Recently, the Parliament passed a law that addresses the issue of sexual harassment in the work place. The Bill, introduced in the Lok Sabha on December 7, 2010, drew on the 1997 judgment of the Supreme Court (known as the Vishaka judgment) to codify measures that employers need to take to address sexual harassment at the work place. (See PRS analysis of the Bill here). The Bill was first passed in the Lok Sabha on September 3, 2011. It incorporated many of the amendments recommended by the Standing Committee on Human Resource Development that examined the Bill. The Rajya Sabha passed it on February 27, 2013 without any new amendments (see Bill as passed by Parliament). We compare the key provisions of the Bill, the Standing Committee recommendations and the Bill that was passed by Parliament (for a detailed comparison, see here).
| Bill as introduced | Standing Committee recommendations | Bill as passed by Parliament |
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Clause 2: Status of domestic workers |
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| Excludes domestic workers from the protection of the Bill. | The definition should include (i) domestic workers; and (ii) situations involving ‘victimization’; | Includes domestic worker. Does not include victimisation. |
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Clause 4: Constitution of Internal Complaints Committee (ICC) |
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| The committee shall include 4 members: a senior woman employee, two or more employees and one member from an NGO committed to the cause of women. | The strength of ICC should be increased from 4 to at least 5 (or an odd number) to facilitate decisions in cases where the bench is divided. | Disqualifies a member if (a) he has been convicted of an offence or an inquiry is pending against him or (b) he is found guilty in disciplinary proceedings or a disciplinary proceeding is pending against him. |
| Members may not engage in any paid employment outside the office. | Barring paid employment outside the office goes against NGO members who may be employed elsewhere. This clause must be edited. | Deletes the provision that disallows NGO members to engage in paid employment outside. NGO members to be paid fees or allowances. |
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Clause 6: Constitution and jurisdiction of Local Complaints Committee (LCC) |
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| An LCC is required to be constituted in every district and additional LLCs at block level. At the block level the additional LCC will address complaints where the complainant does not have recourse to an ICC or where the complaint is against the employer. | The functions of the district level and the block level LCCs are not delineated clearly. It is also unclear whether the block level LCCs are temporary committees constituted for dealing with specific cases. Instead of creating additional LCCs at the block level, the District level LCC may be allowed to handle cases. A local member from the block may be co-opted as a member to aid the LCC in its task. | Accepted. |
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Clause 10: Conciliation |
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| The ICC/ LCC shall provide for conciliation if requested by the complainant. Otherwise, it shall initiate an inquiry. | Distinction should be made between minor and major offences. Conciliation should be allowed only for minor offences. | Adds a proviso that monetary settlement shall not be the basis on which conciliation is made. |
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Clause 11: Inquiry into Complaint |
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| ICC/LCC shall proceed to make inquiry into a complaint in such manner as may be prescribed. | No suggestion. | Inquiries will be conducted in accordance with service rules or in such manner as may be prescribed.For domestic workers, the LCC shall forward the complaint to the police within seven days if a prima facie case exists. The case shall be registered under section 509 of Indian Penal Code (word, gesture or act intended to insult the modesty of a woman). |
| Sources: The Protection of Women Against Sexual Harassment at Work Place Bill, 2010; the Standing Committee on HRD Report on the Bill; the Sexual Harassment at Work Place (Prevention, Prohibition and Redressal) Bill, 2012; PRS. | ||
The National Medical Commission (NMC) Bill, 2017 was introduced in Lok Sabha in December, 2017. It was examined by the Standing Committee on Health, which submitted its report during Budget Session 2018. The Bill seeks to regulate medical education and practice in India. In this post, we analyse the Bill in its current form.
How is medical education and practice regulated currently?
The Medical Council of India (MCI) is responsible for regulating medical education and practice. Over the years, there have been several issues with the functioning of the MCI with respect to its regulatory role, composition, allegations of corruption, and lack of accountability. For example, MCI is an elected body where its members are elected by medical practitioners themselves, i.e. the regulator is elected by the regulated. In light of such issues, experts recommended nomination based constitution of the MCI instead of election, and separating the regulation of medical education and medical practice. They suggested that legislative changes should be brought in to overhaul the functioning of the MCI.
To meet this objective, the Bill repeals the Indian Medical Council Act, 1956 and dissolves the current Medical Council of India (MCI) which regulates medical education and practice.
Who will be a part of the NMC?
The NMC will consist of 25 members, of which at least 17 (68%) will be medical practitioners. The Standing Committee has noted that the current MCI is non-diverse and consists mostly of doctors who look out for their own self-interest over larger public interest. In order to reduce the monopoly of doctors, it recommended that the MCI should include diverse stakeholders such as public health experts, social scientists, and health economists. In other countries, such as the United Kingdom, the General Medical Council (GMC) responsible for regulating medical education and practice consists of 12 medical practitioners and 12 lay members (such as community health members, and administrators from the local government).
How will the issues of medical misconduct be addressed?
The State Medical Council will receive complaints relating to professional or ethical misconduct against a registered doctor. If the doctor is aggrieved by the decision of the State Medical Council, he may appeal to the Ethics and Medical Registration Board, and further before the NMC. Appeals against the decision of the NMC will lie before the central government. It is unclear why the central government is an appellate authority with regard to such matters.
It may be argued that disputes related to ethics and misconduct in medical practice may require judicial expertise. For example, in the UK, the GMC receives complaints with regard to ethical misconduct and is required to do an initial documentary investigation. It then forwards the complaint to a Tribunal, which is a judicial body independent of the GMC. The adjudication and final disciplinary action is decided by the Tribunal.
What will the NMC’s role be in fee regulation of private medical colleges?
In India, the Supreme Court has held that private providers of education have to operate as charitable and not for profit institutions. Despite this, many private education institutions continue to charge exorbitant fees which makes medical education unaffordable and inaccessible to meritorious students. Currently, for private unaided medical colleges, the fee structure is decided by a committee set up by state governments under the chairmanship of a retired High Court judge. The Bill allows the NMC to frame guidelines for determination of fees for up to 40% of seats in private medical colleges and deemed universities. The question is whether the NMC as a regulator should regulate fees charged by private medical colleges.
A NITI Aayog Committee (2016) was of the opinion that a fee cap would discourage the entry of private colleges, therefore, limiting the expansion of medical education. It also observed that it is difficult to enforce such a fee cap and could lead medical colleges to continue charging high fees under other pretexts.
Note that the Parliamentary Standing Committee (2018) which examined the Bill has recommended continuing the current system of fee structures being decided by the Committee under the chairmanship of a retired High Court judge. However, for those private medical colleges and deemed universities, unregulated under the existing mechanism, fee must be regulated for at least 50% of the seats. The Union Cabinet has approved an Amendment to increase the regulation of fees to 50% of seats.
How will doctors become eligible to practice?
The Bill introduces a National Licentiate Examination for students graduating from medical institutions in order to obtain a licence to practice as a medical professional.
However, the NMC may permit a medical practitioner to perform surgery or practice medicine without qualifying the National Licentiate Examination, in such circumstances and for such period as may be specified by regulations. The Ministry of Health and Family Welfare has clarified that this exemption is not meant to allow doctors failing the National Licentiate Examination to practice but is intended to allow medical professionals like nurse practitioners and dentists to practice. It is unclear from the Bill that the term ‘medical practitioner’ includes medical professionals (like nurses) other than MBBS doctors.
Further, the Bill does not specify the validity period of this licence to practice. In other countries such as the United Kingdom and Australia, a licence to practice needs to be periodically renewed. For example, in the UK the licence has to be renewed every five years, and in Australia it has to renewed annually.
What are the issues around the bridge course for AYUSH practitioners to prescribe modern medicine?
The debate around AYUSH practitioners prescribing modern medicine
There is a provision in the Bill which states that there may be a bridge course which AYUSH practitioners (practicing Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy) can undertake in order to prescribe certain kinds of modern medicine. There are differing views on whether AYUSH practitioners should prescribe modern medicines.
Over the years, various committees have recommended a functional integration among various systems of medicine i.e. Ayurveda, modern medicine, and others. On the other hand, experts state that the bridge course may promote the positioning of AYUSH practitioners as stand-ins for allopathic doctors owing to the shortage of doctors across the country. This in turn may affect the development of AYUSH systems of medicine as independent systems of medicine.
Moreover, AYUSH doctors do not have to go through any licentiate examination to be registered by the NMC, unlike the other doctors. Recently, the Union Cabinet has approved an Amendment to remove the provision of the bridge course.
Status of other kinds of medical personnel
As of January 2018, the doctor to population ratio in India was 1:1655 compared to the World Health Organisation standard of 1:1000. The Ministry of Health and Family Welfare stated that the introduction of the bridge course for AYUSH practitioners under the Bill will help fill in the gaps of availability of medical professionals.
If the purpose of the bridge course is to address shortage of medical professionals, it is unclear why the option to take the bridge course does not apply to other cadres of allopathic medical professionals such as nurses, and dentists. There are other countries where medical professionals other than doctors are allowed to prescribe allopathic medicine. For example, Nurse Practitioners in the USA provide a full range of primary, acute, and specialty health care services, including ordering and performing diagnostic tests, and prescribing medications. For this purpose, Nurse Practitioners must complete a master’s or doctoral degree program, advanced clinical training, and obtain a national certification.
