Rampant fraud at medical schools leaves

Indian healthcare in crisis

MEDICAL MAYHEM: India has been rocked by a series of recent medical scandals. These women underwent sterilization surgery last
November at a government-run camp where a doctor operated on 83 patients in less than three hours; at least a dozen died.
REUTERS/Anindito Mukherjee

By Andrew MacAskill, Steve Stecklow and Sanjeev

Miglani-Filed June 16, 2015

Patients pretending they are sick and doctors posing as faculty members are routine.
The ramifications of Indias broken medical-education system are being felt beyond the
countrys borders.
MUZAFFARNAGAR, India Last December, Dilshad Chaudhry travelled with about
100 of his fellow villagers by bus to a local Indian medical-school hospital. Theyd 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 theyre not sick, he
said. The 20-year-old electrician said he never saw any foreign physicians that day,
but the hospitals 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 hospitals 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 schools principal, when asked
about the episode with Chaudhry.
Indias 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 countrys borders: India is the worlds 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
Indias medical-education system. It found, among other things, that more than one out
of every six of the countrys 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.

SCHOOL OF SCANDAL: Muzaffarnagar Medical College was accused of hiring local villagers, including children, to pose as patients to
pass a government inspection; the principal denies it. REUTERS/Anindito Mukherjee

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 Indias 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 Indias 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 governments 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 systems problems are felt abroad, too. Tens of thousands of Indias 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 Britains 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 patients 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 doctors 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 Indias biggest hospitals, giving diagnoses,
prescribing medicines and even conducting surgery.

Video: Indias chronic shortage of doctors

Object 1

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 havent 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. Thats because the size of graduating classes is small typically 100 to 150
students.
Indeed, gaining admission to Indias 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 magazines past five annual surveys. According to the
registrars 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 Indias 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.

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.

SIDE EFFECT: Sujatha Rao, former health secretary, says the government made it easier to open private medical schools because it
lacked money to build public institutions. REUTERS/Adnan Abidi

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 Indias 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
countrys 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 dont 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 dont come to classes,
they dont 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.

TROUBLED WATCHDOG: The Medical Council of India, charged with overseeing medical education, has itself been the target of
criticism and the subject of controversy. REUTERS/Anindito Mukherjee

Sudhir Deshmukh, the colleges 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 councils 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.
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. Im totally frustrated
with the MCI. Totally frustrated, he said.
Dr. Vedprakash Mishra, the head of MCIs 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 dont 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 governments 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

HELP WANTED: Saraswathi Institute of Medical Sciences in Hapur has had problems attracting professors; a recruitment firm tried to
hire a doctor to show up for a government inspection. REUTERS/Anindito Mukherjee

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 Impacts executive director, confirmed that the
firm had tried to recruit doctors to appear during government inspections at medical
colleges where they dont 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 dont 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
cant afford the cost of treatment.
School principal Agarwal denied the allegations by MCI inspectors that the colleges
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 cant 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 arent prepared to be doctors when they finish college. And the result is the
patient suffers.
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