Anand Rai, whistleblower in the Vyapam case, told the Supreme Court this month that the Oversight Committee—set up by the court to look at all MCI decisions—was creating “Munnabhais”, alluding to the popular Bollywood comedy where Sanjay Dutt played a gangster who pretended to be a doctor and got an MBBS. The court told Anand Rai to not get so emotional.
Here was a classic dispute over the appropriate line of treatment. Medical education itself is ailing, and the universal diagnosis is: critical. In May, the apex court appointed a three-member OC comprising Justice R.M. Lodha, former CAG Vinod Rai, and and Dr Shiv Sarin, director of the Institute of Liver and Biliary Sciences, Delhi. Given the taint of corruption on the MCI, one might have pictured almirahs full of dubious permissions to substandard medical colleges being opened up, and a flurry of cancellations by the OC.
Instead, the opposite happened. Assessment norms were relaxed and dozens of bans were overturned, even if conditionally. Justice Lodha, the panel head, says this was being “practical”, since classes were to begin on October 1. “There’s a huge demand-supply gap. We have freed up thousands of seats.” Nearly 8,000 seats in 63 colleges, to be precise. That’s also 8,000 students who may find themselves in a limbo if a surprise check by the OC leads to a cancellation.
Yes, the OC also agreed with the MCI and denied permissions to 29 colleges (2,050 seats). But the idea of oversight implies a degree of alignment in objectives. With policy responses to the crisis in medical education going in all directions, the whole process gets a bit muddied.
The MCI is not a decision-making body but recommends actions to the Union health ministry. Now, it must first pass everything through another filter. It’s this usurping of regulatory space by the OC that Rai is contesting now. “Unless you amend the Indian Medical Council Act, the OC cannot act like a super-body. The parameters for checking quality are already set by it,” says Rai, who has also opposed corruption in the MCI.
The gap was apparent as soon as the OC started looking at the ban on 268 colleges. It asked the MCI to reassess 150 colleges (which they had already checked) that wanted to start new MBBS courses for 2016-17. The ministry was to make comments and recommendations on the files. “Neither of them did this, so we hired technical assistants and checked each application by looking at their websites, photos and other available material,” says Justice Lodha. Dr C.V. Bhirmanandham, MCI vice-president, says the OC had unrealistic expectations. “In two weeks, we were asked to reassess nearly 150 colleges. Each college needs three assessors from different parts of the country to fly in,” he says. “We cannot round up so many of them in such a short period.”
What colleges put up on their websites are, of course, largely stock images or 3D visualisations of buildings. “What they show online is always ‘fair and lovely’. If we start sanctioning on that basis, we will be creating more Munnabhais,” says Bhirmanandham.
An MCI official argues, “In many cases, the ministry had agreed with us on a ban. Now the ministry has changed its stand and is siding with the Lodha committee. How can you dilute medical education like this?” A senior ministry official parries that off thus: “The OC had to step in because MCI lacks credibility. How can we live with this mismatch of a high number of applicants and low number of approvals? We have to stop this inspector raj.”
This idea—abolition of ‘inspector raj’—resonates widely at a time when public services are being given over to private interests. There is growing consensus in the fields of labour standards, food safety and now healthcare that routine inspections of all be replaced by random inspections of a few. But people in the field don’t agree. An MCI official says, “Physical verification is a must in healthcare as it concerns human life.”
Though Justice Lodha emphasises there is no unconditional permission, health sector watchers ask how affidavits and Rs 2 crore bank guarantees from colleges can suffice to ensure standards. Any college with permission for 150 MBBS seats can collect anything from Rs 15-60 crore in a single year’s capitation fees. A penalty of Rs 2 crore will not hurt the colleges, only the thousands of students who have signed up.