Why the National Medical Commission Bill 2017 needs to be stopped
The Medical Council of India (MCI) has been earmarked as an unworthy and corrupt institution. In 2010, it was superseded by a Parliament legislation for a Board of Governors. In 2014, Dr Ranjit Roy Choudhury pointed to failures. In 2016, the Parliament’s Standing Committee for the Ministry of Health and Welfare laid its 92nd report. Noting these reports, the Supreme Court of India in the Modern Dental Case (2016) declared that the “massive failures of MCI... there is total system failure and medical education system is fast sliding downwards”.
The court appointed the Lodha Committee to “oversee” MCI’s work. The committee found many of the MCI’s decisions untenable. A massive litigation in 2016-17 followed which exposed the MCI. Tarnishing its image made no difference to the MCI’s lawyers who took the high ground. Its reputation soured, its lawyers made a lot of money. Perhaps those in MCI and its inspectors took more.
Privatisation
In TMA Pai case (2002), an 11-judge bench of the Supreme Court recognised that technical (indeed, all) education requires a huge private sector without which tertiary education for all was impossible suggesting greater working and financial autonomy for private colleges. The state governments — driven by politics wanted private institutions to allot quotas for “weaker sections” to enable not necessarily social justice but political patronage for votes. This is not to say the increasing private medical colleges are paragons of virtue — dodging standards and charging capitation (under the table) fees. Today, 266 out of 479 medical colleges are private.
The new National Medical Commission Bill 2017 is a sprawling monster of institutions including the Medical Commission, the Medical Advisory Council, four autonomous bodies for undergraduate (UG) and post-graduate (PG) medical education each, a Medical Assessment and Rating Committee and an Ethics and Medication Registration Board with their own advisory committees.
Each “shall be an autonomous body which shall carry out its functions under this Act subject to regulations made by the commission”. Apart from this plethora of institutions, this kind of “autonomy” without supervision is bound to further the web of potential corruption which plagued the MCI especially in respect of recognition and de-recognition of colleges.
In the projected new regime of this Bill, this task is assigned to the Medical Assessment and Rating Board who will receive applications to establish new medical colleges. If this fails, an opportunity is provided for rectification and appeal to the National Commission. This has been an area of immense corruption and litigation. Even the Supreme Court looking at a cachet of cases in 2017 thought many decisions were arbitrary.
Before this Bill, apart from new colleges, there were annual inspections for five years looking at financial resources, facilities, staff and hospital strength. Now we are told of (i) future assessments without prior notice anytime a much more stringent provision based on hearsay and (ii) relaxation of standards for medical colleges in “such areas” the central government shall specify.
Money factor
This will create two kinds of medical education. Instead of persuading doctors to hilly and rural areas, inferior standards would be off loaded to the “relaxation” doctors who in any case, could practice anywhere in India, thereby obviating the purpose of relaxation.
For medical colleges, the vexed question of fees is not really resolved. But there is a curious provision that the commission shall frame guidelines for fees to the extent of up to 40 per cent students. The remaining 60 per cent (I assume) will be left to the colleges who at present subsidise fees by higher fees from NRIs and foreigners. Will the states impose reservations on full or partly aided colleges? Will there be “fee fixation” (as indeed and “admission committees”) by the states as decreed by the Supreme Court Inamdar (2005)? Can colleges fix any fess to create a “rich” (60 per cent)and “poor” (40 per cent) dichotomy which the Supreme Court played with in Unnikrishnan (1992). Huge problems on admission and counselling are brushed under the carpet.
For students, who studied for five years with clinical training, there will now be “licentiate” examination to determine the right to practice as a doctor and for admission to PG courses. Such an examination is absurd both for graduate doctors to practice and to select post-graduates. This will then become the defining moment in doctors lives after five years of slogging to be a doctor and for PG admission without looking at their actual merits.
Training
Driven by providing health to rural areas, homeopaths and Indian medicine practitioners who have taken a “bridge” course may prescribe allopathic medicine to be recognised in a separate register of the National Commission. They will be “quasi-allopathic” trained in another medical discipline called “Ayush” doctors. Dispensing allopathic and other medicines and recognised by the National Commission to compete with MBBS graduates as general practitioners, would mislead patients as to the kind of medicine they dispense. True these “Ayush” practitioners are the only medical help available in places. But health services cannot be fudged in this way.
Assuming that the Bill is an honest consideration of health delivery through supplied medical services and education, this Bill is untidy and lacks clarity. Good doctors will go abroad and urbanise. Ayush doctors dispensing allopathic medicines will not be restricted to rural areas to urbanise and will compete with fully qualified ones. There are too many ill thought out fancy solutions bowing to lobbies. The Bill goes to a Parliamentary Standing Committee where it should be challenged by stakeholders and others.
(Courtesy of Mail Today)