6 years on, bill against ‘cut practice’ in medical sector back in spotlight

Mumbai: The discovery of unauthorised bank accounts operated by the heads of 11 JJ Hospital departments who collected Rs 6 crore and spent some of it on foreign trips, flight bookings and hotels, has reignited the debate around the necessity of enacting a law against ‘cut practice’.

Dr Himmatrao Bawaskar, a Padma Shri awardee, who has in the past exposed commissions offered by diagnostic centres, has written to chief minister Eknath Shinde, urging him to revive efforts to enact a law against kickbacks that the state government began working on six years ago.

To jog memories, the draft of the Prevention of Cut Practices in Healthcare Services Act was almost finalised in 2017 before it was quietly shelved due to apprehensions about implementation and protests by the medical community over the proposed Act’s harsh punishments.

The early version recommended a jail term of five years and a penalty of up to Rs 50,000 for healthcare providers engaging in the cut practice, with the anti-corruption bureau (ACB) launching an inquiry under Section 3 of the proposed Act as soon as a complaint is filed. The ACB was expected to complete the investigation within three months, with an additional three months available if required. The draft legislation also included a provision for fining bogus complainants. Further, anyone trying to malign the reputation of the doctor or healthcare service provider till the completion of the inquiry was to be liable to a one-month jail term.

A nine-member committee worked on the bill and submitted the first draft to the state's medical education department in July 2017, but they were asked to refine it further before it was abandoned. “The proposed legislation was put away to die a natural death,” Bawaskar, who was a part of the committee, told TOI. “However, the recent corruption scandal at JJ Hospital highlights the necessity for such legislation. I have urged both the CM and the medical education department to reconsider bringing in the law,” he said. Former DGP Praveen Dixit, who headed the committee, recalled a lot of pushback from the medical fraternity then.

In the recent J J Hospital case, an inquiry was first launched in 2018 by the then medical education secretary Dr Sanjay Mukherjee, revealing that 11 departments were operating unauthorised bank accounts without appropriate permissions.

Sources have told TOI that issues were mainly found in the surgery, radiology and ophthalmology departments. But only the surgery account fell purely under the “ambit of kickbacks” as it was found to have received deposits from pharmaceutical companies, which were then used to fund foreign trips and hotel stays, with nearly Rs 95 lakh of the Rs 1 crore transferred to the account being spent, a government official confirmed. Medical education minister Girish Mahajan, who was instrumental in batting for the Prevention of Cut Practices Act in 2017, promised action against J J doctors in the recent assembly session. However, no action has been taken yet.

Dr Bawaskar said the lack of action is not surprising. In 2013, he filed a complaint with the Maharashtra Medical Council (MMC) against a diagnostic centre that had sent him a Rs 1,200 cheque guised as “professional fee”. However, little concrete action followed. Often complaints fall between cracks as bodies such as MMC can act against licensed doctors and not so much against institutions, Bawaskar said.

In fact, the main obstacle in finalising the cut practice law was the issue of jurisdiction and identifying the executive authority, said former dean of KEM Hospital Dr Avinash Supe, who was also a part of the committee. “A need to curb cut practice was felt then and even now, but our discussions couldn’t move past who would be the implementing authority, whether it should be the police, MMC or any other medical body,” he said. While framing the draft, the committee received more than 500 letters, with many radiology and pathology associations supporting such a law. The Indian Medical Association (IMA), though, showed scepticism and feared that it could be misused against doctors and hospitals.

While the National Medical Commission (NMC) released Professional Conduct Guidelines in 2022, Supe said a law would be more effective in curbing the complex practice of kickbacks, which include not just money but also trips and gifts. A law could also benefit patients by reducing costs and unnecessary investigations, which not only compromise the quality of care but also undermines the trust between doctors and patients, according to Bawaskar.