LUCKNOW, India – The former president of the Medical Council of India, which regulates the country’s medical colleges, stood before a judge last week in a dingy courthouse in this northern city.

For several years, Dr. Ketan Desai has been facing allegations that he conspired in 2009 to have the Medical Council recommend that a private medical college be allowed to add more students. The Lucknow case, which is scheduled to resume Aug. 20, isn’t Desai’s only legal problem. He also faces charges in a separate criminal case in New Delhi. Prosecutors there allege he was involved in a conspiracy in 2010 to obtain a 20 million rupee bribe – about $450,000 at the time – in return for having the Medical Council recommend allowing another school to expand its student body.

Desai, who denies the allegations in both legal cases, no longer heads the Medical Council of India.

But next year, the 58-year-old urologist is scheduled to be inaugurated as president of a much more prestigious organization: the World Medical Association, or WMA, which sets ethical standards for physicians worldwide and represents millions of doctors in more than 100 countries. Known for its pioneering work in ethics, its members include the American Medical Association and the British Medical Association.

Some past and present officials of the France-based WMA express chagrin over Desai’s legal troubles, but the organization continues to back him, as do the American and Indian medical associations.

“It’s terrible in general that this hangs like a great pall over everything,” said Sir Michael Marmot, a British doctor who is slated this fall to become the WMA’s president, to be followed by Desai in 2016. “We need clarity. It’s just not good for anybody.”

In a written response to questions from Reuters, Desai denied any wrongdoing. “I am and have been innocent,” he said, adding that “in not a single case any allegation against me has been proved.” Desai said he is a “handy scapegoat” and a victim of retaliation for his attempts to crack down on fraud at private medical schools during his time as Medical Council president.

“As such,” he wrote in the letter, “I have always remained under a continuous malignant and malicious campaign … of absolutely false and concocted allegations.”

How did a doctor facing criminal allegations manage to be selected as the WMA’s future president? And why have the world’s leading national medical associations stood behind him?

In part, Desai has held on because he enjoys the support of stout allies – distinguished physicians, a New Delhi businessman who boasts that he has partied with pop star Rihanna, and a top WMA official who compared him to a World War II resistance fighter against the Nazis.

A Reuters examination shows that the WMA’s due diligence into the criminal allegations relied heavily on information supplied by Desai and the Indian Medical Association – which Desai once headed.

The Indian association repeatedly asserted to the WMA – inaccurately – that all charges against Desai had been withdrawn. Representatives of major doctors organizations, including the U.S. and British medical associations, accepted the information as fact.

On Thursday, shortly after this article was published, the WMA said it will examine “a number of questions” raised by the Reuters investigation of Desai.

"We take this article very seriously,” the WMA said in a statement. “It raises a number of questions we have to discuss with the Indian Medical Association and that is what we shall now do.”

“The AMA delegation has not had an opportunity or a reason to discuss this issue recently.” Dr. Ardis Hoven, former president, American Medical Association

Dr. Ardis Hoven, a former president of the American Medical Association and now chair of the WMA’s Council, which recommends policies, confirmed that the AMA did not oppose inaugurating Desai as president. “The AMA delegation has not had an opportunity or a reason to discuss this issue recently,” she told Reuters in an email. “The facts as we know them still stand absent any other information.”

One prominent ethicist says Desai’s election threatens the credibility of the world body. Arthur Caplan, director of the Division of Medical Ethics at New York University Langone Medical Center, urged the WMA to look for another leader.

“The whole force of the WMA is its moral authority,” Caplan said. “You can’t have a compromised leader, you just can’t.... If you push against torture, if you try to defend doctors in jeopardy from totalitarian regimes, if you try to speak up about getting more care for the poor, people will just point toward your president and say: ‘Why should we care? You have a leader who is morally suspect. You’re not in a position to lecture us about anything.’”

Some allies – including a leader of the Indian Medical Association – say Desai is perfect for the job. “He has a vast knowledge, experience and leadership qualities to become the WMA president,” said K.K. Aggarwal, the Indian association’s honorary secretary general.

Desai’s scheduled inauguration provides another example of how problems in India’s medical regulatory system have spread far beyond the country’s borders.

Last month, Reuters documented how the system for training doctors in India – the world’s largest exporter of physicians - is plagued by fraud and unprofessional teaching practices.

“THE HIGHEST POSSIBLE STANDARDS”

Regulators and prosecutors have accused more than one out of six of the country’s 398 medical schools of cheating. Indian recruiting companies routinely provide schools with doctors to pose as full-time faculty members to pass government inspections. To demonstrate that teaching hospitals have enough patients to provide students with clinical experience, colleges round up healthy people to pretend they are sick.

The WMA works with the World Health Organization and other international bodies on public health issues. It was founded in 1947 as a response to the revelations of ghastly medical experiments, torture and euthanasia practiced in Nazi Germany. “The organization was created to ensure the independence of physicians, and to work for the highest possible standards of ethical behavior and care by physicians, at all times,” the WMA states on its website.

“It’s terrible in general that this hangs like a great pall over everything. We need clarity. It’s just not good for anybody.” Sir Michael Marmot, incoming WMA president

Today, the WMA is best known for creating a global framework for medical ethics. It crafted a modern version of the Hippocratic Oath that is used by many medical schools. Its signature achievement was the Declaration of Helsinki, a statement of ethical principles for medical research involving human subjects.

In India, the body charged with maintaining “excellence in medical education” is the Medical Council, which was established by parliament in 1934. Under India’s regulatory system for medical colleges, the council makes recommendations to the health ministry, which has the final say.

Desai has been one of the Medical Council’s most powerful figures in recent decades, twice serving as president. Former colleagues describe him as a politically connected and determined manager with an encyclopedic knowledge of every Indian medical college. But he also has had repeated brushes with law enforcement.

In 2001, the Delhi High Court ordered him removed from office at the Medical Council and prosecuted on allegations brought by another doctor. The court ruled that he abused his position as the chief regulator of medical colleges and received unexplained large monetary gifts.

“If those who are entrusted with the task of ensuring proper medical education and medical services in the country are to act in such dishonest manner, it is complete betrayal of the trust reposed,” stated a court judgment. At the time, Desai also was president of the Indian Medical Association, the equivalent of the AMA, which represents tens of thousands of doctors.

A subsequent probe by the Central Bureau of Investigation found no evidence of wrongdoing by Desai. The case eventually closed.

Desai first ran for WMA president in 2007. He lost. He ran again two years later, at a WMA meeting in New Delhi, this time unopposed. By then, cleared of the 2001 corruption allegations, he had been re-elected president of the Medical Council by its members.

Desai was to be inaugurated by the WMA in the fall of 2010 at its meeting in Vancouver, Canada. But in April that year, he was arrested and jailed.

He and several other defendants were accused by the Central Bureau of Investigation of conspiring in early 2010 to extract a 20 million rupee bribe from officials at Gian Sagar Medical College in the northern state of Punjab.

In exchange, India’s Central Bureau of Investigation alleged, Desai helped the college get a recommendation from the Medical Council to allow the school to accept a new class of 100 students, for a total of about 400 overall, even though it lacked such basics as an auditorium.

Court records show the case was based in part on intercepted telephone conversations between Desai and J.P. Singh, a New Delhi businessman. Investigators allege the two men discussed the college and the bribe using coded language. For example, the CBI alleges the men used the surname of a local politician as code for the college. A transcript of the phone calls is included in a New Delhi district court order.

Those and other intercepted conversations between the various defendants led investigators to raid Singh’s home and seize about 20 million rupees in cash.

In his response to Reuters, Desai said he “never discussed Gian Sagar Medical College issue in coded telephone conversations with him in early 2010.”

In an interview, Singh described Desai as “a very dear acquaintance” but denied the bribery allegations against them. He said the seized cash was an advance payment to him for a land deal from a businessman he did not name. “There was no money dealing with Dr. Ketan Desai,” he said.

Singh said a college official had visited his home the morning of the raid and given him a gift of two bottles of whiskey that cost nearly $400 each. The liquor was confiscated, too.

“I am fond of good things,” Singh said in the interview. He later pointed Reuters to a fashion website. The site includes pictures of Singh at a New York event with Rihanna, along with an article that describes Singh as “Delhi’s very own fashion wolf.”

A spokeswoman for Rihanna did not respond to a request for comment. The school in the case, Gian Sagar Medical College, is not a defendant. It declined to comment.

“THE EVIDENCE IS WEAK”

Then, in May 2010, India’s national crime-fighting agency brought a separate case against Desai in Lucknow. The Central Bureau of Investigation alleged he had entered into a criminal conspiracy in 2009 to help another private medical school get a favorable ruling from the Medical Council: Shri Ram Murti Smarak Institute of Medical Sciences, in the state of Uttar Pradesh.

In that case, Desai was accused of conspiring with institute officials to obtain a recommendation from the Medical Council that the school be allowed to expand, despite a shortage of faculty and other deficiencies.

The school ultimately received health ministry approval. Investigators allege that in order to pass inspections, the college paid doctors to pose as full-time faculty and falsified registries to inflate its number of hospital patients.

Dev Murti, the college’s chairman and one of the defendants, denied the allegations. “The evidence is very weak,” he said.

Dr. Suresh C. Shah, a Medical Council inspector, told investigators that Desai had instructed him to be strict during two initial inspections of the college, but later directed him to overlook shortcomings during a third inspection. Shah was accused in the case of conspiracy and corruption. He declined to comment.

A summary of Shah’s testimony is contained in the case’s charge sheet. He is the same inspector who Desai allegedly conspired with in the Gian Sagar Medical College case. Desai called Shah’s allegations about him “false and totally baseless.”

With the two cases hanging over his head in 2010, Desai never made it to the WMA meeting for his inauguration. He had been released from jail on bail by then. But days before the meeting, the Medical Council suspended his medical license “in view of the grave and serious allegations against you,” according to a letter the council sent Desai. The council barred him from representing doctors at any conference.

By then, the central government, in response to Desai’s arrest, was trying to remake the regulatory system. The government had disbanded the Medical Council’s elected board and installed a new board of governors. The plan was to win parliamentary approval to replace the Medical Council with a new regulatory body, according to health ministry officials.

Desai still had influential backers. Ahead of the WMA meeting, Dr. Otmar Kloiber, the WMA’s secretary general, weighed in. He described Desai in an article in the organization’s journal as a “charismatic and powerful leader” who for years had fought attempts by the Indian government to take away the Medical Council’s independence.

Kloiber, who is German, compared Desai to the late André Wynen – a Belgian who as a teenager joined the resistance to the Nazi occupation and ended up in a concentration camp. Wynen survived and later went on to become a surgeon and the WMA’s secretary general.

Asked in an interview with Reuters why he had compared Desai to a concentration camp prisoner, Kloiber responded: “Have you seen any evidence that he has been bribed? Have you seen that?”

WMA officials said in interviews that back in 2010, their organization had no rules defining what to do if a president-elect or other senior official was arrested. The association did, however, have guidelines on how to deal with an ill leader. So, according to a report in its organ, the World Medical Journal, the WMA decided Desai should “be considered ‘disabled’ and unable to carry out his duties,” and it voted to suspend his inauguration indefinitely.

In 2013, Desai’s luck turned. The central government failed to win parliamentary support for replacing the Medical Council. So, in 2013, the government ordered elections for the council’s board. In one of its first acts, the new board reinstated Desai’s medical license, according to council officials at the time.

That same year, Desai got a hand from another ally: the Indian Medical Association, where he had served as president from 2001 to 2002. The doctors’ lobby asked the WMA to lift the suspension, claiming that the charges against him had been withdrawn.

Dr. Mukesh Haikerwal, an Indian-born Australian physician, was chair of the WMA’s Council at the time. He told Reuters he met with Desai and other members of the Indian Medical Association in New Delhi after learning of the effort to make him president. Based on information given by the association, he said, he came away believing Desai had been cleared.

“The question was, ‘Are there any other pending charges that we should be worried about?’” Haikerwal said. “And the answer was that all the charges had been dropped.”

In his letter to Reuters, Desai said Haikerwal had been provided with all of the court orders pertaining to his cases. He didn’t address whether Haikerwal had been told that the charges had been dropped.

PENDING ALLEGATIONS

According to the World Medical Journal, Haikerwal provided an update on Desai in October 2013 at the WMA annual meeting, telling members that the charges against him had been withdrawn. “Dr. Haikerwal said Dr. Desai had been badly maligned by the Indian court system,” the journal reported. Haikerwal confirms making those remarks. Afterward, the assembly voted overwhelmingly to lift the suspension and to decide at a later date when Desai should take office as president.

But a review by Reuters of Indian court records and interviews with people involved in the two cases show that to this day, criminal allegations are still pending against him in both New Delhi and Lucknow.

One supporter compares Desai to a Nazi-resistance hero. “Have you seen any evidence that he has been bribed? Have you seen that?” Dr. Otmar Kloiber, secretary general, World Medical Association

In New Delhi, the district court charged Desai with corruption and criminal conspiracy over the Gian Sagar Medical College matter. The charges are listed in a court order [PDF] dated June 1, 2012. The case proceedings were stayed - put on hold - by the Supreme Court in 2013 pending the outcome of an appeal by another defendant. But Desai still faces the charges, according to people familiar with the case investigation.

In fact, Desai appeared at a hearing in the case in New Delhi in March. Another is scheduled for August.

“The charges have not been dropped. A stay does not mean that he has been exonerated from the charges,” said a Central Bureau of Investigation official who is close to the probe.

Desai also still faces criminal allegations in Lucknow in the Shri Ram Murti Smarak Institute case. In response to an appeal by Desai, the High Court in Lucknow set aside corruption allegations in February, ruling there was no evidence he had received anything of value. But the court did not dismiss allegations of criminal conspiracy and cheating.

WMA officials said they relied almost entirely on the Indian doctors’ lobby for their inquiries into Desai’s legal situation. “We’ve gotten all of our information from the Indian Medical Association,” said Kloiber, the secretary general. He said the Indian association told him the Lucknow case “has been closed,” and he didn’t know about the outstanding conspiracy allegations in the case.

Indian Medical Association officials say they never misled the WMA about Desai. They insist that his legal problems are over.

“We are very clear about it that there are no corruption charges against him as of now,” said Aggarwal, the Indian Medical Association’s honorary secretary general.

Aggarwal cited, among other things, the recent High Court decision to dismiss the corruption allegations in Lucknow. And he said that the conspiracy allegation won’t stand. “If there is not corruption, how can there be a conspiracy? That is my interpretation,” he said.

The Central Bureau of Investigation official said Aggarwal is wrong. Desai still could be prosecuted in both the Lucknow and New Delhi cases.

Desai is scheduled to take over the WMA presidency in a little more than a year. That leaves the association’s succession plan at the mercy of India’s courts, where cases typically drag on for years.

Additional reporting by Sharat Pradhan

————— Broken Health By Steve Stecklow, Andrew MacAskill and Aditya Kalra Photo editing: Thomas White Graphic: Jane Pong Designed by Troy Dunkley Edited by Peter Hirschberg