Healthcare in India has long had the ignominious distinction of being corrupt at all levels. To brush off this disrepute, a national medical organisation has set out broad ethical guidelines for healthcare providers. But not everyone is convinced of the sincerity of its efforts.

The Indian Medical Association, a voluntary welfare organisation of doctors across the country, is issuing an elaborate code of ethics for hospitals, nursing homes and other medical institutions providing healthcare in India to discourage all kinds of kickbacks, commissions and freebies.

The announcement of the code came four days after the Central government announced a ban on pharmaceutical companies offering freebies to doctors after January 1. The Medical Council of India already has a set of similar codes governing individual doctors, so the IMA is hoping to plug the gap by creating a set of guidelines for the third wheel in the profession: healthcare-providing institutions.

Healthcare experts are not particularly impressed, though. They point out that the IMA itself does not have a credible name and has shown little alacrity in dealing with unethical practices in its midst.

Well-meaning declaration

On December 27, IMA’s central council passed a declaration that specifically targets institutions like hospitals, nursing homes and other healthcare providers.

The declaration, of which has a copy, states that such institutions shall not “accept expensive gifts, cash benefits or gratification from the drug and equipment suppliers, diagnostic centres or similar agencies”. It further states that healthcare providers shall not indulge in any illegal or unethical practices, including “unjustified admissions, unjustified billing to the patient... giving cuts and commissions to anyone for soliciting patients”.

As the most prominent representative body for Indian doctors, the IMA has 2.5 lakh member doctors and about 5,000 hospitals as members of its Hospital Board of India. Although the new code of ethics will be applicable only to member hospitals, the IMA is writing to all hospital associations in India, asking them to display the declaration prominently on their premises.

Over the next three months, the IMA will formulate a complete, detailed code of ethics for healthcare providers, which will explain the action that the IMA will take against those violating the code.

“If any member hospital is found breaking the code, we can, at the most, revoke its membership and ask our doctors not to work there,” said Dr KK Aggarwal, secretary general of the IMA. “Of course, we cannot do anything about hospitals that are not members.”

According to Aggarwal, the code is meant to address the lack of specific guidelines for institutions like hospitals and nursing homes in a field where there are clear regulations against corruption for doctors and, now, the pharmaceutical industry.

“Any code of conduct is incomplete till the same rules are binding on all three sections,” said Aggarwal.

Image management                                                                                        

The main reason for IMA’s initiative seems to be image rebuilding, particularly after recent international attention on the rampant corruption in the Indian healthcare sector.

In June, an article in the British Medical Journal created a stir in India after it pointed out that kickbacks and bribes permeate every part of the country’s healthcare system, starting from the medical college. This corruption, according to the article, is ruining the doctor-patient relationship.

“These codes of ethics for pharmaceutical companies and hospitals have come to the forefront now only because of the British Medical Journal article and the international media attention,” said Dr Sanjay Nagral, a Mumbai-based surgeon on the editorial board of the Indian Journal of Medical Ethics.

The IMA admits this itself.

“We don’t know how prevalent corruption is in the field, but media and public perception has definitely been against us,” said Aggarwal. “We wanted to make our ethics clear.”

Look who’s talking?

For healthcare experts, a code of ethics for hospitals and nursing homes is definitely a welcome step, but one that comes with several limitations and riders.

“For one, the code will only be applicable to the limited hospitals that are members of the IMA,” said Anant Phadke, the co-convener of the Maharashtra chapter of the Jan Swasthya Abhiyan. “We don’t even know what machinery they have in place to monitor and enforce the code.”

Both Phadke and Nagral believe that the track records of the IMA and the Medical Council of India do not inspire confidence in their ability to curb corruption.

“The IMA should have been checking the behaviour of its own members all this while,” said Nagral. “It has a history of not investigating or punishing its office-bearers for unethical practices.”

An elevation

The most prominent case is that of Dr Ketan Desai, a former president of both the IMA and the MCI who was briefly arrested on corruption charges in 2010. Even though the Central Bureau of Investigation closed most of the cases against him, some are still pending and Desai has been stripped of his licence. Nevertheless, he has been made the president of the World Medical Association for 2016.

“The IMA needs to first ask itself: how come its national conference was inaugurated by Desai, who has been in Tihar jail for some time.” said Nagral.

In an age of large, branded private hospitals and poor public healthcare, Nagral points out that the IMA will have to work on its own reputation before it can enforce guidelines on others. “It’s great that the association has woken up to the fact of corruption, but it will have to demonstrate that it means business,” he said.