INDIA'S PATHOLOGY LABORATORY SCANDAL! By Our Special Correspondent

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INDIA’S PATHOLOGY LABORATORY SCANDAL! By Our Special Correspondent

The evidence emerging from India points to a serious problem with diagnostic accountability. The most revealing cases are not necessarily laboratories whose machines fail, but laboratories that issue reports without the claimed supervision of a qualified pathologist.

How many Indian pathology laboratories have been indicted?
There is no reliable nationwide total of pathology laboratories formally indicted or prosecuted for diagnostic fraud in the public data I found. A parliamentary answer states that the central government does not maintain comprehensive national data on unauthorised pathology laboratories; enforcement is primarily a state responsibility.
However, several recent reports document specific allegations and cases:

300+ Mumbai
A pathologists’ association alleged that more than 300 laboratories were operating without appropriate qualified supervision. This was a demand for investigation, not a finding that all had committed fraud.
17 people Karad, Maharashtra
Police registered a case in December 2025 involving alleged pathology reports issued despite the tests not being conducted or supervised as claimed. The report concerned individuals associated with a laboratory, not 17 separate laboratories.

Several districts Maharashtra
A February 2026 complaint alleged that a pathologist’s signature continued to appear on reports after the doctor had died. A separate complaint alleged that a pathologist was signing reports for laboratories across several districts without adequate supervision. These are allegations requiring investigation.
The distinction matters. A laboratory being unaccredited, a laboratory being inadequately supervised and a laboratory committing fraud are three different things. The first two may warrant regulatory action without necessarily establishing criminal wrongdoing.

Goa Medical College: what tests are outsourced?
The Goa Medical College (GMC) website confirms that its pathology department provides routine and specialist services to inpatients and outpatients, including histopathology, cytopathology, haematology and emergency laboratory services. It also identifies outsourcing arrangements being initiated for flow cytometry and advanced immunohistochemistry.
A Goa government document also lists outsourced tests and the laboratories named for them. The list includes:
The document also lists histopathology at GMC. It does not establish that these are all the tests currently outsourced, or that every arrangement remains in force today.
What about the financial value? I could not establish a verified current annual expenditure or contract value for GMC’s outsourced pathology tests from the records retrieved. The list of tests and suppliers is not enough to calculate that amount.
To establish the expenditure, the relevant records would be the test-wise rates, annual test volumes, purchase orders, invoices and payments made to each laboratory. Without these, quoting a total would be speculation.
If tests are outsourced, why maintain pathology and microbiology departments?
The answer depends on what is outsourced. There is an important difference between outsourcing a few specialist investigations and outsourcing the entire diagnostic service.

Routine pathology
Full blood counts, routine biochemistry, urine analysis and other high-volume tests are often best performed in-house where the hospital has functioning equipment, trained staff and sufficient volume.

Microbiology
Culture and sensitivity testing, identification of pathogens and antimicrobial-resistance surveillance are essential to treating infections. A hospital needs microbiological expertise even when certain advanced molecular tests are sent elsewhere.

Specialist investigations
Flow cytometry, advanced immunohistochemistry and molecular diagnostics can require expensive equipment, specialised staff and relatively small test volumes. Sending these to a qualified reference laboratory may be more economical than maintaining every capability in-house.
The National Health Mission’s diagnostic guidelines explicitly envisage a mixed model: public hospitals perform high-volume, low-cost tests in-house and outsource expensive, technologically demanding or infrequently required investigations where necessary.
The real question for a government hospital is therefore not whether any outsourcing occurs. It is whether the outsourcing is justified, economical and properly monitored.
If a hospital owns functioning analysers, employs qualified staff and has adequate test volumes, but routinely sends those same tests outside, the government should explain why. If equipment is obsolete, staff are unavailable or quality standards cannot be met, outsourcing may be justified.

Radiology-guided FNAC: who actually performs the test?
Radiology-guided FNAC means fine-needle aspiration cytology performed with imaging guidance, commonly ultrasound or CT. The image helps the clinician place a fine needle accurately into a suspicious lump, lymph node or deeper lesion.

The process involves several distinct responsibilities:

Radiologist or appropriately trained clinician: guides the needle to the target under imaging.
Sample-processing laboratory: prepares and stains the aspirated material on slides.
Cytopathologist: examines the cells and reports whether the sample is adequate and what the findings indicate.
These stages can take place in different departments or facilities. Sending slides to a reference laboratory for interpretation is not automatically improper, provided the sample is properly handled and a qualified professional takes responsibility for the report.
However, if a hospital advertises a complete in-house cytopathology service but routinely sends the actual work elsewhere, patients and administrators should be able to establish exactly what is performed in-house, what is outsourced, who interprets the slides and who signs the final report.
The accountability test for GMC
A focused audit should answer five questions:
• What percentage of all pathology and microbiology tests is outsourced?
• What was the total expenditure in each of the last three financial years?
• What are the contracted rates compared with GMC’s in-house cost per test?
• What quality-control procedures verify the outsourced results?
• Why are particular tests outsourced despite the existence of a pathology department?
The last question is particularly relevant to radiology-guided FNAC and specialist histopathology. A department’s existence does not prove it has all the necessary equipment or staff; equally, an outsourcing contract does not prove that outsourcing is necessary or cost-effective.
My conclusion: the public material establishes that GMC provides substantial in-house pathology services while arranging outsourcing for certain specialised investigations. It does not yet establish the complete outsourced-test bill, the proportion of tests sent outside or whether the arrangements represent good value for public money.
Those are questions that should be answered through GMC’s purchase records, laboratory workload statistics and audit reports—not assumptions based on the mere existence of outsourcing.