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92nd report of the Parliamentary Standing Committee of Health and Family Welfare

Supreme Court panel
to monitor MCI

: Endorsing the 92nd Parliamentary Standing Committee report on MCI the Supreme Court on May 2 used its rare and extraordinary powers under the Constitution toFormer Chief Justice of India R M Lodha set up a three-member committee, headed by former Chief Justice of India R.M. Lodha, to oversee the functioning of the Medical Council of India (MCI) for at least a year.

Delivering its judgement in Modern Dental College and Research Centre and others case the 5-judge Constitution Bench, led by Justice Anil R. Dave, in a 165-page judgment, said that the apex court was constrained to exercise its extraordinary powers under Article 142 of the Constitution as the government had not acted on the report of the Parliamentary Standing Committee on Health and Family Welfare. Its report on ‘The functioning of the Medical Council of India’ was tabled in Parliament on March 8, 2016.

The judgment referred to the parliamentary panel report, which described the MCI as an “ossified and opaque body” unable to cope with the “humongous” task of managing medical education in over 400 colleges across the country.

‘Unethical practices up’

“Quality of medical education is at its lowest ebb, the right type of health professionals were not able to meet the basic health needs of the country. Products coming out of medical colleges are ill-prepared to serve in poor resource settings like Primary Health Centres. Graduates lacked competence in performing basic health care tasks. Unethical practices continued to grow. The MCI was not able to spearhead any serious reforms in medical education,” the judgment said, citing the panel report.

“The MCI neither represented the professional excellence nor its ethos under the MCI Act,” Justice A.K. Sikri, who authored the judgment for the Bench, said, referring to the Parliamentary
panel report.

Besides Justice (retired) Lodha, the committee has Professor (Dr.)Dr S K Sarin Shiv Sareen (Director, Institute of Liver and Biliary Sciences) and Vinod Rai (former Comptroller & Auditor General of India).

The Supreme Court said the Justice Lodha committee “will have the authority to oversee all statutory functions under the MCI Act. All policy decisions of the MCI will require approval of the Oversight Committee. The Committee willMr Vinod Rai be free to issue appropriate remedial directions. The Committee will function till the Central Government puts in place any other appropriate
mechanism after due consideration of the Expert Committee Report.” The court referred to how the Centre had set up the Dr. Ranjit Roy Chaudhury expert panel in July 2014 to study the Indian Medical Council Act, 1956 and make recommendations.

No action taken

Though the committee did submit its report in September the same year, no action was taken on the reforms suggested by it, including overseeing under-graduate and post-graduate medical education.

Unethical practices

Medical professionals indulge in unethical practices conducting unnecessary diagnostics tests and surgical procedures in order to extract money from hapless patients, the judgment said.

“The challenges facing medical education of the 21st Century are truly gigantic... Game changer reforms of transformational nature are therefore the need of the hour and they need to be carried out urgently and immediately,” it said.

‘MCI has failed on
all its mandates’

The department related standing committee on Health & Family Welfare looked into the functioning of the MCI in its 92nd report. The committee is chaired by Prof. Ram Gopal Yadav, a Rajya Sabha member from the Samajwadi party. The committee has 10 members from the Rajya Sabha and 21 members from the Lok Sabha.

In its scathing report, the standing committee felt that the MCI has repeatedly failed on all its mandates over the years. The committee noted the following as some of the prominent failures of MCI.

  • Failure to create a curriculum that produces doctors suited to working in Indian context especially in the rural health services and poor urban areas. The committee felt that this has created disconnect between medical education system and health system.
  • Failure to maintain uniform standards of medical education, both at the undergraduate and post-graduate levels.
  • Devaluation of merit in admission, particularly in private medical institutions due to prevalence of capitation fees, which make medical education available only to the rich and not necessarily to the most deserving.
  • Failure to produce a competent basic doctor.
  • Non-involvement of the MCI in any standardized summative evaluation of the medical graduates and post-graduates.
  • Failure to put in place a robust quality assurance mechanism when a fresh graduate enters the system and starts practicing.
  • Very little oversight of PG medical education leading to huge variation in standards.
  • Heavy focus on nitty-gritty of infrastructure and human staff during inspections but no substantial evaluation of quality of teaching, training and imparting of skills.
  • Abysmal doctor-population ratio.
  • Failure to create a transparent system of medical college inspections and grant of recognition or de-recognition.
  • Failure to guide setting up of medical colleges in the country as per need, resulting in geographical mal-distribution of medical colleges with clustering in some states and absence in several other states leading to disparity in healthcare services across states.
  • Acute shortage of medical teachers.
  • Failure to oversee and guide the Continuing Medical Education in the country, leaving this important task in the hands of the commercial private industry.
  • Failure to instill respect for a professional code of ethics in the medical professionals and take disciplinary action against doctors found violating the code of Ethics.

The committee also felt that the onus of failure has to be shared by successive governments both at the center and states also. The committee noted that the medical education is fast sliding downwards and quality has been hugely side-lined in the context of increasing commercialization of medical education and practice. The committee further noted that incremental tweaks won’t be enough and that a complete overhaul of the system is necessary. The committee observed that MCI is an opaque body with very little transparency.

‘Doctor – Population ratio should guide the setting up of new Medical Colleges’

The committee made a number of recommendations to overhaul the system. Some of the important recommendations of the committee are the following,

  • Doctor – Population ratio in India is 1:1674 as against the WHO norm of 1:1000, hence the government should immediately spell out policy stance in great detail to augment the capacity of production of doctors including specialists and super-specialists at the scale and speed required to meet India’s health needs.
  • State level doctor-population ratio should guide the setting up of new medical colleges and also the increase in UG and PG seats. Medical manpower planning should be bottom-up also and not just top-down with each state planning for an optimal number of doctors, with a target of 1:1000 doctor-population ratio.
  • The regulatory framework of medical education and practice should be comprised of professionals of the highest standards of repute and integrity, appointed through a rigorous and independent selection process. This process must be transparent. Nominations could be sought but the reason for the final selection should be made public.
  • Urgent measures have to be taken to restructure the composition of MCI to encourage diversity so that it does not become an exclusive club of doctors.
  • Physical infrastructure requirement should be pruned down in such a way that it should have just about 30 to 40 percent standing value in the total assessment of a medical college.
  • Support to convert district hospitals into medical colleges. If a district hospital is converted into a medical college, it will not only be equipped with specialists of all disciplines, providing the healthcare services across the whole spectrum but will also produce some doctors in its area of operation and will thus help reduce geographical mal-distribution of doctors.
  • The PG entrance exam should be held immediately after the final MBBS examination so that the graduate doctor could concentrate on practical skills during his internship.
  • Soft skills (including ethics) should be made one of the cornerstones of the syllabus of medical education.
  • Introduction of Common Medical Entrance Test (CMET) should be done across the nation barring those States who wish to remain outside the ambit of the CMET. However, if any such States wish to join the CMET later, there should be a provision to join it.
  • A common exit test should be introduced for MBBS doctors as an instrument of quality assurance and to ensure that the qualities and competencies of a doctor before he starts practicing are guaranteed and standardized in terms of various quality norms.

Advocate Gopal Sankaranarayanan wrote :

...There is a very thin line that divides what is dubbed as “corridor gossip” and to paraphrase Sherlock Holmes, the “improbable truth”. It would have been impossible for anyone to have suggested anything questionable about the conduct of Justices Ruma Pal, Sinha, Thakker, Kapadia or a hundred others. A mischievous rumour-monger would have been nipped in the bud with the contempt he deserved right at the outset, simply because these eminences had carefully built spotless reputations over decades. With Kabir, the opposition to such a story is not so fervent.

In a little while, on his last day in office, the Chief Justice’s court will deliver the much awaited judgment concerning the validity of the national medical entrance test to be conducted by the Medical Council of India. For the better part of the last week, senior counsel and junior advocates alike have without compunction shared a story that the appeals by the private
colleges will be allowed with a declaration that the MCI has no jurisdiction, and that Justice Dave will dissent from this view. The judgment, it is confidently touted, runs into more than 190 pages and in excess of 300 paragraphs. It is my fervent hope that this tale is false – a figment of some perverse and destructive mind. In a few hours, we will know the truth.

In either event, the tragedy remains – that doubt has taken root. It is a long trudge uphill from here.

(Gopal Sankaranarayanan is a practicing Advocate in the Supreme Court of India. The views and opinions expressed in this article are those of the author and do not reflect the opinions or position of Bar & Bench)

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 No faculty, no facilities at new medical colleges

NEW DELHI : Empty intensive care units (ICUs), no faculty, locked operation theatres (OTs), and under-construction departments and buildings. This is what awaits a fresh batch of students in at least five out of 57 medical colleges permitted by the Supreme-Court appointed oversight committee to admit MBBS students in 2016-17.

In a report published by the Hindustan Times on September 28, credited to Jeevan Prakash Sharma, the newspaper said that its reporter's visit to five private medical colleges, all located 50 km to 100 km from Delhi, found some shocking realities.

Here is the HT report, verbatim : "KM Medical College and Hospital, Mathura and Venkateshwara Institute of Medical Sciences, Gajraula were virtually locked with no patients in wards and non-functional OT and ICU. HT also found that patients with headache and stomach ache were admitted in a couple of wards in Venkateshwara.

While MCI norms mandate 60% bed occupancy in any college’s hospital to admit first batch of 150 students, HT found that only 10% to 20% beds were occupied by patients in NC Medical College and Hospital, Panipat, World College on Medical Science and Research, Jhajhar and Rama Medical College and Research Centre, Hapur.

KM Medical College denied that it lacks facilities, Rama College didn’t respond while others say they will work to improve infrastructure.

Former chief justice of India RM Lodha, who heads the oversight committee said the panel directed MCI to carry out fresh inspection of all such colleges which MCI had rejected, but that was not done, leaving OC with no option but to find some method to verify the compliances reported to have been done by the applicants.

“With stringent conditions imposed by the OC, it is fairly reasonable to assume that all these colleges will have no deficiency when the course commences and the students would be able to pursue their medical education,” he said.

MCI ignored the OC order on the ground that out of 218 colleges, it rejected 129 after inspecting them twice so there is no reason to inspect them afresh.

After receiving complaints from a section of senior medical practitioners that some medical colleges approved by the SC-appointed oversight committee lacked infrastructure to train students, HT conducted an independent investigation in five colleges. Before that, HT also obtained the MCI’s inspection report and colleges’ affidavit for compliance (filed between June 15 to June 22) through an application under RTI.

HT found the NC medical college well­maintained but with hardly 20­25 patients. The reporter found Venkateshwara college virtually locked and apart from 6 patients in KM college’s emergency unit, the rest — operation theatre, intensive care unit, IPD — were either locked or empty.

This is what prevails in the five colleges:

Rama Medical C0llege and Research Centre, Hapur, Uttar Pradesh

MCI assessment report:
The report (March 18 & 19 and April 19, 2016) say the college had a 29.41% shortage of resident doctors and senior residents were staying away from the hostel. The outpatient department attendance was inflated. Patients had vague complaints and didn’t require admission.

Rama college’s affidavit for compliance:
Number of residents are as per MCI norms and OPD has sufficient patients. The patients admitted were genuine on the day of assessment.

HT’s Investigation:
HT visited the Rama Medical College on September 17, between 1:30pm to 3pm and found bed occupancy between 10% to 20%. The private ward was locked and residents’ doctors’ rooms were either empty or locked. There was one patient in the second –floor ICU.

College response:
The college didn’t respond to HT’s query.

KM Medical College and Hospital, Mathura, UP

MCI assessment report:
The report (December 18 & 19, 2015 and May 6, 2016) highlighted 86.15% deficiency of faculty, 89.13% shortage of resident doctors ,0% bed occupancy and inadequate patients and consultants.

KM College affidavit for compliance:
The college countered MCI’ s assessment report saying deficiency of faculty and residents was not more than 5% and bed occupancy was more than 60%. OPD attendance was more than 600.

HT’ s investigation:
HT reached KM College on September 20,2016 between 1PM to 3PM. Situated in a sparsely-populated area, the hospital lacked infrastructure. Except 6 patients in the emergency, there st—operation theatre(OT), intensive care unit( I CU ), in-patient department (IPD) — were either locked or empty.

College response:
“I don’t agree with your inspection as I know I fulfil all the norms. Whatever shortcomings are there, we will take step to rectify ,” said Kishan Chaudhary, chairman.

NC Medical College and Hospital, Panipat

MCI assessment report:
The December 9 & 10, 2015 report said deficiency of faculty is 84.61%, shortage of resident doctors 89.13% OPD attendance on the day of assessment was nil and bed occupancy was zero.

NC College affidavit for compliance:
The college denied MCI assessment and said it has adequate faculty and residents, OP Dis operational with daily 650 attendance and the bed occupancy is 69%.

HT Investigation:
HT visited the college on September 21 around 11am and found the hospital well-maintained. However, there were hardly 20-25 patients admitted. Both emergency OT and minor OT were locked and six patients were admitted in the emergency ward. There were 50 to 80 patients in OPDs.

College response:
“There is no shortage of doctors. Still, we are trying to live up to the expectations of the OC,” said the college spokesperson.

World College on Medical Science and Research, Jhajhar

MCI assessment report:
The report, dated January 12 and 13 2016, points out deficiency of faculty and residents 93.85% and 97.83% respectively. There was no medical superintendent in the hospital and residents were not staying in the campus. Bed occupancy was 1%.

World College affidavit for compliance:
Rejecting MCI’s report, the college claims full strength of faculty and residents. “Medical superintendent was appointed and residents are in hostel. Bed occupancy is more than 60%.

HT Investigation:
HT visited the hospital on September 21 (between 2:30 to 4pm) and found it in good condition. However, emergency ward was empty and hospital’s bed occupancy was between 10% to 20%.

College response:
“There is a scope of improvement in bed occupancy which we will improve,” said Narendra Singh, chairman.

Venkateshwara Institute of Medical Science, Gajraula

MCI assessment report:
The MCI assessment report, dated December 18 & 19, 2016, says the hospital was locked. The deficiency of faculty and residents was 98.46% and 100% respectively. Bed occupancy and O PD attendance was zero.

Venkateshwara College affidavit:
The college said that due to students’ agitation on December 14, 2015 the college campus was closed and students, teachers and other staff were asked to vacate the campus.

HT Investigation: When HT visited the hospital on September 22, 2016 between 1:30pm to 3pm, it was virtually locked. When this correspondent interacted with a nursing staff, she informed that none of the patients admitted in the gynacology ward had any health complications. Some of them had mild ailments like stomachache or headache. OT was empty and ICU, ICCU, NICU, PICU were locked.

College response:
“We are aware of shortcomings and are in the process of acquiring all the facilities,” said Prof Madhusudan, vice chancellor, Venkateshwara University.

SC panel in MCI driver's seat, takes decisions

By Sanjiv Dube
The Supreme Court appointed Lodha Oversight Committee (OC) has settled itself in the MCI's driver's seat and has, in fact, taken decisions that may embarrass the MCI's governing body.  

On August 13 the three member Justice R M Lodha-led committee overturned the Council’s decision denying permission to start/establish 86 new medical colleges for the current academic session starting September 30.

The panel, reviewing MCI’s rejections, granted permission to 26 new colleges out of the 86 rejected earlier and promptly sent its recommendations to the Health Ministry, paving the way for the establishment of these colleges, which will be added to the existing 400.

The panel has given private medical colleges the permission to teach courses which they had been forbidden from running after being found to be lacking the required infrastructure.

While the MCI denied permission to start/establish new colleges on the basis of MCI's team inspection which found the faculty and infrastructure lacking in the colleges the Lodha panel overturned the MCI decision on the basis of colleges' claims on their websites and affidavits.

The panel has asked colleges to submit an undertaking to MCI that they would comply with all the norms and won't remain deficient when the new session starts on September 30. The panel has also reserved the right to inspect these colleges before or after September 30 and if any non-compliance is found, it can withdraw the permission. “If the committee is not satisfied while conducting its own inspection, it reserves the right to debar new colleges from admissions for the subsequent two years,“ an MCI official said.

The 26 new colleges allowed to start enrolment will also have to deposit bank guarantees worth Rs 2 crore each to MCI.

Among the newly approved institutions are Ananta Institute of Medical Sciences, Rajasthan; NIMRA Institute of Medical Sciences, Andhra Pradesh; Saraswati Medical College, UP; Sri Sakshi Medical College, Madhya Pradesh; World College of Medical Sciences, Jhajjar, Haryana; Kerala Medical College; NC Medical College, Panipat (Haryana); Local Medical College, Saharanpur and Prasad Institute of Medical Sciences, Lucknow.

After the MCI rejected 86 applications, the Lodha panel (OC) comprising ex-CJI Lodha, former CAG Vinod Rai and renowned liver expert SK Sarin opened a fresh window from June 15 to 22 asking applicants to apply afresh and show compliance.

“The OC received 39 applications from institutions promising compliance by September 30 when the new session starts. The panel after considering these cases has granted a go-ahead in 26 cases,” a Health Ministry source said.

Lodha report relied on colleges' website info

According to a Times of India report the Lodha committee granted conditional approval to 26 new medical colleges based on information and “snapshots“ uploaded on college websites being verified by technical consultants.

“In an MBBS institute in Chhattisgarh, it appeared that teaching faculty were just called for assessment...In another hospital, many patients who were not genuine and did not require admission were admitted in wards,“ an MCI official said, pointing to instances in the report that are reminiscent of the Sanjay Dutt-starrer Bollywood hit.

“Availability of faculty on the website was considered supportive evidence from the applicant colleges before being considered favourably for approval. Snapshots of infrastructure from the websites wherever available were also obtained and kept on record,“ the Lodha report, reviewed by TOI, said.

The report also noted that the “position of faculty was independently verified through the technical consultant with reference to websites of the respective medical colleges too, by June 16, 2016“.

But MCI teams, which inspected the sites, found that some hospitals were “under construction“ while some others resisted or “would not allow inspection“. For instance, a college in UP did not permit inspection on the ground of holidays for Holi and Good Friday. In some cases, the bed occupancy was as low as 12%, ICUs and OPDs were found locked and non-operational, the MCI's inspection report said.

However, the panel, headed by ex-Chief Justice of India R M Lodha, maintained it took a “considered view“ that was “in best interest of medical education“. Speaking to TOI, Justice Lodha said, “We received over 100 complaints alleging irregularities in MCI inspection. Some said the inspections were carried out during holidays, while many alleged discrimination between government and private medical colleges.“

He said the oversight committee had asked the MCI to re-inspect the applicant sites. “However, the MCI did not follow our directive and this itself is violation of the SC order,“ Lodha said, adding that the committee was left with no other means but the college websites to verify compliance. It hired two independent consultants -- one each from Lucknow and Delhi -- to verify the information given by colleges.

“We do not want to compromise on quality of medical education and, therefore, we have attached conditions to the approvals. We have told the colleges that by September 30 everything should fall in place and we reserve the right to inspect the facilities and if any deficiency is found they will be barred for two simultaneous years,“ Lodha said.

SC bars pvt colleges/assn to hold admission test

By Rajiv Shukla
Giving another pungent blow to private college owners and their associations the Supreme Court barred them from holding any kind of admission test for MBBS or BDS seats. The bar will also be applicable on the deemed universities, the court said.

The bench said "it is clarified that no examination shall be permitted to be
held for admission to MBBS or BDS studies by any private college or association or any private/deemed university."

Continuing daily hearing in Sankalp Charitable Trust case on May 6 the three-judge bench of Justices Anil R. Dave, Shiva Kirti Singh and A.K. Goel said the issue with regard to students who had appeared or who are due to appear in examinations conducted by the states in accordance with local laws, shall be decided after hearing the Solicitor General Ranjit Kumar on May 9.

The bench said students who had appeared for Neet Phase-I on May 2 would not be permitted to take Neet Phase-II. Those who could not appear for the phase-I test may appear for the second phase on July 24.

The court is expected to allow Tamil Nadu to admit students on the basis of marks in the higher secondary exam. Students of states like Telangana, Andhra Pra-desh, Kerala, Maharas-htra and Gujarat maybe allowed to admit students on the basis of local CETs.

Senior counsel Rajeev Dhavan, submitted that if private colleges are not allowed to make admissions through their own CET or through the association of private medical colleges, they were not obliged to surrender 50 per cent of their seats to the government quota and that this would result in a piquant situation.

Mr Ranjit Kumar informed the court that the Centre had convened a meeting this weekend with all the stake-holders. He would inform the court on Monday of the outcome of the meeting so that it can pass appropriate orders.

“We want NEET. On the legal side, we supported it. But I have to take instructions if states can be allowed to hold their tests this year or not. We want to resolve the issue after discussing with them,” he said.

The order came as a window of hope for states opposing NEET. The states contended that their students were not prepared to take the test as some of them studied in the vernacular medium.

NEET is back, SC bench scraps earlier judgement

By Rajiv Shukla
In a landmark move the Supreme Court of India on April 11 recalled its one of the most controversial judgements -- NEET case judgement -- and ordered that "the case be heard afresh".

The case, called National Eligibility-cum-Entrance Test (NEET) case was delivered on July 18, 2013 by the Chief Justice of India Altamas Kabir a dayAltamash Kabir before he was to retire, giving ample relief to private medical colleges. Some  private medical colleges had challenged the Medical Council of India and Dental Council of India regulations on admissions to medical and dental college -- and the relief allowed them to have their way in the matter of admissions.

With the recall of the judgement status quo ante has been restored and the MCI has been told to organise a combined all-India admission test for private and government medical colleges.

However, the MCI vice-chairman Dr C V Bhirmanandham has expressed his inability to hold the all-India test this year because of paucity of time and this may allow the private players to have their way this year as well.

Hearing the review petitions on April 11 the Constitution bench of the Supreme Court headed by Justice A R Dave and comprising Justices A K Sikri, R K Agrawal, A K Goel and R Banumathi recalled the judgment dated July 18, 2013 which had quashed NEET. It said the “majority verdict“ delivered by then Chief Justice Altamas Kabir did not consider an earlier SC judgment that was binding on the bench, nor had he consulted other members of his bench.

Incidentally Justice A R Dave, who headed the 5-judge Constitution bench that recalled the earlier order had given a dissenting verdict in the NEET case. In his April 11 order he specified that he was not consulted by the then CJI Altamas Kabir.

The April 11 order comes just a month before separate entrance tests are to be held for government and private medical colleges, putting lakhs of students in confusion. There are over 400 medical colleges in the country and lakhs of students sit for admission tests for over 52,000 MBBS seats. Since 2013, state governments and private colleges have conducted separate examinations for these.

Monday's order leaves Medical Council of India with the onerous task of conducting the NEET at a short notice as students have already filled in forms for several entrance tests.

Immediately after judgment reviving the NEET was pronounced in open court, stunned lawyers appearing for private colleges, pleaded that the SC clarify the consequences. The bench replied that “natural consequence“ was that NEET comes into force. It said the court would give a fresh hearing on constitutional validity of NEET but in the meantime, the exam will be restored. The lawyers then pleaded that the MCI's notification to bring NEET back be stayed till its validity was decided afresh and said that in 2013, too, an interim stay was given. The bench, however, rejected the plea saying the interim order was only for one academic session and it could not continue.

“After giving our thoughtful and due consideration, we are of the view that the judgment delivered in Christian Medical College needs reconsideration,“ the bench said.

Recalling earlier order the Constitution bench allowed review petitions by the Union government and the Medical Council of India (MCI) against the July 18, 2013, verdict and restored the NEET 2011 notification.

“The NEET regulations are restored and MCI can conduct the examinations pending the fresh judgement,” the order said.

According to the 2011 notification, the CBSE was to conduct the tests for admission to MBBS and BDS courses and the National Board of Examination for the PG programmes.

The 2013 verdict

The 2013 verdict had created a buzz in the apex court corridors as an advocate had posted the outcome on a social networking site in advance. However, Justice Kabir had reportedly said he was not aware of the leak of the judgment.

While Justice Vikramjit Sen (since retired) had shared the views and findings of Justice Kabir against the NEET, Justice Dave had in his dissenting verdict said that the three judges "had no discussion on the subject due to paucity of time". Justice Dave had stressed that this was not the normal practice.

Justice Dave had written in 2013 that “one of the main considerations of having one common entrance test conducted by the Medical Council of India is to check the malaise of money-making business in the admission process by selling their seats for crores, which has been going on for the last so many years in private colleges.”

The Christian Medical College, Vellore; the States of Andhra Pradesh and Tamil Nadu; several associations of private medical colleges; DD Medical College and DD Hospital, Tamil Nadu; and various private medical colleges had filed petitions in High Courts and obtained an interim stay on the applicability of the NEET on them. On the MCI’s petitions, these cases were transferred to the Supreme Court.

No quota in PG admissions, asserts SC

By Rajiv Shukla
On October 27, 2015 the Supreme Court directed the Union  government and all state government to ensure that super-speciality medical admissions are kept "unreserved, open and free" following complaints that some southern states were allowing only domiciled MBBS doctors to appear for PG medical entrance exams.

Delivering a 58-page judgment in Dr. Sandeep and others versus Union of India and others the bench of Justice Dipak Misra and Justice P.C. Pant said that there should be no reservation in post-graduate medical courses based on caste, religion, residence or any other criteria.

The order came on a batch of petitions challenging the domicile policy followed by Andhra Pradesh and Telangana based on the Presidential order, namely, Andhra Pradesh Educational Institutions (Regulations and Admissions) order of 1974 promulgated under Article 371(D) of the Constitution which gave special privileges of education and employment to the local people of Andhra Pradesh.

The bench cited an earlier case - Dr Pradeep Jain versus the Union of India and others - in which the top court had held in 1984 that merit was the sole criterion when it came to super-speciality medical admissions. But till date, it said, the government has not framed any rules or guidelines to implement the directive.

"In the Dr Pradeep Jain case this court... observed that in super-specialities there should really be no reservation. This is... for improving the standard of higher education and thereby... the quality of available medical services...," Justice Misra, who wrote the judgment, observed.

"We hope and trust that the Government of India and the state governments shall seriously consider this aspect... without delay and appropriate guidelines shall be evolved by the Indian Medical Council so as to keep the super specialities... unreserved, open and free."

The petitioner doctors had complained that while in most of India they are allowed to appear in entrance exams of different states for courses like DM (Doctor of Medicine) and MCh (Master of Chirurgiae), Andhra Pradesh, Telangana and Tamil Nadu permitted only those domiciled in these states.

This, they said, means that while candidates domiciled in these states can sit for exams in other states, students from other states are barred from taking exams in these states.

The petitioners said this went against constitutional provisions like Articles 14 (equality before law) and 16 (equality of opportunity in public employment, education, etc.).

The court asked the Andhra and Telangana authorities to objectively assess the policy to see whether it does justice to the aspirations of students and approach the issue keeping national interest as paramount.

The petitions filed said how students from other States, namely, Maharashtra, Uttar Pradesh, Gujarat, Rajasthan, Delhi, Karnataka, Kerala, West Bengal, Bihar and Haryana, allow candidates from all over India to appear in the entrance examination.

It complained that States like Andhra Pradesh, Telangana and Tamil Nadu confine the eligibility only to the candidates having domicile in their respective States.

This judgment only deals with the two States of Andhra and Telangana. The bench observed that it would consider Tamil Nadu's case separately in a hearing scheduled for November 4, 2015.

Supreme Court defends MCI's PG admission rules

By Rajiv Shukla
On January 12 the Supreme Court upheld the Medical Council of India's (MCI) postgraduate admission regulations and quashed Kerala government's decision to reserve seats for doctors working in its hospitals and other departments.

The court said, in no uncertain terms, that the admissions to the postgraduate medical courses can be done only on the basis of merit of students appearing in the common entrance examination.

The apex court division bench comprising Justices T S Thakur and R Banumathi said that the Post Graduate Medical Education Regulations of the Medical Council of India, 2000 were binding and state governments could not make any rule in violation of the regulations.

The state, the apex court said, overstepped its jurisdiction by making a law earmarking 40% of total seats available to the state quota for its medical officers who were to get admission on the basis of their seniority, without appearing in the entrance examination.

Delivering its judgement in Sudhir N. & ors. versus State of Kerala & ors. on January 12 the bench said : "Regulation 9 (of MCI) is, in our opinion, a complete code by itself inasmuch as it prescribes the basis for determining the eligibility of the candidates including the method to be adopted for determining the inter se merit which remains the only basis for such admissions. To the performance in the entrance test can be added weightage on account of rural service rendered by the candidates in the manner and to the extent indicated," it said.

The court said the method, however, was given a go-by by the impugned legislation when it provided that in-service candidates seeking admission in the quota shall be granted such admission not on the basis of one of the methodologies but on the basis of seniority of such candidates.

"When the maximum marks to be obtained in the entrance test for admission to the institutions for higher education including higher medical education are fixed, the state cannot adversely affect the standards laid down by the Union government. It was held that it is for the MCI to determine reservation to be made for SC/ST and OBC candidates and lowering the qualifying marks in their favour," it said.

Upholding the order, the apex court, however, objected to the observation made by the High Court in which it said that seniority of in-service candidates should be considered while preparing merit list.

"A meritorious in-service candidate cannot be denied admission only because he has an eligible senior above him though lower in merit. It is now fairly well settled that merit and merit alone can be the basis of admission. Their merit cannot be overlooked only to promote seniority which has no place in the scheme of MCI regulations," it said.



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