Team Anna: What about medical corruption?

The Hazare movement and media have focussed on corruption of the 'spectacular' variety. But what has escaped the discussion is the institutionalised corruption in-built in the conduct and practice of professions like the medical profession in India, says Dr Sanjay Nagral.

Throughout the tumultous days of Anna's fast I received messages from doctor colleagues and medical associations to participate in protest actions. Some like the Indian Medical Association and the Association of Medical Consultants actually joined various public actions.

I cannot remember these associations supporting any 'non medical' movement that doesn't directly concern the practice of medicine in the past. Their activities are generally confined to seminars, relief work, social gatherings or campaigns to defend doctors. They largely function as guilds of doctors. So in a sense they seemed to have broken new ground in openly supporting what is an avowedly anti-establishment movement.

One could regard this as yet another example of the 'awakening' of the educated middle class, that Anna's movement seems to have achieved. After all, who can deny that doctors are good representative symbols of this class?

But such new enthusiasm by medical associations also brings up an important contradictory dimension about the participation of professionals in the anti-corruption movement in India. The medical profession in this country exemplifies this paradox in many ways. There are certain dominant forms of corruption that are currently in the public domain.

The Hazare movement and the media have focussed on the mega scams or the corruption of the 'spectacular' variety. Then there is the 'petty' corruption of the day to day type that all of us engage with either as bribe givers or whine about as social critics.

But what has escaped the discussion it deserves is the institutionalised and internalised form of corruption that is in-built in the conduct and practice of professions in India. It is so impregnated and long standing that one has ceased to even recognise it as corruption. And this is the variety where unknowingly or knowingly the main protagonist is not the State or politicians, but educated professionals themselves.

The practice of medicine in India has several telling examples of this form.

Take the commercialisation of education in the form of private medical colleges where seats are sold through underhand dealings. What is pertinent to this discourse is the level of collusion with this market by institutions, medical teachers and medical practitioners.

Private medical college empires have grown because they have managed to hire and retain medical teachers, set up arrangements with hospitals to provide 'clinical material' in the form of patients and get recognition for postgraduate courses from inspection teams consisting largely of doctors.

Many doctors' children study in these colleges. Thus not only is there no internal resistance to both the idea and practice of the sale of medical seats, but it has been co-opted as an acceptable form of medical education. A more revealing example is something that plays out in daily medical practice.

It would be no exaggeration to say that a significant proportion of medical practice in India, especially in the dominant private sector is conducted through the payment of 'commissions' or more colloquially called 'cuts'. These are cash transactions, not revealed in official documents and arbitrary in amount. This all pervasive practice operates for patient referral from family doctor to specialist, doctor to hospital, pathology and radiology clinics.

What qualifies this activity as 'corrupt' is the fact that it is non transparent and secretive especially for the patient. Besides, of course, it increases the cost of health care and affects quality. Again, this practice has been internalised and legitimised by its sheer scale and acceptance in the profession. Hardly any medical association ever --including the ones who have joined Hazare -- have ever tried to build internal resistance or opposition to such a patently corrupt practice.

Our profession has, of course, also had its share of 'spectacular' corruption. In 2010, Dr Ketan Desai, president of the Medical Council of India, ex-president of the Indian Medical Association and president-elect of the World Medical Association, was arrested by the Central Bureau of Investigation on charges of corruption and sacked by the central government as president of the MCI. He is now cooling his heels in Tihar jail.

Desai amassed crores of rupees (one estimate pegs the amount of money recovered from the raid on his home at Rs 1,800 crores or Rs 18 billion), essentially from the lucrative business of recognition of medical colleges.

Incidentally, Desai had been repeatedly indicted by various courts and had been temporarily sacked in 2002, but staged a return. Thus such an individual not just survived, but actually thrived for an entire decade at the highest levels in the Indian medical establishment, both as the president of the Medical Council as well as the Indian Medical Association, due to a certain permissiveness of his constituency and peers.

This is also a reflection of a tolerance and ambivalence medical professionals have developed towards internal corruption in their own representative bodies.

It is easier and safer for a professional to symbolically identify with the Hazare movement, but much more challenging and daring to question internal corruption at one's workplace. Over the last two decades we have tried to raise issues related to the ethics of practice of medicine in India through a publication, but have met with a considerable resistance from doctors and their organisations to speak out openly and identify with the cause.

Whatever way the Hazare movement finally goes, if it serves to stir up some self introspection amongst educated, elite professionals it could be an important long-term gain. When the dust and noise of the spectacular settles it may be worth remembering to turn our gaze inwards.

Dr Sanjay Nagral is a Mumbai-based surgeon.