People in the present world rely on doctors more than themselves. They just believe the words of a doctor without any question because of their honourable and noble profession. If any crime occurs in that field, then people have no place to believe anyone in a complete sense.

If doctors carry out their duty with love, they will be crowned with success. Everyone wants to earn money but they do not consider the way of earning it. Some earn by providing service and some by doing business. There are some more people who do service as business to earn money which leads society into the path of obstacles.

These people enter all fields and do malpractices to earn money, but they fail to understand the problems that arise out of their entrance. This paper deals with some of the crimes which come under the medical field, the involvement of the Legislation and the next upcoming crime using the mask of medicine.

White Collar Crimes In India

Introduction
In the present running world, every individual aims to get fit in a comfortable position in their career rather than involving themselves in the fieldwork. This idea blinks in the individual's mind from the stage of schooling. Only very few plan to go for fieldwork. Some individuals plan to achieve their comfortable position and strive hard in studies and reach their aimed position by completing the respective educational qualification.

A profession which has an occupation backed by a specialized body of knowledge is known as white-collar jobs or it can also be said as any specified educational qualification which leads to a particular job which is directly related to the qualification, and such kind of job is concerned with the welfare of others. Doctors, advocates, architects, educationalists are some examples that come under white-collar jobs.

These professionals ­­­­mostly ­use their knowledge skills and do enhance less of physical work.
When these professionals either knowingly or unknowingly involve themselves in any malpractices, it constitutes into crime and is termed as a white-collar crime as a whole. It constitutes a crime because any malpractice done by the professionals ultimately affects the people who believe in them.

For example, if a doctor does any unwanted operations for the patients then the ethics for the profession gets violated and it becomes a crime or if an advocate knowingly misleads his clients it also comes under a crime. If an architect knowingly draws a plan which would collapse the building then it comes under the definition of crime. \

In short, white-collar crime can be defined as any failure in the responsibility of the doers to lead the action done into the path of crime. If this is the case then there arises a question that any failure in the duty of the respective doer, advocates for example: if the client gets convicted despite being supported by an advocate does not make the advocate enter into the field of crime. He enters the field of crime only when he knowingly misleads his clients or enhances the case without any prior knowledge or experience.

Crime in the field of medicine[1]

In India, most of the medical practitioners are found involved in activities like issuance of a false medical certificate, unnecessary billing, selling sample drugs to patients, etc. These activities are some of the petty crimes, but few of the well-practiced doctors with a mindset of doing a crime tactically would help them to escape from punishments, voluntarily involves in the purpose of money-making to perform some activities like practicing medicine without any qualification and by using a fake certificate of completing the respective course (these people are termed as quackery), abortion as a common term but female foeticide as a medical term when especially done for the girl child, organ trade combined with murder will fall under serious crimes.

Based on the crime done by the doctors every one stays punished accordingly in the eyes of law. Frequently the doctors committing the petty crimes fall under the concept of cheating as mentioned under Section 420 and fraud as defined under Section 25 with Section 471 for using a forged document for a genuine reason as mentioned under the same code.

Meanwhile, each serious crime done by the doctors as mentioned above has respective laws and acts enacted by the government to stop the inhuman activities of the doctors and punish them accordingly. These people use the defence of consent given by the patients to them to protect their liability, but the patients also are liable if they indulge in such activities with a wrong intention and they get excluded from liability if they are made to believe in the doctor by his activities.

Indian Penal Code and Medical Crime

Cheating:

As mentioned in the Indian Penal Code (IPC) if any act is done to deceive a person with the intention of either to receive property from others or alter it, constitutes to be cheating. Here the quackery influences the people of curing them and receives the money, thus it comes to be cheating. The same applies to any person who deceives any person with a wrongful intention by expressly saying that the illness of the people can be cured by his prayer.

The Supreme Court in the case of Shri Bhagwan Samardha v. State of Andhra Pradesh[2] took a positive move by considering that when somebody represents himself to offer prayers to god for curing the illness and induces the person to give money or any complements for that activity and he does not get a result, then it is a fraudulent representation and the court can consider that the offence of cheating as mentioned under Section 420 of IPC has been committed. In such cases, the penalty extends to a period of 7 years of imprisonment.

Forgery:

According to Section 471 of IPC forgery is committed when a person for the reason of developing belief over him among others, fraudulently uses a document as genuine and knows to himself that the document is forged. Here the quacks are the people who use such kinds of false certificates to establish themselves as a graduated medical practitioner.

Medical Profession-a Business or a Service

The reason for quacks in the medical field is that they view the medical profession as a business rather than seeing it as a service. Here arises a question whether service requires money? This introduces a concept of service for the welfare of society. Service which requires no money creates people who do service for their self-satisfaction, but people giving money for the welfare of the society also involves service.

Thus, receiving a reasonable amount (considering all the expenses for example fees for nurses, electricity bills, etc.,) for each service rendered by the medical profession does not become a business. Quacks enhance this kind of jobs to make profits only, therefore it comes under business but being a business it should be for the welfare of the people, as it does not satisfies the condition “for the welfare of the people”, this kind of business is illegal and violates Article 19(1)(g) of the Indian Constitution which falls as a Fundamental Right.

According to Article 19(1) (g) “All citizens shall have the right to exercise any occupation or to carry on any trade or business”. The exception is that this right does not increase when the business is illegal or abandoned by the country.

Involvement of the Legislation

The petty crimes are punishable under the Indian Penal Code. As development gets improved day by day, different types of crimes also get introduced and practiced on the way of affecting the public. To add a full stop to these new entering crimes, the legislation also enacts new laws, amends the existing laws, etc. time to time along with the development of the world. By such means, these are the few acts that entered the society.

1. Drugs and Cosmetics act, 1940:

   This act regulates the sale, manufacture, and import of drugs and cosmetics within India. Under Section 6 this act provides the presence of Central Drugs Laboratory for testing sample drugs for the safety of the users. Section 10A gives the power to the Central Government to stop the import of unsafe drugs and cosmetics which creates a danger to the public, whereas Section 26A gives the power of stopping the manufacture of unsafe drugs and cosmetics that disturbs the public interest. Therefore, this act prevents quackery from its very level of the foundation by preventing the manufacture, import of unsafe drugs.
    

2. The Dentist Act, 1948

   It is enacted to organize the dentist into a legal framework and control them from entering into any malpractices. This act makes the dentist enrol his name in the register of the State Council to confirm his eligibility for practice. If the doctor violates the rules and ethics mentioned in Section 17A of the above-mentioned act or involves in any of the malpractices or is convicted for any of the offence then according to Section 41, the State Council can pass an order to remove his name from the register. By Section 48 the court has no authority to raise a question against the decision of the council on the removal of the name. Under Section 49 quacks will be fined with Rs.500 or 6 months of imprisonment and a fine of Rs.1000 if caught again. This above provision lays a platform to catch the quacks.
    

3. The Drugs and Magic Remedies Act, 1954:

   The purpose of establishing this act is to control and prohibit persons making advertisements of remedies similar to possessing of magical remedies (curing by magic or prayer), to control the quackery. Section 3 ensures that no person should involve himself in making advertisements in suggesting the use of any drug for miscarriage, mitigation, treatment or prevention of any disease, etc as mentioned in the schedule. Section 5 deals with banning advertisements related to magical remedies and others mentioned in Section 3. The act also deals with punishment of imprisonment to an extent of 6 months on 1st conviction and imprisonment for 1 year if it continues.
    

4. The Medical Termination and Pregnancy Act, 1971:[3]

   The reason for the enactment of this act is to stop abortion unnecessarily. Before the introduction of this bill, the same crime was punished under Section 312 of IPC (intentionally causing miscarriage). On the base, abortion (miscarriage in medical term) is not a crime unless and until it is done for the welfare of the mother. In case if the mother would enter into danger because of the birth of the child, then there is no wrong in proceeding with an abortion.
   
   This act provides some conditions for terminating pregnancy along with the condition seen above. This allows certain qualifications and places to conduct the termination if it is for the welfare of the mother. Knowing the gender of the baby in the prenatal stage is a crime in India. Illegally knowing the gender and conducting the termination if the child is a girl child then it is specially termed as female foeticide which also constitutes a crime in India. Thus, this act prevents the doctor to conduct the termination even if the patient gives his consent. Consent of the mother is immaterial and even the parents get punished if the termination proceeds.
    

5. Transplantation of Human Organs Act (THOA), 1994:

   This act is enacted to control the individuals who do transplantation of organs as a business, known as organ trade. Transplantation of organs does not come under a crime unless it is done with consent accompanied legally. But if the same is done by murdering a person for his organ or to earn money, then transplanting an organ to another person becomes a crime. In a recent scenario doctor Deepak Shukla, CEO of Pushpawati Singhania Hospital and Research Institute in Delhi[4] was arrested for the crime of organ trafficking. According to the report of the Kanpur Chief of Police, the doctor was involved in helping illegal kidney donation.

Another case held in August 2016 known as Thakur's case[5] establishes that how India's organ transplant laws protect the organ donors who are often from a poor background and it also lays an example for the fact that these poor people are also sometimes coerced for making organ donation. In this case, the operation was almost started by the doctor but the Mumbai Police stopped them before they retrieved the victim's organ, because there involved payment for the organ.

This breaks the law which bans commercial organ donation. Most probably a middleman gets involved in this transplantation between the donor and the recipient. In some situations, he acts even against the will of the donor. In such cases, if the middlemen are arrested the penalty extends to a period of 5 to 10 years of imprisonment and a fine of between Rs.20 lakh and 1 crore.

Other legislations

The Indian Medical Council Act, 1954 is enacted to deal with the matters connected to modern scientific medicine. The Indian Medical Council and the State Medical Councils are formed as the regulators under this act. This regulates and recognizes the universities that grant medical qualifications to the people. Any committee can be formed under Section 9 of this act for any specific purpose. Therefore, an anti-quackery committee can also be formed (done in Delhi Medical Council) to control the involvement of quackery.

Same as the above act Indian Medical Central Council Act, 1970 was enacted to regulate Indian medicines such as Ayurveda, Siddha, etc. This act prevents the quacks to enter into this medical field.

Other Developing Crime - Related to Medicine

Medical Mafia

Medical Mafia is the expression used to define the unholy trinity of the FDA (Food and Drug Administrator) and big Pharmacy companies. In the past 30 years, the Nexus has achieved to understand their ethical operations. The Medical Mafia has originated in the west and now controlling the whole World. One of the main ways to earn money is through Medical Mafia. Below are some examples of Medical Mafia and its effects:

1. Medical Mafia is against the Generic Drug and they require strong patent laws for the medicine in this field, so the big pharmacy companies will only have the patent rights to sell the medicines for some disease. Because of this, the price of medicine will be unreasonable.
    
2. It does not control only the medicines; rather they have also extended their tentacles to food and other beverage industry.
    
3. In this field, they would receive some percentage of money or some shares with the other companies. For example, the cancer drug company has a share with the Tobacco manufacturing company.
    
4. The Medical Mafia may sell their Propaganda of the company in the name of research.

Bribing of Doctors:
Doctors around the world are paid by the Medical Mafia. Some Doctors may prescribe unnecessary tests to specific center for particular tests; Because of this they will receive some kickbacks from those centers. In the case of Medicines, the doctor will not prescribe the medicine based on their quality or price. They will prescribe the medicine only based on the vendors who have paid them some money.

The Medical sector becomes more and more commercialized as the doctors begin to ask a commission from the patients, the number of patients coming to the doctors reducing day by day. Though the kickbacks are illegal in India the young doctors can't avoid it as there are many student debts available to them while they were studying, so the upcoming doctors can't survive without the kickbacks.

Medical Representatives have divulged that the big Pharmacy companies are bribing the doctors by giving tickets for foreign trips, expensive phones, and jewels. Thus, the government of India drags its feet in 2016 to introduce a uniform code that is Pharmaceutical Marketing Practices.

They also revealed that they were training women for salesmanship and “Management of Customer Relations”. According to them, 10-20% of the doctors follow the ethics of the Medical Council of India, whereas other doctors ask some incentives to prescribe their pharmacy company products. Even sometimes they may threaten their targets and doctors to prescribe their product.[6]

Doctors Cheating Patients:
Doctors will receive kickbacks for the help they do for the pharmaceutical company in making their product to be sold. In the government hospitals, the doctors will prescribe generic medicines that are good for health whereas in some private hospitals the doctors would prescribe brand name medicines to advertise the pharmacy company names[7]; it is because of the above-mentioned reason.

Some doctors are cheating patients with unnecessary tests and medical operations even though it would be solved easily. Doctors are also cheating the patients by converting a normal delivery into a caesarean delivery to earn more money from the operation for hospital rent by keeping the patient on the ventilator for more days.

They also cheat the patient through Insurance. While claiming the Insurance from the patients and not by cash they will ask the patients to take unnecessary tests and scans to claim more money from the insurance. Doctors are selling Energy powders which were given by the big pharmacy companies which may give side effects to the patients.

To earn more money doctors are making a deal with the Pharmacy companies even though knowing that it hurts poor people economically. Dr. Anil Pichad living in Mumbai revealed that he has been overcharging the patients as he wants to give commission to the doctors. After he went through a personal tragedy, he stopped charging over the fee and bribing the doctors.

In Major Pankaj Rai vs the State of Karnataka[8], it states that Major Pankaj Rai's wife Seema was suffering from a Kidney Ailment. The doctors took Seema to the operation theatre for Kidney and Pancreas Transplant without her family's permission. Pankaj Rai had to pay 8.25 lakh for the operation and Seema has lost her life also.

The doctors didn't even tell their families about Seema's death and switched off their mobiles. The hospital doesn't have a license for the pancreas transplant. The court has ordered that the Respondent (i.e. doctor) is debarred from performing the surgery. In this case, it tells that the hospital has operated without a license for pancreas transplant and consent of the patient's family. In this case, it is well clear that to make money some doctors involve in such kind of unnecessary operation to earn money.

Conclusion:
White-collar crimes are crimes that should be controlled with serious steps. Among all other white-collar crimes (professional crimes) few professions stand as important among the people. One such is the field of medicine. Among the other profession, this medical field has its origin even before ancient times. Every proof related to ancient and historic periods refers to doctors at least in one place. Such an old and growing service/profession has now become a business for some people.

Though the government enacts various laws to make this honorable profession to release it from the hands of white-collar crime, it becomes impossible unless every medical practitioner understands the history of the profession and do their job as a service to the society. Thus, it is rightly coined that “Good doctors understand their responsibility better than privilege and practice accountability better than business.”

End-Notes:

1. https://shodhganga.inflibnet.ac.in/bitstream/10603/129394/14/14_chapter%208.pdf
2. AIR 1999 SC 2332
3. http://tcw.nic.in/Acts/MTP-Act-1971.pdf (Act No. 34 of 1971)
4. Annie todd, (10 June 2019, 18:11) India: Doctor Arrested in Illegal Kidney Transplant Case, https://www.occrp.org/en/daily/9908-india-doctor-arrested-in-illegal-kidney-transplant-case.
5. Maneka rao, (Dec 14, 2017 · 02:30 pm )https://scroll.in/pulse/861390/indias-laws-on-organ-transplants-to-little-to-protect-rights-of-organ-donors.
6. Dinesh C Sharma, (Friday,22 June 2012, 15.56), https://www.indiatoday.in/india/north/story/aamir-khan-generic-drugs-parliamentary-committee-on-commerce-106599-2012-06-22
7. https://www.linkedin.com/pulse/how-private-hospitals-cheating-patients-corporates-ritesh-kumar-singh
8. Ritesh Kumar Singh, (Thursday,11 August2016 ), https://indiankanoon.org/doc/151735876/

Written By:

1. Deepak N S, B.Com., LL.B. (Hons.) - Sastra Deemed To Be University
2. Akshayan K S, B.Com.; LL.B. (Hons.) - Sastra Deemed To Be University