Considering the issue of shortage of post graduate clinical pathologists in the country, the Medical Council of India (MCI) needs to review and ease the qualification norms with regard to running pathology labs as the country's healthcare system requires many such laboratories, observed eminent doctors from across the country in an online discussion.

Medical professionals representing various associations point out that it is high time the MCI reworks on the eligibility criteria in running path labs. Relaxation of norms will help solve the shortage issues in a big way. This can be done on the same lines as in the case of relaxing the qualifications for performing sonography under the PNDT Act, 1994, they opined.

The MCI stipulates that only those pathologists who have recognized postgraduate qualifications in pathology are competent to run pathology laboratories. All over India, there is a big shortage of recognized MD pathologists. If the norms are not relaxed, the existing law will continue to be violated openly. It is a basic principle of legal theory that laws must be realistic. Unrealistic laws are bound to be broken, said the moderator of the discussion, a former department head in AIIMS, New Delhi.

He comments that according to a study report by Royal College of Pathologists of Australasia (RCPA), there is a shortage of pathologists worldwide, including Australasia which comprises Australia, New Zealand, Hong Kong, Singapore and Malaysia. The shortage is in general pathology as well as in its various sub disciplines which include anatomical pathology, chemical pathology, haematology, cytopathology, immunopathology, microbiology, genetic pathology and forensic pathology. The report states that more than 70 per cent of all diagnoses involve pathology tests and there is a real risk that overworked, tired pathologists are more likely to make misdiagnoses.

Another point highlighted in the discussion is that, quoting the president of the ‘Association of Practising Pathologists’  India, in Haryana, there are only 22 pathologists and at least 500 labs are operating in Faridabad, as per a study held in January 2011. According to a study conducted in Maharashtra in 2007, in 33 of the 35 districts in the state (excluding Beed and Mumbai suburban) it was found that out of the 339 talukas, as many as 210 were without a qualified pathologist.

The doctors observe that running of pathology labs by DMLT persons is illegal as per many Acts and High Court judgements. The Indian Medical Council Act, 1956, MCI Code of Ethics Regulations, 2002 and Maharashtra Pathology Laboratories Control Act, I997 stipulate that qualified persons in pathology alone are eligible to run path labs.

The court verdicts in cases such as Madhya Pradesh High Court judgment in the case of Kamla Patel v/s State Of MP and others (January 2003), Bombay High Court interim order in Dr. Pratap Sitaram Patil and Others  v/s State of Maharashtra and others (October 2007), Gujarat High Court order in the case of Association of Pathologist and others v/s Health Secretary, government of Gujarat and others (September 2010) etc make it obligatory that pathology labs should be run only by qualified pathologists.

Based on these Acts and judgements, the online forum of doctors exhorted the practicing pathologists and their associations to file cases against labs run by unqualified persons.

The discussion concludes with a suggestion that since the country is in terrible need of numerous path labs and there is shortage of MD pathologists, the MCI should relax the norms apropos running pathological laboratories. A point of concern is that pathologists with MD in pathology and recognized by MCI to run the large number of path labs existing at present are not available.

The work done in path labs belongs to two categories, clinical pathology and histopathology (including cytology and haematology). The histopathological work calls for special pathological skills.

According to the doctors, the shortage issue can be solved if the MCI broadens the definition of a pathologist for the limited purpose of running path-labs where histopathology work is not undertaken. The moderator of the discussion concluded the discussion with the suggestion that the MCI should hold that “a person would be competent to run a pathology laboratory (excluding histopathology) if he has a recognised qualification in pathology or is a registered medical practitioner having six months training or one year experience in clinical pathology”.