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CORRUPTION IN HEALTH CARE AND HOSPITALS

What is CORRUPTION?
In simple words it’s a Dishonest or fraudulent conduct by those in power, typically involving
bribery; a vicious and fraudulent intention to evade the prohibitions of the law. The act of
an official or fiduciary person who unlawfully and wrongfully uses his station or character to
procure some benefit for himself or for another person, contrary to duty and the rights of
others. U. S. v. Johnson1; State v. Ragsdale.2; Wight v. Rindskopf,3; Worsham v. Murchison,4;
U. S. v. Edwards5.6
Moving onwards to our topic of corruption in health care units and hospitals. man deem
faith in two entities blindly one is god, the other is doctor. We tonsure our head as vow to
god but we trust a doctor with our lives. That doctor shouldn’t go astray, misdeeds happen
in every fields but that happens in medical field isn’t a mere misdeed its treachery. There is
no forgiveness for this betrayal.
Corruption in the health sector can mean the difference between life and death. Poor
people are worst affected. Medical staff can charge unofficial fees to attend to patients.
They may demand bribes for medication which should be free. Or they may let patients who
bribe them queue-jump. Corruption also costs lives when fake or adulterated medications
are sold to health services.
Without proper checks from regulators, public health funds can easily disappear. World
Bank surveys show that in some countries, up to 80 per cent of non-salary health funds
never reach local facilities. Ministers and hospital administrators can siphon millions of
dollars from health budgets. Or they can accept bribes. This distorts policy and denies
people hospitals, medicines and qualified staff. Stolen funds also hamper efforts to beat
major health challenges, such as malaria and HIV/AIDS.
It’s not only developing countries which suffer. Wealthy countries lose millions of dollars
each year to insurance fraud and corruption.7
The government is also responsible
Though India is a welfare state, the role of the government at the centre and in the states in
providing healthcare facilities is deplorable. Against the recommendations of the WHO that

1
(C. C.) 20 Fed. 082
2
59 Mo. App. 003
3
43 Wis. 351
4
00 Ga. 719
5
(C. C.) 43 Fed. 07
6
Featuring Black's Law Dictionary Free Online Legal Dictionary 2nd Ed.

https://thelawdictionary.org/corruption/

7
https://www.transparency.org/topic/detail/health
the total health expenditure should be 6.5% of the gross national product (GDP), India
spends only 4.8% of GDP on health. Further, public health expenditure is just 1.2% of GDP,
or barely 25% of the total health expenditure; the rest of the money is paid by patients
directly to private doctors and hospitals8 for whom profits may take precedence over their
patients’ interests.
Even in government hospitals, medical facilities favour the well-to-do and are often beyond
the reach of the poor who need them the most. The allocation of funds is often determined
by the influence and manipulations of hospital authorities, and the maintenance of
government hospitals is poor9 . Public funding for research and development is inadequate
and whatever meagre resources are available may actually be used by people at the top to
serve their own interests.
The connivance of regulators
The dubious functioning of regulatory bodies of the medical profession, namely the Medical
Council of India (MCI) and the Indian Medical Association (IMA), has helped spread
corruption in the profession. What can we expect if the president of the MCI, who also
happens to be head of the IMA, must be removed from his post after being found guilty of
dishonest practices and misuse of power10 ?
Large amounts of money can be involved in getting the MCI’s approval for setting up a
private medical college. Even government medical colleges and hospitals go on reckless
spending sprees before an MCI inspection. As medical and nursing colleges are income
generating ventures, their owners readily offer huge bribes to the officials who matter in the
establishment of such institutions.
Unfortunately, we cannot rely on justice from the legal system. When prosecutions do
occur, only a small fraction of these cases reach the courts. In some cases of medical
negligence, the punishment has been notional. Many cases of medical negligence are
pending in various courts in the country; in the Supreme Court of India alone, there are
some 3,000 cases of medical negligence 11.

8
Tandon A. The eport of NSSO. The Tribune (Chandigarh Ed.). 2009 Feb 2:2 (col.7).

9
Singh V. Five newborns were burnt alive. The Sunday Tribune. 2009 Feb1:1(col. 2).

10
harma R. Head of Medical Council of India removed for corruption. Student BMJ [Internet]. 2001
Dec 15 [cited 2009 May 21]; 323(7326):1385 Available
from: http://www.bmj.com/cgi/content/extract/323/7326/1385
11
Tandon A. 11 years after, Ohio doc’s fight for justice still on. The Tribune [Internet]. 2009 Jan 31
[cited 2009 Aug 31]; [about 1 screen.]. Available from:
http://www.tribuneindia.com/2009/20090131/nation.htm#6
By the 1990s, India had achieved the distinction of being the biggest bazaar for the sale of
human organs and the sale of kidneys was described as a cottage industry in India 12 . Such
scandals prompted the government of India to enact the Transplantation of Human Organs
Act, 1994 but the nexus of doctors and brokers involved in the sale of human organs has
never been afraid of the law13 , which has been violated with impunity. For example, the
Gurgaon kidney scamsters, who had been arrested for conducting illegal kidney transplants
in the 1990s, evaded punishment14 and managed to run their trade in kidneys for years,
obviously with the connivance of law enforcement authorities15 . It is known that the main
accused evaded arrest by bribing Delhi police officials16 .
Poverty and public ignorance
The nexus between corrupt medical professionals and politicians, bureaucrats and the
police is one of the major factors multiplying medical corruption. The common man is afraid
of exposing wrongdoings – the authorities may hush up the matter and target the whistle
blower instead.
Public apathy and fear are also partly responsible for breeding medical corruption. Even if
people come to know about unethical and illegal activities in the profession, they turn a
blind eye, either because it does not concern them, or because they are afraid of the
doctors. For example, many people were aware of the kidney racket but did not report the
matter to law enforcing agencies fearing the consequences to themselves 17.
The organ trade has been fuelled by poverty; poverty drives people to fall into the trap set
by unscrupulous elements who lure them with offers of money and jobs in exchange for a
kidney. At the same time, voluntary donation of human organs is not properly promoted or
utilised because of poor hospital infrastructures, inefficient transportation systems for the

12
Jyothi PT. Where kidney donation is a cottage industry. The Indian Express (Mumbai Ed.). 1995
Jan 25: 1(col.1).

13
Kidney donor alleges fraud by doctors. Bio-Medicine [Internet]. Available from: http://www.bio-
medicine.org/medicine-news/Kidney-Donor-Alleges-Fraud-by-Doctors-22445-1/

14
Machiah M G. Senior politicians, cops collude to bury kidney scam. The Indian
Express (Mumbai Ed.).1995 Feb 4: 9(col.13).

15
Not first time for Dr Amit. Hindustan Times [Internet]. 2008 Jul 7[cited Aug 31]. Available
from: http://www.hindustantimes.com/FullCoverage/FullCoverage.aspx?Special=TheKidney
Scam

16
Fatah S. Indian officers charged in kidney scandal February. The Star.com [Internet]. 2008 Feb
16[cited 2009 Aug 31]; [about 4 screens.]. Available
from: www.thestar.com/News/World/article/304157

17
Makkar S. Gurgaon kidney scam or Nithari murders, apathy was same. Boloji.com [Internet]. 2008
Feb 1[cited 2009 Aug 31]; [about 3 screens]. Available from:
http://news.boloji.com/2008/02/17157.htm
timely revival of organs, and a shortage of cadaveric transplant surgeons. Because of the
shortage of cadaver donors, doctors, donors and patients waiting for transplants collude in
illegal practices.
Social compulsions accelerate the process of medical corruption. A medical professional
finds it very difficult to refuse a VIP’s request; it could mean isolation or posting to a remote
area. When honest doctors cannot afford to even buy their own houses, but see that their
dishonest colleagues enjoy a luxurious life, they may wonder if they are right to stick to their
principles
September 2— A man in Odisha’s Malkangiri district walked 6 km with his seven-year-old
daughter’s body as the ambulance transporting them to the hospital left them midway after
learning that the girl has died.
August 30 — A man lost his ailing 12-year-old son on his shoulder after the state-run Lala
Lajpat Rai Hospital in Kanpur sent him to a children’s hospital, 250 metres away, without
providing an ambulance, stretcher or wheelchair.
August 27 — A man was forced off a bus with his five-day-old baby and mother-in-law, after
his ailing wife died in the vehicle in MP’s Damoh district.
August 25 — With his sobbing daughter in tow, a tribal man in Odisha’s Kalahandi
districtcarried his dead wife for more than 10km because he had no money for transport
and the government hospital, where she died, refused him an ambulance.
The plight of these families underscores human apathy and a basic failure — the breakdown
of public healthcare in India.
Successive governments promised to transform the healthcare system, including PM
Narendra Modi’s announcement of a Rs 24,000-crore national health protection scheme.
But little has changed on the ground. Since health is a state subject, wide disparities exist in
delivery and access between states, rural and urban population.(ayushman bharath yojan)
Health allocation has risen marginally or remained stagnant over the past six years across
states — average of 4.4% of the annual health spending of India’s 17 largest states.
The use of infected, date expired items in a Delhi hospital contributed to the deaths of at
least 26 patients in the 1990s, an expert inquiry team has found.
The union accused them of culpable homicide, the spreading of infection, and concealment
of crime and conspiracy (under various provisions of the Indian penal code).
The current case is the continuation of a series of court complaints about major corruption
deals through huge irregular purchases in the 1990s running into several hundred million
rupees.
The date expired material implicated in hospital acquired infections and deaths was
purchased in the early 1990s and used on patients until around 1998.in its report that
hospital records showed that there was an organised and concerted attempt by the hospital
administration, through orders and circulars, to use the expired materials.
The materials included catheters and heart valves, many of which were more than five years
old. There was damage, discoloration, visible fungal growth, and overall contamination of
these items. “They were dangerous to use on patients,” it noted.
Hospital records showed that some non-expired materials also had growth of
Staphylococcus aureus. Date expired materials were sterilised again but still tested positive
for contamination. The chances of life threatening hospital acquired infections were
therefore almost certain, the report said.
As a consequence, the number of deaths from septicaemia rose substantially in
postoperative patients from 1992 to 1998.18
Populism vs rationale
Increasing outlay is not enough if spending is determined by populism and less by need
Cases of medical negligence that end in deaths make national news each month.
In May, two infants were given nitrous oxide instead of oxygen in Indore’s government-run
Maharaja Yeshwantrao Hospital died. The previous month, Gwalior police busted a racket of
abandoned babies being sold with the help of government-paid ASHA workers.
In March, a tribal woman was found carrying her dead child in a bag in Sagar district
because she had no money for transport. The Damoh government hospital made news in
June when district collector Srinivas Sharma’s mother died because she couldn’t get timely
treatment.
Doctor shortage
India had around 740,000 registered doctors in 2014. But the country of 1.252 billion people
has a doctor-population ratio of 1:1,674, against the recommended 1:1,000.
The shortage is increasing out-of-pocket spending, with people seeking care from private
clinics and doctors with little or no training. In the absence of regulation to determine
accountability and quality standards, quacks run a flourishing trade.

18
The National Center for Biotechnology Information,, Time expired materials “contributed to 26
deaths”
Rohit Sharma
Monitoring medical colleges
The process of individual corruption begins early, right at the start in medical colleges, with
capitation fees for entry to the MBBS course in many private substandard medical colleges,.
These experts believe corruption in medical education is the reason behind the worsening
situation in healthcare.

India is the only country where sale of medical seats by private medical colleges is part of
official policy. It means the ability to pay counts more than merit. Apart from the huge
capitation fee, the process of walk-in type of admissions is also problematic. In such cases,
even those who lack interest in the profession get admission. And the patients bear the
brunt of these lapses as they get treatment from unskilled doctors. To make matters worse,
many such doctors unscrupulously indulge in unethical practices to make quick money.

Private medical colleges are also mushrooming by the dozen and the government has little
regulation in this regard. According to information received from MCI, there are 27 medical
universities in India. Of these, 14 are in the private sector. Till June 30, there were 387
medical colleges, including six new AIIMS, in the country. Of these, 205 colleges are run by
private players, informs Union health minister Harsh Vardhan, who admits to the problems
in the education sector. “We are looking into how to improve medical education in the
country and MCI’s reform is under serious consideration,” he told Down To Earth. On the
question of making donations for medical seats illegal, he says, “We will see what is possible
through law.”

Ban on kickbacks
China, which is facing similar issues, has recently taken steps to tackle systemic kickbacks in
the healthcare sector. In December 2013, China’s National Health and Family Planning
Commission introduced new regulations for hospitals, physicians and medical product
manufacturers. The country prohibited doctors from participating in product promotional
activities or illegal disclosure of patient data. It also banned accepting kickbacks and
commission, and accepting inducements from patients or their families. The guidelines
prescribe prohibitive punishment for defaulters.

Body to check private players


The need for an effective central body to govern the sector is more real than ever today
because of rapid privatisation in the sector. According to the National Health Profile, 2013,
the money paid by patients to private hospitals for treatment accounted for 71.62 per cent
of the total fund inflow in the healthcare sector in 2008-09. The share is expected to
increase to 81 per cent by 2015. Thus, experts say, effective reforms in the MCI are
important to check malpractices in the health sector. One of the major reforms suggested
by experts is to include non-medical members in MCI, which is common in Western
countries. “In the UK, the General Medical Council is very tough on corrupt doctors. Its
members include journalists, social workers and other professionals, unlike MCI whose
members are only doctors and they want to protect themselves,” is essential to have an
effective redressal system. There should be transparency in the selection to repose people’s
faith in the healthcare system, says More.

Experts say it is unfortunate that the country, whose researchers are playing a pivotal role in
medical advances globally, is still struggling with corruption, even in basic healthcare
systems.19
The obligation of the State to ensure the creation and the sustaining of conditions congenial
to good health is cast by the constitutional directives contained in Articles 39, 42 and 47 20
Article 21 reads as:
“No person shall be deprived of his life or personal liberty except according to a procedure
established by law.”
According to Bhagwati, J., Article 21 “embodies a constitutional value of supreme
importance in a democratic society.” Iyer, J., has characterized Article 21 as “the
procedural magna carta protective of life and liberty.
This right has been held to be the heart of the Constitution, the most organic and
progressive provision in our living constitution, the foundation of our laws.
Article 21 can only be claimed when a person is deprived of his “life” or “personal liberty” by
the “State” as defined in Article 12. Violation of the right by private individuals is not within
the preview of Article 21.
Right to Health
In State of Punjab v. M.S. Chawla21, it has been held that- the right to life guaranteed under
Article 21 includes within its ambit the right to health and medical care.
The Supreme Court in Vincent v. Union of India22, emphasized that a healthy body is the
very foundation of all human activities.Art.47, a directive Principle of State Policy in this
regard lays stress note on improvement of public health and prohibition of drugs injurious
to health as one of primary duties of the state[xlv].

19 How to cure corruption in healthcare


https://www.downtoearth.org.in/coverage/how-to-cure-corruption-in-healthcare-45570
20
THE CONSTITUION OF INDIA ,MP JAIN
21
AIR (1997) SC 1225
22
1987 AIR 990 : 1987 SCR (2) 46
In Consumer Education and Research Centre v. Union of India23, The Supreme Court laid
down that:
“Social justice which is device to ensure life to be meaningful and livable with human dignity
requires the State to provide to workmen facilities and opportunities to reach at least
minimum standard of health, economic security and civilized living. The health and strength
of worker, the court said, was an important facet of right to life. Denial thereof denudes the
workmen the finer facets of life violating Art. 21.”
Right to Medical Care
In Parmananda Katara v. Union of India24, the Supreme Court has very specifically clarified
that preservation of life is of paramount importance. The Apex Court stated that ‘once life is
lost, status quo ante cannot be restored[xlviii].’ It was held that it is the professional
obligation of all doctors (government or private) to extent medical aid to the injured
immediately to preserve life without legal formalities to be complied with the police.
Article21 casts the obligation on the state to preserve life. It is the obligation of those who
are in charge of the health of the community to preserve life so that the innocent may be
protected and the guilty may be punished. No law or state action can intervene to delay and
discharge this paramount obligation of the members of the medical profession. No law or
State action can intervene to avoid/delay the discharge of the paramount obligation cast
upon members of the medical profession. The obligation being total, absolute and
paramount, laws of procedure whether in statute or otherwise which would interfere with
the discharge of this obligation cannot be sustained and must, therefore, give way. The
court also observed:
“Art. 21 of the Constitution cast the obligation on the State to preserve life. The patient
whether he be an innocent person or a criminal liable to punishment under the laws of the
society, it is the obligation of those who are in charge of the health of the community to
preserve life so that the innocent may be protected and the guilty may be punished. Social
laws do not contemplate death by negligence to tantamount to legal punishment…. Every
doctor whether at a Government hospital or otherwise has the professional obligation to
extend his services with due expertise for protecting life.”
In another case Paschim Banga Khet Mazdoor Samity v. State of West Bengal 25, a person
suffering from serious head injuries from a train accident was refused treatment at various
hospitals on the excuse that they lacked the adequate facilities and infrastructure to provide
treatment. In this case, the Supreme Court further developed the right to emergency
treatment, and went on to state that the failure on the part of the Government hospital to
provide timely medical treatment to a person in need of such treatment results in violation
of his right to life guaranteed under Article 21. It acknowledged the limitation of financial
resources to give effect to such a right, but maintained that it was necessary for the State to
provide for the resources to give effect to the entitlement of the people of receiving
emergency medical treatment[l].

23
1987 AIR 990 : 1987 SCR (2) 46
24
AIR (1989) 2039, (1989) SCR (3) 997
25
AIR (1989) 2039, (1989) SCR (3) 997
It has been reiterated, time and again, that there should be no impediment to providing
emergency medical care. In Pravat Kumar Mukherjee v. Ruby General Hospital &
Others26, it was held that a hospital is duty bound to accept accident victims and patients
who are in critical condition and that it cannot refuse treatment on the ground that the
victim is not in a position to pay the fee or meet the expenses or on the ground that there is
no close relation of the victim available who can give consent for medical treatment.
The court has laid stress on a very crucial point, viz., state cannot plead lack of financial
resources to carry out these directions meant to provide adequate medical services to the
people. The state cannot avoid its constitutional obligation to provide adequate medical
services to people on account of financial constraints.
But, in State of Punjab v. Ram Lubhaya Bagga27, the Supreme Court has recognized that
provision of health facilities cannot be unlimited. The court held that it has to be to the
extent finance permits. No country gas unlimited resources to spend on any of its projects.
In Confederation of Ex-servicemen Association v. Union of India28, right to get free and
timely legal aid or facilities has been held to be not a fundamental right of ex-servicemen. A
policy decision in formulating contributory scheme for ex-servicemen and asking them to
pay one time contribution does not violate Art. 21 nor is it inconsistent with Part IV of the
constitution.
Solution
Governments need to publish detailed health budgets and financial information that’s easy
to understand. Then we can track funds and prevent them from being stolen. Health
workers need adequate pay and guarantees that salaries will reach them. This makes them
less susceptible to bribes or likely to demand them. Governments need to tackle counterfeit
drugs at source. This means cooperation between countries, involving customs, suppliers,
medical institutions and the police.
At the local level, we all have an important role to play. We must demand accountability
from health professionals and administrators. We can scrutinise clinic or hospital budgets.
Or make sure we’re aware of official charges for services – so we and others don’t pay
more. We must also demand public consultations over health services. These allow us to
participate actively in planning and implementation. Open tender systems and clear
procurement processes are also needed. By monitoring these, we can help ensure that
health facilities give us the best possible care.29
The task ahead

26
II (2005) CPJ 35 NC
27
AIR 1998 SC 1703 : (1998) 4 SCC 117
28
AIR 2006 SC 2945 : (2006) 8 SCC 199
29
https://www.transparency.org/topic/detail/health
It is not too late to restrain the medical profession. This calls for a well-coordinated
campaign involving doctors, the government and the public. A beginning has to be made by
health professionals launching a zero tolerance assault on medical corruption. The MCI code
has to be practised in letter and spirit.
The list of things that doctors must do is long. A few of them are given below.

 Refuse to take bribes.


 Collectively publicly oppose outside interference – political, bureaucratic or
otherwise.
 Make a commitment to rational drug use, referral and evidence-based interventions.
 Shun erring colleagues.
 Refuse to accept any favours from pharmaceutical companies.
 Follow medical ethics and treat poor patients the same as rich ones.
 The government must support and protect the interests of upright doctors. For this,
it must take the following steps:
 Evolve a transparent system for the allocation of funds, for deciding the location of
medical facilities and for the posting of medical personnel; this system must be
insulated from political and other interference.
 Have people of integrity conduct prompt enquiries into reports of medical
corruption, and take prompt action on the basis of these reports.
 Let doctors know that transgressions will be met with punishment. Medical
corruption is not a crime committed in the heat of the moment. It is calculated and
based on greed, and the punishment must be severe and deterrent.
 Plug the loopholes in the law on human organ transplants that enable transplant
tourism and marriages for the purposes of kidney “donation”. A campaign must be
started to dispel myths on cadaveric donations. The transplant programme must
include a computerised national database, efficient transportation and a network of
state-of-the-art transplantation centres with expert surgeons.
 Reward upright doctors to encourage role models for new entrants in the profession.
 Tackle the problem of doctors shunning government service.
 Support and protect whistleblowers who report medical corruption.
 Form a task force to defend high ethical standards in the medical profession and to
fight corruption in public healthcare.
Medical corruption contributes to poverty and misery in a developing country like India. The
public must contribute to efforts made by medical professionals and the government to
clean up the medical system. It can do this by:
acting as a watchdog reporting corruption or wrong doing;
checking unscrupulous elements who blackmail doctors in cases of inadvertent lapses in
medical treatment;
being more responsive to the stress that doctors have to deal with, and
running awareness groups to educate people on the necessity of organ donation and to
encourage the framing of laws that would empower medical authorities to extract organs of
unidentified and unclaimed dead bodies within the stipulated time for organ revival.
Corruption is spreading its tentacles far and wide in the medical system. To restore its noble
and distinct status, all sections of society must work together to stamp out the biggest killer
in the medical system – corruption.30
With the private sector providing 80% of outpatient and 60% of inpatient care and patents
pushing up the cost of medicines, out-of-pocket spending on health is steadily growing,
pushing people into poverty. “This system must address acute as well as chronic healthcare
needs, offer choice of care that is rational, accessible, and of good quality, support cashless
service at point of delivery, and ensure accountability through governance by a robust
regulatory framework”.
Everyone talks about the right to health, but with more than 30 million pending cases
before courts, ailing people denied healthcare in overcrowded hospitals are unlikely to
queue up to get justice.31

30 White coated corruption, by Vijay Mahajan


http://ijme.in/articles/white-coated-corruption/?galley=html
31
Why are the poor deprived of proper healthcare in India by,
Sanchita Sharma

https://www.hindustantimes.com/india-news/why-are-the-poor-deprived-of-proper-healthcare-in-
india/story-i8VZjCC6HXgqYuYRMACTHM.html