Doctored & Dangerous, Everywhere In India

The story of a fake cardiologist in Damoh, Madhya Pradesh, once again highlights the abysmal state of India’s medical registry system and regulation of healthcare. Police identified “Dr Narendra John Camm” as Narendra Vikramaditya Yadav, who is alleged to have presented to Mission Hospital in Damoh a fraudulent medical registration certificate supposedly from Andhra Pradesh Medical Council. However, neither Andhra’s nor Telangana’s medical registries list any doctor by that name. Camm’s registration number (153427) does not exist in either registry or in National Medical Commission’s (NMC) Indian Medical Register (IMR). So how did the Damoh hospital in the first place hire a “doctor” without verifying his credentials, potentially endangering patients’ lives?A Dr Narendra Vikramaditya Yadav does exist in IMR. The 2013 registration shows the 1971-born Yadav graduated in medicine from University of North Bengal in 1996. He has no other qualification registered. But his fraud certificate claims he completed MRCP (Member, Royal College of Physicians) from St George’s Hospital, London, in 2001. But this point is not recorded in his official registration. Yadav, under his real name, was previously employed at Apollo Hospital in Bilaspur, Chhattisgarh, in 2006. There, he allegedly performed a procedure on Chhattisgarh assembly speaker, who died later. Did the hospital verify his certificates?Notably, IMR’s registration gives no indication that MCI had suspended Yadav’s licence in 2014 for five years. According to police, he was banned from practice after being charged in UP’s Noida for document forgery. But there is no practice in India of linking registration data to any recorded misconduct for which a doctor might have been penalised. That means even if Yadav used his real name to seek a job, hospitals would have no way of knowing about the suspension.The only record of this suspension appears in a response to a question in Parliament on action taken by MCI on professional misconduct by doctors. In response, MCI had provided a list of doctors whose licences were suspended. Yadav is on this list. But it has no details on nature of misconduct.There’s a list of 60 blacklisted doctors on NMC’s website. Yadav’s name isn’t on it. The list has cases from as far back as 2012 and all 60 are listed as “not disposed of” with no explanation of what that means. There’s no consolidated year-wise list of suspended doctors with quantum of punishment or reasons for suspension. This renders the registry largely useless for both public and healthcare employers.Yadav’s absence from the blacklist isn’t surprising. His five-year suspension would have ended by 2019, allowing him to resume practice – with no public record of his suspension. Thus, a doctor involved in fraud or serious misdemeanour or medical negligence can return to practice after the suspension period with none the wiser. Worse, neither state medical councils nor NMC have any mechanism to monitor whether suspended doctors continue to practice illegally while under suspension. When Telangana was formed in 2014, many registrations were shifted from Andhra’s medical council to the newly formed Telangana Medical Council. But IMR doesn’t reflect this shift. So, a patient/hospital searching for Dr Yadav in Andhra’s medical council basis his IMR registration will find no record of him there. In the IMR there are six doctors with the same registration number (78855) including Dr Yadav, though from six different state medical councils.Since 2016, plans to create unique identification numbers for all doctors remain unrealised. There are several cases of doctors using registration numbers from one state council to continue practising after having licenses suspended by another.Despite tall claims of Digital India and Ayushman Bharat Digital Mission (ABDM), govt has failed to assign unique IDs for around 13L doctors, the smallest health workforce. ABDM’s Healthcare Professionals Registry is intended to document doctors from all medicine systems and nurses. But if maintaining a registry of 13L doctors from a highly regulated medical education system proves impossible, how feasible will it be to maintain records of 35L nurses and 7L Ayush doctors from mostly poorly regulated private colleges?The John Camm scam is the proverbial canary in the coal mine, one of several. Numerous cases have documented patient deaths and injuries to patients caused by Ayush practitioners claiming MBBS qualification, and MBBS doctors faking degrees, or unrecognised qualifications, and physicians performing procedures beyond their training. What will it take for govt to wake up to its failures in basic healthcare regulation?