Friday, April 20, 2018

Attention members of DCI

Respected sirs and madams,
I happened to see a memo from the office of the DCI restricting the conduct of any kind of course not pre approved by the Dental Council of India ( No De-110(186)(complaint)-2018/457. This obviously sponsored notice, coming as it does at this point of time, seems to suggest that all programmes aimed at providing knowledge or refreshing skills must have the approval of the Dental Council of India. 
Respected president and members, I beg to differ, like thousands of others, because the DCI has no such powers to curtail the improvement or renewal of knowledge and skills from qualified persons with or without the sanction of the DCI. The notice cites sections 10, 10A, 10B, 51 and 52 to make the fallacious argument that the DCI is the custodian of all clinical learning or updating. It has freely and wrongly interpreted the meaning of the term ' qualification' to mean competence or acquisition of knowledge and skills. I hope the statutory body had spent a little more time taking a legal and grammatical opinion before coming out with such an ambiguously framed memo hindering the fundamental right to learn and benefit society.
Sirs and madams, the heading of section 10 of the Dentist Act refers to registrable qualification. I am sure that you are aware that the medical and dental statutory bodies regulate only registrable degrees which indeed are qualifications. The prime registrable degree in dentistry is BDS . A registered dentist with a BDS is allowed to practice dentistry including all specialties depending on their interest, ability and training. The postgraduate qualification is only an additional or add on registration. Add on Registration for post graduation essentially permits one to become a teacher in a college approved or recognised by the DCI. It does not provide exclusivity of clinical practice in a specialty, as India ' DOES NOT HAVE' a separate specialty register.
In other words, the members of the statutory body must understand, that a qualified BDS graduate can do Endodontics, Oral surgery, periodontics or orthodontics according to his expertise which is achieved through experience, practice and skill enhancing programmes. Where they obtain these additional skills within the purview of dentistry is not the business of the DCI . This is made clear in the definition of 'recognised dental qualification' in chapter1 (j) which includes only 'qualification in the schedule'. In which part of the schedule are there references to refresher courses recognised by DCI, sir??? 
Section 10(2) requires all these qualifications to be entered in the schedule. Which courses other than those offered by recognised dental colleges are included sirs? Are the courses conducted by IDA or Specialty associations part of the schedule? Does the DCI have powers and guidelines to include them? NO! Quoting section 51 and 52 in the aforesaid  memorandum/ notice is at best a wrong interpretation and at worst an attempt to mislead. These sections only refer to practice of registered dentists and has nothing to do with acquisition of further skills and knowledge by them. 
In fact the code of ethics regulation ( of which I was one of the draftees) encourages the acquisition of knowledge without conditions. It exhorts dentists to continuously upgrade skills in Chapter I, 3.2 and subsections. Nowhere does it say that imparting knowledge and giving a certificate of experience is unethical as implied in your notice.
Let me try to cite an example. Several hospitals provide Basic and Advanced life support training for a fee. The same with Trauma Life Support. Does the DCI have to whet every certificate programme in every hospital or institution in India and abroad to have a current training record in BLS, which you will agree is an essential part of safe practice. Skill renewal and enhancement can be provided in formal and informal settings with and without certification from a person with established skills. Dental practitioners get trained by other practitioners in the use of new techniques and materials. They attend courses conducted by industry pioneers and manufacturers of new devices and equipment. What has DCI to do with these?
Medical science has advanced only because of these courses which cannot be or has not been provided in teaching institutions during their limited course of study. In fact the need has arisen because many recognised dental colleges have not been able to provide the knowledge and skills as prescribed in the curriculum.
Sirs and madams, I request you to withdraw the memorandum which was issued in haste. If indeed the Dental Council wishes to bring in regulation for accreditation of providers of knowledge and skills, please create terms of reference, guidelines and make amendments to the constitution rather than issue fiats which retard the continuous enhancement of knowledge and skills by imposing unreasonable and unconstitutional bars on the dissemination of information.
Thanking you,
Your sincerely

George Paul
Reg No 10285 ( TNSDC)
Past President AOMSI

Friday, October 7, 2016

Sharon palliative centre- dignity in life

It has been said that "Death with dignity is better than life with humiliation". It is an affirmation of what most of us secretly hope for. In India, a dignified death is a difficult proposition. A TOI report says that of the 9 million deaths every year in India, nearly 6 million need some kind of palliative care. The fact that most do not have access to it, is altogether another matter.The same article throws up a shocking reality- 80% of the palliative care centres in India are situated in one state, Kerala ( with 3% of the nation's population). 
Sharon Cancer Centre in Salem, TN, has just been renovated to serve as the largest palliative centre in our region. Most Doctors, over the years, have been obsessed with strategies and means of prolonging life without actually considering the quality of life. Palliative care focuses on providing care for the hopelessly sick by helping patients and family to cope with their physical pain and disability. While palliative care can sometimes be given along with their treatment, most patients admitted for end of life care will receive very little in the form of therapeutic interventions.
The staff at Sharon's palliative facility have been carefully chosen, keeping in mind the special needs of patients with advanced disease. The doctors, nurses, counsellors and social workers form a tight and empathetic group of specially trained personnel committed to making the life of terminally ill patients comfortable and dignified.
The premises have been carefully structured and planned keeping in mind the special needs of our patients. The verdant campus, situated in sylvan surroundings at the foothills of the Shevarayan hills, is a pleasant blend of natural beauty and functional efficiency.  The buildings are disability friendly and well equipped to handle the unique needs of our special patients.
Sharon palliative centre was conceived as a non profit establishment committed to egalitarian principles that will not discriminate on the basis of type of diseases, social status, race, religion, language or ethnic background. 
However in the absence of any external funding the management will strive to run it at a minimum fee to cover actual expenditure. A percentage of the beds will be reserved for indigent and extremely poor patients who will be screened by a select panel. Sharon palliative care currently provides clean and airy housing, bed and linen. Diet plans and pain medication is provided on an actual cost basis. Specially trained palliative nursing is covered in the base costs. Surgical or medical interventions are generally not curative and meant only for alleviating pain and discomfort through licensed narcotic medications and limited toilet or pain relieving surgeries. Special requirements including visits by external consultants can be obtained on request through the administration. Special needs like private rooms, air conditioning etc can be made available at cost price but all general services are charged on a flat affordable fee structure. We look forward to volunteers from the public, who can provide solace, comfort or mere companionship.
Sharon will also expand its services to include domiciliary care where nurses and social workers will make periodic visits to homes to counsel, advice and intervene for terminal patients needing home care. Placement of trained male or female nurses for continuous home care will eventually be rolled out later to meet in -house domiciliary care needs.
Those willing to offer their services on a voluntary basis are requested to contact Dr Karthik Rajaratinam 9894027274

Saturday, September 10, 2016

An open letter to the Hon. Minister for Health and Family Welfare - Shri J P Nadda

This letter is a reflection of the angst that has preoccupied the minds of thousands of professionals in the field of dentistry. Over the last decade and a half, dentistry has suffered enormously at the hands of several persons who have been running the Dental Council of India and the Health Ministry. The profession has become a burden to thousands of young people who have chosen it, believing that it would give them a meaningful role in society and a means to a stable economic career. The unprecedented and totally unplanned increase in colleges and seats has caused an irreversible glut in the profession leaving hundreds of unemployed dentists and specialists. Many have abandoned the profession resulting in an unforgivable waste of human resources. All this was done to feed the business interests of certain persons who run private institutions as a pure business with the help of the statutory bodies- indeed an unholy nexus!
We appreciate the initiatives being taken by the government and the judiciary to revamp the medical statutory bodies. Dentistry is perhaps the worst.  In this regard I wish to bring to your notice the fact that the Dental Council of India continues to be run through the agency of corrupt members, nepotism and poor governance. It is a sad reflection on the Health Ministry that despite numerous petitions pointing out the illegal membership of the President and several members, no action has been taken against them. The nomination of the President of DCI Dr Dibeyendu Mazumdar to is flawed ab initio as also that of several others. Despite overwhelming evidence produced by several persons and pending cases challenging such nominations, the health ministry has done little to correct the situation. Nothing short of disbanding the DCI and reconstituting  it anew will solve the continuing problems faced by the profession. 
Sir, there has to be 
1. A complete moratorium on new dental colleges and increase of seats in under graduation and post graduation, because of the super saturation by poorly qualified dentists. 
2. The quality of students entering and exiting the institutions have to be monitored through appropriate examinations in the interest of public safety.
3. The complete administration of the profession has to be revamped to remove illegal members and prevent concentration of power in the hands of a few. This has to start by sacking all the illegal members, starting with president. It is after all the Health Ministry that has been tasked with the job of constituting all the statutory bodies. It has to be their responsibility to dissolve and reconstitute when it becomes unbearable.
Looking forward to a speedy reaction from your ministry.
I remain

George Paul

Thursday, August 25, 2016

A half ticket to Heaven!

The in-flight newspaper on the Kenyan Airways flight from Mumbai to Nairobi announced that hundreds of people were dying of malaria in the rift valley. The rift valley is endemic for rift valley fever and malaria which kill hundreds of humans and animals annually.I never imagined that malaria took its toll in such a dramatic way until I saw a child die in his mother’s lap. I had just landed at the mission Hospital in Kilimongogo, where I was to spend the next one-month as a volunteer dentist. A little boy with cerebral malaria lay on the lap of his mother, his eyes rolled up to reveal only the whites. He was delirious, muttering words and making incomprehensible noises. The mother sat mute and helpless as the young doctor examined the boy and drew blood. “Cerebral malaria” the doctor informed me “do you see it in your country?” The doctor was himself a refugee from Rwanda- A Tutsi, who fled massacre in his own country. “ I am sure there are cases” I replied “ I haven’t seen one though.” Later that evening he informed me that the child died and they were keeping the boy till morning so that the mother could take him back home- somewhere in the rift valley, I assumed. There was no public transportation. The hospital had just one ambulance and several people were dying. I wondered how the mother was going to deal with it. She was gone in the morning, carrying her dead son !This incident brought back memories of something that happened many years before that incident, in my hometown of Salem in India. A little boy with an ulcerated growth on his palate was referred to me from a village.  As an Oral surgeon I often encountered these conditions. The father explained that he was an extremely poor sharecropper. They were unable to get any treatment at the government hospital and were referred to me by their village doctor. The growth was surgically removed under local anaesthesia and sent for a biopsy. The report was inconclusive. A couple of months later the same boy was brought to me again. The surgical site in his mouth had healed completely but he now had an ulcerated lesion on his leg, quite similar to the one he had in his mouth earlier. His leg was grossly swollen, as were his genitals. I had the boy admitted and asked for my friend Dr Ranjan David, a general surgeon, to see him. Despite Ranjan’s best efforts the boy died of septic shock a day later. We never found out what the problem was. The hospital was gracious enough to waive all the expenses except the drug bill. As the little boy was admitted in my care, I went over to complete the formalities. The boy’s father was extremely distraught. He was inconsolable and kept wondering how he was going to tell the boy’s mother in the village. I realized he did not have the money to pay the drug bills. We passed the hat around and collected some money to pay it off. I then asked him how he planned to take the dead boy home. His brother in law had enquired at the local taxi stand and was told that they charged a hefty sum to carry a dead body. Virtually no ambulances transported corpses those days, as there was a stigma on such vehicles. A couple of taxis parked around the general hospital did transport dead bodies, but they charged exorbitantly. He told me that he could not afford the transportation costs and that he would manage somehow. I watched helplessly as he thanked me and heaved the boy onto his shoulder and threw a cloth on to his head. He told me that he was going to take a one-hour bus ride to his village. When I asked him if the conductor would allow it, he answered simply “ I will say the boy is sleeping and take a half ticket for him.” The picture of a father carrying a dead child on his shoulder in a bus was imprinted indelibly in my mind and it comes up every time we consider the inequities in our health system.

Thursday, June 23, 2016

Appointing a secretary- breaking the rules!

How the rules and regulations have been twisted to select a secretary to DCI.

As per the Dentist Act, section 8.1  ( quoted by the DCI in its office memo) it says ' the Council shall select a secretary'. It was decided that the secretary will be selected by a committee ( probably to give the impression of fairness). The 1956 regulation in Part IV section 47-51, clearly defines how a committee has to be selected. It says that ' The council at anytime shall, by adoption of a motion, appoint a committee........'
The key word is 'the Council'. In the preamble to the 1948 Act and the 1956 Regulation, 'The Council' is defined as ' The Dental Council of India, constituted under section 3 of the Dentists Act'. This means that the Council means all the members of the General Body ( GB). Therefore any act by the DCI requiring the Council to decide means that the decision has to be taken at a GB.
Now look at how the Secretary was selected. The DCI calls for a vacancy of secretary ( having thrown out the previous acting secretary because he was not co-operative) in the Employment news. The President/ EC appoints a committee. Now it is very important to understand that neither the President of DCI nor the EC is the 'Council'. I am reiterating again, that the Council means, all the members of DCI under section 3, which means the GB. Therefore 'the committee' should have been formed at the 134 th GB. It was not. It was constituted illegally by the President and the EC subsequently. They then went ahead with the interview despite objection from the Health Ministry ( letter reproduced). The selection was then ratified by the EC and the 135th GB. This is completely illegal as 'the Committee' consisting of the President, Vice President and a member are per se illegal because it was illegally constituted.
This same modus operandi has been used to grant favours to Dental Colleges, by sanctioning PG and increasing BDS and MDS seats without prior sanction of GB. The whole process, it appears, is a manipulation by the President and his close friends in the EC leaving the GB to be a silent spectator with no powers. The subsequent ratification is obviously just a joke!!

Sunday, May 8, 2016

Everything you wanted to know about NEET but was afraid to ask!

What will happen about admissions this year?
As per the Supreme Court directives, the following are almost certain . There will be two phases of NEET for MBBS/ BDS. One has already been completed on 1st May 2016 and the other will be held on 24 th July 2016. All admissions to be completed by September. The Supreme Court clarified on 6th May 2016 that those who attempted the first phase ( AIPMT) on May 1st cannot  attempt the 2nd phase. The Supreme Court also clarified on 5 th May that private institutions cannot conduct their own entrance tests. With regard to State Government Entrance tests, the Court is yet to give a ruling.
My take: it is a good beginning. The state government admissions, if permitted, is also acceptable since there was insufficient time. The stricture on private entrance test is a great boon for merit students and a very bad blow to those institutions, particularly DeemedUniversities that conducted fake tests, and believed that the party was for ever!!!
I personally think it is unfair to not permit those who attempted in the first phase ( AIPMT) to not have a second try. It is unfortunate but not as bad as things were before. Those who attempted first time were serious students who prepared. Those who did not are unlikely to score much anyway. That is consolation for the former!!!

2. What about PG admissions?
For this year there will be no change in PG admissions as per the Supreme Court. Those already admitted in private and Deemed Universities after paying huge capitations may have escaped by the skin of their teeth. The NEET will be imposed from next year.
My take: hundreds if not thousands of merit students have been disenfranchised by the system, hopefully for the last time. In many institutions crores of rupees were paid, seats booked and fake exams held. Hopefully it will not happen again.

3. How will private institutions survive financially and make profits if the new policy is implemented?
Private institutions are not expected to make money. The Supreme Court has issued a clear directive in several cases that There can be no profiteering from higher education including medical education. They can levy a reasonable tuition fee based on actual expenses to be supervised by a High Court appointed Retired Judge and a chartered accountant to audit the expenses and income. Here is the relevant portion of the judgment
"The fee structure for each institute must be fixed keeping in mind the infrastructure and facilities available, the investments made, salaries paid to the teachers and staff, future plans for expansion and/or betterment of the institution etc. Of course there can be no profiteering and capitation fees cannot be charged. It thus needs to be emphasized that as per the majority judgment imparting of education is essentially charitable in nature. Thus the surplus/profit that can be generated must be only for the benefit/use of that educational institution. Profits/surplus cannot be diverted for any other use or purpose and cannot be used for personal gain or for any other business or enterprise." And also 
"we direct that in order to give effect to the judgment in TMA PAI's case the respective State Governments concerned authority shall set up, in each State, a committee headed by a retired High Court judge who shall be nominated by the Chief Justice of that State. The other member, who shall be nominated by the Judge, should be a Chartered Accountant of repute..." Islamic Academy Of Education And ... vs State Of Karnataka And Others on 14 August, 2003
Author: V N Khare
Bench: V. N. Cji, S. N. Variava, K. G. Balakrishnan, Arijit Pasayat, S.B. SinhA. CASE NO.:Writ Petition (civil) 350 of 1993

My take: private medical institutions run a multi multi crore business with support from politicians of every hue and enormous financial resources. They have been thumbing their noses at the judiciary, NGO's and most importantly to the people of India. The bench headed by Justice Anil Dave will put them in their places. Nobody asked these private institutions to run medical or dental colleges as business!  If they wanted to make money there were so many avenues. They do not have to play with the quality of medical care and put the public at risk by admitting sub standard students. I must mention that there are several good private institutions that have served the profession well! They will not feel the pinch of this order as they have fulfilled a need by starting and running colleges without profiteering. The others who made business out of it will need to re think and still find a way to contribute!  I only hope that it is not once again upstaged by money power and politics!!!! 

4. How will the government ensure that there is no 'exploitation' by the private institutions by taking capitation fee from the super rich and refuse deserving students?
The Supreme Court has ruled that the institutions must publicise their tuition fee ( endorsed by the committee mentioned above). If a merit student through NEET wishes to join at the stated fee, he/ she can apply with full knowledge of the fees quoted by the institution. If the candidate is bypassed by a person with a lower rank ( who probably paid under the table), the rank holder who is denied the seat can approach the government and punitive measures can be instituted against the principal/ admission officer.
This is reflected in a tabled star question in the Rajya Sabha by a member Vijay Jawaharlal Darda ( no 1092) on 3 rd May 2016 "c) how Government proposes to stop prevalence of capitation fee in private medical colleges in flagrant violation of the law and the details thereof?"
The answer by the Honourable Minister JP Nadha was
c): In case of Government medical colleges, the respective State Governments are responsible for fixation of fees. However, in the case of private unaided medical colleges, the fee structure is decided by the Committee set up by the respective State Government under the Chairmanship of a retired High Court Judge in pursuance of the directions of the Hon’ble Supreme Court of India. It is for the Committee to decide whether the fee proposed by an Institute is justified and the fee fixed by the Committee is binding on the Institute.
To quote a leading article on this issue
The bench characterised capitation fee as “nothing but a price for selling education” which amounts to commercialisation of education adversely affecting educational standards, characterising such institutions charging capitation fee as “teaching shops”. “The concept of teaching shops is contrary to the constitutional scheme and is wholly abhorrent to the Indian culture and heritage.”
Thus, the notion which was first observed in Mohini Jain’s case, was upheld in the Unikrishnan’s case, in Father Thomas Shingare and others v. State of Maharashtra and others, the Pai foundation case, Islamic Academy of Education, Modern School v. Union of India, P.A. Inamdar and finally in Modern Dental College & Research Centre v. State of M.P in the following words:
“Capitation fee is prohibited, both to the State Government as well as the private institutions, vide Para 140 of Inamdar case….”
My Take: capitation fee is illegal. It has been taken in flagrant violation and it has been exposed by the media several times, but no action has been taken. The fees have to be announced in advance as decided by the Committee referred to earlier, so that students can decide whether they can afford the fee. The fee is invariably never advertised and students who claim admission are often harassed at the time of admission, during the course and at times of examination. There has to be a clear announcement of tuition fees as submitted by the Institution to the designated Supreme Court mandated committee based on fee fixation. This is never done and it is up to the state governments/ UGC/ HRD Ministry to ensure that it is followed at the pain of punitive action. The state/ central government can show intent of justice for merit only if they take action against erring institutions!
5. What is a reasonable fee quoted by the private college?
The fee for a medical dental admission is decided by the fee fixing committee based on the information submitted on the salaries of staff, patients treated and other expenses. No profit can be made by the management. A 10-15% extra fee per year to be used only for expansion is allowed.  This needs to be reported through an auditor who calculates the actual expenses. The relevant Supreme Court paras are quoted above.
My Take: Deemed Universities and private medical colleges are supposed to be run only by private charitable trusts. These trusts appropriate money received by black money and distribute it amongst relatives, friends and even employees who have amassed great wealth despite the funds being held in Trust! Salaries to staff are often not paid on time while children of these trustees drive fancy cars and invest in real estate. Only a complete investigation can reveal where this money running into several thousand unaccounted crores was sourced and the necessary action taken against them through the CBI or other investigating agencies. Some of these are even going overseas! 
6. I have paid advance capitation fee on the promise of a seat. What do I do?
Go back to the institution and take back your money if you can! It was illegal to give money or for the institution to accept it in the first place. Prepare and write the NEET on July 24 th and book a deserved place in a Medical/ Dental College of your choice. By paying money you are depriving another merit student of a seat. .
It has happened several times!
My Take: being anti national is not related to chanting slogans alone. It comes from paying black money in cash for getting admissions which are against the laws of the land. It is a crime against a fellow Indian. Take a deep breath and allow merit to take its course. If there is a fee to be paid for private education, you must know what it is and take a decision accordingly. It is wrong to get an admission by paying more  illegally to gain advantage over a more deserving person. It is not only morally wrong but it is also anti national!

I wish to state that there will be hiccups in the process. There are problems of language, syllabus etc. some may argue that everything was done in a haste. But this has been in the pipeline for several years. Prevaricating on a decision now will only give those who want to make a business proposition out of medical admissions will get another opportunity to hijack the whole process through a legal or legislative process. The opportunity to have a single window is, now! The small glitches can be sorted out by states improving their syllabus and trying to get as many regional languages as possible included in the entrance tests! Any postponement will only give academic businessmen a foot in the door to continue to make money selling medical seats. This is not good for the meritorious students and the public. Act now or never! 

Wednesday, August 19, 2015

All the President's men- A Fairy Tale

It is almost exactly 5 years since the Madras High Court ruled that the then President of DCI, Dr Anil Kohli's membership in DCI from Delhi was illegal. The then President of DCI resigned after his illegal membership in DCI was exposed through a Writ Petition filed by me. History now repeats itself. Dr Mazumdhar's nomination from a little known University in Jharkhand called Nilamber Pitamber University appears to be faulty just as the membership of 21 other members of the DCI ( for various other reasons). Here is the reason why Dr Mazumdhar is likely to be an illegal member.
1. To become member of the DCI under section 3(d) i.e Representative from University, one must be elected from amongst the Faculty of Dentistry of the University ( not teaching faculty).
2. While the Nilamber Pitamber University has an affiliated private dental college called Vananchal Dental College, it has no Faculty of Dentistry in the University. So the Nilamber Pitamber University cannot elect a member to DCI u/s 3(d).
3. Dr Mazumdar was made a honorary teaching faculty of Vananchal Dental College which is a private Dental College, in 2013 ( and it was kept a secret) despite he being a government servant of the Government of West Bengal. Either due to ignorance or by design the Nilamber Pitamber University has thought that being a member of the teaching staff of an affiliate dental college is the same as being a member of faculty of dentistry of a University. The two are quite different.
4. On May 31st 2015 Dr Mazumdhar who lost his membership to DCI from West Bengal ended up losing his Presidency of the DCI too, as they are co- terminus. He again stood for the post of president on June 11 th 2015 by claiming membership from Nilamber Pitamber University. He suddenly revealed his Hon. Professorship to claim membership under 3 (d). Based on this illegal membership he was elected by DCI members without opposition ( no one was allowed to oppose).
5. The question now is whether we have an illegal president Dr Mazumdhar and 21 members including the famous Ketan Desai in our statutory body. Dr Ketan Desai in fact found it convenient to enter DCI after being disallowed in the MCI. The reason why Dr Mazumdhar's Presidency is illegal is very simple. The Dentist Act does not allow membership from amongst faculty members of a private dental college ( which Dr Mazumdhar claims he is by honorary appointment). It only allows a person who is a member of a duly constituted faculty of Dentistry of a University who should thereafter be elected by a senate of the University. Nilamber Pitamber University by its own RTI admission does not have such a faculty with a fixed tenure and the election by senate was a farce. The member of an affiliated college's teaching faculty CANNOT be a legal member of DCI and therefore Dr Mazumdhar CANNOT  be president of DCI.
His membership and election as President will hopefully be challenged.