Quacks thrive unchecked in health landscape

When 38-year-old Ravi (name changed), opted for a hair transplant at a clinic in Koramangala, Bengaluru, he had no clue that the doctor was unqualified to do the procedure.

During his preliminary visits to the clinic last November, the doctor told Ravi that 6,000 hair follicles could be grafted onto his scalp. But when Ravi expressed hesitation about the low density of the graft, the clinic’s manager assured him of a transplant of 10,000 follicles. The manager charged a total of Rs 1.9 lakh for the procedure. It was only later that he found out that just 3,500 hair follicles were transplanted during the surgery.

Other doctors whom Ravi consulted later informed him that not more than 4,000 to 5,000 hair follicles could have been grafted in his case. When confronted, the clinic’s manager refused to refund him after which Ravi filed a complaint at the Koramangala police station.

Based on Ravi’s complaint, the District Health Officer, Bengaluru Urban, found that the doctor had an MBBS, and did not have the necessary qualifications to carry out a hair transplant surgery. These surgeons are required to have qualifications like a postgraduate degree in dermatology or plastic surgery. The doctor is also currently not registered under the Karnataka Medical Council (KMC) — which is mandatory for any doctor who practises modern medicine in Karnataka.

Dr Jagadish P, a Bengaluru-based dermatologist, explains that such hair transplants, carried out by unqualified people can put patients’ lives at risk. Unfortunately, such surgeries are all too common. “Doctors have to check for conditions like alopecia and infections before hair transplant. Transplants should only be conducted if indicated. Improper implants can even cause death. Such fatalities have recently occurred in Delhi and Chennai.”

In Ravi’s case, justice has evaded him. Before the authorities could take any action, the staff absconded, even shutting down the clinic. The Bengaluru Urban District Health Officer, Dr Ravindranath M Meti, explains that action has not yet been initiated against the doctor since the police have been unable to trace him.

Ravi has tracked down around 20 others who have lost up to Rs 2 lakh each at various clinics run by the same doctor and manager in the city. “Though some of them had complained to authorities earlier, there were no results,” Ravi says.

The clinic’s website still remains functional, advertising services like weight loss management and laser hair removal.

While Ravi’s loss was financial, there are some who have been put in grave danger at the hands of unqualified medical practitioners and quacks. This April in Tumakuru, Mamata (34) died due to complications from IVF treatment conducted by a quack couple. The fake doctors had only passed SSLC. 

Last December, Jyothi (26), a garment factory worker, developed complications after she was administered injections for a fever by a quack. In Shiragur in Belagavi district, a 14-year-old boy died this May, after a fraudulent doctor attempted a cure by beating the child up, claiming he was possessed by a demon.

There are plenty of such heart-rending incidents of people suffering both damages to their person, finances or even dying at the hands of quacks. In fact, according to KMC's registry, only about 57,000 doctors are authorised to practise modern medicine in the state. According to the Indian Medical Association (IMA), however, the number of quacks operating in the state would be three times as much — 1.5 lakh.

Who is a quack?

According to the Karnataka Private Medical Establishments (KPME) Act, 2007, it is mandatory for physicians practising modern medicine to be registered under the KMC. Practising without KMC registration is illegal, and can lead to imprisonment of up to three years and fines up to Rs 1 lakh. 

While a quack could be a completely unqualified person, they could also be someone with only a medical diploma, an AYUSH doctor practising modern medicine, or someone who studied abroad, but has not registered with KMC. AYUSH doctors have their own state registers and cannot register under the KMC. 

The public can register complaints against unqualified persons and action can be taken by the taluk health officer (THO) or district health officer (DHO). They inspect the premises, file an FIR against the individual and issue a notice to them. Such action can be initiated suo motu as well. At the district level, the District Registration and Grievance Redressal Authority (DRGRA), headed by the District Commissioner (DC), conducts hearings. The authority also includes the DHO as member secretary and other members including the district AYUSH officer and an IMA representative. 

If the person is found to be without registration, the authority forwards the FIR to the judicial magistrate, who will preside over the case.

Unfortunately, according to data from the state health department accessed by DH, district officials file few FIRs. Most of the time, the clinics are only temporarily shut or permanently closed, which would still leave quacks free to practise elsewhere.

Slow processing 

According to data from the health department, 1,433 cases of unregistered practitioners were recorded across all districts in the past two years (from mid-2021 to September 2023). However, FIRs were filed only in 64 (or 4.5% of the) cases.

The highest number of cases were from Bidar (423), followed by Kolar (179) and Belagavi (170). Health officials filed no FIRs in any of these cases.

All other districts reported fewer than 100 cases of unregistered practitioners. Kodagu was the only district to report zero cases. In most instances, officials issued notices or shut down clinics.

Of the districts that did file FIRs, the highest numbers were from Ballari (20), followed by nine each in Dharwad and Yadagiri, seven in Mandya, and much smaller numbers in nine other districts. 

“The health department shuts clinics but allows them to reopen later once they give an assurance or pay a fine. But the KPME Act does not say that DRGRAs can compound (settle) the offence this way. DRGRAs are supposed to verify documents, and if the person is unregistered, forward the FIR to the judicial magistrate,” says Dr Sandeep Prabhu, chairman of IMA’s state anti-quackery sub-committee. 

In Kolar, for example, the DRGRA has filed FIRs against five quacks who were first identified in 2019 but let go at the time. “When the clinics were shut in 2019, the building owners gave an undertaking that they would not allow quacks to practise there. But the quacks started clinics in new locations. They have been making huge profits,” says Dr D Vijaykumar, IMA president at the Kolar Gold Fields and a member of the Kolar DRGRA.

This time, the authorities verified the quacks’ documents and found that most had only a PUC qualification or lesser, along with invalid qualifications like diplomas in community medicine from unrecognised institutions.

Most DHOs say they usually do not file FIRs, and that the proceedings are limited to notice and closure. Fraudulent practitioners also abscond once a complaint is registered, making it difficult to issue notices, explain Bengaluru Urban DHO Dr Meti and Tumakuru DHO Dr Manjunath. Pushback from associations of traditional healers can also hinder action.

In Tumakuru, Dr Manjunath says, 11 clinics have been identified as providing unqualified care, of which only one has been shut down. No FIRs have been filed.

“We have ordered taluk health officers to shut down the other 10 clinics, but some villagers are protesting such closure. They depend on these clinics as these are open at night and Primary Health Centres are far away,” he says. “The quacks are mainly those who worked under a doctor at some point and have some knowledge of medicine.”

In Dharwad, Dr Shashi Patil, DHO, says action is only initiated once complaints are filed by patients.

As a result, fraudulent medical practitioners are hardly convicted or jailed under the KPME Act. Any action, if at all, is only initiated when a police case is registered in the instance of bodily harm or death by victims or their families. FIRs filed by the police are not linked to those filed by health officials under the KPME Act. 

Though the IMA had filed PILs requesting action against quacks, these have not been fruitful since only DRGRAs have the power to take action under the KPME Act.

In a PIL filed by the IMA in 2014, the Karnataka High Court had ordered health officials in Tumakuru district to verify the documents of 59 people who were practising medicine in Pavagada taluk. 

Those without qualification or registration should be stopped from practising, the court said, adding that officials should communicate the action taken to IMA within the next three months. Dr Prabhu says no action was taken or communicated to IMA.

Some quacks approach courts to stall the procedures against them as well.

Dr Prabhu cites a case of a person without any qualification or certificates, practising at Bhusappa Chowk in Dharwad, against whom IMA had complained to the DRGRA. When the DHO rejected his plea to let him practise, the quack approached the court saying that only the DRGRA and not the DHO had the powers to reject his application. 

“The court upheld his argument and disposed of the case,” says Dr Prabhu. This person now has a thriving practice. 

Neelavva, 40, hailing from Mangalwarpeth in Dharwad, has been visiting this clinic for the treatment of her seven-year-old son for the past five years for various ailments. She says she is happy with the treatment.

Low-income areas targets 

Dr Gopal Dabade of the All India Drug Action Network (AIDAN) says that quackery is common in rural areas due to an acute shortage of doctors. “MBBS graduates are not trained to become family physicians. They do not fit into the cultural milieu of slums and rural areas, and do not prefer practising there. Also, now most doctors become specialists, so there are more consultants than general physicians, who also charge more,” he says.

Many rural areas do not have general physicians or paediatricians for miles together, so quacks, who are often people from the same village with experience of having worked briefly in a hospital, are welcome, Dr Dabade says. “The government’s PHCs have doctors, but labourers are working during those hours and cannot forgo their wages. Sub-centres under PHCs are supposed to bring healthcare closer to people, but several of these centres do not have either staff or medicines.”

The consequences 

B C Roy national awardee Dr Rajan Deshpande, based in Dharwad, describes the case of a five-year-old patient who was unable to walk after a quack injected her in the gluteal area, damaging the sciatic nerve. The girl recovered, but it could have caused permanent weakness in many, he says.

In yet another instance, a doctor at a clinic in Bengaluru shows the prescriptions that some of his patients had previously received from quacks. The prescriptions show oddities like an anti-malarial drug prescribed for a common cold, and paediatric doses of antibiotics prescribed for a healthy adult.

“These patients come to me when their disease is not cured or when they develop complications. The condition is much more challenging to treat then,” he says. The doctor adds that fraudulent clinics are usually located in low-income areas. Though these clinics charge low fees, they also have tie-ups with labs or pharmacists who pay them a commission, doctors say.

Other than risking patients’ health, a major fallout of quackery is rising levels of antimicrobial resistance. 

Dr Jagadish P says that quacks are prescribing steroids and antifungals widely, causing fungal infections to become more resistant. “A fungal infection that can be easily cured within three to six weeks, would take three months to heal if steroids are used inappropriately.”

Even hospitals employ AYUSH doctors in junior positions, says a source at the Private Hospitals and Nursing Homes Association (PHANA), Karnataka. “They would make up about 5% of the doctors employed in hospitals. But they usually work as physicians’ assistants and not as consultants who make final decisions about the patient,” he says.

While the IMA has been strongly advocating for regular raids and strong legal action against quacks, public health activists like Dr Dabade say the problem is more deep-rooted and can be resolved only by addressing issues such as the shortage and inaccessibility of doctors in rural areas and around urban slums.

(With inputs from R Shrinidhi in Dharwad)