NAME OF THE AUTHOR

LEKHA G.D

NAME OF THE INSTITUTION

RAMAIAH COLLEGE OF LAW, BENGALURU

TITLE OF THE PAPER

AN EVIL PRACTICE CAUSING THREATS TO HUMAN LIFE: CORRUPTION IN

HEALTH CARE AND MEDICINE

CLASS

4th YEAR (VIIth SEMESTER)

E-MAIL

lekhadhilipk@gmail.com

MOBILE NUMBER

9845630413
AN EVIL PRACTICE CAUSING THREATS TO HUMAN LIFE: CORRUPTION IN HEALTH
CARE AND MEDICINE

ABSTRACT-

This paper discusses corruption in health care units and in medicine. A basic necessity of very
human being is undoubtedly a good health condition and corruption in a health industry is one
among the serious invasions of corruption in today’s times in this country. Corruption in health
care industry is one of the least discussed and debated issued. People believe that medicine is a
rocket science that only a few can actually understand and it is also need of human life, they don’t
see the devil named corruption hiding behind it.

World’s largest democracy and second most populous country, India, ranks 145th among 195
countries in health care quality and health care access. Unarguably Indian health care has
developed since 1990 but it is not satisfactory or how it must and should be?

This paper aims to deal with a triangle conflict between health care and corruption in it and that
corruption which causes threat to the Constitutional mandate of Right to Health enshrined under
Article 21 and various Directive Principles of State Policy enlisted under Part VI of the
Constitution. Providing proper health care is a duty of a welfare state and it is right of each person
of this nation to have access to proper health care.

This paper also aims to focus on various corruption practices in the field of medicine and in health
care industry. Corruption is not just an economic issue or a political issue, it is also a social threat
that could affect each and every individual and his livelihood. A quality health care and medicine
cannot be where the roots of corruption is long grown. But is high time public should take stages
to discuss and unite to abolish corruption.
INTRODUCTION-

India ranks 6th in Nominal GDP1, ranks 1st in Mobile Phone in Use2, ranks 4th in Television
Broadcast Stations3, ranks 2nd in Population index4 and it is also the world’s largest democracy
and also ranks 81 in global corruption perception index. Does corruption need any introduction or
any short story? Of course not.

Corruption is a dishonest or illegal behaviour by people in power, involving all forms of bribery.
Indian health sector is seen from outside as a glorious institution, that it provides quality treatment
at a reasonable cost. Health sector is a feather in the cap to be worn by India but is it the truth?

Corruption invaded this nation a long time ago and subjugated all industries, departments and
institutions, and healthcare sector is no exception to this. India healthcare sector has involved itself
in unethical and corrupt practices since a very long time.

Corruption in health sector is undisputed reality; it is in fact corruption in health sector is more of
a threat than any other institution. Health sector revolves and handles with life of crores of people
and corruption puts their life at risk.

Corruption is in healthcare also puts question of constitutional mandate on right to health. To

abolish corruption and protection of right is both the duty of the state but is this both guaranteed
in today’s context.

CORRUPTIONAL PRACTICES IN HEALTHCARE SECTORS

The health service is the most corrupt service sector in India, as gauged by people's actual
experiences, according to a new survey released by the India office of the international non-
governmental organisation Transparency International. It ranks India as one of the 30 most corrupt
countries in the world. The survey, conducted with private marketing research company ORG-
Marg Research, interviewed some 5000 citizens in a household survey to assess the public's
perception of corruption. It covered 10 sectors with a direct bearing on people's lives, including
education, health, the police, the judiciary, and power utilities. While the respondents rated the

1
International Monetary Fund
2
908,358,714 million lines (74.71% density) for 1.2 billion population as of August 2012
3
857 licensed stations as on 2016
4
The World Factbook- Central Intelligence Agency. www.cia.gov
police as the most corrupt sector, followed by health, power, and education, the impact of
corruption is on a much larger scale in the health and education sectors, says the report. A quarter
of the respondents had paid bribes for health services, compared with 18% in the power sector.
Payment to staff to gain admission to hospital is the commonest corrupt practice in health care.
Such payments are higher in southern India. "The key actors leading to corruption in this sector
across zones are allegedly doctors (77%) followed closely by hospital staff (67%)," says the report.
"These revelations are a cause of serious concern for the whole country, as two thirds of the 19.3
million public servants are involved in these 10 sectors, said R H Tahiliani, chairman of
Transparency International in India. The impact of corruption on the poor is profound, given their
lower earnings, although the total amount paid is higher among the rich, says the report. "The fact
that money is being demanded directly and openly by the corrupt is a clear indication that the
corrupt persons are confident that no worthwhile action will be taken against them," said
Transparency International. It advocates adoption of instruments such as citizens' charters, people's
ombudsmen in government departments, and greater use of e-technology.5

Corruption in healthcare sector can mean the difference life and death. Corruption in healthcare is
problem in multidimensional nature. Corruption may be in construction of hospitals/ healthcare
centres, for purchasing of instruements and medicine, quality of medicine and goods, overbilling
of insurance claims and extends even till appointment of medical professionals. Another aspect of
the problem is the involvement of multiple parties, e.g. policy-makers, ministers, economists,
engineers, contractors, suppliers, and doctors. All this may give rise to innumerable clandestine
transactions of a corrupt nature among various stakeholders.

Health sector witness corruptions in various ways, following are a few which include in it but it is
not limited to only these-

Bribery and kickbacks

Bribery and kickbacks are one of the hallmark forms of corruption and it is no surprise does exist
in healthcare sector too.

Bribes and kickbacks can be paid by individuals and firms to

5
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1168938/ and also at http://www.transparency.org/
 i. take government contracts, leases or license for construction of healthcare units and
also for supply of medicines, equipments, instruments, drugs and services, and also for
ensuring favorable terms and conditions;
ii. prefix and ‘rig’ the bidding process;
iii. manipulate and falsify records i.e to produce fake records and documents, and modify
‘evidence’ to give the appearance of its being in compliance with the norms of
regulatory agencies;
iv. speed up the procedure of permission to carry out legal activities, eg obtaining affliation
for an institutional, company registration or construction permits; and
v. influence or change legal outcomes so as to avoid punishment for wrong-doing.6

Theft and embezzlement

Sometimes it may so occur that there has been a theft of public assets and goods, such as medicial
equipments, instruments and medicine by private individuals for sale or for personal use, to use in
their respective clinics which is run for profit motive. The theft of government revenues, such as
patient registration fees, and the payment of salary to deceased or “ghost” workers are other forms
of corruption.7

Causing damage to public property intentionally

Damaging public assets such as hospitals, equipments intentionally and thereby creating an
negative impression in the minds of public that public hospitals are not the best place to seek
treatment from, which in turn brings public to private hospital where the poor and needy cannot
afford to pay high price for their life.

6
United Nations Development Programme. Fighting corruption in the health sector – methods, tools and good
practices [Internet]. New York: United Nations Development Programme; 2011Oct 31[cited 2013 Jul 4]. Available
from: http://www.undp.org/content/undp/en/home/librarypage/democratic-governance/anti-
corruption/fighting_corruptioninthehealthsector/

7
Transparency International. Global Corruption Report 2006. London: Pluto Press; 2006.
The ultimate aim of causing damage to public assets to get commission which another form of
corruption that is in existence.

Absenteeism
This is not just corruption but a step more than that. Not attending hospitals or not working but
claiming the salary on right time as if it is his right. No doubt that claiming salary is right but there
exists a duty on you to perform your work effectively.8

Use of human subjects for financial gain

Clinical researchers get paid by the biomedical industry for the recruitment of poor and illiterate,
ie vulnerable, human subjects for clinical trials.9Another way in which hospitals and physicians
use patients is by charging uninsured patients and patients with other health plans far more than
the actual costs involved and what the health insurers pay.

INSTANCES OF CORRUPTION IN HEALTHCARE SECTOR

In 2013, in “Satyameva Jayate” a social awareness program in Star Plus where Amir Khan was
the host and also the producer of the show focused on healthcare sector and services rendered in
the nation. He pointed various instances where corruption in health care industry was evident. He
initially started the program with a young boy who complained of infection in his leg had been
performed multiple surgeries, which was not firstly necessary. This is one such example, let us
not forget there is ocean left still or who knows multiples oceans.

A landmark judgement by the Hon’ble Supreme Court of India in the case of Mohini Jain10
indicates that charging exorbitant capitation fees by the private medical colleges is a violation of
Article 14 of the constitution of India. It directed that the only method of admission to medical

8
United Nations Development Programme. Fighting corruption in the health sector – methods, tools and good
practices [Internet]. New York: United Nations Development Programme; 2011Oct 31[cited 2013 Jul 4]. Available
from: http://www.undp.org/content/undp/en/home/librarypage/democratic-governance/anti-
corruption/fighting_corruptioninthehealthsector/
9
Anonymous. Illiterate persons not to be used for clinical trials. Times of India [Internet]. 2011 Sep 7[cited 2013
Jun12]. Available from: http://articles.timesofindia.indiatimes.com/2011-09- 0 7 / h y d e r a b a d
/30122246_1_cros-clinical-trials-axis-clinicals
10
AIR 1992 SC 1858
colleges should be by merit and merit alone11. This led the private medical colleges to start
admissions based on admission tests. Though in practice, the admission tests exist, but there is an
unreported practice of bribing the college management for admissions before the entrance
examinations and manipulating the results. Such corrupt practices need to be checked and the
capitation fees taken in the name of management quota should be regulated. The Government of
India initiated a common entrance test for MBBS, BDS students both for private and public funded
medical and dental colleges in India in the name of National Eligibility-cum-Entrance Test
(NEET). There were several objections from the private medical colleges in this regard and a
judgment by the Hon’ble Supreme Court order on July 18, 2013 scrapped the NEET. The intention
of the NEET was clear- to have a uniform common entrance test and decide on a common merit
list.12 The rejection by the Court order is a setback on the control of bribery practices in admission
in private medical and dental colleges in India.

In addition to medical admissions, instances of corruption prevail in the patient care even in public
funded hospitals or health care facility. The long waiting list of patients for hospital admissions,
or for surgery can be cut short if the dealing official is bribed. Though unreported, surgeons do not
operate till they get a commission for the surgery in the form of either by cash or for getting
surgical materials as per their choice of the company with whom they are tied up for commission.
Similarly, corruption exists while ordering investigations outside the hospital when the
investigations are not available in the hospital. There are cuts or kick –offs for ordering the
investigations in a particular private laboratory.

Another point that needs to be considered is the link between doctors and pharmaceutical
companies. MCI has issued an order in this regard to stop doctors from getting gifts from
pharmaceuticals. However, the practice of giving benefits in other forms such as sponsoring a trip
for conferences, symposia with full payment of registration fees, travel, stay and lodging in star
rated hotels still exists. This leads to the unfair practice of prescribing medicines of the brand they
are tied up with the pharmaceutical company.

11
Shome, S. Supreme Court Judgement on Mohini Jain Case: Right to Education as a Fundamental Right.
Published online. Available on http://metastudio.org/topics/Supremecourtjudgementon.
Sting operation conducted for exposing corruption serve public interest. A number of sting
operations has been undertaken to show the corruption scenario in health sector in India. The sting
operation “Operation Jonk” in Delhi on 22nd July 2014 conducted by a Hindi news channel News
Nation TV disclosed the connection between doctors and diagnostic centres. It revealed that
laboratories in the national capital offering commissions as high as 50 percent to doctors who
referred patients to their diagnostic centres. Tests such as magnetic resonance imaging (MRI), CT
scans, ultra sound, and routine pathological tests, are sometimes prescribed even when not
required. The then Health Minister Mr. Harsh Vardhan commented that the health system is riddled
with corruption, a problem that pervades public life in India. Corruption among medical
practitioners is rampant. One more sting operation on doctors exposing greed and readiness to shed
professional ethics. NDTV programme aired on national television created a lot of angst among
those in the medical profession.13A doctor who produced fake medical degree certificates when
questioned by the Medical Council of India was arrested and two others were summoned by the
Medical Council of India.14

There are instances wherein Medical representatives induce practitioners to change their
prescribing habits by offering them bribes in the form of expensive consumer goods and all-
expenses-paid trips to exotic tourist spots.15Patients often trust doctors with their lives. Doctors,
for their part, owe unwavering allegiance to their patients and should recognize that any breach of
faith erodes the doctor-patient relationship and desecrates the Hippocratic oath. These issues has
got a huge momentum due to the TV headlines, the British Medical Journal (BMJ) had also
exposed this facet of Indian healthcare.16

Another sting operation was in Mumbai. The sting operation undertaken on July 16th 2014
revealed how a pathology Lab registered in Navi Mumbai is run by a doctor registered with
Karnataka Medical Council and he does not even the sign reports himself.According to a report

13
Mehrotra S. Doctor Arrested after NDTV Expose, Two Others Summoned by Medical Watchdog. [Last accessed
on 2014 Aug 13]. Available from: http://www.ndtv.com/article/india/doctor-arrested-after-ndtv-expose-two-others-
summoned-by-medical-watchdog.575106 . [Ref list]
14
Mehrotra S. Doctor Caught in NDTV Investigation Arrested. [Last accessed on 2014 Aug 13]. Available
from:http://www.ndtv.com/article/india/doctor-caught-in-ndtv-investigation- arrested-575501 . [Ref list]
15
Who pays for the pizza? Redefining the relationships between doctors and drug companies. 1:
entanglement.Moynihan RBMJ. 2003 May 31; 326(7400):1189-92.[PubMed] [Ref list]
16
https://www.linkedin.com/pulse/medical-ethics-nirvana-healthcare-dr-deepak-yaduvanshi/
published in the Time of India (July 13th 2014), the costs of medical devices like stents and
pacemakers at hospitals are double or triple the normal market price. And as per hospital’s rules
and policies, the patient has to buy the equipment from the hospital where he has been treated and
not from outside.17 These are just few instances. The list is endless. In the remotest areas, more
shocking and unthinkable situations will come up. Corruption is a social evil and doctors are no
exception and perhaps there are more temptation or opportunity for those have an extra need or
greed. Good civic sense will make any citizen to follow ethical practices, if everyone work towards
ethical and non-corrupt practices it is achievable.

IMPACT OF CORRUPTION IN HEALTHCARE SECTOR IN INDIA

No doubt, corruption has a severe impact on the society. It has not only affected the health industry
and the economy as a whole, but also the people of the co especially the poor and the common
people. The results are evident Low-quality healthcare facilities that do not fulfil our needs
Government hospitals and health centres in rural areas are in shabby conditions. .Lack of access
to medicines and other basic healthcare facilities for poor patients Huge medical bills Incomplete
treatment of patients circulation of fake or inappropriate drugs goods and equiprment ih the market
Spread of diseases and no control of infectious diseases like dengue Death of patients for wrong
treatment or inadequate services Unnecessary medical tests Unqualified and inefficient doctors
Healthcare professionals in the vicious cycle of unethical practices Loss of faith in the system

CONSTITUTIONAL MANDATE

“A healthy body is the very foundation for all human activities. This is why the adage
‘sariramadhyam khalu dharma sadhanam’. In welfare state, therefore, it is the obligation of the
state to ensure creation and sustaining of conditions of congenial to health”18

The “rights” approach to health issue is a common and convincing approach in international legal
norms.19 According to the Human Rights Committee the ‘inherent right to life' under Art. 6 of
ICCPR requires the states to adopt positive measures to reduce infant mortality, to increase life
expectancy and to eliminate malnutrition and epidemics. Article 25 of the Universal Declaration

17
https://www.mapsofindia.com/my-india/india/impact-of-corruption-in-indias-healthcare-sector
18
Ranganath Mishar J. in Vincent v. Union of India AIR 1987 SC 990 at p. 995.
19
Virginia A Leary, implications of Right to Health in Kathleen E. Mahoney and Paul Mahone, Human Rights in the
21st Century : A global challenge, 481
of Human Rights provides that "everyone has the right to a standard of living adequate for the
health and well being of himself, and his family including medical care". More specific provisions
can be found in ICESCR (Art. 21) and Covenant on Right of the Child (Art. 24) aiming at the
highest attainable standard of physical and mental health. The response of state parties range from
monitoring of private health agency to universal state-paid health care system.20 It is because of
state's involvement in health service, and requirement of fairness in policy implementation that
significant role is expected from the interrelationship doctrine.

The Supreme Court, in Paschim Banga Khet Mazdoor Samity & Ors v. State of West Bengal &
rs, 21while widening the scope of art 21 and the government‟s responsibility to provide medical
aid to every person in the country, held that in a welfare state, the primary duty of the government
is to secure the welfare of the people. Providing adequate medical facilities for the people is an
obligation undertaken by the government in a welfare state.

In A.S. Mittal v State of U.P,22 in the context of 'disastrous medical misadventure' resulting in loss
of eyesight of 84 persons operated in an eye camp conducted by a social organization, the Supreme
Court directed the State Government to pay to each victim Rs. 12,500 as compensation on
humanitarian grounds. The Court examined the merits of Central Government's guidelines on eye
camps, and by a subsequent order refined them. But it rejected the argument of vicarious liability
of State since the camp was conducted by a private body and Government had taken due care in
framing the guidelines.

Over the last few years, the medical profession in India has been in a protracted state of crisis.
Doctors across the country have been exposed and indicted on counts of corruption, professional
negligence, taking kickbacks, and illegal dual practice, both in the court of law, and in society at
large.23 24
The statutory body responsible for stewardship of the medical profession is the Medical
Council of India (MCI)25; its mandate is to oversee medical education, professional and ethical

20
Daniel Wikler, Privatization and Human Rights in Health Care: Notes from the American Experience in in
Kathleen E. Mahoney and Paul Mahone, Human Rights in the 21 st Century : A global challenge, 495
21
(1996) 4 SCC 37.
22
AIR 1989 SC 1570; (1989) 3 SCC 223
24
The medical trade .Bawaskar HS Indian J Med Ethics. 2013 Oct-Dec; 10(4):278.
25
Medical Council of India website. http://www.mciindia.org/
standards in the medical profession, and the registration of medical doctors in India. With multiple
and ever serious allegations and indictments related to corruption, incompetence and dereliction
of duties in checking the misconduct amongst doctors, the MCI is at the heart of this crisis.2627 In
a dramatic turn of events, a recent Parliamentary Committee report on the functioning of the MCI
noted that "the Medical Council of India has repeatedly failed on all its mandates over the decades,"
and that the state of the medical profession is perhaps at its "lowest ebb" (p.20)28. In an exceptional
move, on May 2, 2016, the Supreme Court of India also intervened using its rare and extraordinary
powers under the Constitution, to set up a three-member committee headed bv a former chief
justice of India, to oversee the process of overhauling of the regulatory framework of the medical
profession.29 In their judgment, the Supreme Court of India, added "that the need for maior
institutional changes in the regulatory oversight of the medical profession in the country is so
urgent that it cannot be deferred any longer." The parliamentary committee tellingly added that
"respect for the profession has dwindled and distrust replaced the high status the doctor once
enjoyed in society" (p.110).30 This erosion of trust is not a problem that s unique to the medical
31 32
profession in India; evidence shows that it is a growing concern, globally , and the Indian
situation has parallels in many low- and middle-income country (LMIC) health systems33 34.

The human right to health care means that hospitals, clinics, medicines, and doctors‟ services must
be accessible, available, acceptable, and of good quality for everyone, on an equitable basis, where

26
Professional codes, dual loyalties and the spotlight on corruption. Jesani A Indian J Med Ethics. 2014 Jul-Sep;
11(3):134-6.
27
Mani MK. Our watchdog sleeps, and will not be awakened. Issues Med Ethics. 1996;4(4):105–107.
28
The functioning of Medical Council of India. Department-related parliamentary standing committee on health and
family welfare (Report No. 92). India: Parliament of India; March 2016.
29
Sikri AK. Judgment of the constitutional bench of the supreme court of India, Civil Appeal No. 4060 of Modern
dental college and research centre and others versus State of Madhya Pradesh and others. Published May 2, 2016.
30
Medical Council of India in constitutional crisis.Vijayakumar K, Saini N J Indian Med Assoc. 2013 Oct;
111(10):706.
31
Public trust in physicians--U.S. medicine in international perspective. Blendon RJ, Benson JM, Hero JON Engl J
Med. 2014 Oct 23; 371(17):1570-2.
32
The continued social transformation of the medical profession. Timmermans S, Oh HJ Health Soc Behav. 2010; 51
Suppl():S94-106.
33
Exploring the influence of trust relationships on motivation in the health sector: a systematic review. Okello DR,
Gilson L Hum Resour Health. 2015 Mar 31; 13():16.
34
Rebuilding patient-physician trust in China.Tucker JD, Wong B, Nie JB, Kleinman A, Patient-Physician Trust
Team. Lancet. 2016 Aug 20; 388(10046):755.
and when needed. The design of a health care system must be guided by the following key human
rights standards:

Universal Access: Access to health care must be universal, guaranteed for all on an equitable basis.
Availability: Adequate health care infrastructure (e.g. hospitals, community health facilities,
trained health care professionals), goods (e.g. drugs, equipment), and services (e.g. primary care,
mental health) must be available in all geographical areas and to all communities.

Acceptability and Dignity: Health care institutions and providers must respect dignity, provide
culturally appropriate care, be responsive to needs based on gender, age, culture, language, and
different ways of life and abilities.

Quality: All health care must be medically appropriate and of good quality, guided by quality
standards and control mechanisms, and provided in a timely, safe, and patient-centered manner.

Non-Discrimination: Health care must be accessible and provided without discrimination.

Transparency: Health information must be easily accessible for everyone.

Participation: Individuals and communities must be able to take an active role in decisions that
affect their health.

Accountability: Private companies and public agencies must be held accountable for protecting
the right to health care.

But this germ called stands as antonym to all these and make us feel that healthcare is not
something that is at affordable by the poor and needy. Healthcare units and hospitals run by
Government are not acceptable and there exists a serious lack of quality.