A Thesis on

White collar crime in health sector:

Bangladesh Perspective

Course code: LAW 432

Course Title: Project & Thesis

Submitted by
Ifaz Alam Bhuyan
ID:17200026
Batch:10th
Department of Law and Human Rights

Supervised by
Kazi Latifur Reza
Assistant Professor, Department of Law and Human Rights
Ranada Prashad Saha University

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 Table of content
Part 1: Acknowledgement………………………………………………………………………………. …………………… 3
2.Abstract………………………………………………………………………………………………………………………………… 3
3. Introduction…………………………………………………………………………………………………………………………. 3
4. Objective of the study …………………………………………………………………………………………………………. 4
5. Methodology of the study……………………………………………………………………………………………………. 4
Part 2: White collar crime in medical sector: Bangladesh perspertive
6.Fake medical surgery ………………………………………………………………………………………………………….. 6
7. Fake and misleading advertise ………………………………………………………………………………………………7
8. Corruption in health sector…………………………………………………………………………………………………. 12
9. Billing for service not rendered……………………………………………………………. …………………………… 15
10. Unecessary medical test for business reason………………………………….. …………………………….. 16
11. Ilegal aboration………………………………………………………………………………………………………………… 19
Part-3: National Policies, Statues and Other Legal document……………………………….. …………… 20
13. The Drugs Act, 1940………………………………………………………………………………………………………… 22
14. The Drug Control Ordonance …………………………………………………………………………………………… 22
15. The Medical Practice and Private
Clinics and Laboratories (Regulation) Ordinance, 1982………………………………………………………….. 23
16. The Consumer Rights Protection Ordinance, 2008…………………………………………………………… 23
17. Penal Law in General: The Penal Code, 1860…………………………………………………………………… 23
Part 4: Remedy against white collar crime in medical sector in Bangladesh………….. ………….. 24
Recommendation……………………….…… …………………………………………………………………………………… 26
Part 5. Conclusion ……………………….…… ………………………………………………………………………………… 27

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 Part -1

Acknowledgement:
I’m Ifaz Alam Bhuyan, currently studing law and human right at Ranada Prasad Saha University.
I would like to express my gratitude and thanks to my respected teacher and advisor kazi Latifur
Reja Sir , Assistant professor, Dept of L.H.R, Ranada Prasad Saha University, for his keen
observation and valuable direction about this research. I’m also very grateful to my Teacher
MD Shafiqul Islam Sir for giving me academic guidance to prepare this report and friends for
their nice cooperation and inspiration about the research work. I am indebted to all the authors
and researchers, whose work has been referred to in this report.
Abstract
The main object of this research work is to find out the available remedies for white collar crime
in medical sector in Bangladesh. This research work is qualitative in nature. Books, Journal
Articles, Case law and Statutory Laws have been reviewed to formulate this work. Findings For
suffering for white collar crime in medical sector instances in Bangladesh a person may go to the
court seeking his or her remedy under the Criminal Law, Civil Law and Constitutional Law.
Moreover, Medical professionals are expected to know about the legal consequences of their
medically malpractise and should avoid themselves landing in such controversial situations and
litigations. Originality/value The main reasons for unaccountability of medical practitioners are-
the unwillingness of people to bring action against medical practitioners and lack of legal
knowledge about the remedies for medical negligence instances. This paper will assist to gather
legal knowledge.

Introduction:
White-collar crime, crime committed by persons who, often by virtue of their occupations,
exploit social, economic, or technological power for personal or corporate gain. The white collar
crime in medical sector are so wide spread that it does not confine itself in the legal arena.
Similar unfortunate instances can be drawn from other professions too, like that of medical
practitioners, engineers, educationalists, businessmen, politicians and the list goes on. The
medical practitioners are often found involved in issuance of false certificates, carrying out
illegal abortions, selling out sample drugs and medicine, even in some cases adulterated drugs
and medicines to the patients. Dilatory tactics are often adopted by them in providing treatment
to their patients with a menswear to extract huge amount of money, no matter the person has
good practice. Medical professionals put up before the society the optimum level of brutal
character they can reach for the crave of making money. Misleading and fake advertisement

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claiming absolute cure is also one of the frequent malpractices being carried out in the medical
profession. The problem lies in the fact that, they often escape punishment, since they cannot be
said to have violated the letter of law, but, by violating the spirit of law, they commit crimes
which are truly anti-social and creates enormous damage to the public health and safety at large.

Objectives of the Study

The present study aims at ascertaining the legal status of white collar crime on medical sector or
fraudulent practice in medical sector on review of existing laws and policies of Bangladesh. .
The main objective of this study is to make the people awareness regarding the unethical
practices of some physicians and other members working on medical sector. And To know the
present status of health sector in Bangladesh.My article refers to the overall situation of medical
negligence and malpractices existing in medical sector, This study also aims to identify the
gaps and inconsistencies in the existing laws and policies to ensure accountability of health care
service providers and to protect the right to health care of the citizens. The study finally attempts
to make certain recommendations or remedy to stop health care fraud and malpractice.
Methodology of the Study
This study has been conducted to find out the unethical practices of the physician and
malpractice in the health sector in the perspective of Bangladesh. It relies on a number of
previous reports, publications, laws and policiy and Aims of the Study and Structure of this
study. On identifying the gaps in the legal regime, The study also attempts to identify the
possible remedies available under the existing legal regime.Primary data and information of this
study has been collected from different source through observation, interview, discussion and
face to face interactions. Secondary data have been taken from various sources such as television
advertising, internet, radio, newspaper, Facebook, previous relevant articles, etc. After collecting
this data and information I have been presented in a descriptive way.

Literature Review :
This report contains a comparative analysis of white collar crime on medical sector. Also I
focused on The overwhelming number of incidents of medical negligence mostly goes without
any legal action, public frustration , where public trust is completely lost on the medical service
providers. The report finally offers a set of recommendations for legal and policy level
intervention and improvement of existing practice. An accountable system of medical
administration coupled with effective legal arrangements, under the surveillance of a vigilant
civil society can establish a safe and sensible health care system in Bangladesh.

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 Part -II

Definition of white collar crime:  

White collar crime" can describe a wide variety of crimes, but they all typically involve crime
committed through deceit and motivated by financial gain. The most common white collar
crimes are various types of fraud, embezzlement, tax evasion and money laundering. Many types
of scams and frauds fall into the bucket of white collar crime, including Ponzi schemes and
securities fraud such as insider trading. More common crimes, like insurance fraud and tax
evasion, also constitute white collar crimes

White collar crime in medical sector :Bangladesh perspective

White collar crimes are characterized by “deceit, concealment, or violation of trust and are not
dependent upon the application or threat of physical force or violence. Such acts are committed
by individuals and organizations to obtain personal or business advantage”. Health care fraud is a
form of white collar crime that may be committed by health care providers, consumers,
companies providing medical supplies or services, and health care organizations. There is a trend
toward increased participation by organized crime groups in complex health care fraud schemes.
There are many different types of illegal and unethical schemes that constitute health care fraud.
The common types of fraud committed by physicians include billing for services that were never
rendered, providing unnecessary treatments or tests, up coding (billing for a more expensive
diagnosis or procedure), falsifying or exaggerating the severity of the medical illness to justify
coding, and accepting Health care fraud has failed to capture the attention of the public or the
media.
There has been renewed interest by political leaders and prominent government officials in
Bangladesh raising public awareness of the enormity of the problem. In addition, investigation
of health care fraud is fast becoming one of law enforcement's major priorities.Health Care Fraud
is expected to continue to rise as people live longer. This increase will produce a greater demand
for Medicare benefits.
As a result, it is expected that the utilization of long and short term care facilities such as skilled
nursing, assisted . living, and hospice services will expand substantially in the future.
Additionally, fraudulent billings and medically unnecessary services billed to health care insurers
are prevalent throughout the country. These schemes are becoming increasingly complex and can
be perpetrated by corporate-driven schemes and systematic abuse by certain provider types

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White collar crimes which are commonly committed by persons belonging to medical profession
include :

 Issuance of false medical certificates

 Helping illegal abortions
 Billing for service not rendered
 Selling sample-drugs and medicines to patients or chemistry
 Dialatory tactics adopted by the members of this profession in treatment of their patients
with a view to extracting huge sums from them has become an accepted norm,
particularly with those medical men who do not have a good practice or have only a
marginal earning.
 Misleading and fake advertisement claiming absolute cure is common fraud occure in
medical sector in Bangladesh. Many paitient lost everything their money, their heath,
When they consult with those so called Doctor, Most of those so called Doctor don’t even
have medical degree.

Fake Medical Certificates :Big business in Bangladesh medical sector is sellimg fake medical
certificates, The persons employed in essential services of the government or other
undertakings are often confirmed with the problem of getting leave due to shortage of staff.
They, therefore, procure medical certificate regarding their false sickness and produce it to the
department to justify absence from duty. In return, they have to pay certain amount to the
concerned medical staff. This practice, though a white collar crime, has proved a boon and a
workable alternative to employees who have difficulty in obtaining leave from the
employers.During pandamic of corona virus in Bangladesh different criminal syndicates were
operating across Bangladesh, luring migrant workers with virus-free certificates and, in turn,
endangering many live .
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A Bangladeshi hospital owner on the run for nine days was arrested by federal police for
allegedly selling patients fake COVID-19 negative certificates.Mohammad Shahed, 42, was one
of more than a dozen people in Bangladesh detained in a scam to sell fake coronavirus test
results without actually testing patients. According to officials, he was arrested while trying to
flee from Bangladesh to India disguised in a burqa. Shahed is the owner of the Regent Hospital,
whose branches in the Uttara and Mirpur localities of capital city Dhaka were sealed on July 6
for issuing fake certificates. The Rapid Action Battalion (RAB), an anti-crime unit of Bangladesh’s
federal police, detained eight hospital employees on several charges, including issuing the fake
1
https://www.dhakatribune.com/bangladesh/nation/2020/07/15/regent-hospital-chairman-shahed-arrested

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test results.His hospitals carried out 10,500 coronavirus tests, out of which 4,200 were genuine
and the rest, 6000 reports, were given without conducting tests.
Shahed is also accused of pocketing $350,000 after charging people for fake tests even though he
had an agreement with the government to offer patients free medical care at his hospitals in the
capital city Dhaka.The fake COVID-19 certificate scam has cast doubt on not just official figures
of coronavirus patients in Bangladesh, but also people’s confidence in the testing process. There
are so many cases when plaintiff wants fill a criminal cases they create a fake medical certificate
declaring that they were seriously injured, they use fake medical certificate to support their
evidence. And made innocent people suffer.There so many fraud who cretate fake certificate,
there is doctor named Dr Saiful Islam.His registration as a doctor expired many years ago. He
does not work at Dhaka Medical College Hospital or Mitford Hospital, which are authorised to
issue medical certificates in Dhaka city for criminal cases.But Saiful carries on his booming
trade sitting at a private clinic, National Diagnostic Centre, at Chankharpool intersection. In
exchange for Tk 5,000, he will certify that you were “grievously injured”.
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Saiful used to be a medical officer at the DMCH. He was suspended and made an officer on
special duty (OSD) at Directorate General of Health Services (DGHS) in 2008. His suspension
was withdrawn in 2010 and he remains an OSD to this day.But he continued giving false medical
certificates using the former identity of a DMCH medical officer with a chamber at a private
clinic.
Criminal cases are sometimes recorded with the police and courts without valid medical
documents. This leads to harassment of the accused in the false cases.In connection with a
criminal case in May 2010, Narsingdi Sessions Judge's Court summoned Saiful for “issuing false
and fabricated medical certificates”. A court official, having looked into the records of the case,
said Saiful appeared at the court on June 7 that year. The court reprimanded an apologetic Saiful
and referred him to the DGHS. Saiful gave a medical certificate along with an injury report about
an alleged physical assault on a woman in Gulshan on April 28 this year. 
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Advocate Molay Saha, who has dealt with cases of women repression and family issues for one
and half a decades, said nearly 60 percent cases about women repression due to dowries are
based on false accusations and fake documents. Shahjahan Mian Sachchu, another advocate at a
Dhaka court, said special tribunals that try women repression cases and metropolitan magistrate
courts often carry out a judicial inquiry to check the authenticity of the allegations before trial.
“Police sometimes take such cases despite a lack of authentic medical records apparently to
squeeze the accused for unfair gains,” he said. Officer-in-Charge Sheikh Masud Karim of
Nawabganj Police Station said, “Even if we register such cases, we do not file the final report
until authentic medical documents are produced.”.
Whoever wilfully procures or attempts to procure himself to be registered under this Act as a
medical practitioner or dentist making or producing or causing to be made or produced any false
or fraudulent representation or declaration, either orally or in writing, and any person who assists
2
Toufique Ali,’Doctor of false certificates' the daily star june19,2013
3
Adv Molay Saha, The daily star newspaper, june 19,2013

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him therein, shall be punishable with fine which may extend to Taka two thousand, or with
imprisonment for a term which may extend to one year, or with both under THE MEDICAL
AND DENTAL COUNCIL ACT, 1980
The Code of Medical Ethics :
The Code of Medical Ethics adopted8 by the BMDC sets the normative guidelines of
professional conduct to be followed by the registered physicians and dentists. Amongst other
instructions and prohibitions, the guidelines prohibits issue of certificate containing false
statements; attempt to make improper profit; abuse of professional knowledge, skill or
privileges; abuse of patient relationship; canvassing, advertising and using false title etc. The
guidelines also address disregard of personal responsibility to the patient. It states:
(a) Gross negligence in respect of his professional duties to his patient may be regarded as
misconduct sufficient to justify the suspension or removal of the name of a Medical/Dental
Practitioner from the Register.
(b) Assisting an unregistered person to practice medicine or dentistry etc., or a professional
association with such a person performing the functions of a practitioner in relation to
medicine, surgery and midwifery, dentistry etc.; knowingly will make a registered practitioner
liable to disciplinary action. ...” However, the Code does not specifically set any standard for
degree of care that a medical or dental practitioner owes to the patient; it only addresses
gross negligence and unauthorized professional association.

Fake and misleading advertise : It is also one of the common white collar crime in medical
sector that happens in Bangladesh . They make illegal and misleading claims of medical cure
through advertisements in newspapers, magazines, radio and television thus adding to human
misery. Many patent medicines are not only worthless but harmful. Similar advertisements for
cosmetics and adulterated food are also widespread in practices which are injurious to public
health. These persons may not violate the letter of the law in its sprints but they commit crimes
which are anti-social and injurious to public health.
Some Doctors can run afoul of these laws and regulations in a variety of unintentional ways:

 Advertising discounted or free services

 Misrepresenting their credentials and those of other clinicians and staff
 Using before-and-after photographs
 Using celebrity testimonials or endorsements
 Stating the effectiveness, safety or painlessness of treatment

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4
When a person under the veil of being a doctor or having some quick remedies leads the
ignorant victim into erroneously believing that he can cure his disease or distress by way of
medicine or prayer or any such method is deceiving that person, he is said to have done it
fraudulently, that is, with the intent to defraud where defraud means the loss of money of the
person so deceived in exchange of the false belief of his wellbeing which can be dangerous to his
body. He also does it dishonestly as he is trying to cause the wrongful monetary gain to himself
and the wrongful loss of money and the danger that persists on the body of the disease not being
properly diagnosed. The requirement of inducement is realized when the deceived person pays
the quack the money as the victim has then acted upon the deception of the quack. The quack
has, by his fraudulent misrepresentation, induced the hopeful person to deliver him the money
which the person would not have done without such deception. This has caused the victim the
damage of loss of money without getting the service promised.
Many so called doctor’s website tends to falsely stated that they are board certified. And many
patient chose the physician based in part on the board certification claim. And the patients
procedure was completed without complications; however, the most of the patients was never
satisfied with the results. Those doctors make various false advertisement to deceive the patient.
Several recent advertisements put out by some of the biggest and the smallest drug companies in
Bangladesh or selling their potions, lotions, clinics, tablets and treatment for all sorts of ailments
have been banned . because they violated the Drugs Act. This Act forbids the advertising of
products that claim to cure incurable diseases such as cancer, diabetes, AIDS, paralysis, balding,
and many more.

Heres how Phycians and company deceive people by using misleading advertisement:

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A company, was promoting its product with claims that had 10 times more geneplex youth
compound (whatever that is), which could successfully reverse ageing! Predictably, it also had a
celebrity endorsing the product in an advertisement.
A complaint was made which urged the company to prove its claims. Lotus, however, did not
respond to its queries. The Authorities ruled that it was making claims with no proof of the
efficacy of their product and were also guilty of ignoring the new guidelines set down by it
regarding the engagement of celebrities for advertising.
Short height to diminishing libido, they cure it all!

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Kabir, M. (2013). Unethical practices of advertising in Bangladesh. Academic journal of Siddheswari
Girl’s College
5
Advertise given in all Mass Media in Bangladesh.

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Another company in Bangladesh was promoting its Capsules, assuring consumers that it would
cure heart block, cholesterol, thyroid, diabetes, obesity, failing eye sight, Alzheimers and even
kidney function. The faulty English, vague terminology and the reckless claims in its
advertisements are all unnerving. The authority banned this advertisement saying that it could
lure consumers into taking this medicine without proper medical guidance. According to the
Council, the diseases for which they offer cures are serious and fatal and the vague usage could
mislead and harm consumers.
Many fraud physian advertise that treatment for a slipped disc without operation or medicine. It
also claimed to have curee/solutions for migraine, height deficiency etc. But the police after
investigation found out that they are fraud. The so called doctor didn’t even have a medical
degree. A enterprise that ensured obese customers that they would lose 4 inches in just 7 days
with its treatment, but when asked, could not give any evidence to the about how it would do
this. Those frauds were fined after. Another website offers products for sale in the Bangladesh.
Some of the products the site sells are Medicine for Sex Problems in Men/Sex Booster,
Medicines for Sexual Weakness and Sexual Strength, for impotence in men, medicine for
hearing loss and one that treats infertility in women. In reality those product only harm people.
No monitoring by government made consumers victims of deceptive advertisements by Doctor
or seller .The obvious upshot being false and misleading advertisements are dished out through
media outlets, both print as well as electronic. In this regard a wide spectrum of social media are
also used for dishing out misleading advertisements often conveying double meanings about
products to the gullible consumers.Consumers Association of Bangladesh president Ghulam
Rahman called it ‘a shame’ for the authorities to allow the consumers being cheated by
advertisements based on lies.Strict laws of civilized countries protect consumers from greedy
merchants and their deceptive advertisements.But Bangladesh is possibly among few countries
that have no effective law to protect the vulnerable consumers from the deceptive traps laid by
sellers using the handy tool of advertisement.
Doctors and communication experts said unregulated advertisements seriously impair
consumers’ interests in Bangladesh, with its poor record of product standardisation and an
equally poor record of enforcement of the law.Even products certified by the Bangladesh
Standards and Testing Institution often convey misleading picture relating to the quality of items
sold in the market.The label on the Teer brand of Soybean oil certified by the BSTI claims that
this particular cooking oil boosts immunity, strengthens teeth and bones, resists osteoporosis,
depression and night blindness.
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The label also states that this cooking oil brand also prolongs youth of consumers, strengthens
their hair and improves the health of their skin.The BSTI certification mark on the label makes
the claims credible to consumers though the BSTI does not take the responsibility of its label.

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Advertise telecast on various TV channel in Bangladesh.
Advertise given in all Mass Media in Bangladesh.
Advertising given in online and social Media in Bangladesh.

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BSTI certification wing director SM Ishaque Ali said quality claims printed on the label were
manufacturers’ responsibility.
In newspaper advertisements, City Group which sells the Teer brand of soyabean oil publicizes
that their cooking oil also helps control blood cholesterol and insulin.In 2017, Bangladesh Food
Safety Authority’s safe food inspector Mohammad Kamrul Hasan filed a case against the City
Group for using the misleading label on the soyabean oil brand marketed by it under the Safe
Food Act 2013.He said that he was shocked to see the label claiming the healing powers of the
cooking oil sold by this company.Cooking oil cannot be a medicine with this attributes,
Since 2013, only five cases were filed by Dhaka South City Corporation’s seven Safe Food
Inspectors against the use of misleading labels on consumer products.In February, the BFSA in a
notice accused Pran, a major food processing company, of misleading consumers in its
advertisements.Bangladesh Diabetic Association laboratory development director Subhagata
Choudhury described these actions as ‘totally inadequate’ on the part of the enforcement
authorities, He said that often additives and preservatives were used in packaged foods in
Bangladesh beyond permissible levels.Though excessive use of additives and preservatives make
food harmful for the consumers, he said, the firms selling them boast about the health benefits of
items in their advertisements.
He blamed foods laced with excessive preservatives and additives for the rapid rise in
hypertension, diabetes, cancer, kidney and cardiac complications and other non- communicable
diseases.Children and adolescents are particularly vulnerable targets of misleading
advertisements, said Dhaka University mass communication and journalism professor Gitiara
o.Being more sensitive, she said, children and adolescents are more likely to trust the
information in advertisements.Online media platforms are abundant with examples of false
advertisement influencing consumers.Until March 24, the verified Facebook page of Horlicks
Bangladesh was liked 379,769 times and had 379,782 followers.Mothers continuously interact
with updates posted on the page, sharing their desire to feed Horlicks to their kids, often aged
about three.

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The responses of mothers came in comments to posts containing advertisements that claimed
that children drinking Horlicks grow ‘taller,’ ‘stronger,’ and ‘sharper’ than those who do not
drink it. The advertisement is also extensively shown on TV channels. Another benefit children
get from drinking Horlicks, another advert said, is the ability to concentrate better than those
who don’t.The advert goes as far as saying that it has been proved scientifically. But ‘There is no
scientific proof to back this claim.
In 2017, the BBF served a legal notice on GlaxoSmithKline, which produces Horlicks, for
confusing consumers with such misleading adverts.In 2008, the Advertising Standards Authority
in UK banned a similar Horlicks advert mistakenly broadcast on Ntv Europe, airing programme
7
Advertise telecast on various TV channel in Bangladesh.
Advertise given in all Mass Media in Bangladesh.
Advertising given in online and social Media in Bangladesh.

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for Bangladeshi community there. The ASA had banned a Nestle advert for that claimed Maggie
noodles strengthens muscles and bones.‘The health and nutritional claims made by GSK and
Nestle may be allowed in other parts of the world, but they breach the strict rules in the UK and
we have seen no evidence to substantiate them,’ said ASA after slapping the ban.
Manufacturers of both the products had said in reply that the adverts were never meant to be
shown in the UK.
A 2016 study, conducted by Work for a better Bangladesh trust, revealed that about 20 per cent
of the advertisements studied promoted unhealthy foods.Swadhinata Chikitsak Parishad
president Iqbal Arsnal said that only greedy advertisers could promise cancer treatment with
guarantee or health improvement in a few weeks or heart block removal without any surgical
interventions.Immediate past information secretary Nasir Uddin Ahmed admitted only a
broadcast policy was not enough to deal with the situation.Advertising Agencies Association of
Bangladesh president Ramendu Majumdar said that the country needs a code of ethics for the ad
firms as ads influence people. 

Being a responsible consumer:

a) Before shopping for your medicines either online or at the chemists’ store, check with
your doctor. Do not waste your money and risk your life by falling for glitzy ads making
tall claims. No matter how well-known the company, or the face on the ad.
b) Also check out the newspaper or news where you will find more than a thousand
advertisements selling risky medicines, potions, doctors, clinics, lotions, pills and
powders of dubious quality. You can also lodge a complaint,  if you feel that any
advertisement is blatantly false or misleading.

Punishment for fake advertise in Bangladesh:

Bangladesh has enacted Consumer Rights Protection Act, 2009 to deal with the consumer affairs.
The Law is an addition to a number of around 61 relevant laws dealing with the consumer rights.
10 years imprisonment and/ or fine of taka two hundred thousand for manufacturing sub-
standard or prohibited drugs under the Drug Control Ordinance, 1982
l 3-years punishments and/ or fine of taka two hundred thousand under the Consumer Rights
Protection Act, 2009 for adulteration of food or medicine
l Compensation 5-times the actual loss under the Consumer Rights Protection Act, 2009;

l 4-years imprisonment and/ or fine of taka one hundred thousand under the BSTI Ordinance,
1985
l Fine of taka 50 thousand and/or rigorous imprisonment for one year under the Pure Food
Ordinances for sub-standard food items or giving false warranty etc;  
l 6-months imprisonment or fine of taka one thousand under the Penal Code, 1860 for

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adulteration of food or drug or sale of adultered food or drug. For fraudulent use of false weight
or measure of length or capacity, one year imprisonment or fine or with both.

Corruption in Health care : Its also a part of white collar crime in medical sector of
Bangladesh. Corruption is prevalent in all sectors of the economy. Healthcare is by no means an
exception. From mis-invoicing the price of medical equipment to pretending to be doctors,
corrupt individuals have adopted many methods to use public resources for their private gain.
This pervasive nature of corruption tends to reduce the effectiveness of government spending in
healthcare. As a result, the quality of healthcare is appalling and the quantity of healthcare is
inadequate.
The impact of corruption on public health expenditure can be analysed using a simple model. In
the absence of corruption, the government provides healthcare services at a price which
maximizes social welfare. However, if public healthcare services are dispensed through a
government official, then the official in charge is susceptible to corruption. Under such
circumstances, the government official may behave like a monopolist and restrict access to
healthcare services. Thus quantity of healthcare services offered to the public with corruption is
lower than the quantity of healthcare services provided without corruption. Moreover, instead of
charging the government mandated price, the government official charges a bribe which is lower.
Thus the government official succeeds in completely superseding the government and becomes
the de facto provider of healthcare services. Since the government is deprived of the revenue
from the sales of healthcare services, its ability to fund healthcare expenditure in the future is
seriously hampered. Furthermore, the effectiveness of government expenditure in healthcare is
reduced since fewer people benefit from healthcare services in the presence of corruption.
Research has shown that corruption can reduce the returns to investment in healthcare. The
incidence of high infant mortality rate and low birth-weight of babies can both be decreased by
curbing corruption in public healthcare services. This implies that corruption stands in the way of
achieving the better health outcomes. In Bangladesh, studies have revealed that patients are
incentivized to pay bribes through the promise of better quality healthcare in public hospitals.
Improving the quality of healthcare and reducing the influence of corruption are both important
objectives for Bangladesh, especially considering its commitment to ‘leave no one behind’. In
order to resolve the problem of corruption in the healthcare sector, a holistic approach is required
that involves general anti-corruption policies coupled with specific healthcare sector measures.
Moreover a social paradigm shift is necessary so that rejection of corruption becomes the norm.
As Bangladesh graduates out of Least Developed Country (LDC) status, it is imperative to defeat
the dragon of corruption that has entangled its healthcare sector. Otherwise, the productivity of
the workforce and the competitiveness of the economy will invariably be compromised.
Petty and bureaucratic corruption in the health sector :
According to a survey by TI Bangladesh, 40.2% of healthcare seekers were victims of
different kinds of irregularities and corruption. In particular, 21.5% reported making irregular

13
payments, averaging 258 taka (US$3.24), almost a third of which (32.6%) were made to
ambulance services. Moreover, 31.7% of the households who paid unauthorised money did so
to get services quicker, 27.2% to get a better service, and 46.5% because it was the only way to
obtain a service (TI Bangladesh 2012a). This picture is largely corroborated by Transparency
International’s 2013 Global Corruption Barometer, which found that 16% of those who had
accessed medical and health services in the previous year had paid a bribe, while 33% of
those surveyed perceived the sector to be corrupt or extremely corrupt (Transparency
International 2013.

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Grand corruption in the health sector :Beyond bribery and unauthorised payments, a number
of other irregularities exist in both the public and private healthcare sectors in Bangladesh. One
recent study by TI Bangladesh found the main types of irregularities to include:

 Politically influenced recruitment, promotion and transfer of doctors, often involving

illegal financial transactions and overlooking requirements on length of service,
 qualifications, exam scores and annual confidential reports.
 Selective training often depriving the most deserving candidates of training
opportunities while financially benefiting others.
 Political influence and collusion in the selection of contractors for food supplies and
purchase of unnecessary medical equipment.
 Doctors failing to fulfil their official hours of service.
 Private healthcare institutions employing unregistered doctors and doctors with fake
qualifications, or failing to employ the legally required minimum number of doctors and
support staff.
 Private diagnostic centres maintaining contracts with doctors in exchange for a
commission ranging from 10-50% (TI Bangladesh 2014b).
The same study found that reports of financial irregularities in the health sector are also
common in Bangladesh. In one recent case, the World Bank threatened to withdraw financial
assistance to Bangladesh’s Health Population and Nutrition Sector Development Program after
audit investigations found financial irregularities of Tk160 crore (US$20 million) committed by
twenty mid-level managers. A subsequent review by the World Bank’s International
Development Association found indications of inappropriate procurement practices and
fraudulent activities, including the procurement of unapproved items, deliberate avoidance of
competitive procedures, and honorariums paid to directors for training programmes which they
didn't attend (Bangladesh Chronicle 2014).
Governance failures in the health sector:

8
Bangladesh Chronicle. 2014. Twenty Health Ministry Doctors Made OSD amid Corruption Concerns.
http://www.bangladeshchronicle.net/index.php/2014/09/ twenty-health-ministry-doctors-made-osd-
amidcorruption-concerns/

14
Many of these challenges may be the result of broader governance and institutional weaknesses
in the health sector in Bangladesh. The health budget has decreased from 6.38% of the national
budget in 2008-09 to 4.6% in 2013-14 (TI Bangladesh 2014b), and Bangladesh has among the
lowest number of doctors per head of population in the world (WHO 2011). The situation is
compounded by high absenteeism rates. One study found absenteeism rates in primary
healthcare centres in Bangladesh to be as high as 35% (Capacity Plus 2012). At the same time,
the regulatory framework for monitoring health service delivery is weak, with 45 separate laws
related to various aspects of health (Ara 2008).
9
The Bangladesh Medical and Dental Council (BMDC), responsible for maintaining proper
standards of health services, suffers from the absence of a system for monitoring practitioners
(Ara 2008), and the legal means to hold doctors accountable for negligence are not used (TI
Bangladesh 2014b). The law does not stipulate the frequency of inspections of private clinics
and laboratories, which means that there is no guarantee of regular inspections. Fees and
charges for private medical services are not updated and are not required to be displayed,
which creates the opportunity for clinics to charge patients arbitrarily (TI Bangladesh 2014b).
Other challenges include lack of coordination among different levels of service and between
ministries to monitor public health, highly centralised health planning, lack of accountability to
citizens, limited incentives for strong performance and widespread mismanagement of drugs
and equipment (Ara 2008). Governance weaknesses are also apparent in the pharmaceutical
sector in Bangladesh. The Directorate General of Drug Administration does not have enough
institutional capacity to monitor the industry, and the regulatory framework is inadequate,
including a lack of regulation on drug pricing. As a result, there have been allegations that some
companies are producing fake, low quality, adulterated and inessential drugs, as well as selling
expired drugs. Corruption has therefore become “institutionalised at almost every point of
service delivery through collusive corrupt practices” (TI Bangladesh 2015).

Billing for services not rendered: Medical professionals today in our country are using
different types of illegal and unethical schemes to get over on and to defraud the healthcare
insurance companies. Some of the frauds committed by these medical professionals include
billing for services that were not rendered, providing unnecessary treatments or tests, upcoding
(billing the insurance company for a more expensive diagnosis or procedure), falsifying or
exaggerating the severity of the medical illness to justify bill coding, and accepting kickbacks for
referrals.
The unnecessary procedures physicians may bill are done to increase their reimbursement and
can compromise the patient’s safety. When billing for services not rendered, these physicians
create a false medical history for the patients that causes problems for them in the future when
obtaining disability or life insurance policies. A medical history may influence treatment
decisions and allow some insurance companies to deny coverage based on a previous falsely
reported medical condition.

9
Ara, F. 2008. Key Issues to Health Governance in Bangladesh

15
Medical billing fraud can occur in a variety of ways.  Some of the most common ones
are , unbundling, and billing for services that were not provided.  Many other fraudulent schemes
exist, however.  When a provider submits a fraudulent bill for payment, they may be liable under
the False Claims Act, and whistleblowers pay a critical role in exposing this kind of fraud.
10
Upcoding Fraud
Upcoding is a kind of medical billing fraud that occurs when a provider sends a bill to Medicare
or another payor for a more expensive service than the one actually performed. For example, the
provider might:
 exaggerate the time the procedure took to perform
 misstate the equipment involved in the procedure
 lie about the staff involved in performing the procedure
 bill for individual therapy when group therapy was actually provided
 simply make up that a procedure happened
 perform (and bill for) procedures that patients simply do not need in violation of “medical
necessity” rules
Upcoding also occurs with risk adjustment fraud committed under Medicare Part C, when a
Medicare Advantage patient’s diagnostic data is exaggerated in order to draw additional risk
adjustment payments from Medicare.
The Government will only pay for medical services that are actually performed or for equipment
that is actually delivered. It can be a violation of the False Claims Act to bill the Government for
healthcare services, supplies or equipment that were not performed or delivered. While
sometimes bills are submitted for completely fictional services, medical billing fraud also
happens when, for example, a diagnostic testing lab submits a bill claiming it has performed both
a two dimensional CAT scan and a sophisticated 3D scan and analysis, when, in fact, only the
2D scan was performed.  They are billing for service that was not actually provided.
Also Rising healthcare costs have become a major cause of pushing people deeper into poverty.
According to a 2015 study by the health ministry, out-of-pocket (OOP) health expenditure in
Bangladesh is as high as 67 percent of the total healthcare cost—the global average is only 32
percent—and is the highest in South and Southeast Asia. Another study by the International
Centre for Diarrhoeal Disease Research, Bangladesh found that OOP expenditures push four to
five million people in the country into poverty every year.
Although the feeble state of our public healthcare system is mainly to blame for these alarming
figures, what has become difficult also is accessing even that. Over 63 percent of households
seek healthcare services from the private sector, according to Transparency International

10
‘People left high and dry by medical bills' The daily star newspaper april 08,2019

16
Bangladesh. And while a fraction of households does so willingly, the majority is simply forced
into it because public hospitals are ill-equipped to treat various diseases and are often riddled
with corruption. Even when they can treat patients, our public hospitals afford very little benefits
compared to those in other countries. One example is the lack of free cancer medicines in all
hospitals but one—opposite of what is standard practice in most countries. Aside from that,
patients get further ripped-off by corrupt doctors, health workers, medicine sellers and brokers,
colluding to squeeze every penny possible out from patients.
The government should fix the standard cost of critical tests and treatment so that patients no
longer have to endure such abuses. It should establish specialised hospitals in all divisional states
that treat non-communicable diseases which account for approximately 59 percent of total deaths
in the country, and consider other measures that can give some relief to the population—
especially the poorer sections of it—that is being overwhelmed by increasing medical costs

Unnecessary medical tests for business reasons: Medical Practice is no longer the
humanitarian profession but a Business.Medical Education is not the entry in to the Noble
Profession but an investment to make millions in return.The hospitals, pathological laboratories,
radiological clinics and other diagnostic clinics work in tandem like an organised Vicious Circle
and their ultimate objective is to take care of each other and loot patients.Even if the patient
reports to the doctor with a simple headache, the doctor explains the patient that the headache
may be due to fatigue, heat, cold or can be due to brain hemorrhage and to rule out every
possibility, the doctor advises Blood Picture, Haemogram, OTPT, Urea, Lipid, X Ray skull, C T
Scan, MRI etc.
If the patient goes to the doctor with Chest Pain, he is the potential customer as a patient of
Cardiac Arrest and can be advised all blood tests, ECG, Colour Dopler, Angiography and
sometimes Angioplasty also. It is very likely that some of the blood vessels are normally
blocked. It has been found that some of the doctors conduct illegal abortions, illegal sex
determination tests and even stealing kidneys also. The above is the dark side but bright side also
is there. Many of the doctors do charity and treat the poor patients free of cost. Exceptions are
everywhere.Fabricating test results after dumping blood samples in the sink.Stitching up the
cervix of pregnant women on the pretext of preventing miscarriage.Labeling healthy people as
having diabetes.Most experts agree that healthcare fraud is rampant in the world’s largest
democracy, with recent corruption scandals engulfing everyone from doctors to drug
companies and health regulators.
Alternative practitioners such as homeopaths and Ayurvedic healers are common in India, and
many people prefer them over doctors with a diploma in modern medicine. While not allowed to
use modern drugs, in practice they do so with impunity, often encouraged by drug company sales
representatives. Medical scams intended to wring money from patients also emerged as a major
topic in the interviews.In the so-called “sink test,” the doctor orders lab tests despite not
suspecting any medical problems. “Only a few of the tests are performed, and the extra blood
collected is dumped in the sink.Fabricated results are given in the normal range for all tests that

17
were not performed. The patient pays a large sum, which is shared by the referring doctor and
the pathologist.” Other examples include unwarranted C-sections and hysterectomies, he said, or
cervical stitches based on false reports suggesting a pregnant woman might miscarry.
Although Bangladesh’s public health centers are known to be understaffed and dysfunctional,
many public health experts believe privatization of medical services and education is at the root
of the problems. lack appropriate laws to regulate hospitals, diagnostic centers and other
healthcare facilities in the private sector. “Right now, anybody can start up anything, Doctor can
charge whatever, there is no legislation.

11
Here are the example of how doctors looting money by giving unnecessary test:
1.Admitting the patient to "keep him under observation"
People go to cardiologists feeling unwell and anxious. Most of them aren't really having a heart
attack, and cardiologists and family doctors are well aware of this. They admit such safe patients,
put them on a saline drip with mild sedation, and send them home after 3-4 days after charging
them a fat amount for ICU, bed charges, visiting doctors fees.
2. ICU minus intensive care
Nursing homes all over the suburbs are run by doctor couples or as one-man-shows. In such
places, nurses and ward boys are 10th cl-ass drop-outs in ill-fitting uniforms and bare feet. These
"nurses" sit at the reception counter, give injections and saline drips, perform ECGs, apply
dressings and change bandages, and assist in the operation theatre. At night, they even sit outside
the Intensive Care Units; there is no resident doctor. In case of a crisis, the doctor -- who usually
lives in the same building -- will turn up after 20 minutes, after this nurse calls him. Such ICUs
admit safe patients to fill up beds. Genuine patients who require emergency care are sent
elsewhere to hospitals having a Resident Medical Officer (RMO) round-the-clock.
3.  Unnecessary caesarean surgeries and hysterectomies
Many surgical procedures are done to keep the cash register ringing. Caesarean deliveries and
hysterectomy (removal of uterus) are high on the list. While the woman with labour -pains is
screaming and panicking, the obstetrician who gently suggests that caesarean is best seems like
an angel sent by God! Menopausal women experience bodily changes that make them nervous
and gullible. They can be frightened by words like " and "fibroids" that are in almost every
normal woman's radiology reports. When a gynaecologist gently suggests womb removal "as a
precaution", most women and their husbands agree without a second's thought.
4.Cosmetic surgery advertized through newspapers:
Liposuction and plastic surgery are not minor procedures. Some are life-threateningly major. But

11
MS Islam, pysician-Patient Relationship: The Present Situation and Our Responsibilities, Bangladesh Medical
Journal 2012 Vol. 41 No. 1

18
advertisements make them appear as easy as facials and waxing. The Indian medical councilhas
strict rules against such  misrepresentation. But nobody is interested in taking action.
5.Indirect kickbacks from doctors to prestigious hospitals
To be on the panel of a prestigious hospital, there is give-and-take involved. The hospital expects
the doctor to refer many patients for hospital admission. If he fails to send a certain number of
patients, he is quietly dumped. And so he likes to admit patients even when there is no need.
6  "Emergency surgery" on dead body
If a surgeon hurriedly wheels your patient from the Intensive Care Unit to the operation theatre,
refuses to let you go inside and see him, and wants your signature on the consent form for "an
emergency operation to save his life", it is likely that your patient is already dead. The
"emergency operation" is for inflating the bill; if you agree for it, the surgeon will come out 15
minutes later and report that your patient died on the operation table. And then, when you take 
delivery of the dead body, you will pay OT charges, anaesthesiologist's charges
7. Sink Tests
Some tests prescribed by doctors are not needed. They are there to inflate bills and commissions.
The pathology lab understands what is unnecessary. These are called "sink tests"; blood, urine,
stool samples collected will be thrown.

       

President M Abdul Hamid rightly asked physicians not to prescribe the patients unnecessary
medical tests as many patients cannot bear the expenses. While addressing the 29th Annual
Conference and International Scientific Seminar-2018 organised by Association of Physicians of
Bangladesh (APB) in the capital Saturday he said that many patients are being harassed in the
name of treatment. Terming the medical profession a very noble one, the president urged the
doctors and others concerned to abide by the "Code of Medical Ethics" aimed at ensuring proper
health services and professional standard.
It is worrying to note that there are some doctors who are more concerned about their personal
incomes than the welfare of patients. They can go to any length where their personal profit is
concerned forgetting the Hippocratic Oath they took at the beginning of their profession. These
doctors fleece patients in the name of medical care inflicting a blow to this noble profession.
Asking patients to do unnecessary medical tests without rhyme or reason has become the habit of
a section of doctors. There is no dearth of enthusiasm of these doctors to order unnecessary
medical tests and procedures putting pecuniary strains on the patients and their relatives.     
These doctors are carrying on ‘commission business’ making a bonfire of the medical ethics.
Owners of clinics and diagnostic centres are giving these doctors substantial commission on the
tests done. Many clinics and diagnostic centres are surviving ant thriving through these
doctors.   

19
 The culture of unnecessary medical tests for patients should be stopped forthwith. Tests should
be done where it is necessary but unnecessary tests thrust upon a patient should be shunned.
  Besides, there are doctors, particularly specialist doctors, who have very little time for patients.
This in some cases leads to wrong diagnosis and the patients have to suffer ultimately. Some
doctors have become so much commercial that money earning is their sole motto and humanity
becomes a secondary thing. A doctor’s lack of attention to his patient may prove to be fatal for
the patient. There are some physicians whose comforting words give a healing touch to the
patient. Our doctors should keep it in mind that their keen attention can save many a life. For a
quality health care this mentality should be changed. A doctor should be more sympathetic to a
patient.  That is what a patient wants. Our doctors should be more careful and accountable in the
interest of public health.

Illegal abortion :
Women with low complication rates more often had abortions induced by medical practitioners.
These women were younger, of lower parity and better educated than women having abortions
initiated by other practitioners. Poorly educated women from slum areas almost always had an
abortion induced by a non-medical practitioner through the insertion of a solid object. These
women experienced high complication rates and often required hysterectomies. This group also
had high mortality rates. The drain on hospital resources needed to treat these abortion patients
was great.
12
Every year millions of women have an unwanted pregnancy, some unwanted pregnancies
are carried to term, and others end in induced abortion. An estimated 26 to 31 million legal
abortions were performed in 1987. Illegal abortion is restricted by law in many countries. In
others, pregnancy termination is legal on medical and social grounds. Sometimes, even where
induced abortion is legal, services may be insufficient to meet demand or are inadequately
distributed. Alternatively, a woman may be unaware of their availability. Despite restrictive
laws and lack of adequate services, women continue to seek to terminate illegal abortion .
Women who report to unauthorized facilities and/or unskilled providers put their health and lives
at risk. Restrictive legislation is associated with high rates of unsafe abortion. It is, however
the number of maternal deaths, not abortion, that is most affected by legal codes5. As
record-keeping systems are inadequate or nonexistent, many abortions are not reported, it is
estimated that worldwide, 40-60 million induced abortions are performed each year. Every
year, hundreds of thousands of these women die unnecessarily or suffer disastrous
consequences, including sepsis and sterility, from clandestine abortion. In Bangladesh, it has
been reported that at least 7800 women die due to abortion complications each year.

12
Measham AR, Obaidullah M, Rosenberg M et al. Complication from induced abortion in Bangladesh related to
types of practitioner.
Kabir SM. Causes and consequences of unwanted pregnancy from Asian women’s perspectives. SupplInt J Gynecol
Obstet 1989; 3:9-14.

20
Abortion can be done only in a hospital established, maintained or approved by the government.
But a quack, not being a registered practitioner (unless he has obtained a name in the register by
misrepresentation), is not immune from provisions. Such a person is then liable to be punished
under sections 312 to 318 of the Penal Code, 1860 regarding miscarriages which have various
punishments including imprisonment for life. Some of these offences exclude those acts done in
good faith, but, since quacks cannot be said to act with due care and attention, there is no good
faith and thus, they can be punished under those provisions.

Part-III

National Policies, Statues and Other Legal Documents Relating to Health Care and
Medical Services:
The policies, statutes and other documents of legal importance that govern the health and
medical sector in Bangladesh are discussed here. It is worth mentioning that these policies and
laws deal with many different and diverse subject matters, of which only those concerning
medical practice, operation of public and private medical centres and regulation of health care
services will be attended here. Accountability has always been an issue in the debates relating
to white collar crime in medical sector and operation of private medical clinics. So, specific
importance has been given on the provisions of law and policy that can help towards establishing
accountability in medical services. The policy that mostly covers the right to health and
medical care issues is the National Health Policy (NHP) of 2011. Two other important
policies that partly address similar issues are the National Women Development Policy of 2011
and National Child Policy of 1994. Apart from these policies there are a number of statutes
that are directly or indirectly linked with medical practice. The laws include:
• The Vaccination Act, 1880
• The Drugs Act, 1940
• The Eye Surgery (Restriction) Ordinance, 1960
• The Pharmacy Ordinance, 1976
• The Drug (Control) Ordinance, 1982
• The Medical Practice and Private Clinics and Laboratories (Regulation) Ordinance, 1982
• The Bangladesh Unani and Ayurvedic Practitioners Ordinance, 1983
• The Transplant of Organ in Human Body Act, 1999
• The Safe Blood Transfusion Act, 2002
• The Consumer Rights Protection Ordinance, 2008

21
• The Bangladesh Medical and Dental Council Act, 2010
In addition to these laws, the Penal Code, 1860 also needs to be considered, especially when
white collar crime or fraudulent medical practices give rise to criminal liability. Apart from the
laws the Code of Medical Ethics adopted by Bangladesh Medical and Dental Council, the
regulatory body of medical and dental profession in Bangladesh, is of great importance. The
relevant provisions of these documents are discussed here followed by an analysis of missing
and/or contrary provisions in the policies and laws to ensure accountability and people’s right to
health and medical care
National Health Policy, 2011 The National Health Policy, 2011 replaced the previous Policy of
2000. The new Policy in its goals reaffirms Government’s commitment to establish treatment as
a right as per Constitution and different international instruments. The goals include
improvement of quality of service by better management public health care centres and
hospitals; to ensure supply of necessary equipments and resources therein, to ensure the quality
of service in the private medical colleges, medical education and training institutions, hospitals,
clinics and diagnostic centres, to keep the expenses of medical service and education within
the rich of the people, to ensure people’s right to information regarding health etc. The policy
adopted a number of principles to achieve the goals.
National Children Policy, 1994 The National Children Policy (NCP) of 1994 generally deals
with the affairs of children. The Policy specifically addressed the health and nutrition concerns
for children in Bangladesh. However, it appears that the NCP did not specifically attend the
question of children’s right to proper medical care and treatment. The focus was mainly on
nutrition and other health aspects. Nevertheless, the Policy adopted the principle of the best
interest of the child, which can be an important aid to construction of other legal documents.

The Drugs Act, 1940

This law provides for establishment of a central drug laboratory by the Government to carry out
the functions entrusted to it by this Act (Section 6). Section 9 of the Act provides for
misbranded drugs. In case of imported drugs, a drug shall be deemed to be misbranded if it
falls under any of the heads mentioned in the said Section e.g. if it is an imitation, or if it makes
false statement etc. Section 10 of the Act prohibits import of certain drugs; such as drugs
which are not of standard quality, or misbranded drugs etc. Contravening with any provision
relating to import of drugs is punishable under Section 13, for which the maximum
punishment is imprisonment of one year or fine of Taka 500 or both. Section 14 also provides
for confiscation of such drugs. Section 18 of the Act prohibits manufacturing and sale of certain
drugs e.g. drugs which are not of standard quality, misbranded drugs etc.

The Drug (Control) Ordinance, 1982

22
This Ordinance was promulgated with a view to control manufacture, import, distribution and
sale of drugs in Bangladesh. Section 5 of the Ordinance provides for registration of medicines.
The Section reads, no medicine of any kind shall be manufactured for sale or be imported,
distributed or sold unless it is registered with the licensing authority. A registration shall be
granted on the conditions as may be prescribed by the licensing authority. Under Section 6 of
the Ordinance, the licensing authority may cancel the registration of any medicine if such
cancellation is recommended by the Drug Control Committee. The Committee shall evaluate
every medicine that may be manufactured or imported, to determine its safety, efficacy and
usefulness. On such evaluation of a medicine, if it is found that such medicine is not safe, the
Committee may recommend to the licensing authority for cancellation of the registration of the
medicine; or if the medicine is sub-standard, the licensing authority may suspend the
registration of such medicine till it is satisfied that the medicine has attained its standard.

The Medical Practice and Private Clinics and Laboratories (Regulation) Ordinance, 1982
This Ordinance is intended to regulate medical practice and functioning of private clinics and
laboratories. This is a vital law in dealing with private medical services as it provides for
regulation of private practice, private clinics and laboratories. Section 4 of the Ordinance
prohibits a registered medical practitioner in service of the Republic to carry on private
medical practice during office hours. As per Section 5 all medical practitioners are required to
maintain hygienically sound chamber and room for the examination of patients. Section 9 lays
down the conditions for licensing of private clinics.

The Consumer Rights Protection Ordinance, 2008

Under Section 76 of the Ordinance the Director General of Consumer Rights Protection
Department can inspect any private health care centre to check out if there is any deviation or
violation of law. If he finds any deviation or non-compliance he shall immediately inform the
Secretary, Ministry of Health or the Director General of Health; but he has no power to directly
take any action in this regard. Section 52 provides punishment for unlawful acts endangering
life or personal safety of the consumer; whereas Section 53 provides punishment for loss of
money, health or life of the consumer due to negligence, irresponsibility or carelessness of the
service provider. Both offences are punishable with imprisonment for a term not exceeding
three years, or fine not exceeding taka two thousand, or with both. Section 69 provides for
civil remedy for compensation, independently of any criminal case. The civil courts are
empowered by Section 70 to award compensation up to the sum equal to five times of the
actual damage caused and other reliefs in a proceeding for compensation due to negligence.

23
Penal Law in General: The Penal Code, 1860
Depending on the nature and culpability of the alleged act, white collar crime in medical sector
and fraudulent or ill practices involving medical profession or service can also come within the
purview of general penal law9. The Penal Code of 1860 is the main penal law of Bangladesh
that generally deals with different types of criminal offences. The offences under the Penal
Code are tried in the criminal courts according to the provisions of the Code of Criminal
Procedure, 1898. The Penal Code, however, does not contain any specific section to
particularly address culpable negligence of a medical practitioner, except those relating to
causing miscarriage etc. Nevertheless, the following sections of the Penal Code are of some
relevance in cases of medical negligence, acts threatening public health, fraudulent conduct
and so on. The sections are mentioned below with their short title:

Sections Short Title of the Section/Offence

272 Adulteration of food or drink intended for sale
273 Sale of noxious food or drink
269 Negligent act likely to spread infection of disease dangerous to life
270 Malignant act likely to spread infection of disease dangerous to life
271 Disobedience to quarantine rule
274 Adulteration of drugs
275 Sale of adulterated drugs
276 Sale of drug as a different drug or preparation
304(A) Causing death by negligence
312 Causing miscarriage
313 Causing miscarriage without women's consent
314 Death caused by act done with intent to cause miscarriage
315 Act done with intent to prevent child being born alive or to cause it to die after
birth
316 Causing death of quick unborn child by act amounting to culpable homicide
338 Causing grievous hurt by act endangering life or personal safety to others
415 Cheating by personation
416 Cheating with knowledge that wrongful loss may ensue to person whose interest
the offender is bound to protect

Part-IV

24
Remedy against white collar crime or Fraudulent Practices of medical sector under the
Existing Law and Practice in Bangladesh:

White collar crime can legally be addressed in a number of ways. Any case of medical
negligence or malpractice obviously involves a breach of duty. This breach can be redressed
by civil remedy, such as compensation. In cases where the negligence is culpable, then
criminal action can also sustain. In addition to that as medical negligence and malpractice
essentially contain elements of breach of a professional duty, it comes within the purview of
professional misconduct and hence, liable to departmental or disciplinary actions. Different
laws that regulate the medical services in Bangladesh define offences relating to the concerned
subject matter and also provides for punishment for those offences. Therefore, actions can be
taken under those specific legislations also. Finally, action can be taken commonly on behalf of
the people through PIL or employing other means of judicial review, such as writ petition. In
this part the remedies available under the existing laws that can be resorted to in cases of
medical negligence have been categorically discussed.
Criminal Action
The scope for criminal action for medical negligence is also very limited. The difficulties in
proving doctor’s guilt in a criminal court has been discussed in the preceding part. There are
very few Sections in the Penal Code that can be applied in cases of medical negligence. The
offences described in the Penal Code typically have a strong emphasis on mens rea or guilty
mind. In a case of medical negligence, where admittedly it all starts with an attempt to cure the
patient, the very context itself presupposes a good faith, and therefore, it is always very
difficult to establish the underlying elements of a crime. It can be argued that in such cases
mens rea need not be proved, or alternatively that instead of actual guilty mind, knowledge of
the probable injury/loss or constructive mens rea should suffice. But that is not possible and
practicable to apply, particularly when prosecuting medical negligence under the Penal Code;
where by virtue of his profession the doctor always has to take certain risks, obviously with
knowledge, with or without consent of his patient. The immunity as provided in Sections 88
and 92 of the Penal Code is founded on this reasoning, which cannot be ignored or opposed in
order to maintain the balance of fairness.

Civil Suit for Compensation

Civil suit for compensation is generally maintainable for all instances of medical negligence.
Section 9 of the Code of Civil Procedure (CPC), 1908 empowers the civil courts to try all suits
of a civil nature, unless expressly or impliedly barred by law. Section 19 further provides:
“Where a suit is for compensation for wrong done to the person or to movable property, if the
wrong was done within the local limits of the jurisdiction of one Court and the defendant

25
resides, or carries on business, or personally works for gain, within the local limits of the
jurisdiction of another Court, the suit may be instituted at the option of the plaintiff in either of
the said Courts.”

Remedies under the Consumer Rights Protection Ordinance, 2008

Sections 52 and 53 of the Ordinance provide for punishment of the service providers in cases
of negligence etc. The Ordinance, at the same time, also provided for parallel civil
jurisdiction. A civil action for compensation under the Ordinance is maintainable
independently of the criminal case. The court of Joint District Judge of the concerned local
jurisdiction is the court of first instance. An appeal can only be preferred to the High Court
Division of the Supreme Court. Along with other powers, the Court can award the plaintiff
compensation up to five times of the actual loss.

Judicial Review : whether in PILs or in other writ cases, can provide certain remedy
regarding medical negligence. The remedy accorded by judicial review may not directly benefit
an individual but it does have a collective impact on the issue. Judicial review can have
multiple impacts on a particular issue. The High Court Division of the Supreme Court has the
power of judicial review under Article 102 of the Constitution. The failure of the State
mechanisms to fulfill their legal and constitutional obligations is an obvious ground where the
Court can intervene in exercise of its power of judicial review. Apart from providing individual
remedy where there is no other equally efficacious remedy available under the law; judicial
review can also provide for prospective collective remedy or open the sealed doors of procedural
relief.

Recommendations :
Based on the assessment of different aspects of laws and policies in the preceding parts,
some recommendations for legal advocacy are made in this part. These recommendations
concern policy-level interventions, legal reform and initiatives for bringing a change in
the existing practices. Bangladesh Law Commission has also made a set of proposals
which have been discussed in 3.5. The Commission’s suggestion and the assessment of this
report come to the concurrent conclusion regarding necessity of a fresh and specific law on
medical negligence. These, recommendations can render better result if implemented in
time bound logical framework.

Recommendations for Policy Advocacy:

26
1. Develop a time bound plan of action for policy advocacy; upon identifying and
prioritizing the sectors of medical and health care services where there is a need for
specific policy guidelines in order to ensure right to health care and proper treatment.

2. Lobby with the Government to expedite specific legislation on medical negligence and
implementation of strategic plan of the NHP, 2011.

3. International advocacy and networking with a view to highlight the want of

accountability in the medical sector of Bangladesh and motivate the international
pressure groups to press the Government of Bangladesh to take measures on the issue.

4. Liaison with the Government agencies in order to identify the lacuna in the policies
that are contributing to or aggravating the difficulties with monitoring of medical
services.

5. Form specific proposals for policy reform and negotiate with the Government.

6. Advocacy for increase of national health budget, greater allocation for public
hospitals and adequate supply of medical equipments, medicines and other resources in
the public hospitals.

7. Policy advocacy with a view to ensure promotion of alternative systems of medicine;

such as Unani and Ayurvedic medicine.

Recommendations as to Improvement of Existing Practice and Awareness Building:

 Arrange training of the young lawyers to develop their skill and expertise in
preparing and conducting civil and criminal cases on medical negligence.
 Provide legal aid to the victims of crime and encourage litigation.
 Take legal actions and follow up cases of white collar crime in health sector
 To ensure citizen’s charter to be displayed in a conspicuous place, in all public
and private medical and health care centres.
 Take initiatives to ensure proper documentation and preservation of medical
data in every medical centre, private clinics and private or public hospitals;
and also to ensure lawful access of the people to the preserved medical data.
 To initiate public debates on different aspects of health care rights and medical
negligence.
 To introduce awareness programmes to raise awareness of the people about their
right to health and proper treatment.

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  Launch awareness programmes to sensitize the medical practitioners regarding
the legal consequences of , malpractice and misconduct, and the sufferings of
the patients as a result of that.

Part-V

Conclusion:
White collar crime and malpractice in the entire health care administration have led to an
unbearable condition both in public and private health care sector of Bangladesh. Ill practise
by doctors, and from looting money by poor patient to causing death of patient by malpractise -
all these are reality in the context of medical services in Bangladesh. Nevertheless, with
utmost respect to the contribution of the medical professionals who are delivering services in
such an adverse condition, it must be clarified that such a reality or scarcity cannot be
accepted as a justification for negligence, misconduct or unscrupulous activities. It is all the
more important to state that all these vices are ultimately found to be interconnected.
Therefore, the vicious chain has to be severed from a certain point, and that is accountability. A
greater sense of accountability, will not only encourage public trust upon medical profession,
but also substantially improve the overall condition of health care services in the country. the
government should make solid policy and law to end this crime and make sure that every citizen
can have qualith health service. Again, there is no doubt that the government has to play the
central role in order to bring a change. But, at the same time, it is also essential that the civil
society attributes including the NGOs, have to trigger the process and continue interacting with
the government and each other through to the transformation.

List of reference :
 https://www.dhakatribune.com/bangladesh/nation/2020/07/15/regent-hospital-
chairman-shahed-arrested
 Toufique Ali,’Doctor of false certificates' the daily star june19,2013

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  Kabir, M. (2013). Unethical practices of advertising in Bangladesh. Academic journal of
Siddheswari Girl’s College
 Advertise telecast on various TV channel in Bangladesh.
 Advertise given in all Mass Media in Bangladesh.
 Advertising given in online and social Media in Bangladesh.
 Ara, F. 2008. Key Issues to Health Governance in Bangladesh
 ‘People left high and dry by medical bills' The daily star newspaper april 08,2019
 MS Islam, pysician-Patient Relationship: The Present Situation and Our Responsibilities,
Bangladesh Medical Journal 2012 Vol. 41 No. 1
 Measham AR, Obaidullah M, Rosenberg M et al. Complication from induced abortion in
Bangladesh related to types of practitioner.
 Kabir SM. Causes and consequences of unwanted pregnancy from Asian women’s
perspectives. SupplInt J Gynecol Obstet 1989; 3:9-14.

List of Laws:
• The Vaccination Act, 1880
• The Drugs Act, 1940
• The Eye Surgery (Restriction) Ordinance, 1960
• The Pharmacy Ordinance, 1976
• The Drug (Control) Ordinance, 1982
• The Medical Practice and Private Clinics and Laboratories (Regulation) Ordinance, 1982
• The Bangladesh Unani and Ayurvedic Practitioners Ordinance, 1983
• The Transplant of Organ in Human Body Act, 1999
• The Safe Blood Transfusion Act, 2002
• The Consumer Rights Protection Ordinance, 2008
• The Bangladesh Medical and Dental Council Act, 2010

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