The Maharashtra Association of Practicing Pathologists and Microbiologists (MAPPM) has appealed to the state government to incorporate 'doctors referring patients to illegal pathology laboratories for medical test to get a kickback' in Cut Practices in Healthcare Services Act 2017.

The draft of the Act which is likely to be tabled in the winter session of the Maharashtra Legislative Assembly aims to prevent kickbacks in healthcare services amongst doctors, pharmaceutical companies, diagnostic laboratories and hospitals. Unfortunately pathology is one of the front runners in cut practices. The root cause is the very high extent of quackery in this field.

There has been a steep rise in the number of path labs run by people having Diploma in Medical Laboratory Technology (DMLT) and equivalents which is illegal as per Maharashtra Medical Practitioners Act, 1961. It says if a person other than pathologist certifies medical reports then it amounts to quackery in medical field. That is offence punishable under section 33 of the Act. But in state of Maharashtra thousands of illegal laboratories are functioning where tests are performed and reports are certified by laboratory technicians with BSc, DMLT or even lower qualification, said Dr Sandeep Yadav, president of MAPPM.

Act of referring a patient for pathology investigations to unregistered unqualified medical practitioners such as DMLT & equivalents and accepting reports from them is clearly unethical act as per Medical Council of India (Professional Conduct, Etiquette and Ethics) Regulations, 2002, he said.

In such laboratories patient receives substandard services by paying full (or some times more) fees. Doctors referring to such labs are aware of the facts, but still refer with intention to earn cut practice. Many reports are given falsely positive and based on these reports patients are admitted unnecessarily (ex. Dhule case). It results in substandard and wrong pathology reports, leading to wrong and delayed diagnoses. Few shocking instances of death due to these wrong reports have come to light (ex. Nagpur, case). Also unindicted investigations are requested. Through this daily lakhs of people fall prey to these illegal acts. Yearly almost thousands of crores of rupees are looted, he said.

The main aim of the proposed Cut Practice Act is to provide a common man with standard health care facilities from a legal healthcare provider at a reasonable cost. The cost should not increase and standards must not be compromised due to any unethical act by the health care provider, he opined.

We have anti-quackery GRs.anti quackery committees at district, tehsil and Municipal Corporation levels to stop and prevent quackery in medical field. To our knowledge committees in many district are non functional. Very few quacks have been penalized in last ten years.

The anti-quackery committees should be made functional which can act efficiently to uproot the quackery. Illegal pathology laboratories run by laboratory technicians, clinics where treatment is given by person not registered with medical council should be closed immediately. We need effective and strict implementation of MMP Act, 1961, MMC Act, 1965 and IMC Act, 1956, he added.

As per the bill, Maharashtra Anti-Corruption Bureau (ACB) shall investigate allegations of money exchange, ‘cuts’, commissions or material gifts offered in exchange for referral of patients. It prevents healthcare service providers --- hospitals, doctors, pharma companies, diagnostic labs, maternity homes, dispensaries and clinics from demanding or accepting commission. Punishment ranges from a fine of Rs.50,000 to imprisonment up to five years.

Dr Yadav has expressed reservation over above provision of the Act. “Police should not be the first action taking authority. During enquiry doctor should not be arrested. A committee like the anti quackery committee under the chairmanship of district collector with participation of doctors, police and FDA officers should be established. This committee will examine every complaint first and if prima facie offence is made out then the police can enquire it further and after due investigations FIR may be lodged, added MAPPM president.

If ACB or police is the first authority to investigate it may become a source of harassment to the doctors. People may complain to police just to malign doctors and police may also try to entertain irrelevant or non specific complaint before confirming it, said Dr Yadav.