Practising at a Distance: How Geography Is Being Erased For Cross-State Pathology Reporting

In medicine, a signature at the bottom of a laboratory report carries far more weight than ink on paper. It is a declaration of responsibility, an assurance of scientific rigour, and for clinicians, a foundation on which diagnosis and treatment decisions rest. When that signature becomes detached from physical presence, legal accountability, and ethical boundaries, it quietly erodes the trust that holds healthcare together. A recent controversy involving a Telangana-registered pathologist whose name appeared on pathology reports issued by laboratories across multiple districts of Maharashtra has brought this uncomfortable reality into sharp focus, forcing the medical fraternity to confront a practice that has long existed in the shadows.

The issue surfaced when practising pathologists in Maharashtra began noticing laboratory reports from districts such as Beed, Nashik, Jalgaon, and Chhatrapati Sambhajinagar bearing the same name and signature. At first glance, the reports appeared routine. The qualifications looked legitimate. The signature appeared professional. Yet something did not add up. The pathologist whose name featured on these reports was not known to be practising in Maharashtra, nor was she registered with the Maharashtra Medical Council, a mandatory requirement for any doctor legally practising in the state. What seemed like an administrative discrepancy soon unfolded into a much deeper question about ethics, legality, patient safety, and the growing commodification of pathology services in India.

An investigation by the Maharashtra Association of Practising Pathologists and Microbiologists revealed that the doctor in question had been registered with the Telangana Medical Council since 2013 and was employed as an assistant professor at a reputed private medical college in Tamil Nadu. Despite being physically located hundreds of kilometres away, her name and signature were found prominently displayed in laboratories across Maharashtra. Inspections revealed that some laboratories even showcased her credentials on their premises, giving patients and clinicians the impression that a qualified, locally compliant pathologist was overseeing diagnostic services.

When the association sought verification from the Maharashtra Medical Council, the response was unequivocal. No doctor by that name was registered with the council. Cross-checks with the Telangana Medical Council confirmed her registration there, along with her qualifications. Pathology reports affecting patient care in Maharashtra were allegedly being certified by a doctor who was neither registered in the state nor present during the conduct of tests.

This revelation is not merely about one doctor or a handful of laboratories. It exposes a systemic vulnerability in India’s diagnostic ecosystem, where demand, cost pressures, and regulatory gaps create fertile ground for unethical shortcuts. Pathology, often perceived as a backend service, is central to modern medicine. From cancer diagnosis to infection control, from metabolic disorders to organ function monitoring, laboratory data shapes clinical decisions every day. Any compromise in the integrity of this process has direct consequences for patient outcomes.

The legal framework governing pathology practice is clear. Supreme Court judgments and state-specific regulations emphasise that laboratory tests must be conducted under the supervision of a qualified pathologist, who is registered with the relevant medical council and is responsible for preparing and certifying reports. In Maharashtra, the Medical Practitioners Act of 1961 explicitly categorises unregistered medical practice as a cognisable and non-bailable offence. The law does not recognise remote signatures, borrowed registrations, or proxy oversight as acceptable substitutes for physical presence and accountability.

Despite these provisions, cross-state reporting appears to be thriving in pockets. Advances in digital technology have made it technically easy for reports to be generated in one location and signed in another. Cloud-based laboratory information systems allow access from anywhere. Slides can be photographed. Data can be shared instantly. While technology has undeniably improved efficiency, it has also blurred boundaries that regulations were designed to enforce. The distinction between technological facilitation and ethical violation becomes dangerously thin when convenience overrides compliance.

For laboratory owners, especially in semi-urban and rural areas, hiring a full-time registered pathologist can be expensive. Margins are often thin, competition is intense, and patients are price-sensitive. In such an environment, the temptation to rely on a distant signature is strong. A single pathologist’s name can be used to legitimise multiple laboratories, creating an illusion of compliance while cutting operational costs. For the pathologist whose signature is used, the arrangement may appear harmless or financially attractive, particularly if oversight is perceived as minimal. Yet this transactional view ignores the profound responsibility embedded in medical certification.

Treating doctors depend on laboratory accuracy and accountability. When an unexpected result appears, a clinician may seek clarification, correlation, or repeat testing. The ability to directly communicate with the reporting pathologist is crucial. In a system where the signatory is geographically distant and not legally bound to the state, this professional dialogue becomes difficult, if not impossible. Clinical decision-making suffers, and patient trust is compromised.

Patients, meanwhile, remain largely unaware. For them, a pathology report is an authoritative document. Few patients question where the tests were conducted, who supervised them, or whether the signatory doctor is legally authorised to practise locally. This information asymmetry places patients at the greatest risk, as they bear the consequences of errors without the means to detect systemic lapses.

The response from regulatory bodies highlights another layer of complexity. While the Maharashtra Medical Council acknowledged the complaint, it reportedly stated that the matter fell outside its jurisdiction and forwarded it to the Telangana Medical Council. This procedural handoff, while legally understandable, raises concerns about regulatory fragmentation. When medical practice crosses state boundaries, accountability often becomes diluted. Each council operates within its territorial limits, yet the practice itself spans multiple states. Without coordinated mechanisms, such cases risk falling into administrative grey zones.

This situation exposes the need for stronger inter-state regulatory cooperation. Medical practice in India is increasingly mobile. Doctors train in one state, work in another, and consult across borders. While this mobility is essential in a diverse country, it must be anchored in clear, enforceable rules. Registration requirements exist for a reason. They allow state councils to monitor practice standards, address complaints, and protect patients. When these requirements are bypassed, the entire regulatory architecture weakens.

Beyond legality, there is an ethical dimension that demands reflection within the medical fraternity. Pathology is a discipline built on meticulous observation, quality control, and contextual interpretation. Being physically present in a laboratory is not a ceremonial obligation. It allows the pathologist to oversee sample handling, ensure equipment calibration, supervise technicians, and address discrepancies in real time. Remote reporting, especially without formal telepathology protocols and regulatory approval, strips away these safeguards.

The issue also intersects with medical education and professional identity. The doctor at the centre of this controversy is reportedly an assistant professor, a role that carries the responsibility of shaping future doctors. Academic positions are grounded in the values of ethical practice, evidence-based medicine, and patient-centred care. When educators are linked to questionable practices, it sends conflicting signals to trainees and undermines the moral authority of medical institutions.

For associations like MAPPM, raising the alarm is part of a broader effort to protect the profession from erosion. Ethical practitioners often find themselves competing with laboratories that cut corners, underprice services, and operate outside regulatory norms. Over time, this creates a race to the bottom, where quality becomes negotiable and compliance is seen as optional. By filing complaints and demanding enforcement, professional bodies attempt to level the playing field and uphold standards that benefit both doctors and patients.

This episode also invites introspection about the future of pathology in India. As diagnostic services expand rapidly, driven by preventive health awareness, corporate chains, and technological innovation, governance must evolve in parallel. Telepathology, for instance, holds immense promise, especially in underserved areas. However, its adoption must be guided by clear guidelines, robust accreditation, and transparent accountability. Remote expertise should complement local infrastructure, not replace legal and ethical obligations.

Search terms like “illegal pathology practice,” “bogus doctor pathology,” “medical council registration rules,” and “cross-state medical practice” are increasingly appearing in public discourse, reflecting growing concern among professionals and patients alike. These are not isolated keywords; they represent systemic anxieties about the direction of healthcare delivery. When diagnostics become detached from accountability, the ripple effects extend across the healthcare continuum.

The Maharashtra Medical Practitioners Act categorises unregistered practice as a serious offence for a reason. It recognises that medical errors are not mere technical glitches; they have human consequences. A misreported biopsy can alter the course of cancer treatment. An inaccurate blood test can delay life-saving intervention. When responsibility is diffused across borders and signatures become commodities, tracing accountability after harm occurs becomes a formidable challenge.

At a policy level, this controversy could serve as a catalyst for reform. A centralised, interoperable medical registration system accessible to laboratories, clinicians, and patients could help verify credentials in real time. Mandatory display of state registration numbers on reports, stricter audits of diagnostic centres, and harsher penalties for violations could deter unethical practices. Importantly, regulatory bodies must communicate and collaborate across states, recognising that healthcare delivery no longer fits neatly within administrative boundaries.

This is a reminder that professional integrity is indivisible. Each compromise, however small it may seem, chips away at collective trust. In an era where healthcare is under intense scrutiny, maintaining ethical clarity is as important as clinical competence. The credibility of pathology depends on the vigilance of those who practise it and those who regulate it.

When a pathology report crosses state lines, it should carry expertise, compliance, and accountability along with it. Anything less risks turning science into a transaction and healthcare into a gamble. For a profession built on trust, that is a risk India’s medical community cannot afford to ignore.

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