The Supreme Court, during a suo motu hearing on the issue of alleged malpractices of private medical colleges last week, dissolved the semi-autonomous regulatory body Pakistan Medical and Dental Council (PMDC), which was responsible for maintaining high standard of medical education in public and private medical colleges.

The court has constituted a seven-member interim committee that will help draft legislation for the body and inspection of those colleges.

In earlier hearings, the apex court barred those colleges from inducting students and prohibited them from charging more than Rs0.642 million per year in fees until the court ordered to the contrary. The court warned them of a complete shutdown in case of non-compliance.

A three-member SC bench, led by Chief Justice Mian Saqib Nisar, had observed that the standard of medical education has deteriorated to the extent that some medical colleges are being run on rooftops and in garages. "Now we will get to know the science of private medical colleges," said the chief justice.

The SC is focusing on human rights issues, particularly people’s right to quality education and healthcare under its 2018 agenda.

PMDC counsel, Akram Sheikh, sided with the SC on the matter, claiming, "Private medical colleges are holding medical education hostage, and this is a result of Dr Asim Hussain’s policies."

Medicine is considered to be the noblest of professions. Doctors deal with sufferings of the humanity. Patients come with acute pain and agony, however, because of kind and humble efforts of the doctors and paramedical staff they return healthy. What doctors achieve in response is respect and prayers. That is why medical is still the most sought after profession.

However, private medical and dental colleges in Pakistan are accused of being a ‘mafia’ consisting of politicians, retired army officers and health professionals, which in the name of fixing shortage of doctors in the country, is ‘exploiting’ aspiring medical students and their parents. These colleges are admitting students with base merit of 60 per cent, or even lower as compared to the merit of public medical colleges which is plus 85 per cent. They charge high tuition fees in the garb of ‘donations’ in addition to the maximum prescribed fee, offering ‘substandard’ medical education, awarding degrees by relaxed marking in internal examinations and producing ‘incompetent’ doctors, and eventually posing a threat to the poor patients and the society at large.

On the other hand, the association of private medical and dental colleges rubbishes all those allegations and blames Pakistan Medical & Dental Council (PM&DC) for being responsible if there is any college involved in malpractices.

PMDC is an official regulatory body which is responsible for maintaining high standard of medical education in public and private medical colleges by registering private medical & dental colleges, setting policies, rules & regulations, and ensuring the implementation of laws devised by the authority. However, PMDC is so far unable to implement the rules in letter and spirit, and instead blamed for siding with owners of those so-called medical colleges which are ‘bypassing’ the law. Sometimes, it seems to be at loggerhead with those colleges and at times giving them out of the way concessions.

It cannot be said that all of those medical & dental colleges are violating the law. There still are many well-reputed private medical institutions and some of them are way better than public sector medical colleges. At the same time, it cannot be said all of them are abiding by the rules of business.

The SC wouldn’t have taken suo motu notice of this case if there weren’t any real leads. Where there’s smoke, there’s fire. There is need to scrutinise them. For example, what is the use of over 25 registered and un-registered private medical and dental colleges in Lahore alone and what are they producing. The good ones must remain and bad ones ought to be eliminated. This is what the US did back in 1910 by following Abraham Flexner Report.

The SC noted that misconduct at some private medical colleges have eroded the value of Pakistani degrees at international level. "We don’t get respect at international universities because our degrees have lost their value," Chief Justice Nisar said, adding, "these last four days we’ve been contemplating to declare illegal all the admissions by private medical colleges."

The chief justice also criticised the medical college industry’s admission policy and passing-out criteria, saying: "Private medical colleges do their own marking and pass their students themselves. There should be a uniform admission policy and one merit. We will not let admissions take place on the basis of donations and money."

Private medical colleges came into being in the 1990s and there are big names like Aga Khan Medical College and Baqai Medical University but after being commercialised and facing interference of the ruling elite in later years, the standard of medical education started deteriorating. It was a time when the PPP’s former petroleum minister became the vice-president of PMDC and formulated policies in favour of those colleges. He allegedly gave licenses to 85 medical colleges in Pakistan.

The SC, on January 3, asked Dr Asim Hussain to clarify his position on why he devised such policies that benefited private medical colleges. Hussain had been summoned by the apex court after his name appeared multiple times in a petition filed by the PMDC against a December 2017 ruling of the Lahore High Court, which had declared the PMDC illegal and nullified its 2016 regulations for admission to MBBS and BDS programmes offered by various medical colleges.

"Your name comes up whenever there is talk of malpractices within private medical colleges. It is said that people were given permission to open private colleges in return for bags filled with Rs200 million," the chief justice reminded Hussain. The court warned him, "No one will be able to save you from the noose if you fail to clear yourself."

A former member of PMDC, Dr Shershah Sayed, said, "Today politicians, retired generals and health professionals, having connections in the corridors of power, have jumped on the medical education bandwagon to exploit the non-meritorious students seeking admissions and earn easy money, and letting those students exploit others including their patients."

Dr Javaid Asghar, Punjab President Pakistan Private Medical & Dental Institutions (PAMI), talking to TNS, rubbished the allegations. He suggested holding PMDC responsible in case of any malpractice by private medical colleges.

He said, "Today we are being called a mafia, but there is a need for 400,000 doctors and private institutions are doing their job to facilitate the public. Aspirants are given a chance to get medical education in their home countries instead of going abroad."

Dr Javaid said that SC and PMDC should encourage them instead of creating hurdles. He said that colleges involved in wrong doings should be closed and his association itself is going to form a team which will scrutinise those colleges.

Dr Amir Hussain, member PMDC, said that PMDC is working to upgrade the medical profession. "There are 16 registered private medical and dental colleges in Lahore and 16 other which are waiting to be approved by PMDC."

A source in PMDC, on condition of anonymity, told TNS that most of those 16 unregistered colleges are operating in violation of the law. "So, it makes more than a dozen private medical colleges in Lahore alone as compared to just three public sector medical institutions."

Dr Amir said that private medical colleges have many loopholes and are actually admitting students on 38-40 per cent aggregate, whereas the aggregate for public medical colleges in 2017 was 87 per cent. "Those institutions are conducting their own mid-term and final examinations, awarding MBBS degrees and producing doctors whose credibility and competency is doubtful."

About the challenges faced by PMDC in implementing the laws, he said, "PMDC recently closed four substandard medical colleges, but they obtained stay order from the court and some others are working on stay order for three years."

Similarly, he said, the Lahore High Court in its December 2017 ruling declared PMDC illegal and suspended all clauses related to merit, advertisement, entry test and aggregate, which gave room to the culprits to exploit the situation.

He said medical professionals condemn such medical & dental colleges who are trying to misguide students and their parents and openly violating the merit policy which is creating a bad name for medical profession.

President Pakistan Medical Association (PMA), Prof Dr Ashraf Nizami, while speaking to TNS, said as of November 2017 the number of registered doctors and specialists is 208,658, which is 1 doctor for 1000 people and meets the minimum requirement set by WHO for a developing country. He maintained, however, that there is still need for more doctors, but that doesn’t necessarily mean that quality should be compromised over quantity and substandard colleges should be free to operate. Dr Nizami said, "You can’t expect good from a student who has spent eight to ten million rupees to buy a medical degree. He will not take patients as they should be taken in line with ethics of medical profession, but clients."

Dr Nizami appealed to the Supreme Court to constitute a transparent commission comprising honest medical professionals who should scrutinise private medical & dental colleges keeping in view the Flexner Report.