New Delhi: In the fourth episode, ‘Every Life is Precious’, of the TV programme Satyamev Jayate, Aamir Khan explored the issue of medical malpractices in India. He said the episode was not about mistakes and negligence that a doctor, being a human being, might be susceptible to do, but the intention behind his various actions, many of which may come under fraud and breach of trusts.
As the programme started, a middle aged man identified as V S Venkatesh said his toes had been amputated by a surgeon to save him from infection, the infection, later he found out, could have been easily cured through medicines. Venkatesh said he spent Rs 2 lakh on the operations, “which were not needed”.
The programme then mentioned about Major Pankaj Rai who has filed a case of medical negligence against doctors who operated his wife, without his consent, and made her go through kidney and pancreas transplant operations in which 60 litres of blood were consumed and which cost Major Rai Rs 8.25 lakh in medical expenses. Major Rai also lost his wife who could not survive the operations. What’s more, the doctors did not even inform the family and switched off their mobile phones.
Dr Anil Pichhar, who runs a pathological laboratory at Santa Cruz in Mumbai, said when he started his lab he was asked by other doctors to pay 40-50 per cent commission for referring patients to his laboratory. Later, due to a personal tragedy, he decided to stop this practice and now charges almost half of the fees he used to charge earlier for conducting lab tests.
Dr Amol Pandit, an oncologist who currently practices in Wales, England, said that after studying abroad when he came to India he was asked by other doctors to pay 30-50 per cent commission for referring patients to him. Even in big hospitals, he found that doctors were advised to exaggerate their patient’s illness so much so that the patient becomes mentally prepared for huge medical expenses. Disappointed, he decided to leave India and began practicing in another country.
At Kowdipally village of Medak district in Andhra Pradesh it was found that many rural women were made to undergo hysterectomy. It is believed that in most of those cases, hysterectomy might not have been medically required. Dr Puneet Bedi, a gynaecologist, said it was impossible to believe that so many women would medically need to undergo hysterectomy.
Describing our medical services as sick, Aamir Khan asked why so many doctors have become ill? What do they need to get well?
In 2001, Dr Ketan Desai, then chairman of the Medical Council of India (MCI), was removed from his post by an order of the Delhi High Court. In his place Major General (Retired) Som Jhingon was appointed. But within a year, Major General Jhingon resigned from his post because he could not tolerate what he had to witness there. According to him, everywhere it was only money — Rs 2-3-4 crore — in the play. For instance, there were professional contractors who would arrange patients, doctors and equipments on rent during the inspection of a medical college. Soon, Dr Desai came back as the chairman of the MCI and remained in that position till the CBI arrested him in a case of corruption.
When Aamir Khan asked Dr K K Talwar, the current chairman of the Board of Governors of the MCI, what’s happening, Dr Talwar said, whatever happening was wrong and that it’s sad for the medical profession. Dr Talwar also acknowledged media reports, which claim students are paying Rs 40-50 lakh donations for getting admission in a medical college. He also acknowledged the practice of deploying rented doctors, rented patients etc during a medical college’s inspection.
When asked what actions the MCI has taken to address these issues, Dr Talwar said, “We need to find a way out. It’s been happening for long and will need some time to fix.” Speaking about the mass hysterectomy in Andhra Pradesh, Dr Talwar said it cannot be justified and that doctors should be ashamed of this. He also assured that it’s his duty to take action in this case.
Talking about the functioning of the MCI Ethics Committee, Aamir Khan said the MCI has revealed in an RTI (Right to Information) reply that since 2008, not a single doctor’s license has been permanently cancelled in India. In comparison, according to Khan, in the UK, the medical license of 42 doctors in 2008, 68 doctors in 2009 and 73 doctors in 2010, were cancelled permanently.
On being asked when a bad doctor’s licence will get cancelled permanently in India, Dr Talwar said, “We will not hesitate to take this action.”
Diagnosing the state of healthcare in India, Dr C M Gulhati, editor of Monthly Index of Medical Specialties, India (a journal on drugs) said, the real problem is in India health is not a top priority. Even today, just 1.4 per cent of the country’s GDP (gross domestic product) is spent on healthcare and according to him, unless it is raised to 6 per cent, the country cannot provide reasonable healthcare to all its citizens.
Since 1990-91, the government policy, according to Dr Gulhati, has been to make government institutions smaller and private set-ups bigger. Agreeing with Dr Gulhati, Aamir Khan said research by his team has revealed that prior to independence, India had 20 government medical colleges and one private medical college. But since 2001, whereas 106 medical colleges have been set-up in the private sector, only 31 medical colleges have been established by the government.
Talking about the incentives given by pharmaceuticals companies to doctors to prescribe their branded drugs, Dr Gulhati said doctors get about 20 per cent commission on the drugs they prescribe to their patients. He also said that pharmaceuticals companies give Rs 1.31 lakh per doctor per year amounting to a total of Rs 12.5 thousand crore. He also pointed out that while in every other field both giving bribe as well as taking it are illegal, in medical line, only taking bribe is illegal, not giving it.
The programme also featured Dr Devi Shetty of Narayana Hrudayalaya who has made good healthcare accessible and affordable to even common man through his various healthcare schemes, including the Yashaswini scheme that covers 40 lakh farmers. Under the scheme, each farmer gives Rs 10 per month and the government contributes Rs 30 for every such farmer. Dr Shetty said people covered by the scheme get all their treatment, including heart operations, if the need be, for free.
When asked how he is able to provide affordable healthcare services to even poor people, Dr Shetty said while he charges rich people Rs 1.40 lakh for a heart operation, the same operation is offered for Rs 60,000 to poor people. Also by doing more operations — 35 heart operations are performed at Dr Shetty’s hospitals per day, he is able to bring cost per operation. He also said that since 12 per cent of the country’s total surgeries are done at his hospitals, he gets surgical goods at a discounted rate from the companies.
According to Dr Shetty, India’s strength lies in its 120 crore people. He said in our country, there are 75 crore people who individually spend Rs 150 per month on their mobile phone. If they can be convinced to pay Rs 10 per month to subscribe a healthcare scheme, they all can get access to good and affordable healthcare services.
Exhorting medical students to listen to their heart and do what they believe to be right, Dr Shetty said, “If you decide to do something good for the society, all the obstacles in your way will start disappearing on their own.”
Dr Samit Sharma, a former doctor and now an IAS (Indian Administrative Service) officer and managing director of Rajasthan Medical Services Corporation (RMSC), raised another issue of how 65 per cent of the country’s population, according to the WHO (World Health Organisation), still cannot afford essential medicines. He said this could be changed if doctors start prescribing generic version of essential drugs. Currently, doctors mostly prescribe only branded drugs, which are costly, as compared to the generic version of the same drugs.
For instance, a branded drug for diabetes, according to Dr Sharma, is sold for Rs 117 whereas the generic version of the same drug is available in the market for just Rs 1.95 per 10 tablets. Similarly, a branded medicine for blood cancer is sold for Rs 1.25 lakh per packet, which lasts for a month, whereas the generic version of the same medicine is sold by three different companies for Rs 10,200, Rs 8,800 and Rs 6,500 per packet. Dr Sharma said India is currently exporting Rs 45,000 crore worth of generic medicines to other countries.
On this, Aamir Khan wondered why doctors don’t prescribe the generic drugs to their patients. Responding to this, Dr Sharma said when doctors start their practice the sales team of various pharmaceuticals companies pressurise and tempt them to prescribe their companies’ branded drugs. Still, he said, all doctors are not bad, even today there are doctors who give free samples to their patients, and in some cases they even pay for the medicines.