Tuesday, January 2, 2018
Coming straight to the core point, the Indian Medical Association (IMA) on January 1 has called for a 12-hour shutdown of all private hospitals in India on January 2 to protest what they call it the “anti-people and anti-patient” National Medical Commission (NMC) Bill, 2017 that seeks to replace the Medical Council of India (MCI). This NMC Bill was presented in the Lok Sabha on December 29. The IMA has 2.77 lakh members, which includes corporate, hospitals, polyclinics and nursing homes across the country.
Dr Avinash Bhondwe who is former President of IMA said that the IMA has announced a nationwide strike between on January 2 as a mark of protest against the Bill. Dr SS Utture who is President of IMA said that the Bill in its present form was unacceptable and the IMA action committee has declared a black day on January 2.He said that, “This Bill is anti-poor, anti-people, non-representative, undemocratic and anti-federal in character”.
It must be brought out here that the decision to go on a 12-hour strike came after a delegation of the IMA led by President KK Aggarwal and its national President Ravi Wankhede met Union Minister of health and family welfare JP Nadda seeking strict amendments in the Bill that was tabled in the Lok Sabha. Wankhede said that, “IMA strongly opposes this Bill and has no option but to take the issues to our patients and the people. We have called for 12-hour shutdown.” Routine medical services like OPD and elective surgeries across the country will be withdrawn between
Terming the Bill as “anti-people and anti-patient”, the IMA in a statement has stated that the Bill purported to eradicate corruption is “designed to open the floodgates of corruption”. IMA, which is not a statutory body, has been vehemently opposing the Bill to set up the NMC ever since it received the Union Cabinet clearance and has demanded key amendments in it. It issued a statement after the delegation met the Health Minister Nadda which stated that, “NMC is an anti-poor Bill with pro-private management clauses. A Bill to regulate the medical education and medical practice without the concurrence of the medical profession will be a disaster.”
To be sure, the IMA doctors alleged that there are hidden agendas in the proposed Bill. According to Section 26(1)(b) of the Bill, permission to start medical colleges/PG/superspeciality courses or increase seats in MBBS/PG/superspeciality courses will be directly granted by the Medical Assessment and Rating Board directly, which will have three members nominated by the Centre. This will vastly increase Centre’s clout which can misuse whenever it likes as all the three members would be directly nominated by it!
It must be added here that as per Section 26(1)(f) of the Bill, it is provided that MAR Board take such measure, including imposition of monetary penalty, against a medical institution for failure to maintain the minimum essential standards specified by the UGME Board or the PGME Board, as the case may be. The material point for consideration is that all the three monetary penalties are not to be less than one half and not more than ten times the total amount charged by such institution for one full batch of students of undergraduate course or postgraduate course as the case may be. The medical fraternity points out that it yields such wide period and discretionary power to the Board and in the name of charging fine, the permissibility of the period turns out to be substantial before the closure is invoked which means that during the impending period the learner would be taught and trained in compromised ambience resulting in impoverished teaching and it would end up in generation of half-baked health manpower, which would be ill conducive to the healthcare delivery system! They have a valid point!
Going forward, as per proviso 2, Section 33(1)(d), the NMC can permit a medical professional to perform surgery or practice medicine without qualifying the National Licentiate Examination, in circumstances and period that may be specified by regulations. Utture said such sweeping powers are not only illegal but will give ample scope for manipulation and corruption. This operationally means that without ascertaining the required levels and certification thereto, the Commission would be permitting people to practice surgery and medicine in an open ended manner which tantamounts to legalizing quackery in an operational sense and thus the lives of the people at large would be openly under threat! Medhavi Tomar who is President of IMA (Meerut unit) lambasted the illogical move saying that, “On one hand, the government plans to abolish exams for foreign graduates despite the fact that they will not be conversant with the infections and diseases of the country, but on the other hand, they want the MBBS students who have already studied for the degree to go through another entrance exam to get themselves a degree. The doctors will also protest against the EXIT exam which the government believes should be undertaken by the MBBS students to finally get their graduation degrees.”
It is noteworthy that the doctors are protesting against the NMC Bill for seeking to allow practitioners of ayurveda, yoga and naturopathy, unani, siddha and homeopathy, to practice modern (allopathy) medicine once they complete a short term “bridge” course.” Dr Shishir Jain who is Joint Secretary, IMA (UP unit) and Finance Secretary, IMA (Meerut unit) said that, “According to current norms, cross-pathy is not allowed, which means a doctor belonging to one category cannot prescribe medicines for another category. For example, an allopathic doctor cannot prescribe homeopathic medicines. But if the NMC Bill is passed, cross-pathy will be allowed, once they complete a six-month course.”
It cannot be lost upon us that many in the medical fraternity are voicing their serious apprehensions over the Health Ministry calling the shots in the days to come and not the doctors! SK Sarin who is former Chairperson of Governors, Medical Council of India minces no words in stating it most unequivocally that, “It is possible that in the near future NMC will become subservient to the health ministry, given that the representation of the medical profession in the new regulatory framework is minimal. The proposed NMC Bill discreetly intends to equate the post-graduate degrees given by MCI or proposed NMC and the National Board of Examination (NBE), which is unjustified too. Standards have been laid down for MCI courses, but not for NBE courses which are often run in private hospitals and nursing homes.”
Elaborating further, SK Sarin also points out that, “It is well known that doctors in private practice have limited time and exposure to teaching and research. Equating the two degrees would do disservice to the profession. Why would a teacher stay in a government run medical college if he or she can earn five times more and still be designated as a professor? It would be advisable if some serious thought is given before the burial of government-run medical college starts. Similarly, NMC shouldn’t open gates to overseas doctors to regularly practice medicine or perform surgery without qualifying the National Licentiate Examination or induct Ayush colleagues without clearing NEXT. Also, the accreditation and rating function of the Medical Assessment and Rating Board (MARB) should be out of the ambit of NMC. This was also the recommendation of the Parliamentary Committee report in March 2016. MARB’s impartialty is dented if it seeks directions from the commission or government, more so as penalties on non-compliance on educational standards are monetary and regulation of fee structure of up to 40% of seats in private institutes is under its domain.”
As per Section 55(2) (zl) of the National Medical Commission Bill, the Ethics and Medical Registration Board shall maintain a separate national register including the names of licensed AYUSH practitioners. The names of BAMS and BHMS graduates are already registered with their respective councils and on availing the bridge course they would be incorporated in a separate register maintained by the NMC, resulting in dual registrations with two registering councils, which is neither open nor permissible. Utture lamented that, “The disciplinary jurisdiction on such persons with reference to breach of ethics is not indicated in the proposed Bill as they have dual registrations to their credit. As such these are the floodgates that have been opened up in terms of the statutory provisions for backdoor entry into medical profession entitling practicing modern medicine.”
The proposed NMC will have 10% elected members (part time) and 90% nominated members. We thus see that it will not have a desired “representative character” with reference to “elected and nominated/appointed members” whereas currently we see that the MCI has 75% elected members and 25% nominated members. Why has the strength of elected members dwindled down to a mere 10% and that too part time whereas the strength of nominated members has been raised hugely from 25% to 90%? Will this not directly increase government’s interference?
As per Section 10 of the Bill, the functions vested with the Commission under the Act are generic and cosmetic in character. Thereunder it is to exercise appellate jurisdiction with respect to decisions of the autonomous boards. As per Section 10(1) of the Bill, Commission would be framing guidelines for determination of fee in respect of such proportion of seats not exceeding 40% in the private medical institutions. This operationally means that the fee regulation would be limited to a maximum of 40% seats in the private medical institutions, which is difficult to comprehend as to why such a ceiling and furthermore it could be anything from nil up to 40% which is quite paradoxical!
It also brings into fore as to what would be the chargeable fee for those percentage of seats for which no guidelines would be framed by the Commission. Does this not open the floodgates of discretion and nepotism? Also, this operationally will mean that the present 15%, which is available to private institutions which includes deemed universities for charging higher fee, would stand augmented to the entire remainder which could be anything between 60% or more which as is blindingly obvious is a real travesty of its type.
Section 15 of the proposed Bill inserts provision which introduces licentiate examination as mandatory for practicing and doing further post graduate courses after acquiring MBBS qualification. It has been discussed above but it must be added here that the IMA doctors apprehend that the standard and level of licentiate examination would be such that the students belonging to backward communities would find it greatly difficult to clear the same easily and handily! They would thus suffer immensely as they would neither be able to practice nor even take admission in PG courses. The same holds true for those who come from backward areas/states and also from north-east region as well!
Be it noted, as per Section 29(b) of the Bill, the MAR board is to look into ‘whether adequate faculty and other necessary facilities have been provided to ensure proper functioning of the medical college or would be provided within the time limit specified in the scheme while granting permission to start Medical college or PG courses. Does this not vest the board with the sword of wide discretionary power to accord approval by hypothetically making the assumptive presumption that the stipulated minimum requirements would be completed within due course of time? Will this not impact adversely and prejudice the desired quality of medical education?
What is even more concerning to note is that as per proviso 2 , Section 29(d) of the Bill, the MAR Board can relax the criteria for opening of the medical colleges at its discretion with the previous approval from the Central Government? Will this not ensure that extraneous considerations finally rule the roost in relaxing criteria? Why the regulatory stipulations which are mandatory in nature and binding in character should be opened to concessions or condonation by exercising the route of discretionary authority? Should such route of discretionary authority be allowed? Certainly not!
As per Section 44(1)(2) of the Bill, although autonomy is widely anticipated to be the hallmark of the NMC Bill, 2017 and the Boards thereunder would be called as “Autonomous Boards” but the ground reality is just the opposite! Centre would be entitled to give directions to the Commission and autonomous boards on all questions of policy which would be binding for the Commission and autonomous boards to comply with! Where is the guarantee that Centre will not misuse it?
Section 45 further strengthens the hands of the Centre by incorporating that Central Government would be within its rights to give such direction it may deem necessary to the State Government for carrying out all or any of the provisions of this Act and State Government shall comply with such directions. Does this not directly undermine the authority of the State Government and clashes directly with the cardinal principles which govern the federal polity as stipulated in the Constitution? Similarly we see how Section 10(1)(f) of the proposed Bill makes it obligatory for State Medical Councils to comply with the directions/policy of the NMC thus bringing it under Centre’s direct thumb!
Last but not the least we see how Section 58(3) has a direct adverse bearing on the employees of the MCI. It brings out that on the dissolution of the MCI the person appointed as Chairman of the MCI and every other person appointed as the member and any officer and other employees of the council and holding office as such immediately before such dissolution shall vacate their respective offices and such chairman and other members shall be entitled to claim compensation not exceeding three months pay and allowances for the premature termination of term of their office or of any contract of service. This clause severely impacts the employees of the council who earlier enjoyed full time salaried status and permanence of employment in character but are now rendered jobless thus leaving them to fend for themselves. Is this not violation of Article 21 read with Article 12 of the Constitution of India because Article 12 vests entitlement to decent life and living as a fundamental right to every citizen and Article 12 clearly mandates a State (in this instant case the MCI) to be an ideal employer?
I can still go on and on. But due to constraint of space I have to now finish. One has to concede that the IMA protests are not without reason. Centre must work out the solution which lies in the problem itself! Centre must take into board all the legitimate concerns of the IMA and work out a new Bill after addressing them properly! Why insist on EXIT exam for Indians alone when Centre is planning so many concessions for foreign students? All such vexed issues must be addressed and they can be if the government is willing and earnest in its endeavours to do so!
Sanjeev Sirohi, Advocate,
s/o Col BPS Sirohi,
A 82, Defence Enclave,
Sardhana Road, Kankerkhera,
Meerut – 250001, Uttar Pradesh.