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The National Medical Commission Bill, 2017 was introduced in Lok Sabha recently and is listed for consideration and passage today.[1]  The Bill seeks to regulate medical education and practice in India.  To meet this objective, the Bill repeals the Indian Medical Council Act, 1956 and dissolves the current Medical Council of India (MCI).  The MCI was established under the 1956 Act, to establish uniform standards of higher education qualifications in medicine and regulating its practice.[2]

A Committee was set up in 2016, under the NITI Aayog with Dr. Arvind Panagariya as its chair, to review the 1956 Act and recommend changes to improve medical education and the quality of doctors in India.[3]  The Committee proposed that the Act be replaced by a new law, and also proposed a draft Bill in August 2016.

This post looks at the key provisions of the National Medical Commission Bill, 2017 introduced in Lok Sabha recently, and some issues which have been raised over the years regarding the regulation of medical education and practice in the country.

What are the key issues regarding the regulation of medical education and practice?

Several experts have examined the functioning of the MCI and suggested a different structure and governance system for its regulatory powers.3,[4]  Some of the issues raised by them include:

Separation of regulatory powers

Over the years, the MCI has been criticised for its slow and unwieldy functioning owing to the concentration and centralisation of all regulatory functions in one single body.  This is because the Council regulates medical education as well as medical practice.  In this context, there have been recommendations that all professional councils like the MCI, should be divested of their academic functions, which should be subsumed under an apex body for higher education to be called the National Commission for Higher Education and Research.[5]  This way there would be a separation between the regulation of medical education from regulation of medical practice.

An Expert Committee led by Prof. Ranjit Roy Chaudhury (2015), recommended structurally reconfiguring the MCI’s functions and suggested the formation of a National Medical Commission through a new Act.3   Here, the National Medical Commission would be an umbrella body for supervision of medical education and oversight of medial practice.  It will have four segregated verticals under it to look at: (i) under-graduate medical education, (ii) post-graduate medical education, (iii) accreditation of medical institutions, and (iv) the registration of doctors.  The 2017 Bill also creates four separate autonomous bodies for similar functions.

Composition of MCI

With most members of the MCI being elected, the NITI Aayog Committee (2016) noted the conflict of interest where the regulated elect the regulators, preventing the entry of skilled professionals for the job.  The Committee recommended that a framework must be set up under which regulators are appointed through an independent selection process instead.

Fee Regulation 

The NITI Aayog Committee (2016) recommended that a medical regulatory authority, such as the MCI, should not engage in fee regulation of private colleges.  Such regulation of fee by regulatory authorities may encourage an underground economy for medical education seats with capitation fees (any payment in excess of the regular fee), in regulated private colleges.  Further, the Committee stated that having a fee cap may discourage the entry of private colleges limiting the expansion of medical education in the country.

Professional conduct

The Standing Committee on Health (2016) observed that the present focus of the MCI is only on licensing of medical colleges.4  There is no emphasis given to the enforcement of medical ethics in education and on instances of corruption noted within the MCI.  In light of this, the Committee recommended that the areas of medical education and medical practice should be separated in terms of enforcement of the appropriate ethics for each of these stages.

What does the National Medical Commission, 2017 Bill seek do to?

The 2017 Bill sets up the National Medical Commission (NMC) as an umbrella regulatory body with certain other bodies under it. The NMC will subsume the MCI and will regulate the medical education and practice in India.   Under the Bill, states will establish their respective State Medical Councils within three years.  These Councils will have a role similar to the NMC, at the state level.

Functions of the NMC include: (i) laying down policies for regulating medical institutions and medical professionals, (ii) assessing the requirements of human resources and infrastructure in healthcare, (iii) ensuring compliance by the State Medical Councils with the regulations made under the Bill, and (iv) framing guidelines for determination of fee for up to 40% of the seats in the private medical institutions and deemed universities which are governed by the Bill.

Who will be a part of the NMC?

The NMC will consist of 25 members, appointed by the central government.  It will include representatives from Indian Council of Medical Research, and Directorate General of Health Services. A search committee will recommend names to the central government for the post of Chairperson, and the part-time members.  These posts will have a maximum term of four years, and will not be eligible for extension or reappointment.

What are the regulatory bodies being set up under the NMC?

The Bill sets up four autonomous boards under the supervision of the NMC, as recommended by various experts.  Each autonomous board will consist of a President and two members, appointed by the central government (on the recommendation of the search committee).  These bodies are:

  • The Under-Graduate Medical Education Board (UGMEB) and the Post-Graduate Medical Education Board (PGMEB): These two bodies will be responsible for formulating standards, curriculum, guidelines, and granting recognition to medical qualifications at the under-graduate and post-graduate levels respectively;
  • The Medical Assessment and Rating Board: The Board will have the power to levy monetary penalties on institutions which fail to maintain the minimum standards as laid down by the UGMEB and the PGMEB.  It will also grant permissions for establishing new medical colleges; and
  • The Ethics and Medical Registration Board: The Board will maintain a National Register of all licensed medical practitioners, and regulate professional conduct.  Only those included in the Register will be allowed to practice as doctors.

What does the Bill say regarding the conduct of medical entrance examinations?

There will be a uniform National Eligibility-cum-Entrance Test (NEET) for admission to under-graduate medical education in all medical institutions governed by the Bill.  The NMC will specify the manner of conducting common counselling for admission in all such medical institutions.

Further, there will be a National Licentiate Examination for the students graduating from medical institutions to obtain the license for practice.  This Examination will also serve as the basis for admission into post-graduate courses at medical institutions.

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[1] The National Medical Commission Bill, 2017, http://www.prsindia.org/uploads/media/medical%20commission/National%20Medical%20Commission%20Bill,%202017.pdf.

[2] Indian Medical Council Act, 1933.

[3] A Preliminary Report of the Committee on the Reform of the Indian Medical Council Act, 1956, NITI Aayog, August 7, 2016, http://niti.gov.in/writereaddata/files/document_publication/MCI%20Report%20.pdf.

[4] “Report no. 92: Functioning of the Medical Council of India”, Standing Committee on Health and Family Welfare, March 8, 2016, http://164.100.47.5/newcommittee/reports/EnglishCommittees/Committee%20on%20Health%20and%20Family%20Welfare/92.pdf

[5] “Report of the Committee to Advise on Renovation and Rejuvenation of Higher Education”, Ministry of Human Resource Development, 2009, http://mhrd.gov.in/sites/upload_files/mhrd/files/document-reports/YPC-Report.pdf.

On December 1, 2010, the Judicial Standards and Accountability Bill was introduced in the Lok Sabha.  The Bill revamps the present system of inquiry into complaints against judges.  The case of Justice Sen was the one of the more recent instances where the integrity of judges has been called into question.

A motion was moved by 58 members of the Rajya Sabha for the removal of Justice Soumitra Sen, (a Judge of the Calcutta High Court) on grounds of misappropriation of funds. The Chairman, Rajya Sabha constituted an Inquiry Committee on March 20, 2009 to look into the matter. The Committee comprising Hon’ble Justice B. Sudershan Reddy (Chairman), Hon’ble Justice T.S.Thakur and Shri Fali S. Nariman submitted its report on September 10, 2010.

Charges framed in the Motion

The two charges which led to an investigation into alleged misconduct of Justice Soumitra Sen were:

  • Misappropriation of large sums of money, which he had received in his capacity as Receiver appointed by the High Court of Calcutta; and
  • Misrepresentation of facts with regard to the misappropriation of money before the High Court of Calcutta

 

General observations of the Committee on the case:

  • Justice Sen’s assertion that he had the right to remain silent during the investigations was fallacious.
  • He did not cooperate with the Court proceedings; was not present for hearings, did not furnish information requested by the Court and did not provide any evidence in his defence.

 

Facts and Findings of the investigation by the Committee:

a. During the period he was an Advocate:

  • Justice Soumitra Sen was appointed Receiver in a case by an order of the Calcutta High Court on April 30, 1984. A Receiver appointed by the High Court has the power to collect outstanding debts and claims due in respect of certain goods.
  • As required by the High Court, the Receiver should file and submit for passing,     his half yearly accounts in the Office of the Registrar of the High Court. However, Justice Sen did not comply with this rule both as an Advocate and a Judge.
  • The High Court requires the Receiver to open only one account and not move funds without prior permission. However, the Committee found that two separate accounts were opened by Justice Soumitra Sen as Receiver, with ANZ Grindlays Bank and Allahabad Bank.
  • A total sum of Rs 33,22,800 was transferred in these accounts from the sale of proceeds of the goods which was not accounted for either when Justice Sen was an Advocate or when he was made a High Court Judge.
  • Justice Sen claimed he could not account for this amount since it was invested in a company called Lynx India Ltd. to earn interest. The Committee found this claim to be false as well.
  • The Committee concluded that this was a case of misappropriation of funds as both of the Receiver’s bank accounts were closed with a nil balance without any investments being made on behalf of the High Court.

b. During the period he was a Judge:

  • Justice Soumitra Sen was appointed a High Court Judge on December 3, 2003. The committee noted that Justice Sen’s actions were, “an attempt to cover up the large-scale defalcations of Receiver’s funds”.
  • After he became a Judge he did not seek any permission from the Court for approval of the dealings, as required by the Court, nor did he account for the funds.

Conclusion

Based on the findings on the two charges the Inquiry Committee was of the opinion that Justice Soumitra Sen of the Calcutta High Court is guilty of “misbehaviour”.