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 There was nothing wrong with Chaudhry; he was accompanying his
brother, who had a back problem. But “every person was told to lie
in a bed even if they’re not sick,” he said. The 20-year-old
electrician said he never saw any foreign physicians that day, but
the hospital’s Indian doctors kept checking that the phony patients
were in bed. “They wanted to make sure no one escaped,” he said.
That was the same month government inspectors visited the hospital,
which is at Muzaffarnagar Medical College, 80 miles northeast of New
Delhi. The inspectors checked, among other things, whether there
were enough patients to provide students with adequate clinical
experience. They determined there were.
But a year earlier, inspectors had found that most of the college
hospital’s outpatients “were fake and dummy and seems to be hired
from nearby slum area,” according to the official report. “In
pediatric ward all children were admitted ... without any medical
problem and were hired from nearby area!!!!!”
“I am not very keen to reply,” said Dr. Anil Agarwal, the school’s
principal, when asked about the episode with Chaudhry.
India’s system for training doctors is broken. It is plagued by
rampant fraud and unprofessional teaching practices, exacerbating
the public health challenge facing this fast-growing but still poor
nation of about 1.25 billion people.
The ramifications spread beyond the country’s borders: India is the
world’s largest exporter of doctors, with about 47,000 currently
practicing in the United States and about 25,000 in the United
Kingdom.
SCHOOLS AND SCANDALS
In a four-month investigation, Reuters has documented the full
extent of the fraud in India’s medical-education system. It found,
among other things, that more than one out of every six of the
country’s 398 medical schools has been accused of cheating,
according to Indian government records and court filings.
The Reuters probe also found that recruiting companies routinely
provide medical colleges with doctors to pose as full-time faculty
members to pass government inspections. To demonstrate that teaching
hospitals have enough patients to provide students with clinical
experience, colleges round up healthy people to pretend they are
sick.
Government records show that since 2010, at least 69 Indian medical
colleges and teaching hospitals have been accused of such
transgressions or other significant failings, including rigging
entrance exams or accepting bribes to admit students. Two dozen of
the schools have been recommended for outright closure by the
regulator.
Paying bribes – often in the guise of “donations” – to gain
admission to Indian medical schools is widespread, according to
India’s health ministry, doctors and college officials.
“The next generation of doctors is being taught to cheat and deceive
before they even enter the classroom,” said Dr. Anand Rai. He
exposed a massive cheating ring involving medical school entrance
exams in the central Indian state of Madhya Pradesh in 2013. Rai was
given police protection after he received death threats following
the bust.
The poor state of India’s medical education reflects a health system
in crisis. The country has the highest rates of mortality from
diarrhea, pneumonia and tuberculosis, creating pressure to train
more physicians. Patients are regularly denied treatment at public
hospitals that are so overcrowded, often the only way to see a
doctor is to pay a bribe.
The causes of the crisis are manifold: Too few doctors. A
government-backed surge in private medical schools which, to boost
revenue, frequently charge under-the-table fees for admission.
Outdated government regulations that, for example, require college
libraries to keep paper copies of medical journals and penalize
those that subscribe instead to online editions.
Charged with maintaining “excellence in medical education” is the
Medical Council of India (MCI). But this government body is itself
mired in controversy. Its prior president currently faces bribery
allegations. The council is the subject of a mountain of lawsuits,
many of them pitting it against medical schools challenging its
findings. The cases often drag on for years.
“The best medical schools in India are absolutely world class,” said
David Gordon, president of the World Federation for Medical
Education. But, he added, the Indian government’s process of
accrediting a “huge” number of recently opened, private medical
schools “has at times been highly dubious.”
India has been rocked by a series of recent medical scandals,
including doctors accused of serious crimes. In November, a group of
junior doctors at a medical college in the eastern city of Kolkata
allegedly tied a suspected mobile phone thief to a pillar, slashed
him with a razor and beat him to death with bamboo sticks, according
to local police. Nine of the accused men remain in jail; they deny
murder charges, say lawyers involved in the case. Three suspects
remain at large.
THE SCALPEL THROWER
The system’s problems are felt abroad, too. Tens of thousands of
India’s medical graduates practice overseas, particularly in the
United States, Britain, Australia and Canada. All of these countries
require additional training before graduates of Indian medical
schools can practice, and the vast majority of the doctors have
unblemished records.
But regulatory documents show that in both Britain and Australia,
more graduates of Indian medical schools lost their right to
practice medicine in the past five years than did doctors from any
other foreign country.
In the United Kingdom, between 2008 and 2014, Indian-trained
doctors were four times more likely to lose their right to practice
than British-trained doctors, according to records of Britain’s
General Medical Council. (The U.S. and Canada lack publicly
available centralized databases of disciplined doctors.)
The British cases include that of Dr. Tajeshwar Singh Aulakh, who
received his medical degree in 1999 from Punjabi University in
Patiala, India, according to Indian government records. He was
assisting during a hip operation in 2008 in Shropshire, England,
when he allegedly grabbed a scalpel, slashed the patient’s stitches
and threw it toward a nurse, according to British government
records. The United Kingdom later struck him off its list of
approved physicians. He could not be reached for comment.
The Australian cases include that of Dr. Suhail Durani, who
graduated from an Indian government medical college in the northern
city of Jammu in 2003. He was imprisoned in Perth for more than 18
months after being convicted in 2011 of sexually assaulting a female
diabetic patient who had shown up in the emergency room with
symptoms of a potentially serious illness.
In an interview, Durani maintained his innocence and described his
medical training in India as excellent. He currently is not
practicing medicine.
Dr. Ramesh Mehta, vice president of the Global Association of
Physicians of Indian Origin, said there are “major problems” with
some private Indian medical schools. But he added that a doctor’s
success depends as much on “personality and attitude” as on his or
her college training.
FAKE DEGREES
About 45 percent of the people in India who practice medicine have
no formal training, according to the Indian Medical Association.
These 700,000 unqualified doctors have been found practicing at some
of India’s biggest hospitals, giving diagnoses, prescribing
medicines and even conducting surgery.
Balwant Rai Arora, a Delhi resident in his 90s, said in an interview
that he issued more than 50,000 fake medical degrees from his home
until his forgery ring was broken up by the police in 2011. Each
buyer paid about $100 for a degree from fictitious colleges. Arora
was twice convicted and jailed for forgery.
“There is a shortage of doctors in India. I am just helping people
with some medical experience get jobs,’’ said Arora. “I haven’t done
anything wrong.”
India currently has about 840,000 doctors – or about seven
physicians for every 10,000 people. That compares with about 25 in
the United States and 32 in Europe, according to the World Health
Organization.
The shortfall has persisted despite India having the most medical
schools of any nation. That’s because the size of graduating classes
is small – typically 100 to 150 students.
Indeed, gaining admission to India’s top medical schools is akin to
winning the lottery. The All India Institute of Medical Sciences in
New Delhi has been rated the best medical school in India Today
magazine’s past five annual surveys. According to the registrar’s
office, it takes in only 72 students for its undergraduate course
each year out of about 80,000 to 90,000 who apply – an acceptance
rate of less than one-tenth of one percent. As in the United
Kingdom, most medical school students attend an undergraduate
program.
Similarly, Christian Medical College, a top-ranked school in the
southern city of Vellore, received 39,974 applications this year for
100 places, according to a school official – an acceptance rate of
0.25 percent. By contrast, the acceptance rate at Harvard Medical
School for its entering class in 2014 was 3.5 percent.
Health ministry officials and doctors say India’s medical-education
system began to falter following a surge in new, private medical
colleges that opened across the country during the past few decades,
often in remote areas.
[to top of second column] |
In 1980, there were 100 government-run medical schools and 11
private medical colleges. Thirty-five years later, the number of
government medical colleges has nearly doubled. The number of
private medical schools, meanwhile, has risen nearly twenty-fold,
according to the Medical Council of India. There are now 183
government medical colleges and 215 private ones.
'LITTLE BETTER THAN QUACKS'
Many of the private colleges have been set up by businessmen and
politicians who have no experience operating medical or educational
institutions, said MCI officials. Sujatha Rao, who served as India’s
health secretary from 2009 to 2010, said the boom in private
colleges was driven by a change in the law in the early 1990s to
make it easier to open new schools because the government was
struggling to find the money to build public medical schools.
“The market has been flooded with doctors so poorly trained they are
little better than quacks,” Rao told Reuters.
Not that a legitimate degree necessarily makes a difference.
A study in India published in 2012 compared doctors holding medical
degrees with untrained practitioners. It found “no differences in
the likelihood of providers’ giving a diagnosis or providing the
correct treatment.” The study, funded by the Bill & Melinda Gates
Foundation, concluded that in India, “training in and of itself is
not a guarantor of high quality.”
Last year, an individual described as a “concerned” student at a
rural government medical college in Ambajogai, in western India,
posted a letter online with a litany of allegations about the
school, Swami Ramanand Teerth Rural Medical College.
There were professors who existed only on paper, he alleged, and “no
clinics and no lectures” for students in the medicine and surgery
departments. Conditions were unsanitary at the hospital, and pigs
and donkeys roamed the campus, he wrote. The writer also alleged
that students had to pay bribes to pass exams.
“We are not taught in this medical college,” the letter stated.
Students have graduated “without even attending a single day.” The
writer said the letter had been sent to various government agencies
and health officials.
Records from the Medical Council of India, the body charged with
maintaining the country’s medical education standards, show that an
inspection of the college this January found numerous deficiencies,
including a shortage of faculty, residents and lecture theaters.
Dr. Nareshkumar S. Dhaniwala, who served as the principal of the
college between 2011 and 2013, said “there is some truth in the
letter.” Animals, such as pigs and cows, do roam the campus,
teachers and students don’t turn up for lessons, and there is a
scarcity of running water in the dormitories, he said. And before he
joined, he said, he heard students had to pay to pass final exams.
“I found the students were not very interested in studying, they
don’t come to classes, they don’t come to clinics,” Dhaniwala said.
“Medical education has gone downhill all over the country because
the teachers are not as devoted as they used to be.”
Sudhir Deshmukh, the college’s current principal, did not respond to
requests for comment.
The Medical Council of India, which was established by the
government in 1934 and oversees medical education, has itself been
swirling in controversy. Dr. Ketan Desai, the council’s former
president, faces criminal charges related to his arrest in 2010 for
allegedly conspiring to receive a bribe to recommend authorizing a
private medical college to accept more students. The case is still
pending; Desai has denied the charges.
'JUNK BODY'
In interviews, medical school officials complained that the MCI had
onerous inspection requirements that were outdated and arbitrary.
“The Medical Council of India is a junk body,” said Dr. A. K.
Asthana, principal and dean of Subharti Medical College in the
northern city of Meerut, which has been accused of demanding illegal
fees for admission. Asthana denies the allegations. The council has
tried – unsuccessfully so far – to close the school. “I’m totally
frustrated with the MCI. Totally frustrated,” he said.
Dr. Vedprakash Mishra, the head of MCI’s academic committee, told
Reuters that the agency has created “discipline and accountability”
among medical colleges by imposing fines and, in several cases,
prohibiting schools from admitting students for up to two years. “We
don’t compromise and mitigate on the requirements,” he said.
Asked about allegations of corruption within MCI itself, Mishra
abruptly ended the interview. “This is not what I want to be
discussing,” he said.
Under the government’s current regulations, private medical colleges
generally must have campuses on at least 20 acres of land. Because
urban real estate in India is expensive, many schools open in rural
areas where recruiting qualified, full-time doctors to teach is
difficult because pay scales are low and living conditions are
tough.
Interviews and MCI records show that some private colleges solve the
problem by cheating – they recruit doctors to pose as full-time
faculty members during government inspections. The physicians work
there for just a few days or weeks. Two MCI officials estimated that
there are several hundred Indian companies involved in recruiting
them.
In October, a doctor in New Delhi received an email from a local
company called Hi Impact Consultants with the subject line: “Urgent
requirement of doctors for MCI Inspection in Ghaziabad”
The email offered up to 20,000 rupees a day (about $310) if the
doctor appeared for an inspection at Saraswathi Institute of Medical
Sciences in Hapur, east of New Delhi. The doctor, who requested
anonymity, has no connection with the college.
“If interested please revert back ASAP,” the email concluded. The
sender described itself as “a Medical Executive Search firm.”
In an interview, Sanjeev Priyadershi, Hi Impact’s executive
director, confirmed that the firm had tried to recruit doctors to
appear during government inspections at medical colleges where they
don’t normally work.
“My client wanted to hire full-time faculty members for inspection
purposes,” he said.
Dr. Shailendra K. Vajpeyee, the principal of Saraswathi, said the
college is constantly struggling to recruit qualified professors.
Vajpeyee said he knew of Hi Impact Consultants, but denied he had
employed them during his 18-month tenure.
“I don’t know why that email was sent” by the company, he said. He
declined to comment further about the matter.
'BIASED' INSPECTORS
At Muzaffarnagar Medical College, where electrician Dilshad Chaudhry
was taken in December, students can read medical journals and books
in a sprawling, circular library and take classes in clean and
modern lecture halls.
But finding enough patients to provide students with clinical
experience at rural, private teaching hospitals like Muzaffarnagar
is a challenge. Many people in rural India simply can’t afford the
cost of treatment.
School principal Agarwal denied the allegations by MCI inspectors
that the college’s hospital had inflated its number of patients
during a 2013 inspection. “Sometimes the inspectors are biased, that
is for sure,” he said. He also denied the hospital had ever
recruited local villagers to pose as patients.
But Dr. Vaibhav Jain, a former student at the college, told Reuters
that the hospital would conduct “free check-up camps,” to lure rural
villagers to the facility on inspection days. He said the hospital
sometimes would promise free ultrasounds, but only a small number of
people would be tested. Villagers often later complained about it to
students at a clinic in Bilaspur where he worked, he said.
“We used to say we can’t do anything, the machine was not working,”
he said.
Medical education is in trouble across India, said Jain. “The truth
is that many medical students aren’t prepared to be doctors when
they finish” college. “And the result is the patient suffers.”
(Story repeats to add additional reporting credits)
(Edited by Peter Hirschberg. Additional reporting by Samantha Sunne
in New York and Byron Kaye in Sydney.)
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