INVESTIGATION – PVT MEDICAL COLLEGES
The MCI denied approval to four private medical colleges in 2009-10. But within six months, they got the nod. Etmad Khan and G Vishnu went undercover to find what had changed. And stumbled upon a web of lies
IN APRIL 2010, when the Medical Council of India (MCI) Chairman Ketan Desai was dismissed, it was for allegedly taking a 2 crore bribe to grant recognition to a new private medical college in Chandigarh despite its dismal facilities. But this was just the tip of the iceberg, as whispers abound in medical circles about such fraudulent colleges all over India. Are the thousands of doctors being churned out by the system each year competent to decide on matters of life and death?
One year on, TEHELKA has found that the rot runs deeper. Based on a tip-off by an MCI insider, TEHELKA spent nearly two months investigating four medical colleges just outside Delhi, only to find a horrifying picture of blatant disregard towards basic standards set by the MCI on requirements for medical colleges to function.
After Desai was chargesheeted by the CBI, President Pratibha Patil signed an ordinance on 15 May 2010, dissolving the MCI and replacing it with a seven-member panel of eminent doctors. (It is the MCI that conducts surprise inspections of the hospitals and checks claims of the colleges regarding the hospitals they run, and where medicos train.) A year later, the MCI was reconstituted with cardiologist KK Talwar as its head.
On this new body now rests the responsibility of restoring our faith in the doctors being churned out by the system. It would do well to go for a long drive out of Delhi to find out what is happening in Saraswathi Institute of Medical Sciences, Ghaziabad, SGT Medical College Hospital & Research Institute, Budhera, Gurgaon, School of Medical Sciences & Research, Greater Noida, and Subharti Medical College, Meerut.
Tehelka captured the brazen lies of the managements on camera. In the four colleges, some wards looked like ghost towns, others like disaster zones
All four colleges were first denied approval after an MCI inspection. Inexplicably, six months later, they were awarded recognition after a second inspection. Was it time enough to fix all that was wrong with the colleges? TEHELKA captured the brazen irregularities and lies of their managements on camera — some of their answers being nothing short of ridiculous. Some wards looked like ghost towns, others like disaster zones. One did not need to be a medical expert to decipher the web of deceit that the managements have spun.
The first and foremost requirement of a medical college is a functioning hospital. The hospital should have a minimum 80 percent bed occupancy (60 percent for the first year of functioning). Apart from this, other basic criteria include the adequate number of faculty and proper infrastructure.
In December 2009, the MCI had denied approval to Saraswathi Institute of Medical Sciences (SIMS) based on its inspection report (a copy is in TEHELKA’s possession). Within six months, on 18 June 2010, the college got MCI’s stamp of approval. A similar pattern was noticed in the other colleges. It is unlikely that miracles happened because as TEHELKA discovered in May this year, nothing had changed on the ground in these institutions.
The college in Ghaziabad appears to have improved on all counts within six months. Whereas the inspection report (filed in June 2010) that clinched the approval for the college shows normalcy in functioning, the earlier report (filed in December 2009) reveals a horrific picture. For instance, the hoshospital bed occupancy was just 20 percent, way below the claim of 80 percent. Similarly, the daily averages of OPD and casualty patients were far short of the norm. Worse, when TEHELKA undercover reporters made a round of the hospital, they found hall after hall empty, with no sign of any patient anywhere; the procedure room and nursing stations were deserted; even the doctors’ duty room was locked from outside. The question is, why did the MCI’s second report give this college a green signal?
SGT Medical College in Gurgaon gives stiff competition to SIMS in terms of being a disaster zone. The inspection report filed on 12 March 2010 had denied approval. The report had registered the bed occupancy of the hospital at 38 percent. On the day of the inspection, there were 313 patients as opposed to the requirement of 800 at that stage. To give you an idea, if the number of students in the final year is 200, each MBBS trainee could not have seen more than two patients.
THE SCHOOL of Medical Sciences & Research in Greater Noida was another case in point. Whereas the report that rejected the grant of approval for the college recorded the bed occupancy at 31 percent, the next report filed within a few months in June 2010 cleared the same by recording occupancy at 72 percent, apart from pointing out other supposed improvements.
Students studying here are well aware of the fact that the college doesn’t fulfill the requirements as shown in the prospectus. For them, the only positive aspect is that exam papers are prepared at the college itself and chances of failure are dim. “Anyone can pass the degree here,” said a student.
Meerut’s Subharti Medical College was a slightly different case. Though an approved institute, Subharti had applied to the MCI for an increase in its medical seats from 100 to 150. While one inspection report records 37 percent bed occupancy, against the requirement of 80 percent, the college was granted the approval within three months. But what TEHELKA found on the ground was halls and floors with negligible activity for a hospital with over 750 beds.
Despite the obvious shortcomings, thousands of students seem to have no qualms in joining these dubious colleges. Their marketing blitz lures students from small towns. The students, in turn, play their roles well, often defending their colleges to the hilt even when shown the evidence.
Good teachers make good students. Bad doctors will be bad for a lifetime. It is not like other professions where bad past can be undone,’ says Dr Chowbey
So what makes medical education a lucrative trade? The answer lies in the age-old theory of demand and supply. “India’s doctorto- patient ratio is poor. They have to make up for it. The MCI tends to gloss over facts at times,” alleges Delhi-based Dr Anirudh Lochan, who is the president of the Young Doctors Association of India.
“The quality of medical education is shockingly poor. When an MBBS graduate goes for a PG course, his/her level of expertise is dismal. The internship programme that young doctors must take in their last semester is poorly handled by hospital managements,” he says.
“Even though the desperation and aspiration of the students and colleges is understandable, there is no reason why the medical sector should not be brought under scrutiny. At the end of the day, it’s a matter of life and death for lakhs of patients, who will be at the receiving end of these scams,” he says.
Dr Pradeep Chowbey of Max Healthcare Institute agrees. “Experience is a must as more surgeries you perform the better you get at it, the more lives you save,” he says. “Your clinical acumen depends on that as this is a vicious cycle. Implication of bad colleges are far-reaching. Good teachers make good students. Bad doctors will be bad doctors for a lifetime. It is not like other professions where bad past can be undone. High quality of training at the formative years of a student has great importance as it has long lasting implications and consequences. There should be absolutely no compromise in health education.”
The MCI, a non-political autonomous body, was set up to give recognition and accreditation to medical institutions. Monitoring and ensuring healthy, ethical practices in these institutions is one of its biggest responsibilities.
“It is high time you brought it to the notice of the authorities. The MCI and health ministry should take some serious steps to improve standards, says former AIIMS director Dr P Venugopal.
MCI Secretary Dr Sangeeta Sharma (she quit her post on 17 June after the health ministry questioned the legality of her appointment) argues the council conducts surprise checks to keep tabs on colleges. As for the questions on approvals given to these colleges despite the obvious lacunae, she assures that the MCI will conduct a probe if TEHELKA submits the evidence
Despite the MCI’s assurances, the fact remains that the number of colleges that sprung up in the past five years is perhaps a sign of the unmanageable boom. In 2005, there were 233 medical colleges with an annual intake of 26,192 students. In 2011, there are 357 medical colleges, of which 315 find their names in the MCI list of MBBS colleges.
Many of these colleges have come up in zones where hospitals are hard to find. A welcome sign one would think. However, Patna-based Dr Raj Kamal Choudhary says, “In Bihar, private colleges that have opened in the past five years are a sham. They neither have proper equipment nor a good faculty.”
“Ketan Desai was merely a tip of the iceberg. The MCI gets a major cut in the capitation fees charged by these dubious colleges,” says a Delhi-based doctor. “The capitation fee was about Rs 15 lakh when I was studying. Now my students tell me it’s nearly Rs 35 lakh,” he says. “Everyone gets a cut. Everyone is involved,” alleges another doctor.
Kirtana Sharma (name changed), a second-year student from SIMS, was one of the few to admit the reality of capitation fee. She reveals that her father had to struggle to pay the fee and the donation that the college demanded. “Donation toh diya tha… There are difficulties. He is the sole earner in the family.”
What follows is a detailed look at the functioning of each of these four institutions that TEHELKA’s undercover reporters exposed with their hidden cameras.
Saraswathi Institute of Medical Sciences
Run by Saraswathi Ammal Educational and Charitable Trust, Chennai
No. of students: 100
THE MCI report filed on 16 December 2009, accessed by TEHELKA, did not find the Saraswathi Institute of Medical Sciences up to the mark. For instance, it claimed the out-patient department got an average of 700 patients per day. But on the day an inspection was carried out, only 215 patients turned up. More damningly, the casualty attendance was a mere three, whereas the hospital claimed the daily average as 45.
Similarly, while bed occupancy was shown to be 80 percent (from 1 June to 31 November 2009), the actual occupancy was 20 percent. There was no ICCU, TB/respiratory ICU or defibrillator. Hostel facilities and exam hall seats were inadequate.
Just six months later, on 18 June 2010, an MCI inspection found only negligible differences in the college’s claims and reality and granted permission to run the third batch of MBBS students for academic year 2010-11. For instance, against the hospital claim of average OPD attendance at 714 patients, the inspectors found 689. While average casualty attendance was 44, on assessment it was found to be 35. The inspection report said that the shortage of teaching faculty was only 0.87 percent while the shortage of residents was 1.21 percent.
Is it possible that the college was able to pull up its socks so quickly? It doesn’t seem so, judging by the images captured by TEHELKA’s secret camera in May-June 2011. TEHELKA scanned empty corridors and facilities that appeared to have been under lock and key for a while. We found a female medical ward locked from the outside whereas the medicine ward was almost empty.
On one of the top floors, we saw hundreds of beds without mattresses in a theatre of dust, which suggested that they had been lying vacant for months.
As TEHELKA probed further, hall after hall was found empty with no signs of patients. Further, what would otherwise be the most teeming place in a normal hospital, the doctors’ duty room, was locked from the outside.
To give a rundown of the places that were closed — the department of psychiatry, female surgery ward, departments of physiology and pathology.
TEHELKA found about 10 attendants of patients purchasing medicines even as the adjacent gynae section was deserted. On the first floor, the general wards were lying vacant. On the second, almost all the beds were empty. There were no patients and no mattresses on these beds. Throughout the probe, dust was always a major piece of evidence — a sign of dormancy, decay and disorder.
Further, there were no nurses at the station and no doctors in the rooms and neither did we see any hospital employee in the sections on the second and third floors.
TEHELKA confronted principal Dr Rukma Idnani and executive secretary to the chairman Johnson Varghese. Pat came Dr Idnani’s defence: “This is wheat harvesting season, so people are busy in the fields. It affects occupancy not only here but also in the government hospitals.”
“The shortage of doctors was because resident doctors had left for exam duties during surprise inspections,” says Varghese. But TEHELKA’s ‘inspection’ too had found doctors missing.
THE MEDICOS who were interviewed had predictable complaints, justifications and reasoning for being in such an institute. “My father is an engineer with a public sector undertaking and we do face a lot of difficulty paying the fees,” says Neha, a student. “But it always has been my father’s dream to make me a doctor,” she adds.
Does she think SMC will make a good doctor of her? “Sort of,” she says. She goes on to defend the faculty even as she complains about the standards of infrastructure. A girl student admits her father gave a donation to the medical college but claims not to know the exact sum.
Another girl student, from Himachal Pradesh, admits that her father, a garment trader, had always wanted a doctor in the family.
About the trust: J Rama – chandran is the chairman of the institute and also the chancellor of AMET University, Chennai. A self-proclaimed social worker, he is also the chairman of an NGO called NAESEY. The prospectus says that Ramachandran solely funds all the social welfare programmes and projects.
Sri Guru Gobind Singh Tercentenary Medical College
Run by Dashmesh Educational Charitable Trust
No. of students: 100
THE SGT group of institutions runs a virtual empire of medical, dental, engineering and physiotherapy colleges. The official claims of the hospital put OPD attendance at 600-700 per day, the number of beds at 300, in addition to 66 ICU beds and five operation theatres.
The MCI inspection of 12-13 March 2010 found these claims highly inflated. To begin with, the hospital had only 313 OPD patients that day. Bed occupancy was 38.33 percent against the requirement of 80 percent. Clinical material was found to be inadequate. In terms of power, only 150 KVA load was available against the required load of not less than 700 KVA.
The MCI raised 23 issues related to infrastructure requirements during this inspection. In view of these issues, the inspection team recommended to the Central government not to give sanction.
The second inspection was held on 22 June 2010. On 30 June 2010, the principal approached the MCI for resubmitting a compliance report, saying it would admit only 100 students as against the earlier request for 150. Subsequently, it submitted invoices showing purchase of equipment.
The day TEHELKA entered the campus, the guards at the gate were alert. Inside the emergency ward, there was just one patient, a boy who cried piteously while his family was talking to a nurse. No one was present at the reception and the corridors were poorly lit.
We saw some locked rooms on the ground floor, populated only by a sweeper and a few relatives of patients. The first floor was starkly empty and dark. Same for the second floor, except for a few patients in the female ward.
On the third floor, the paediatric ward was completely vacant. There were neither any mattresses nor sheets on the beds. No doctor or a nurse graced the department.
On the third floor, in the female orthopaedic ward, there were 2-3 patients. The other 20-25 beds were vacant.
ON THE fourth floor, dark corridors led to the male orthopaedic ward. Again, we found empty beds with no sheets. The doctors’ room was empty and dust in ample evidence. The physiotherapy section too was closed and completely dark. It seemed that a lot of departments named on the board were not actually functional. Like the department of general medicine, which was locked.
The male medicine ward was an exception — the beds were occupied, some by relatives of patients. But there were neither any nurses nor any doctors around. On the fourth floor, the administrative block was closed along with other departments.
On the second floor, we came across a labour room. First signs of life — we heard newborn’s cries. But the blood bank and pathology, opposite each other, were found to be closed. From there, till the reception, no doctors could be spotted.
The emergency ward was safely guarded by security staff. The fear of uninvited guests was evident. The ward was vacant except for a patient and his family. A little ahead, we came across some chambers belonging to faculties that were closed. The main hall was empty except for a sweeper. We moved upstairs to the first floor where we saw an operation theatre that was closed.
After crossing endless corridors, we finally entered a ward where a nurse was tending to a few patients. To our surprise, a guard entered the room looking for us. He enquired about us, asking why we were there. We replied that we were relatives of the patient. He had no option but to retreat. We hurriedly left the room and went up to the third floor and reached the paediatric ward that was completely vacant. Apart from the usual missing patients and mattresses, this hall did not even have curtains.
Two students of BDS estimated the number of patients in OPD at 100-300. Both claimed to have had no idea about the fee, even though one of them told TEHELKA that the donation was about Rs 30-35 lakh.
About the trust: Manmohan Singh Chawala is the managing trustee of Dashmesh Educational Charitable Trust under which this college functions. Ram Bahadur Rai, a former Hindi journalist, is the chairman of the trust. The hospital has been built on 28.49 acres.
School of Medical Sciences & Research
Greater Noida, Uttar Pradesh
Run by Sharda Education Trust
No. of students: 200
JUST LIKE the other colleges, the MCI inspection of 14-15 June 2010 had given favourable reviews of the standards maintained here. On paper, bed occupancy is shown as 81 percent. But in May-June 2011, our spycam captured empty wards and dust-filled departments.
The minimum OPD attendance expected of a medical college is 500. The college boasted of 608 as the daily average. On the day of the MCI inspection, the OPD attendance was an impressive 789.
Similarly, bed occupancy, which was 80.15 per cent earlier, was found to be 86.57 percent. Though the college had convinced the MCI about its credentials during the first inspection, the MCI report filed on 29 January 2010, a few months before the 2010- 11 academic year, for renewal of permission for the admission of the second batch revealed some severe dips.
To begin with, on the day of inspection, there was a shortage of 20.06 percent of teaching faculty. OPD attendance had dropped from the stated average of 563 to 316 and the bed occupancy had dropped to a mere 31 percent as against the stated 72 percent daily average. Prima facie, the college had not even maintained its own stated daily averages — let alone the required daily averages. What is more scandalous is the fact that computer records do not tally with the attendance shown in the OPD register.
The TEHELKA team posed as prospective admission seekers. Some BDS students straightaway advised: “Keep this college as the last option. That is, if you do not get admission anywhere else.” They offered plenty of reasons for saying so. “This is a new college and teachers are not experienced,” said a student. Another student put it more bluntly. “If patients don’t come, how will the doctors get the exposure or experience?” he asked.
These students were well aware of the fact that the college doesn’t fulfill the requirements as shown in the prospectus. For them, the only positive aspect is that exam papers are prepared at the college itself and chances of failure are minimal. “Anyone can pass here,” said a student. Another student had an alarming reason for labelling the teachers ‘good’. “In the MBBS department, even if students do not attend classes throughout the year, they are passed,” he said.
Three people stood in a queue at the registration counter. In the emergency ward, there were only about 3-4 patients. Nurses’ duty room was locked. The glass doors were closed in Block A, where we found a few women lying on the floor in the lobby. On the second floor, we entered the gynaecology and obstetrics wards. Crossing the corridors, we found a row of vacant beds.
Further ahead in Block A, we reached the semi-private wards. A nurse told TEHELKA that the people who lived here were not patients.
On the third floor, we found the general medicine male ward, which had just one patient. We took a patient’s name at the desk of the nursing station and were directed to check for ourselves.
In the female ward, there was no one in the rooms. We saw a woman in the adjacent room whose oxygen mask was not in place though she seemed to be critical.
IN BLOCK C, the immunisation ward was vacant. The chamber of pediatrics head of department was empty and lights were switched off in the corridors. The OPD too looked abandoned. In Block D, neurosurgery and OPDs of orthopaedics, opthalmology and surgery had few patients and doctors, but the eye OPD had a deserted look.
On the first floor, the cardiology department was in complete darkness and corridor seats were empty. The chest and TB OPDs had only three people waiting outside. At the topmost floor, the sixth, in the department of pharmacology and therapeutics, the library lay in shambles. Here, we didn’t even have to hide the camera, as there was nobody around. The lab was deserted. In the microbiology department, even chairs and tables were lacking.
Back in Block A, a student complained about the poor quality of food. She revealed that even though the fee was Rs 4.5 lakh per anum, there was an undisclosed capitation fee over and above that.
About the trust: There is an executive council that advises Chancellor PK Gupta on policy matters and also controls the property and funds of the university and approves the budget. The council members include Gupta’s brother YK Gupta, Prof AK Khare, vice-president, IEC Group of Institutions and Prof SK Khanna, adviser Jaypee Group.
Subharti medical College
Meerut, Uttar Pradesh
Run by Subhart KKB (KK Bhatnagar) Charitable Trust
No. of students: 150
SUBHARTI MEDICAL College was allowed to admit 150 students in the first batch as the Chhatrapati Shivaji Subharti Hospital run by it had been affiliated to SVS University until 25 September 2008 and the government of Uttar Pradesh had accordingly granted a certificate. The hospital has 757 beds, out of which 647 teaching beds were to be made available for college purposes.
The MCI inspection report filed on 24-25 June 2010 said that OPD attendance on the day of inspection was 1,164, whereas the daily average is said to be 1,045. Similarly, bed occupancy was found to be 92 percent though the daily average is 83 percent. Several other parameters were also in good health, often more than MCI requirements.
So far so good. But like the others, Subharti had invited trouble for itself by lying. An earlier inspection conducted on 31 March 2010 showed that OPD attendance was just 600 against the requirement of 800. Bed occupancy was 37 percent as against the required 80 percent. Clinical material was inadequate in terms of major surgery requirements. There was a deficiency of 59 teaching beds.
The MCI report further noted that 22 faculty members were found absent and the additional teaching staff was falling short by 14.37 percent. Many infrastructural inadequacies were noted in different departments.
When TEHELKA reached the college, the by-now-familiar scenes of desolation were missing — the campus seemed busy right from the morning. The OPD and registration counters were packed.
But in the female opthalmic ward, behind a curtain, were beds without mattresses, obviously in disuse. In the male orthopaedic ward, most cubicles were vacant and mattresses were piled up on one of the beds. The corresponding female ward had no more than 10 percent occupancy.
At the nursing station, a few junior doctors and nurses could be spotted. Passing through a gallery, we again came back to the main hall. On the third floor, we saw the male surgery ward where only one bed was occupied. All the other beds were bereft of mattresses. A similar scene played out in the paediatric ward, where the occupancy was only two patients
In the ENT ward, there were more empty beds, curtainless windows despite the blazing sun outside. The female ENT had just one patient. Other two cubicles were no better with just a handful of patients with their attendants occupying wards meant for large numbers. The canteen was a picture of appaling hygiene, with flies all around.
Dr AK Asthana, dean of the college, put up a brave front while speaking to TEHELKA. “It’s a biased report and I don’t give it any weightage,” he said about the issues raised by MCI after the June 2010 inspection.
He wondered how two reports, a few months apart, could differ so widely. He expressed willingness to share any necessary information.
JUST LIKE other heads of the colleges that came under TEHELKA investigation, Asthana too had ready excuses for the irregularities. “A few doctors were found absent as some of them had gone on fellowship programmes and other engagements,” he said. A variant of this explanation was offered elsewhere. He too said, “Bed occupancy is low because of harvesting season in this region.” For good measure, he said festivals also keep patients away.
Curiously, Asthana told TEHELKA that approval was suspended in 2005 because of deficiency in faculty. “It was the Ketan Desai team that didn’t consider anything. There were three inspections and we fought a case in the Supreme Court against this before they relented,” he said.
About the trust: The college is run by Subharti KKB Charitable Trust, Meerut. The trust was established in 1991 by Rajwati Bhatnagar in memory of her husband, late Dr KK Bhatnagar. Now the trust is run by Dr Atul Kumar Krishna, a post-graduate in general surgery from LLRM Medical College, Meerut.
G Vishnu is a Correspondent with Tehelka.com.
Etmad Khan is a freelance journalist based in New Delhi.