The Supreme Court recently comprising of a bench of Justices Hemant Gupta and V. Ramasubramanian while overturning the judgment passed by Madras High Court whereby the High Court has allowed the said writ petition filed by the students who had not gone clinical training and were declined the provisional registration required by them to undergo internship ruled that the National Medical Commission (NMC) cannot grant provisional registration to medical students who have not completed clinical training in a foreign MBBS course. (National Medical Commission vs Pooja Thandu Naresh)
The bench asked the National Medical Commission(NMC) to frame a scheme within two months to complete clinical training in medical colleges here to help MBBS students from foreign universities who were facing difficulties because of the Ukraine crisis.
Facts of the case
The present appeals were directed against orders passed by the High Court of Judicature at Madras in the writ petitions filed for quashing the circulars issued by the Tamil Nadu Medical Council and consequential orders of directing respondent No. 1/writ petitioner1 to undergo two months of Compulsory Rotatory Residential Internship,2 followed by one year of internship before granting permanent registration under the Indian Medical Council Act, 19563 (now repealed by the National Medical Commission Act, 2019).
After qualifying for the eligibility test as per the eligibility requirement for taking admission in an Undergraduate Medical Course in a Foreign Medical Institution Regulations, 2002, the respondents joined medical colleges in the People’s Republic of China. The students completed nine semesters of their academic course, including clinical training.
However, due to the outbreak of the COVID-19 pandemic, the clinical training for the subjects of Ophthalmology, Otorhinolaryngology and Nuclear Medicine in their tenth semester was done online and consequently, they were granted degrees of Bachelor of Medicine & Bachelor of Surgery (MBBS) after qualifying in all the subjects as per the teaching plan till May 2020 by the foreign institute.
Later, a few of one of the respondents’ fellow students were granted provisional registration by the Tamil Nadu Medical Council but she was declined the same. This led to petitions being filed before the Madras High Court.
By way of an order, the high court directed the Tamil Nadu Medical Council to provisionally register those petitioners who submit their applications and further, permit them to undergo the Compulsory Rotatory Residential Internship.
The present appeal was filed by NMC.
Contention of the Parties
The argument of Mr. Vikas Singh, learned senior counsel for the appellant, was that in terms of the statutory Regulations, the student has to study the medical course in the same institute located abroad for the “entire duration”. It has been argued that as per the dates of the semester and the date of departure of student from China, it shows that the student has not completed the ninth semester in part and tenth semester completely, therefore, the student is not eligible for provisional registration to undergo one year internship so as to be eligible for registration as a professional under the Act. The argument is that clinical training cannot be imparted through online mode as it is the actual training involving diagnosis and interactions with the patients. There cannot be any online clinical training which will satisfy the requisite condition of the Screening Regulations.
Mr. S. Nagamuthu, learned senior counsel for the respondent-student relied upon a judgment of this Court reported as Medical Council of India v. J. Saai Prasanna & Ors. and contended that the student is eligible for provisional registration. It was contended that the action of the Tamil Nadu Medical Council is completely arbitrary and discriminatory as some students have been granted provisional registration not only by the Tamil Nadu Medical Council but also by the Medical Council of different States. Therefore, declining of provisional registration to the student leads to heartburn amongst the student who has not been granted provisional registration. Mr. Nagamuthu referred to a note filed on behalf of the appellant before the High Court to contend that the stand of the appellant was that acquiring primary medical qualification from the Foreign Medical Institute was acceptable for grant of registration. It was also contended that as per Note V(2), the Screening Regulations grant an opportunity to the candidate to either complete his practical training/internship in the country from where he has acquired the Foreign Medical Qualification or in India.
Courts Observation and Judgment
The bench taking note of the contention of the learned Counsel for the Respondent remarked, "We have heard learned counsel for the parties and find that the reliance on the judgment of this Court in Medical Council of India is not applicable to the facts of the present case as after the judgment of the Andhra Pradesh High Court delivered on 2.5.2008, Regulation 4(3) of the Screening Regulations was inserted to make it mandatory that a candidate should have studied for the medical course at the same institute located abroad for the entire duration of the course. Though, this Court has delivered judgment after the amendment but the student had obtained the degree prior to the amendment of the Regulations. Therefore, such judgment would not be relevant in the present matter."
The bench noted that the student has admittedly not completed clinical training which was part of the curriculum in the tenth semester, maybe she has not completed part of clinical training in the ninth semester as well as per the curriculum. Moreover, the Eligibility Regulations are to ensure that a student meets the minimum eligibility condition as per the Graduate Medical Education Regulations, 1997, but after completing the curriculum, a candidate has to qualify the Screening Test, provided the entire duration of the course has been completed at the same institute located abroad.
The bench noted, "The question to be examined is as to whether the degree granted by the Foreign Institute even in respect of clinical training is binding on the appellant and the student has to be provisionally registered. We find that the appellant is not bound to grant provisional registration to the student who has not completed the entire duration of the course from the Foreign Institute including the clinical training."
The bench remarked that without practical training, there cannot be any Doctor who is expected to take care of the citizens of the country. Hence, the decision of the appellant not to grant provisional registration cannot be said to be arbitrary.
The court also added that the qualifying in the Screening Regulations is no proof of the clinical experience, if any, gained by the students. The court said that the Screening examination is based upon Optical Mark Reader (OMR) answers and has no correlation with any practical training. They do not find that in terms of the Screening Regulations, the students are entitled to provisional registration.
The bench noted that not allowing these young students to undergo training would waste their effort and potential and that their services should be made of some use.
The bench taking note of the same observed, "However, the fact remains that the students were permitted to undergo medical course abroad and that they have completed their curriculum according to the certificate granted by such Foreign Institute. Therefore, such national resource cannot be permitted to be wasted which will affect the life of young students, who had taken admission in the foreign Institutes as part of their career prospects. Therefore, the services of the students should be used to augment health infrastructure in the country. Thus, it would be necessary that the students undergo actual clinical training of such duration and at such institutes which are identified by the appellant and on such terms and conditions, including the charges for imparting such training, as may be notified by the appellant."
The bench further remarked, "We are unable to agree with the High Court that instead of three months of clinical training in China, two months training would be sufficient for provisional registration apart from the 12 months of internship. The Courts are not expert in deciding an academic curriculum or the requirement of the clinical training which may be required to be satisfied by the students."
The court disposing of the appeals issued the following directions to alleviate the pandemic-related problems faced by students with foreign medical degrees:
- to frame a scheme as a one time measure within two months to allow the student and such similarly situated students who have not actually completed clinical training to undergo clinical training in India in the medical colleges which may be identified by the appellant for a limited duration as may be specified by the appellant, on such charges which the appellant determines.
- It shall be open to the appellant to test the candidates in the scheme so framed in the manner within next one month, which it considers appropriate as to satisfy that such students are sufficiently trained to be provisionally registered to complete internship for 12 months.
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