A state uncertainty awaits the 36 year old Maharashtra Medical Council with the term of state government appointed administrator is due to expire on January 13, 2002 with no prospects of MMC getting an elected body by that date, it is learnt. The administrator, Dr.S.M.Sapatnekar, the director of Haffkine Institute for Training Research and Testing was appointed on January 14, 2000 as its administrator after the MMC body was dissolved amidst allegations of corruption within MMC.

In the 22-member MMC committee, only nine are elected by the medical fraternity, in accordance with the 1965 MMC Act, and the other posts are filled through nominations.

The election procedure takes at least two months to complete and as no efforts have been made in that direction so far, sources say, it is very difficult for an elected MMC body to take charge by the time the administrator's term gets over. In that case, the government will have little option but to extend the term of the administrator.

Sources allege that the history of elections to MMC was one of rigging and corruption as the committee has powers in awarding permissions to start new medical colleges. According to Dr Sapatnekar, the matter is still sub-judice. "There was a challenge to the procedure of elections. The Mumbai High Court granted a stay against declaration of results of the fresh elections. This created some kind of anomaly, perhaps. Technically, the old body continued. So the government in its wisdom thought it appropriate to dissolve the Council under the prevailing act and rules on January 14, 2000 and invoked the powers under the statute to appoint an administrator to look after the administration and pending amendment of the rules per se. Accordingly public reactions were sought. The main objections in the writ petition filed by private, voluntary bodies related to the postal ballot about which there were serious allegations and counter allegations. The main allegation was that the postal ballot system could give rise to malpractices."

The Maharashtra Medical Council recommended in September 2000 to the state government after receiving representations from various organizations, that regular ballot box system would be the best answer for elections and it would also be non-controversial. The recommendations have been publicly notified.

As per these draft rules, the system of postal ballot which led to rampant manipulations and rigging has been replaced by secret ballot whereby elections will be conducted in each district under the supervision of the District Collector. Besides the impropriety of appointing the registrar of the body as the returning officer has been corrected and the returning officer, a person not less than the rank of an Under Secretary, would be appointed by the State Govt. as the returning officer.

Having obtained these latest draft proposals, the state government will now approach the legislature with appropriate amendments. As and when the legislature gives its consent, the rules can be amended and the new elections can be announced, provided there is no order to the contrary from the Mumbai high court.

Says Dr Sapatnekar, "I guess that the government will certainly approach the high court and bring it to the court's attention." Under the statute, the administrator cannot continue beyond January 13 2002. The administrator is also under an extension, mainly because there is public interest litigation pending against the Medical Council of India and all the state medical councils where the objection is the large number of pending cases before the council. Dr Sapatnekar says when he took over as administrator; there was a backlog of more than 150 cases. Asked whether he would be asked to continue till the impasse is resolved, he said, "In a democratic set-up, the government appoints an administrator with utmost reluctance."

Dr Ketan Parikh, former chief of Association of Medical Consultants, which has been in the forefront of urging reforms in the Maharashtra Medical Council Act for the last eight years, says MMC is defunct as a body. Those not registered with the Maharashtra Medical Council cannot practice medicine in the state.

Constitutionally, MMC has been designed only for monitoring the practice of the professionals. Protection of the profession from quackery is an important function of the MMC, which it has not been able to do as it can act only against its members. Quacks are not registered and so are not hauled up. They have also become immune to action."

Dr Sapatnekar agrees that the current MMC Act does not cover protection of the profession. "An absolute quack is accountable to no council. That are larger and broader issues and I entirely agree that it is important. If this opinion is to be crystallized in a democratic way, the profession will have to satisfy for enlargement and broadening of the scope and powers of all statutory councils."

Dr Parikh says that cross practising is resorted by Homoeopaths and Ayurvedic doctors with the latter even having the sanction of the Ayurvedic council to do so. "If Homoeopaths also seek to practise allopathy who will stop them? MMC, as of now, has no authority to question them."

But the provision of permitting Ayurvedic doctors to practise allopathy has come as a regular practice and it is not a recent phenomenon, says Dr Sapatnekar. It was gazetted in the early nineties and has not been objected to thus far. "Okay, even if it is objected to, it does not come within the purview of MMC administrator. There will be merits and demerits in anything. It will be in the utmost fitness of democratic traditions that elected members of MMC talk about this."

According to Dr Parikh, the methodology of enquiries undertaken by the MMC is also faulty. All the 22 members have to be present for the enquiry and absenteeism in the Council can destabilize this work. Enquiries get accumulated for long and suddenly one order is made out which is contested in the court. "We have suggested that the hearings be done before a panel of just four council members and the full council can sit and debate the panel findings."

Dr Sapatnekar says he has realized the limitations of the full body sittings, as compliance becomes a problem for all members to reach Mumbai from various parts of the state for all the sittings. "I am going to give definite recommendations before handing over the charge as to the conduct of enquiries."

He suggests regionalisation of the council. "Let there be regional councils to conduct the hearings and let only the appeals be heard at Mumbai. He thinks it will also be worthwhile for experts to examine whether there can be a hierarchy to file complaints, say, at the district level, whether there could be a subordinate forum which will do the preliminary scrutiny and decide whether to take up the case at all.

Says Dr Sapatnekar, "There is nothing like an ombudsman for the citizen. Before a case comes to the consumer forum, there is assistance. Such a provision is not there in the MMC Act. The MMC can act only as a quasi-judicial body.

According to the administrator, Mumbai has more than 32 medical doctors who also have a law degree. A mobile forum can be formed with the help of these doctors or other knowledgeable people.

It is for all of us -- registered practitioners of allopathy and other systems of medicine -- to pursue it with the government and get appropriate rules whereby the common man gets a forum to ventilate his grievance.

Says Dr Sapatnekar, "The primary purpose of the council is disciplining the profession by the people from the profession. If this is not efficient, then there will always be a popular demand to make it a regular judiciary. We must appreciate there can never be a foolproof system."

"The primary job of the profession is not to discipline," says the administrator. "It is to rise to the occasion and treat the patients. This is a profession driven more by traditions than rules. So it is only under exceptional circumstances that the disciplinary power is to be invoked."

"As for the code of ethics, in the absence of the MMC, who will check if they are being implemented?" asks Dr Parikh.

Counters Dr Sapatnekar, "On this, everyone needs to question himself. Ultimately, this is a ground rule of personal management. The motivation is something from within. So, it is true that the complaints of unethical practices are rising.

"So many times I have witnessed that people resort to the judiciary because they are not treated in a humane way. Mahatma Gandhi has said that the customer is always right. So a doctor must sit in his chair with the premise that the patient is right. Even today, people give doctors enormous respect and trust them."

Education is in a mess, says Dr Parikh. MUHS has become a defunct body. There is a greater mess at the individual medical college level. There is nobody to monitor the medical colleges. The continuing medical education proposal is also stuck.

But says Dr Sapatnekar, "A regulatory council does not have education as its mandate. And a regulatory body cannot simultaneously do two things. There could be two separate bodies, no harm. But if you simultaneously ask to discipline and educate, then it becomes tricky. Then I will think only in terms of equity."

Dr Parikh says the MMC is not legally bound to give a reasoned order on hearings. It just has to say whether guilty or not and need not explain why. "This is wrong," he says.

The Supreme Court has brought doctors under the purview of the Consumer Protection Act after it was realized that the state medical councils are not functioning properly.

There are about 60,000 doctors in Mumbai. Dr Parikh says the mandatory re-registration of medical professionals by paying a fees of just Rs 50 does not even meet the cost of sending two warning letters and one "registration cancellation" letter by registered post to the doctors who fail to re-register after every five years. "We want the council to become autonomous and not to depend on government donations. The re-registration charge can be revised upwards to Rs 500."