Sunday, July 6, 2008

Problem of Unrecognition of Medical Degrees / Diplomas


Un-recognition of Medical Degrees: Problems and Solutions
Dr. Mukesh Yadav
Prof. & HOD, Deptt. of Forensic Medicine
Muzaffarnagar Medical College
Muzaffarnagar, U.P.
Email: drmukesh65@yahoo.co.in
Abstract
With the privatization of medical education in India new avenues and opportunities are created to Indians. It also started exposing lacunae in the Indian medical education systems prevalent from quite a long time. One of the problems is that of non-recognition of medical degrees i.e. M.D./M.S./ Diplomas, by the Medical Council of India. In spite of this fact the government medical colleges through affiliated Universities award these degrees.
This is in clear violation of many of the fundamental rights of Indian citizens like right to health care, right to work, etc. under Article 21, 14 and 16 of the Indian Constitution. This paper deals with review of the situation in India regarding the problem of recognition of medical degrees, court’s views, and reasons for the problem and possible solutions to solve the problem.
Key Words: Medical Degree, Medical Council of India, Medical College, University, Court, Diploma, Indian Constitution.
Introduction:
The problem of awarding of un-recognized medical degrees and diplomas by the Indian Universities is prevalent throughout India. These degrees are not only belonging to the specialty of Forensic Medicine but to almost all the medical specialties. The main reasons for the prevalence of this problem is rapid progress in the field of modern medicine after independence, which is not able to keep the pace, by the Medical Council of India (MCI) to keep the watch on medical education standards. Another important reasons include unawareness about the procedure of recognition of degree, lack of initiative by the concerned department, apathy of other government authorities to understand and solve the problem. Prevalent Corruption in MCI and State Medical Councils, etc., along with lack of adequate infrastructure, staff, space and equipments are other important reasons for problem of un-recognized degrees.
“So far as the admission to unrecognized medical seats are concerned, we have, although prima facie, a very strong view. The Medical Council is the over all supervisor of Medical Education in India. Whether an institution is fit to admit students for the purpose of study ultimately with the aim of receiving medical degrees from that institution, is a matter, which is in the sole decision of Medical Council. If the Medical Council de-recognizes institutions, courses or seats, then and in that event it means that those institutions, those courses or those seats, as the case might be, are not fit for producing qualified doctors of that level or that mentality, specialty. [R-1]
In such an event, it is the job of every public authority in India to see to it that these deficient institutions do not admit students or grant them degree which would have inbuilt and hidden incapacity and inadequacy and which would forever in future be of definite danger to the citizen of India at large. Just as an unqualified man practicing medicine is a threat to public health, so also is a half qualified or badly qualified person is a similar danger to the public. If anything the danger in the second case is more. Thus, a degree from an unrecognized institution, course or seat is a misrepresentation. It is a misrepresentation of a permanent nature which is likely to mislead many and unknowing patient. [R-1]
It is the Medical Council / Dental Council which can prescribe the number of students to be admitted in medical courses / dental courses in a medical college or institution. It is the Central Government, alone which can direct increase in the number of admissions but only on the recommendation of the Medical Council. Universities and the State Government of Karnataka had no authority to allow increase in the number of admissions in the medical colleges in the State. No medical college can admit any student in excess of its admission capacity fixed by the Medical council subject to any increase thereof as approved by the Central Government and that Sections 10-A, 10-B and 10-C will prevail over Section 53(10) of the State Universities Act and Section 41 (b) of the State Government Capitation Fee Act. [R-2]
Problem is prevalent through out India:
The problem of un-recognition of degree is prevalent throughout India including States like: Delhi, Haryana, J& K, Punjab, U.P., Bihar, Kerala, etc.
Reasons for problem:
Apathy of Government Authorities:
In spite of clear directions from the High Court of Allahabad, Lucknow Bench, [1] as well as Supreme Court of India [2] to the concerned authorities of State Governments to seek recognition after 1993, no sincere effort in this regard is initiated. After the insertion of Ss. 10A, 10B and 10 C in the Medical Council Act, the MCI has framed regulations with the previous approval of the Central Government which were published in the Gazette of India dated September 29, 1993.
Any medical college or institution, which wishes to increase the admission capacity in M.B.B.S. / Higher Courses (Including Diploma / Degree / Higher Specialties) has to apply to the Central Government for the permission of the State Government and that of University with which it is affiliated and in conformity with the regulations framed by the MCI. No medical college can admit any student in excess of its admission capacity fixed by the MCI subject to increase thereof as approved by the Central Government. Sections 10A, 10B and 10 C in the Medical Council Act will prevail over S. 53 (10) of the State Universities Act and S. 41 (b) of the State Capitation Fee Act. [Paras 25, 28, 30, 31] [R-2]
Apex Court further added that “to say that the number of students as permitted by the State Government and /or University before June 1, 1992 could continue even if medical council has fixed the admission capacity would be allowing an illegality to perpetuate in all time to come. It is not that only future admission will have to be regulated on the basis of capacity fixed or determined by the MCI. [Para 31] [R-2]
Medical Council Act (102 of 1956) – S. 33- regulations framed under – falling within the purpose mentioned in S. 33- will have mandatory force. [Para 25] [R-2]
Consequences:
Un-recognized medical degree holders may face problem of denial of employment by Union Public Service Commission, Delhi, PGIMER, Chandigarh, many private Medical Colleges; problems during promotion to higher post, problem during MCI Inspection, etc., in addition to humiliation and embarrassment for no fault of them.
The writ-petition is directed towards making the recognition available again to these colleges by increasing the teaching staff, making the Laboratories better equipped, and such like.
In a Public Interest Litigation (PIL) filed by the writ-petitioners, which described themselves as Doctors before the High Court in Lucknow Bench, comprising of Ajoy Nath Roy, C.J. and Jagdish Bhalla, J. on 20-04-2005 observed:
They are final year students of M.B.B.S. Course at B.R.D. Medical College, Gorakhpur. The main substance of the writ petition is that the Post Graduate courses of the said Medical College have been substantially de-recognized by the Medical Council of India but this fact notwithstanding, admissions are going on in these Colleges and the Post Graduate Medical Courses even now.
Some other Colleges are also named in the petition like Maharani Laxmi Bai Medical College, Jhansi and S.N. Medical College Agra. As for as we have been able to gather today, these colleges are not legal personalities and are not Bodies Corporate. These are basically State instrumentalities. The State also appears to have issued directives to at least the B.R.D. medical College, Gorakhpur, not to admit students and not to recognize students to Post Graduate Courses.
We are told that a writ petition has also been filed in the Delhi High Court (since the Medical Council is in Delhi) and that in the said writ, orders have been passed calling for reports and for bettering of facilities and that the matter is due to be heard again on the 28th of this month (28-04-2005).
Court’s Views:
Supreme Court has already said as under: [R-5]
Judges comprising of M.M. Punchhi, C.J.I., K.T. Thomas and D.P. Wadhwa, JJ. Observed in 1998:
“The Indian Medical Council Act, 1956 has constituted the MCI as an expert body to control the minimum standards of medical education. It has implicit power to supervise the qualifications or eligibility standards for admission into medical institutions. Thus, there is an overall invigilation by the Medical Council to prevent sub-standard entrance qualifications for medical courses”. [Para 8] [R-2, 5]
Any University or medical institution in India, which grant a medical qualification not included in the First Schedule may apply to the Central Government to have such qualification recognized, and the Central Government, after consulting the MCI, may, by notification in the Official Gazette, amend the First Schedule so as to include such qualification therein. [Para 10] [R-2]
Entry 25, List III relating to education including technical education, medical education and universities has been made subject to the power of Parliament to legislate under Entries 63 to 66 of List I. Entry 66, List I and Entry 25, List III should, therefore, be read together. Entry 66 gives to Union to see that a required standard of Higher Education including scientific and technical should not be lowered at the hands of any particular State or States. Secondly, it is the exclusive responsibility of the Central Government to co-ordinate and determines the standards for Higher Education. That power includes the power to evaluate, harmonize and secure proper relationship to any project of national importance. It is needless to state that such a co-ordinate action in higher education with proper standards is of paramount importance to national progress. It is this national interest; the legislative field in regard to ‘education’ has been distributed between List I and List III of the Seventh Schedule. [Para 14] [R-2]
The Court also referred to an earlier decision [R-6] where, as noted in that case, this Court said Regulation II was directory and did not have any mandatory force. Whether a Regulation is directory or mandatory will depend upon the language used in the Regulation and object of the Act it seeks to achieve. [Para 22][R-2]
Mr. Rama Jois, appearing for J.N. Medical College, Belgaum, respondent No. 16, submitted that if the State or the University has fixed intake for admission to medical college as on June 1, 1992 that would continue to hold good unless the medical college asks for increase. He said that even if the Medical Council had passed production (sic) of the seats existing on June 1, 1992 it could do so only after notice and after hearing the medical college. He submitted that in the letter of the Central Government to the Secretary, Medical Council, which is dated January 19, 1994, clarification was given as to the word “established” mentioned in Section 10 A of the Medical Council Act, as amended. In this letter the opinion of the Ministry of Law, Justice and Company Affairs (Department of Legal Affairs) was communicated, which was to the following effect:
“The provisions of Section 10 A of the IMC (Amendment) Act, 1993 will not apply to those colleges who have obtained all necessary statutory / administrative approvals from the respective authorities and where admission procedure was commenced prior to June 1, 1992. This would imply that all those Medical Colleges who have started the admission procedure prior to 01-06-1992 after taking the following permission, will be outside the purview of ‘Amendment’ Act:
(i) Permission of the concerned State Government.
(ii) Affiliation of the concerned University.
This would also apply to cases of increase in admission capacity in Medical Colleges and starting of new Post Graduate Medical Courses”. [Para 23]
There were further answers to quarries raised by the MCI in this letter, which should that Section 10A would not be applicable in case admission procedure was commenced prior to June 1, 1992. [Para 24] R-2, 7]
Directions issued by The MCI in its letter dated November 21, 1994 to the State Government, copies of which were also sent to the Director of Medical Education and to the Principal and Dean of the Medical Colleges inviting their attention to the provisions of Sections 10 A, 10B and 10C of the medical Council Act which amendment came into effect from August 27, 1992. [Para 27]
A direction, therefore, was issued to take corrective steps and to reduce the excess number of admissions being made in medical colleges in the State to the number as approved by the MCI. By letter dated August 24, 1995, the Central Government informed the State Government that if there was any proposal to increase the admission capacity college-wise to the Central Government. Since there was no response to the request made by the MCI to reduce the admission capacity to that fixed by the Medical Council, it requested the Central Government by its letter dated August 20, 1996 for taking penal action under Section 19 of the MCI Act for the purpose of de-recognizing the medical qualifications granted by the Universities in the State. [Para 27]
Until further orders of the Court the respondents, their servants, officers and agents, the respective colleges including B.R.D. Medical College, Gorakhpur, and their Principles, Professors, employees and servants are restrained from taking any steps towards any fresh admission of any medical student to any course or seat which is not at the time of admission recognized by the Medical Council of India. [R-1]
It is not that only future admissions will have to be regulated on the basis of capacity fixed by or determined by the Medical Council. Plea of the State Government that power to regulate admission to medical college is prerogative of the State has to be rejected.
It is the Medical Council, which is primarily responsible for fixing standards of medical education and over seeing that these standards are maintained. It is the Medical Council, which is the principal body to lay down conditions for recognition of medical colleges, which would include the fixing of intake for admission to a medical college. The Medical Council Act is reliable to Entry 66 of List 1 of Schedule 7 to Constitution.
Judges N.M. Kasliwal, J., and M.M. Punchi, J. delivered a decision on dated: April 26, 1991
These appeals by Dr. Arun Kumar Agarwal (appellant) and the State of Bihar are directed against the judgment of the Patna High Court dated 20th December 1990. The dispute relates for an appointment on the Post of Assistant Professor in Neurosurgery in the Patna Medical College and Hospital, Patna in pursuance to an advertisement dated 19-12-1987. The Selection Committee prepared a Panel on 04-07-1988, which was approved by the State Government on 26-09-1988.
It was also stated that the course of M.Ch. in Neurosurgery was being run only in the Rajendra Medical College, Ranchi, which the State Government recognized, and, therefore, the allegations of the writ petitioner (Respondent No. 5) that the degree obtained by the appellant was not recognized, was baseless and incorrect.
The controversy has been raised before us that the M.Ch. Degree course in Neuro Surgery awarded by Rajendra Medical College, Ranch University is not yet recognized for the purpose of Indian Medical Council Act, 1956 and a letter of Medical Council of India dated 27-02-1991 has been placed on record in this regard. Learned counsel for the respondent No. 5 has tried to contend that M.Ch. degree obtained by the appellant was of no value, as the Medical Council of India has not recognized the same so far. We find no force in this contention, as the Ranch University started this course in 1980 with the consent of the Medical Council of India and the State of Bihar has recognized such degree imparted by the Ranchi University and even before this Court learned counsel appearing for the State of Bihar accepted this position. We are not concerned in this case about the value of such degree for places outside State of Bihar, but so far the present case is concerned which relates to the post of Assistant Professor in Patna Medical College and Hospital, Patna which post is under the Bihar Government, no such objection can be maintained by the Respondent No. 5.
Though the High Court on one stage held that a candidate for Assistant Professor in Neuro Surgery must have a postgraduate degree in Neuro Surgery and having held that the degree of Neuro Surgery of the appellant was recognized and valid, yet committed a serious error in giving preference to respondent No. 5, which was having a degree of M.S. in General Surgery over the appellant who was holding much higher degree of M. Ch. in Superspecialty in Neuro Surgery itself. The High Court further committed an error in holding that Clauses 2 & 3 of the advertisement did not evolve any distinction of specialty, parent specialty and superspecialty. A mere perusal of the said clauses would show that clauses 2 (c) and 3(c) does talk of parent specialty and superspecialty. The finding of the High Court in this regard was clearly erroneous. Clause 3 (c) carved out an exception in favour of superspecialty vis-à-vis experience and, therefore, clause 3 clearly speaks about superspecialty. The High Court in our view committed a further error in not appreciating clause 19 in its correct perspective. Clause 19 envisaged that preference would be given to a person who had a degree in superspecialty along with research or working experience. Thus the appellant having a degree in superspecialty and also having preference in the matter of appointment to the post of Assistant Professor in Neuro Surgery over respondent No. 5 who did not have a degree in superspecialty.
The State Government has also taken a clear stand that there was an acute shortage of qualified Neuro Surgeons in the State and therefore, the Government had provided certain relaxations and priorities in the criteria for appointment to junior teaching posts in various Medical Colleges of Bihar, so that such candidates could be appointed. The appellant had been given preference by virtue of his having M.Ch. degree in Neuro Surgery with research work and working experience. The State Government has further stated that appellant is qualified Neuro Surgeon and has been rightly appointed as Assistant Professor of Neuro Surgery vide Notification No. 1144 (17) dated 28-12-1990 and the appellant joined the said post on 28-12-1990 itself. [R-3]
Thus taking in view the entire scheme of the degree and the relevant clauses of the advertisement, we are clearly of the view that appellant was rightly put in the Select Panel at NO. 1 and the Government of Bihar rightly appointed him on the post of Assistant Professor of Neuro Surgery. [R-3]
Judges A.D. Koshal, J., R.B. Mishra, J. and V. Balakrishnana Eradi, J. obsereved:
--Rajasthan University Ordinance – Ordinance 65 (vii) – Post-graduate medical degree granted by a University duly established by statute in this country which has also recognized by the Indian Medical Council – Ipso facto to be regarded, accepted and treated as valid throughout our country – In absence of any express provision to the country, such a degree does not require to be specifically recognized by other Universities in any State in country before it can be accepted as a valid qualification for the purpose of appointment to any post in such a State be accepted as a valid qualification for the purpose of appointment to any post in such a State. [R-4]
Rajasthan University Ordinance – Ordinance 65 (vii) (occurring in chapter XX of the Handbook of the University of Rajasthan, Part II, Vol. 1) – When the University does not conduct any examination for the award of the degree of M.D. (Forensic Medicine), there cannot be any question of declaration of ‘equivalence’ in respect of such a degree awarded by any University. [R-4]
This appeal by special leave arises out of a writ petition filed by the appellant herein in the High Court of Rajasthan, challenging the legality of the action of the Rajasthan Public Service Commission in issuing to the appellant the communication – Annexure IV – dated July 21, 1973, stating that the appellant was not eligible for being considered for recruitment to the post of Lecturer in Forensic Medicine in the Government Medical College in the State since he lacked the necessary academic qualifications specified in the advertisement and that consequently, the application of the appellant stood rejected. There were also other incidental prayers in the writ petition for the issuance of an appropriate writ or direction to the Public Service commission to refrain from finalizing the selection without considering the case of the appellant, and for a direction being issued to the State Government of Rajasthan not to accept the recommendations of the Public Service Commission in making appointments to the post of Lecturer in Forensic Medicine to Medical Colleges in Rajasthan in case the appellant was not called for interview along with the other candidates.
A learned Single Judge of the High Court allowed the writ petition holding that the Public Service Commission had acted illegally in treating the appellant as not possessing the requisite academic qualifications and rejecting his candidature for the post of Lecturer in Forensic Medicine. The State of Rajasthan and the Public Service Commission carried the matter in appeal before a Division Bench of the High Court. That a Division Bench allowed appeal by its judgment dated October 30, 1974, whereby the appellant was dismissed. Aggrieved by the said decision, the appellant has preferred this appeal after obtaining special leave from this Court. [Para 2][R-4]
On March 3, 1972, the Rajasthan Public Service Commission (for short, ‘the Commission’) issued advertisements inviting applications for the recruitment of two Lecturers in Forensic Medicine for Medical College, Medical & Public Health Department in accordance with the Rules. [Para 5] [R-4]
The sole ground on which the appellant was treated by the Commission as ineligible for consideration was that the post-graduate degree in Forensic Medicine possessed by the appellant is not one awarded by the University of Rajasthan and the said degree has also not been recognized by the University of Rajasthan as an equivalent qualification.
The University of Bihar at Muzzafarpur is one duly established by statute and is fully competent to conduct examinations and award degrees. The degree of Doctor of Medicine (Forensic Medicine) M.D. (Forensic Medicine) of The University of Bihar is included in the Schedule to the Indian Medical Council Act, 1956 as a degree fully recognized by the Indian Medical Council which is the paramount professional body set up by statute with authority to recognize the medical qualifications granted by any University or Medical Institution in India. [Para 11] [R-4]
The appellant had, by then, obtained the M.D. degree in Forensic Medicine from the University of Bihar, Muzaffarpur in 1970 and had been functioning as Lecturer in Forensic Medicine in one of the Government Medical Colleges in Rajasthan on a temporary and adhoc basis from December 31, 1970 onwards. [Para 6] [R-4]
Possible Solutions:
A medical student requires grueling study and that can be done only if proper facilities are available in a medical college and hospital attached to it has to be well equipped and teaching faculty and doctors have to be competent enough that when a medical student comes out he is perfect in the science of treatment of human beings and is not found wanting in any way. Country does not want half-backed medical professionals coming out of medical colleges when they did not have full facilities of teaching and were not exposed to the patients and their ailments during the course of their study. The Medical Council in all fairness, does not wish to invalidate the admissions made in excess of that fixed by it and does not wish to take any action of withdrawing recognition of the medical colleges violating the regulation. Henceforth, however, these medical colleges must restrict the number of admissions fixed by the Medical Council. Any medical college or institution which wishes to increase the admission capacity in M.B.B.S. / higher courses (including Diploma / Degree / Higher Specialties) has to apply to the Central Government for the permission along with the permission of the State and that of the University with which it is affiliated and in conformity with the regulations framed by the Medical Council. Only the Medical Colleges or Institution, which is recognized by the Medical Council, can so apply. [Para 30] [R-2]
Summary and Conclusions:
To say that the number of students as permitted by the State Government and or University before June 1, 1992 could continue would be allowing an illegality to perpetuate for all time to come. [Par 31, 32] [R-2]
A Post-graduate medical degree granted by a University duly established by statute in this country which has been also recognized by the Indian Medical Council – Ipso facto to be regarded, accepted and treated as valid throughout our country. [R-4]
Having thus held that it is the Medical Council, which can prescribe the number of students to be admitted in medical courses in a Medical College or Institution, it is the Central Government, alone which can direct increase in the number of admissions but only on the recommendation of the Medical Council. [Para 31] [R-2]
Standards have been laid by the medical Council, an expert body, for the purpose of imparting proper medical education and for maintaining uniform standard of medical education throughout the country. Seats in medical colleges cannot be increased indiscriminately without regard to proper infrastructure as per the Regulations of the Medical Council. [Papa 29] [R-2]
Regulations framed under – Falling within the purpose mentioned in Section 33 – will have mandatory force. [Medical Council Act, 1956 (Act 102 of 1956), S. 33]
References:
R-1-Om Prakash and Others V. State of U.P. and Others, Writ Petition No. 1563 (M/B of 2005 In the Hon’ble High Court of Judicature at Allahabad, Lucknow Bench, Lucknow.
R-2-Medical Council of India v. State of Karnataka and Others, AIR 1998 SC 2423.
[Civil Appeal Nos. 3275 with 3576-77 of 1998 (arising out of S.L.P. (C) Nos. 14839 of 1997 with 20035 of 1997 and 547 of 1998), D/-16-07-1998. W.A. No. 8413 of 1996, dated 16-07-1997 (Kant.) GP/GP/S100261/98/VVG/CSL]
News papers references.
R-3-Dr. Arun Kumar Agarwal v. State of Bihar & Others, A.I.R. 1991 S.C. 1514; J.T. (1991) 2 S.C. 352. State of Bihar & Others V. Dr. Chandra Mohan Jha & Others, A.I.R. 1991 S.C. 1514; J.T. (1991) 2 S.C. 352.
R-4-Dr. B.L. Asawa v. State of Rajasthan and Others, Civil Appeal No. 303 of 1976 (Appeal by special leave from the Judgment and Order dated October 30, 1974 of the Rajasthan High Court in D.B. Civil Appeal No. 247 of 1974), decided on March 5, 1982.
Rajasthan Medical Service (Collegiate Branch) Rules, 1962 – Rule 12 - Rajasthan University Ordinance – Ordinance 65 (vii), Rajasthan University Act –Section 23-A.
1982 (1) LLN 582: 1982 (1) SLJ 416: 1982 (1) SLR 677: 1982 (1) Scale 22: 1982 (1) SCR 444: 1982 (44) FLR 308: 1982 (022) SCC (0055): 1982 AIR (SC) 933: 1982 LIC 614.
[R-5] State of Kerala v. Kumari T.P. Roshana (1979) 1 SCC 572: (AIR 1979 SC 765 at p. 771)
[R-6] Nivedita Jain’s CASE 91981) 4 SCC 296: (AIR 1981 SC 2045).
R-7- K.P. Varghese v. Income TAX officer, Ernakulam, (1981) 4 SCC 173: (AIR 1981 SC 1922).
Medical Council Act, 1956 (Act 102 of 1956), Ss. 10-A, 10-B, 33.
Karnataka Education Institutionals (prohibition of Capitation Fees) Act (1984), S. 4.
Karnataka State Universities Act, 1976 (Act 28 of 1976), S. 53 (10).
Dentists Act, 1948 (Act 16 of 1948), S. 10-A.

2 comments:

drjunejanitin said...

Dear Sir,
I am congratulating you on starting this blog...This is one of the hot topic of the day...Poor unorganised doctors are suffering from insensitivity of govts..MCI and spoiling there talent and fate..Hope other like minded people will join your forum and make a useful data bank to fight against injustice to doctors...

With Regards,
Dr Nitin Juneja

Anonymous said...

dear sir,
i agree totally with what u have written above.its actually a crime that is silently going on and on and no body is held responsible , no body is punished and this will continue till someone takes unexpected step.
dr ketan shah