Health: Malpractices threaten Medical tourism
With no regulation in India, patients forfeit their right to legal recourse for cheaper treatment
Gayeti Singh Delhi
When 31-year-old Shamshur Rahman learned that he had a brain tumour, the Afghan national booked a flight to India and a room in Kasturba Niketan Colony—South Delhi’s “Little Kabul”.
“I chose to come to India because my friends had come to India and were very happy with the treatment they had undergone here,” Rahman says through an interpreter.
He could not risk having the operation in Afghanistan because the country lacks “the equipment necessary to carry out these critical operations,” he added.
In Kasturba Niketan, every other shop is an Afghan grocery store or pharmacy, and between them are signboards offering rented accommodation in Dari, one of Afghanistan’s two official languages.
According to the Indian embassy in Kabul, more than 100,000 medical visas have been issued in the past three years. The country’s volatile security situation has severely impacted healthcare with a report by international charity Médecins Sans Frontières (Doctors Without Borders) saying that one in every five patients interviewed had a family member or close friend who had died within the past year due to lack of access to medical care.
But these Afghan patients are part of a larger trend. Though India mostly makes headlines for treating patients from the US and UK, patients from South Asia, the Middle East and Africa are the main reason the country’s $2 billion medical tourism sector is growing at an estimated 30 per cent. And, as the sector continues to gather momentum, the number of patients is expected to grow from 850,000 in 2011 to more than 3.2 million this year.
For patients from neighbouring developing countries, India is not so much a cheaper alternative as a safer one, promising treatment comparable to what is available in the West for a fraction of the cost. A bone marrow transplant that costs up to $200,000 in the US, for example, can be done for $25,000 in India. An Indian bypass surgery costs $6,000, compared with $35,000 in the US.
M Rafiqul travelled to India from Bangladesh for precisely this reason. “Although India is not cheaper than my own country for medical treatment, it is cheaper than most other parts of the world and the quality and diagnosis of treatment are better than in our country,” Rafiqul says.
Three-year-old Nigerian Oyeinpreye Katheryn Enemugha’s mother, Ebiakpo Gbefa Enemugha, has a similar story. She chose to travel to New Delhi to avail of treatment that, although available at home, is unreliable in terms of quality and post-operative care. She says, “We are here for follow-up after the successful bone marrow transplant in August 2013. So far, she is healthy.” The child had sickle
Musa Amina Babagana, 45, is another happy Nigerian patient. “We came to know about the Indian healthcare system by word of mouth. We then browsed the Internet [and found a suitable hospital],” she says.
But, as the flow of foreign patients swells, doctors like Alibag-based George Mathai are concerned that regulatory loopholes have made malpractices common.
“Whenever there is any discussion of malpractices in the medical profession, doctors’ associations reply that every profession has a few black sheep,” Mathai said. “But I feel that we will now need a microscope to find any white sheep that remain! This is the level to which this profession has sunk.”
Media reports abound with cases like that of Howard Staab, an uninsured carpenter from North Carolina who travelled to India for a $200,000 heart surgery that could be performed here for just $10,000. But cases like that of Mickey Chastise (not his real name) are also more common than media reports might suggest.
After approaching a New Delhi dental clinic called DentzzDental to have six porcelain veneers replaced, Chastise was eventually conned into getting crowns—a more invasive procedure—and root canal surgeries on all six teeth. Only when she visited her usual dentist back in the UK did she learn she’d been conned.
“My dentist was outraged,” Chastise told Hardnews. “Root canals are to save decaying or infected teeth from being extracted. I was wrongly advised to have root canals performed on perfectly healthy teeth, thereby compromising my health for financial gain.”
On further research, Chastise discovered that there were several other patients who, like her, had had unnecessary treatment and, worse still, were helpless to do anything about it. She also discovered that the clinic, although its website displayed the American Academy of Cosmetic Dentistry (AACD) logo and testimonials from various Bollywood stars, was not accredited.
“It was a sham,” Chastise says. “I called and wrote to the Dental Council of India numerous times, but did not receive any response. I should have known better but in the UK this could not happen. The dentists and the clinic would have their licences revoked if it did.”
Due to an absence of regulation in India, medical tourism remains a gamble, with patients signing away their right to legal recourse in exchange for the lower cost of treatment.
In fact, a disclaimer on the site of a medical tourism hospital puts the industry into context. “A prospective medical tourist should also be aware of possible legal issues. There is presently no international legal regulation of medical tourism. All medical procedures have an element of risk. The issue of legal recourse for unsatisfactory treatment across international boundaries is a legally undefined issue at present,” it reads.
If a patient from the US, for instance, were to bring an action against her overseas provider, she would need to convince the court where she was filing the suit that it had personal jurisdiction over the nonresident defendant. This, in turn, would prove problematic as courts are generally reluctant to assert jurisdiction over physicians who neither reside nor practise in the state where the court sits (i.e. the forum state).
Dr Arun Gadre, a gynaecologist-turned-health activist and author, told Hardnews that the biggest contributor to malpractice in India is the medical profession’s failure to self-regulate.
“There is no truly effective Act to regulate the private healthcare sector in India,” Gadre said. “Private doctors generally are resistant to any regulation.”
Health is a state subject, so each state has to adapt the central Act or enact its own Act. But, while the Central Clinical Establishment Act (CEA) passed in 2010 offers some useful guidelines, medical associations and doctors alike worry that, rather than improving standards, it may empower corrupt officials to harass doctors.
As an alternative, the government should take note of suggestions like those of Jan Arogya Abhiyan, a Maharashtra-based network of activists and health experts, says Gadre. They developed a modified version of the CEA with measures to check bureaucratic harassment, such as a district-level redressal committee comprising doctors’ and people’s representatives.
At the same time, though poverty and lack of education are “multipliers of malpractice,” Gadre points out, the glacial pace of India’s grievance redressal system means that even the wealthiest and best-educated patients are helpless.
Together, rampant medical malpractices and the lack of viable legal recourse leave Indian nationals and medical tourists equally vulnerable—and put all the accomplishments of India’s healthcare industry in jeopardy.