Private vested interests rear their heads

Dr. Sylvia Karpagam

Link to edited version in DH

An online petition to the Governor of Karnataka has been doing the rounds on Change.org, presumably signed by private hospital doctors and those owning medical establishments and demanding the dismissal of the health minister of Karnataka, Mr. Ramesh Kumar.

The petition is filled with language that is dishonest and baseless. The petition at no point clarifies its actual grouse against the Health minister, namely his strong push to regulate, through the Amendments to the Karnataka Private Medical Establishments Act, a private sector that has grown into a monster. For doctors who claim scientific ability, it should be known that petitions that they make should be backed by evidence rather than loose abuses.

The petition starts with accusing the health minister of Karnataka, Ramesh Kumar, of being ‘extremely intolerable, incompetent and highly corrupt’ who is ‘abusing’ the medical profession that ‘he needs to lead, guide and promote’. He apparently, ‘out of his ignorance, lack of social responsibility/leadership and desperation, bordering on insanity is giving unwarranted, unsubstantiated and irresponsible press statements that are demeaning and detrimental to the noble profession of medicine and instigating unrest and undermining the very trust between doctors and patients’.

Firstly, the ‘job’ of a health minister is not to ‘guide and promote’ private interest but to look out for the health of every last citizen, including the poor, the marginalised, the vulnerable and the voiceless. Regulation of the private sector is no small step towards that accountability that is required of every service provider, particularly one who deals with life and death itself. The move to regulate has been supported by several citizen and health rights groups as well as academicians.

It would be interesting to see the break-up of the 4500 people who have signed the petition for removal of the Health minister. It is highly likely that it would have zero representation from patients and those who access health care. It is doubtful if it would have government doctors either. It would comprise entirely the same group that has been protesting in loud voices against Amendments to the Karnataka Private Medical Establishments Act 2013. This group, instead of looking out for patient’s rights, seem to be sitting at the polemic opposite end, having gotten used to exploitation of the government as well as patients.

Secondly, it is shocking that the doctors use words like ‘insanity’ when as professionals they should know what the implications of using such language is and when they should be at the forefront to oppose such stigmatising labels.

Thirdly, the statements of the health Minister are neither ‘unwarranted, unsubstantiated nor irresponsible’. The evidence about violations by the private healthcare industry is available in full public view and has had clamp downs from the Centre as well as several state governments. The minister draws heavily from his own experience of dealing with an exploitative and unaccountable private sector and it would seem that he has a good bird’s eye view of what the issues are with the sector.  The involvement of the private sector through government health insurance schemes in the state has only led to care becoming fragmented, unaccountable and more expensive to the government and patients, with patients continuing to have out of pocket expenses ranging anywhere from 10,000 to a lakh.

Fourthly, the responsibility for statements or positions that ‘demeaning and detrimental to the noble profession of medicine’ rests squarely on the shoulders of the very same profession that is now claiming victimhood. The medical profession has had ample opportunity to uphold the ‘noble’ nature of the profession by putting patient’s rights and interests above all else and by self-regulating from within the profession itself. The highly commercial interests of this so called ‘noble’ profession has led to violations that have been shocking and outrageous. The absence of a sense of commitment and self-regulation is what has led to this need to regulate from outside, which any government is well within its right to do. If the Karnataka Medical Council, the Medical Council of India and other so called regulatory bodies had not become safe havens for corrupt and unethical doctors, there would have been no need for an external regulation. The statement in the petition that the health minister has compared doctors to prostitutes and barbers is however, definitely unfair because one doesn’t hear complaints of negligence or denial of care about either of these two latter professions.

It is well within their ambit for private doctors to make profits to meet their own costs and also for institutional and other expansions, but these profits, sometimes in the range of 1000 – 2000% is what has, in fact, led to the dismal undermining of trust that doctors have been vested with. The erosion of trust has been gradual, but at no point have doctors’ groups felt the need to protect this trust. The supreme confidence that doctors have placed on this very same trust is what has led to wilful unethical treatments in many private hospitals – unnecessary procedures, exorbitant costs, unethical clinical trials – the list is depressingly long.

In fact, the Amendments to the current Karnataka Medical Establishments Act 2013 would do well to include a few more issues. It is also of concern that inspite of the negative fallout of engaging with the private sector on health insurance schemes, the government is still pushing forward with the Arogya Bhagya scheme.

As emphasised by Oxfam, the way forward for the government would be realise that those countries that have been successful at reaching the poor at scale have done so by prioritising the scaling up and strengthening of public health care delivery rather than ongoing promotion of an ever-increasing role for the for-profit companies.

The best that the private doctors of Karnataka should do if they really care about patients, it to put forward regulatory mechanisms that they would like to enforce on themselves, apologise for the innumerable violations that have taken place till date, ensure grievance redressal for all those patients who have experienced negligence and violation, set limits on costs and stop viewing the government as an endless source of funds that can be squeezed to its last paise. This is the only way the ‘noble’ profession can be salvaged. Otherwise they should call themselves a business with purely commercial interest and stop hiding under the label of ‘noble profession.’

The writer is a public health doctor and researcher based in Karnataka and working on universal access to healthcare

 

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