a poor tribal family in Dindori block. We sent her to the private hospital since people are generally unwilling to go to government hospitals in emergency situations.

In January this year, we received a cheque of Rs 1,941 from the hospital. After our initial puzzlement, we realised that this was a ‘cut’ or ‘commission’. We deposited the cheque in our bank, issued a cheque in Ms Gangurde’s name and gave it to her in front of several villagers including two panchayat samiti members. Then we wrote a letter to the hospital saying this was against medical ethics. We sent statements to local papers in Nashik, on the need to act against such unethical practices and to forge corrective mechanisms (two papers, Sakal and Deshdoot, have carried the statement) Meanwhile, we also met some doctors in Nashik to see if a group can emerge around the subject.

The realities of medical practice today are very harsh. The government health sector is demoralised and is working in tandem with the private sector. The private sector has given up whatever values it had in the 1970s. It is throwing in cuts and commissions, parties, favours, even cash advances to all and sundry, including quacks and rickshaw-wallas, to achieve its targets. Unnecessary procedures are on the rise and ‘cutting work’ is the buzzword of today. In a rapid survey of three talukas in Nashik we counted 250 private doctors, three of them MBBS, half with ayurveda, homeopathy and electropathy degrees and half without any. Apart from administering injections and salines for guaranteed incomes, they also get their share of cash from speciality and super speciality hospitals — cuts of anything from 10 to 40 per cent. The cheque we got was just evidence of this deplorable practice.

We could have lodged a complaint with the medical council, but we hope to spark some internal reform in the medical sector by avoiding legal action. The challenge however is daunting.

Are reforms possible? We can roll back the situation as it exists today and bring everything under a public health system; that public systems are also sick in our country is another problem to reckon with. Given the situation, we think there are some ways for reforms. One is to insist on accreditation of health facilities at all levels. This can be either done through existing regulatory mechanisms (Bombay Nursing Home Regulation Act) or an independent body can take this up even as a profitable venture. For the rating system we need to consider the scientific/ technical level of the institute/facility, the ethical and accountability standards, the billing procedures and fee rates.

The second step would be to network with accredited institutes in regional organisations like the health maintenance organisations of the USA, starting from dispensaries to hospitals. With a medical financing component and measures to minimise health risks, such an organisation can be a wholesome answer to our current impasse-high costs and no accountability.

Dr Shyam Ashtekar, On behalf of: Dr Shyam and Ratna Ashtekar, Dr Dhruv Mankad, Dr Arun and Jyoti Gadre, Dr Rajendra and Medha Malose, all from Nashik.

In their letter to the president of the IMA, Nashik, Drs Ratna and Shyam Ashtekar note:

“… The name of the hospital issuing the commission is immaterial and the practice is spreading… We are concerned about this matter and its consequences, such as unnecessary referrals and hospitalisations, procedures for favours; monetary loss to the patient/ consumer; tie-ups with practitioners who do unscientific practices, and permanent damage to the doctor-patient relationship.

“… Such ‘favors’ will definitely hurt all honest practitioners if they do not do something urgently to stop the deterioration… We must not ignore helpless patients who in their hours of ordeal lean on us for life and limb.

“Hospitals like ours in the rural areas have to face several odds and limitations. The sole plank of safety for us is the confidence and faith people have in us. The business of commissions hurts this immunity and the spirit of the medical profession. This is a request to the IMA for urgent action. We feel it is a system-problem, not a problem of hospital A or B.”