Medical School Fraud in India

[azskeptic]

www.indiatoday.com
India Today

February 23, 2004

SECTION: Investigation: Medical Colleges; Pg.64

LENGTH: 3420 words

HEADLINE: Oath Of Hypocrites

BYLINE: Shefalee Vasudev with Amarnath K. Menon, M.G. Radhakrishnan,
Stephen
David, Sanjay Kumar Jha and Sheela Raval

HIGHLIGHT:
India Today exposes how some private, unaided medical colleges fake
the
facilities and flout the Medical Council of India norms, affecting the
credibility and quality of education

BODY:

It was an unlikely phone call. A young Pune doctor was asked by a
prestigious
private medical college if he would be willing to play faculty during a
Medical
Council of India (MCI) inspection. As fees, he was offered Rs 1,000 a
day for
two days-for a branch he had no qualification in. Two days later, on
December
15, 2003, India Today found the Bharati Vidyapeeth Deemed University's
medical
college in Pune geared up for inspection. The MCI team had come to
evaluate
whether the college facilities were adequate for upgrading its student
capacity
from 120 to 150. The hospital car park was overflowing. "Aaj sabhi
doctoron ki
emergency lagi hai (all the doctors are on an emergency today)," joked
the
parking attendant. The corridors were crowded, the OPD was in full
swing and the
residents were readying for a headcount. A guard confided he had been
told not
to limit visitors, even 10 attendants per patient was fine-the hospital
must
look busy. A few doctors even held evening clinics for students, a big
exception.

The next afternoon, after the inspection team had left, the
hospital
corridors were silent. The OPD was lifeless. "First check if the doctor
is
present, then I'll give you a case paper," said the receptionist when
India
Today asked for an orthopaedician during the listed OPD hours. The
deserted look
in the hospital was puzzling. Had so many people suddenly taken ill the
previous
day or was this a particularly good day?

The same day in Mumbai, a report was presented on a high-level
probe into
the working of private medical colleges in Maharashtra. The 700-page
study was
conducted at the behest of Maharashtra Governor Mohammed Fazal, who in
a
September 13, 2003 letter to Chief Minister Sushil Kumar Shinde
expressed
dissatisfaction with the lopsidedness in the fee structure of private,
unaided
medical colleges and the grossly inadequate facilities. He asked for
an
inspection to ascertain if these colleges fulfilled the norms laid down
by
central medical councils.

The subsequent probe by the Medical Education and Drugs Department
found
that of the 17 private MBBS colleges inspected, only one fulfilled the
MCI
norms. Three colleges had a 50 per cent shortage in the professor
cadre, while
four colleges had a shortage of more than 50 per cent in the associate
professor
cadre. This, when the MCI condones only a 5 per cent shortfall. Among
others,
the Bharati Vidyapeeth, whose first batch passed out in 2002, was also
listed
for insufficient teaching and non-teaching staff, inadequate
infrastructure in
some departments, and fewer patients than mandated in the hospital.
However, the
Bharati Vidyapeeth strongly denies the charges. The college registrar
wrote to
India Today, asserting that there was no faculty shortage and that "in
some
departments, faculty members exceeded the normative requirements of the
MCI".

Yet, a few investigators described their experiences in some
private
colleges as "trips to hell". Dr Kalpana R. Sulhyan, dean, Government
Medical
College, Miraj, and a member of the inspection team says that the lack
of
facilities, even in colleges with post-graduate courses, is shocking.
"These
students will become doctors but how will they treat their patients?
This report
is a wake-up call," she says.

Maharashtra Health Minister Digvijay Khanvilkar agrees. "Our worry
is that
medical education is becoming more of a business than a noble service,"
he says.

A number of instances where basic norms of training have been
violated
indicate that private medical education in India has turned into a
shady and
cynical commerce. Maharashtra is its thriving hub, but the problem
spills over
into other states too. The major suspects are the new unaided, private
colleges
mushrooming across the country. In the past four years, 26 private
colleges have
come up in Andhra Pradesh, all conspicuous for their inadequacies. In
Kerala,
six new colleges with 100 seats each have been set up; to begin with,
there were
45 applicants. Karnataka has 13 new colleges with 3,300 medical seats.
With 16
more colleges scattered across other states, in all, 60-odd colleges
have come
up in the past five years. Appallingly, some have got provisional
registrations
from the MCI despite obvious shortcomings.

The MCI is the central regulatory body that controls medical
education,
recognition and approval of colleges. There is a clear charter for the
establishment and functioning of a medical college, including the
space
required, the requisite number of faculty members and non-teaching
staff, and a
well-defined infrastructure for classrooms, clinical and para-clinical
departments.

The Dental Council of India (DCI) too has similar guidelines for
dental
colleges. But most of the norms are being openly flouted, the rules
randomly
bent. Dr Kesavan Kutty Nair, the Thiruvananthapuram-based MCI
president, agrees
that the system needs a massive clean-up. "The allegations that
institutions did
not have the required infrastructure, clinical material and faculty
were true in
some cases," he admits. Rules are also flouted during admissions.
According to
MCI, admissions can only be made through the Central Entrance Test and
no
college can advertise for a medical seat or conduct private entrance
tests.
However, a report by an expert panel of the Maharashtra wing of the
Students'
Federation of India cites an advertisement placed by the two D.Y. Patil
medical
colleges at Nerul and Pimpri in the March 11, 2003 edition of Sakal, a
Marathi
newspaper.

Research is a lofty term because even basic training seems hard to
come by.
Take Nashik's MG Vidyamandir Dental College. On December 17, 2003, the
college's
peak OPD time coincided with an exam for failed students. But as India
Today
found, no examiner turned up till an hour after the scheduled time.
Students
were also found pleading with the few patients present to volunteer as
subjects-mandatory for taking the exam. The few who agreed promptly
disappeared
when the power went off. The college has a DCI clearance to teach 100
students.
"Medical students learn with the help of patients, not on machines. But
where
are the patients and what is the quality of education imparted?" asks
Dr
Ravindra Bapat, vice-chancellor, Health Sciences University,
Maharashtra. He had
also written to the Maharashtra governor, apprising him of the "real"
state of
private colleges.

Hitesh Kakadia, a student of the MG Vidyamandir Dental College who
has been
waiting for four years to get his degree, concurs. "The hospital may
look great,
but where are the patients?" he asks. Kakadia accuses the college
authorities of
deliberately detaining him and not providing the facilities that the
students
are charged for. He also claims that he took incriminating documents to
the DCI
officials during an inspection, but that he was refused a hearing.

DCI's Delhi-based President Dr R.K. Bali expressed ignorance of
the
Maharashtra report and other allegations. Angry students, however,
allege that
the college campus and hostel are used to run other academic courses
and
signboards keep changing to suit the particular inspection. But
hospital
coordinator Professor V.M. Aurangabadkar denies the allegations,
including those
of Kakadia. He insists that the hospital gets more than 150 patients
every day
and that fines or separate fees for entering the exam halls are unheard
of.

To hide their shortcomings and cover up the lapses, many colleges
resort to
tricks-setting up fake wards, hiring fake faculty or listing private
practitioners as full-time faculty. The Maharashtra report quotes a
team member
who found that a patient on traction in an orthopaedic ward had
disappeared
within 10 minutes of inspection, assuming that the team would not
return. Such
cases validate the alarm sounded by Dr Dayanand Dongaonkar, former dean
of Grant
Medical College, Mumbai, and former vice-chancellor of Maharashtra
Health
Sciences University, who detected several inconsistencies during his
tenure.
"Even reputed institutes were presenting fake teachers," says
Dongaonkar, who
found doctors practising in other cities listed as full-time faculty.

These gimmicks are not peculiar to Maharashtra. On December 26,
2003, a
couple of regional TV channels in Andhra Pradesh telecast reports
alleging that
the Bhaskara Medical College at Moinabad in Ranga Reddy district had
arranged
fake patients and got medical students to pose as doctors and nursing
students
as staff nurses. But B. Surender Rao, principal of the college that is
awaiting
clearance for registration, refutes the charges. "It is wrong to
believe that we
do not have competent faculty and have presented nursing students as
staff. We
offer free medical service and transport for those coming to the
hospital. Is
there anything wrong with it?" he asks.

Meanwhile, Maharashtra activist Maruti Bhapkar alleges a corrupt
pact
between the D.Y. Patil Women's Medical college at Pimpri and the local
municipal
corporation, saying that children were brought from a nearby orphanage
to
increase bed occupancy for an inspection in 2003. When India Today
visited the
orphanage-Niradhar Balsangopan at Dapodi village near Pimpri-Malan Balu
Tulve,
its aggressive owner, threw out the team saying she had taken the
children for a
"check-up". She failed to explain why the 50-odd children suddenly
needed to be
"checked up". Dean D.L. Ingole denies it outright: "There is no
question of
bogus patients or wards. The vested interests of some locals are behind
these
accusations."

But the various allegations against the MCI itself suggest that
inspections
can be manipulated. The MCI's image took a beating in 2001 when its
then
president Dr Ketan Desai was suspended by the Delhi High Court. The
charges
included large-scale bungling in admissions and manipulation of
inspection
records of two medical colleges in Pune and Ghaziabad for granting
them
recognition. "The MCI often acts in a whimsical, idealistic manner,"
agrees
Karnataka Medical Education Minister Dr A.B. Malakaraddy. The issue was
also
raised in the Karnataka Assembly which debated the MCI's methods of
granting
recognition to some colleges.

Nair, however, assured India Today that the controversial practices
were
being done away with. "Applicant colleges are no longer allowed to
arrange for
the accommodation of MCI teams," he says. Yet, there is enough evidence
to show
that colleges continue to get recognition by hook or by crook with no
regard for
the impact of such practices on the students' careers.

Ever since the Supreme Court's October 2002 ruling in the T.M.A.
Pai case-50
per cent admissions on merit and the remaining on the management's
discretion-the private medical education industry has been on an
unprecedented
high. The judgement condemned profiteering, but the allowance of
"reasonable
surplus"-money paid in addition to the tuition fees-was left to broad
interpretation. "Management quota" is a litany of corrupt practices. It
is
either reserved for rich NRIs or is governed by influential people and
the seats
can be bought and sold. The Pushpagiri Institute of Medical Sciences
and
Research, Kerala, made more than Rs 8 crore last year even before the
first
batch had begun classes. As opposed to 50 per cent seats to be given at
the
college management's discretion, 75 out of a 100 seats were filled for
cash. The
capitation fees-between Rs 4.5 lakh and Rs 22 lakh-exceeding the
"reasonable
surplus" that colleges are allowed for development work. "The college
managements did not keep their word, causing the Government much
embarrassment,"
laments Chief Minister A.K. Antony.

The disproportionate earnings by colleges have been underlined in
another
incriminating study. Undertaken by the Institute of Cost and Works
Accountants
of India, it exposed large- scale manipulation of accounts in private
medical
and dental colleges of Maharashtra. The study found that in order to
hide
profits, college records showed inflated costs and expenditure as
compared to
their earnings.

No wonder the students are restive. Those thrown out of equalised
competition because they have no money are disillusioned, while those
who have
paid fat amounts to secure admissions-the going rate of capitation fees
is Rs 10
lakh-Rs 25 lakh per medical seat across the country-feel cheated.
Baljeet Singh
Khera of the Darbhanga Dental College waited six years for his degree,
while for
Jafar Iqbal, president of the students' federation, it was a 12-year
wait. The
college kept running into problems with the Mithila University and was
finally
de-affiliated in 2001 for continuing without an NOC from the state
government.
The matter rests with the Patna High Court but infuriated students who
attempted
mass suicide in June last year, left Bihar Governor M. Rama Jois, who
is the
university chancellor, at a loss for words.

An impassioned protest was also held by students in July 2003
against the
D.Y. Patil Women's Medical College, Pimpri, alleging auction of seats,
poor
facilities and failure to fill up vacant faculty posts. Dongaonkar,
then
chairperson of the Maharashtra Fee Fixation Committee, admits that
talks between
parents and college managements were only blame games. There is
lukewarm or no
response from the authorities despite litigation and protests because
many
colleges are owned by politicians, allege local activists.

The politician-promoter nexus is evident in many states. In Andhra
Pradesh,
some private colleges have managed to get NOCs by lobbying with the
ruling TDP
politicians. Others have got the go-ahead from the Health Ministry
without a
clearance from the MCI. In Maharashtra, at least seven colleges are
owned or
supported by politicians.

"In many cases, the doctors are to be blamed. If they don't comply,
nobody
can perpetuate these wrongdoings," says Dongaonkar. The disloyalty to
the
Hippocratic oath has impaled doctors on their own scalpels. Experts
from around
the country say that colleges are being set up to serve vested
interests and
that many states don't need them at all. "Medical education is not
based on the
health needs of the country," says Bapat. He has requested the
Maharashtra
governor to ban new colleges for two years. The Karnataka Government's
Task
Force on Health, chaired by Dr H. Sudarshan, a senior activist and
doctor from
Mysore, has also urged a two-year moratorium on setting up new
colleges.

The MCI president asserts that on the Supreme Court's instructions
a massive
operation has been launched to ensure that the MCI functioning is
rendered
foolproof and transparent. Also, an ad hoc committee of three doctors
has been
constituted for the overall supervision of the MCI. Surprise
inspections and
insistence on affidavits for personal and professional identification,
proof of
work place, salary slips and income-tax return receipts are now sought
to
doublecheck the claims of the colleges and doctors. In Andhra Pradesh,
meanwhile, a panel has been set up under Dr Kakarla Subba Rao,
director, Nizam's
Institute of Medical Sciences, Hyderabad, for a high-level inspection
of the new
colleges in the state.

The situation is worse in many of the Unani, ayurvedic,
homoeopathic and
allied sciences colleges. The MCI needs to indulge in introspection,
says Father
Sebastian Ousepparampil, former administrator and associate director of
St John
's Medical College, Bangalore. "Are all the requirements laid down for
new
colleges justified or is the unwarranted list of demands forcing the
colleges to
resort to malpractice?" he asks.

The MCI and the government must urgently address the issues that
leave a
question mark on the quality of medical education in the country.
Worse, the
credibility of doctors churned out by such institutions will always be
suspect.

-with Amarnath K. Menon, M.G. Radhakrishnan, Stephen David, Sanjay
Kumar Jha
and Sheela Raval

BOX 1

LAPSE 1: SHORTAGE of faculty and patients, inadequate training.

THE FIGHTER

"The college looks great but where are the patients for us to train
with?"

Hitesh Kakadia, student

According to a December 2003 report on a probe by the Medical
Education and
Drugs Department, Maharashtra, the MG Vidyamandir Dental College,
Nashik, had
insufficient faculty and only 50-60 patients a day, inadequate for 100
students.

On December 17, 2003, India Today witnessed several students
pleading with
the few patients present to volunteer as subjects for their
examination.

Students also accuse the college authorities of misusing the campus
and
hostel for other vocational courses and charging heavy penalties for
petty
offences.

BOX 2

GETTING AWAY WITH FLOUTING MCI RULES

LAND: The MCI specifies a 25-acre single piece of land to be used
exclusively for an MBBS college and hospital, with no lease allowed for
any
commercial or academic purpose.

HOSPITAL BEDS: A 300-bed hospital is required to teach 100 students
and
should be upgraded to 500 beds in five years with at least 80 per cent
occupancy.

FACULTY: The MCI specifies 17 professors, 29 associate professors,
48
lecturers and 227 non-teaching staff for 100 students. There are also
norms for
physical and clinical infrastructure.

NO-OBJECTION CERTIFICATE: Only after getting an NOC from the
concerned
university and state government can a college approach the MCI for
registration.

Many colleges blatantly use their campuses for conducting other
courses,
including those on engineering, allied health sciences, vocational
courses, even
junior colleges in some cases.

Many teaching hospitals have been functioning with inadequate
patients in
the out-patient departments. A few colleges don't even have their own
hospitals.

Many teaching hospitals have insufficient faculty, even less than
50 per
cent of the required number. Honorary part-timers, including those with
private
practices, have been listed as full-timers.

Some colleges have directly sought approval from the Central
government
without a no-objection certificate from the state government or an MCI
clearance.

BOX 3

LAPSE 2: HIRING OF FAKE STAFF AND PATIENTS DURING INSPECTIONS

On December 26, 2003, a couple of regional TV channels in Andhra
Pradesh
telecast reports alleging that the Bhaskara Medical College had
arranged fake
patients and hired medical students to pose as doctors and nursing
students as
staff nurses during an MCI inspection. The college denies this.

As many as 26 private medical colleges have been set up in Andhra
Pradesh in
the past four years, many conspicuous for their inadequacies.

BOX 4

PROBE REPORT

Damning Findings

A high-level investigation into private health science institutions
in
Maharashtra was conducted last year and the report submitted in
December 2003.
As per the findings, out of 17 private, unaided colleges, only one
fulfilled all
the MCI norms.

A majority had up to 50 per cent faculty shortage and the
hour-basis
honorary doctors were found to be working on meagre salaries.

Two colleges did not have their own hospitals.

As many as 95 per cent of teachers in dental colleges were not
approved by
the Maharashtra University of Health Sciences.

There was a dearth of equipment and para-clinical material in
almost all the
medical colleges.

BOX 5

LAPSE 3: MCI WAKES UP LATE

The MVJ Medical College and Research Hospital at Channasandra on
the
outskirts of Bangalore did not have a hospital that fulfilled the MCI
norms, but
continued to teach for two years. Finally, the MCI struck down its
registration
for the year 2003-4.

BOX 6

LAPSE 4: DELAY IN DEGREES

In 2001, the Darbhanga Dental College was de-affiliated from the
Mithila
University because it didn't have an NOC from the Bihar government. The
students
continue to wait for their degrees.

BOX 7

REMEDIES

A New Order

The MCI should be reformed. The number of members nominated by the
Central
and state governments should be reduced. Instead, industry
representatives like
chartered accountants and administrative experts should be included in
the
council.

Greater autonomy can help increase the MCI's effectiveness. To
improve the
enforcement of rules, surprise visits should be conducted and
prohibitive
penalties imposed for non-compliance.

Admission procedures should be completely transparent with details
made
available to the public.

Annual perspective plans should be introduced to assess the need of
medical
colleges in a state.

Merit criterion should be introduced even for the NRI seats and
management
quota.