Muzaffarnagar: Last December, Dilshad Chaudhry travelled with about 100 of his fellow villagers by bus to a local Indian medical-school hospital.
They’d been told that foreign doctors were coming to tour the facility, and check-ups would be free. 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 phoney 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, 130km 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 paediatric 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.
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 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.
‘Taught to cheat’
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 diarrhoea, 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 penalise 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.”
Series of scandals
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 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 UK, 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.
About 45 per cent 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.
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 said. 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.”
