How a group of Telangana doctors became part of the same system they opposed to root out ills plaguing healthcare

There is now a beacon of hope with the doctors becoming a part of the TSMC system. They intend to bring about a change from within the system.

BySumit Jha

Published Feb 07, 2024 | 12:00 PM Updated Feb 07, 2024 | 2:35 PM

HRDA panel in front of asbestos covered TSMC office after filing their nominations. (Supplied)

The quacks were everywhere. The self-proclaimed doctors practised with impunity, earning the trust of their patients and relatives, especially in rural Telangana.

The trust they earned eventually put registered medical practitioners in a quandary when the patients insisted the qualified doctors follow the treatment protocol prescribed by the quacks.

Such treatment protocols not only posed a threat to the patient’s health but also raised doubts about the efficacy of modern medicine among the rural populace.

Dr Vanya Jasmine, practising in such a rural area, has many such instances to recall —  instances that left her both alarmed and helpless.

“I am a resident surgeon at the government Area Hospital. It’s a rural area and most people are poor,” she told South First.

“When a patient visits the hospital, I prescribe medicines after examining them. However, they won’t be satisfied, but insist on getting an injection,” she further said.

Ironically, the patients would not know which medicine should be injected. But they all wanted a shot.

Dr Jasmine soon found the root cause of the demand. They had visited a quack in the village, who gave an injection to almost all ailments. And the recovery was fast.

While the patients insisted on injections based on their experience, the doctor’s experience told her not to follow the harmful route as demanded.

“You come across regular sepsis at injection sites, and antimicrobial resistance in patients. Still, they want the injection,” the doctor added.

The quacks prescribed high-end antibiotics and second and third-line drugs for even minor ailments, ignoring the collateral damage they could do to the human body.

Also Read: Telangana boy dies after getting IV injection, police search for RMP

Practising with glee — and a syringe

On 23 January, the Jubilee Hills police in Hyderabad registered a case against a man for prescribing allopathic medicine without the required qualification.

The police case was registered based on a complaint by Telangana State Medical Council (TSMC) vigilance officer M Ramu.

The accused, K Mahesh, had the title Doctor — without an MBBS degree — prefixed to his name, and had been running a clinic, ‘First Aid, Surakshita Clinic.’

The Community Paramedics Welfare Association (CPWA) had issued a certificate to him. Additionally, the Red Cross Society, too, had awarded him a Basic First Aid Certificate.

Armed with these two certificates, Mahesh allegedly practised allopathy.

Mahesh was one among the many unqualified ‘doctors’, prescribing allopathy medicines to patients across the state, based on these two certificates.

Section 20 (i) of the Telangana State Medical Practitioners Registrations Act, 1968 (TSMPR Act), says no person other than a registered practitioner shall practise modern scientific medicine or hold himself out, whether directly or by implication as practicing or as being prepared to so practise.

Mahesh’s was the first case against a quack in the state. Since January, three more cases have been registered against as many alleged quacks in the state for practising medicine without registration and qualification.

Qualified doctors have been up in arms about people like Mahesh practising medicine. However, their efforts had brought in little change.

Also Read: How a group of doctors and medical students is going after charlatans in the state

A step in the right direction

There is now a beacon of hope with the doctors becoming a part of the TSMC system. They intend to bring about a change from within the system. So far, they were fighting against the system, with no apparent positive outcome.

The ripples of change in TSMC became visible after a 13-member Healthcare Reforms Doctors Association (HRDA) panel led by Dr K Mahesh Kumar won the elections to the council that concluded on 30 November last. Dr Kumar is now its chairman and Dr G Srinivas, HRDA secretary, the vice-chairman.

Incidentally, it was after nine years after the formation of the state that Telangana had a full-time elected TSMC.

The entire panel winning the elections was a sweet moment for Dr Kumar. It also reflected the seriousness with which qualified medical practitioners across the state were viewing the quack menace.

Also Read: Medical commission comes down heavily on conversion therapy

Insulted and humiliated

Rewind to 2022. The quacks flourished as Covid-19 raged.

Dr Kumar along with several doctors were giving representations against quacks, a shortage of doctors at primary health centres, as well as the dilapidated condition of many old hospital buildings, such as Osmania General Hospital, and the delay in disbursing the stipend of junior doctors. Their pleas fell on deaf years.

On top of that the authorities even stopped listening to these doctors, and considered them enemies of the system.

“Dr Kumar was seen as the enemy of the system,” a doctor told South First. “Once Dr Kumar was at the receiving end of the outburst of a person in authority. I later asked Dr Kumar about the system’s approach to us. He told me that ‘everything has its own time. This time they can do whatever they are doing but a time will come for a change, and the change will happen’,” he quoted Dr Kumar.

Dr Kumar remained confident. He asked the doctors to be patient. “We need to be patient until our goal is achieved no matter whatever hurdles that may come in our way,” he reportedly said.

Authorities’ anger was not just towards Dr Kumar; it also targeted the organisation he led, the HRDA.

In October 2022, HRDA posted on X a video of the then Health Minister Harish Rao addressing a gathering of Registered Medical Practitioners (RMPs) and Paramedical Medical Practitioners (PMPs), after an inspection by the Director of Public Health (DPH).

In a clip of a phone message included in the video, a voice — purportedly of Rao — was heard saying that action would be initiated against only those RMPs performing abortions and minor surgeries. He allowed them to continue prescribing medicines. The voice promised to instruct the DPH not to intervene with RMPs.

The minister was reportedly speaking using MLA Guvvala Balaraj’s phone. The HRDA felt Rao was “the most ineligible person” to hold the health portfolio.

On HRDA’s call, doctors across Telangana protested against Rao.

“We were not against the government or any person, but the policy which they promote. However, they see us as their enemy,” Dr Kumar, now the TSMC chairman, told South First.

Also Read: Telangana Drugs Control seizes ‘Fair & Bright’ cream that claims to lighten skin colour

HRDA: The genesis

In December 2016, the former members of Telangana Junior Doctors’ Associations (JUDA) held a meeting. JUDA is a body in medical colleges that represents post-graduate and MBBS students. Seven JUDA members attended the meeting.

“There were already prominent organisations representing the medical community but a major challenge doctors faced, particularly in Telangana, is the prevalence of quackery,” Dr Kumar said.

“This issue not only impacts the medical fraternity but also poses a threat to public health. Despite numerous attempts to file complaints with relevant bodies, the response has been discouraging. Recognising the need for a unified platform to address this menace, we decided to establish an organisation dedicated to combating quackery,” he reminisced.

The result was the formation of HRDA on 20 April 2017. Within a month of its formation, it started a fight against Telangana Government Orders (GOs) 41 and 43, which allowed private medical colleges to hike the fees.

“It was the first week of May 2017 when we filed the case. The high court later ruled in favour of us and struck down the GOs,” HRDA tasted its first victory.

“That was the start of HRDA’s fights. Since then we fought against the ills dogging the state’s healthcare system,” TSMC vice chairman Dr G Srinivas added.

The cases which the HRDA initiated were many: A case on behalf of PG medical students against a fee hike and interestingly, one for the conduct of election to TSMC in the high court and the Supreme Court.

“After establishing the organisation, we kept submitting representations against quackery to various authorities and even complaining to the police. But, in the process, I learned about TSMC,” Dr Kumar said.

“We didn’t have the power even to report a quack and get a case registered. Then we started to give representation to the TSMC. We gave more than 1,000 complaints against quackery, but to no avail,” he added.

Also Read: Police arrest Class 10-failed ‘doctor’ who ‘specialised’ in treating piles, fistula

Fight for TSMC elections

Dr Srinivas said the inaction on their complaints surprised them. “We didn’t know the reason why no action was taken. But gradually, we realised that the TSMC comprised only government officials and there were no elected members.”

“The realisation made us fight for elections to the TSMC. We filed a writ petition in the Telangana High Court and it ordered a fresh election. The court also specified that there should be 13 elected members instead of the five, as proposed by the state. Telangana’s argument was to dilute TSMC’s autonomy and its independent nature,” Dr Srinivas said.

However, the fight was far from over. The Telangana government and the then-TSMC filed a petition in the Supreme Court to stop the elections. “We again filed a caveat and the Supreme Court upheld the high court’s decision,” Dr Kumar said.

The TSMC election was notified in August 2023 and HRDA nominated 13 members. “These members were from the different parts of the state, with varying backgrounds — doctors from government and private hospitals, private practitioners, resident doctors, and medical officers from pharmaceutical companies,” he added.

Also Read: How drug officials in Telangana are identifying fake drugs

HRDA’s guarantee

The HRDA’s election manifesto revolved around the commitment to eradicate unqualified doctors (quackery) and the prevalent practice of ‘crosspathy’ in the healthcare system. ‘Crosspathy’ involves the prescription of homoeopathic and ayurvedic medicines along with allopathic drugs.

The organisation promised a specialised Anti-Quackery and Legal Cell under the TSMC, by the guidelines of the National Medical Commission. The HRDA manifesto took a proactive stance against quackery, pledging to register First Information Reports (FIRs) against unlicensed practitioners in a time-bound manner.

The manifesto promised to make it possible in collaboration with district authorities. Additionally, to ensure adherence to prescriptions and patient safety, the TSMC vowed to report instances of unauthorised medicine dispensation to drug inspectors concerned for appropriate action.

The election to the 13 posts of TSMC was conducted through postal ballots, which commenced on 13 September and lasted two months. The result was declared on 22 December.

Also Read: Hyderabad doctor’s wife held for ‘supplying’ synthetic opioid drug

Campaigning for medical ethics

Dr Vanya Jasmine did not contest the polls. However, HRDA’s activities and its legal battles for a larger good won the appreciation of many like her. They actively campaigned for the HRDA panel.

HRDA after winning the election. (Supplied)

HRDA after winning the election. (Supplied)

“TSMC is a regulatory body, established under the state laws to regulate the medical profession and redress complaints related to misconduct by medical practitioners,” Dr Jasmine said.

“It is responsible for prescribing a code of ethics, registering doctors, and ensuring that doctors are fit to practice and provide a good level of care. But, the previous TSMC lacked all these and the HRDA fought for it. So, everyone, around 50,000 doctors in the state had an idea about the HRDA,” she added.

The JUDA, Senior Resident Doctors’ Association, and some medical college alumni associations backed the HRDA panel.

HRDA reached out to registered doctors. “Our biggest advantage was that we went with the manifesto, told them that we are going to work on these points. We never asked them to vote for an individual, but sought support for the entire, for all 13 members. The  contestants sent WhatsApp text messages, and asking for votes,” Dr Srinivas said.

Dr Kumar added that they convinced the doctors that there would be 12 government-nominated members and 13 elected members. “We wanted all our members in the TSMC so that our work would not be hindered.”

“Out of around 50,000 doctors, 45 percent voted for our panel. And we all were elected,” Dr Srinivas said.

The doctors, who were fighting against the system, thus became a part of the same system.

Also Read: Kerala consumer court orders patient to pay compensation to her doctor

Plan to revamp healthcare system

Dr Kumar further stated that the focus now was on adapting to the system, with primary emphasis on streamlining the doctors’ services, addressing issues such as registration, online services, and decreasing the service charge of doctors.

“The goal is to ensure efficient processes, without hurdles or delays. Efforts are also underway to build a dedicated team and subcommittees for tackling quackery through complaints and building a strong system. Also, we are looking to have a permanent building for the TSMC office,” Dr Kumar outlined the priorities.

He stated that they could play a participatory role in improving primary healthcare and expressed willingness to collaborate for bettering healthcare services, even by participating in policy-making, if given an opportunity.

“The ultimate goal is to provide quality healthcare, particularly in rural areas, by eradicating outdated systems and enhancing services at the grassroots level. We can participate in the policy-making process. However, TSMC will do its best to make healthcare efficient for the public,” he said.

Dr Kumar and his team have now sought an appointment with Damodar Rajanarasimha, the health minister in the new Congress-led dispensation.

“We just don’t want to meet and greet, but want to give a presentation and also put in demands. We have been promised that he will give us an audience in a few days,” Dr Kumar said.