Sunday, September 8, 2013

Quality of Medical Education: Supreme Court’s Concern in Judgment dated 6th September 2013

Quality of Medical Education: Supreme Court’s Concern in Judgment dated 6th September 2013
Division Bench of Hon’ble SC shows its anguish in following words:
We think, this is an apt occasion to ponder over whether we have achieved the desired goals, eloquently highlighted by the Constitution Bench judgments of this Court in T.M.A. Pai Foundation and  Others  vs. State of Karnataka and others  (2002) 8 SCC 481 and P.A.  Inamdar andOthers vs. State of Maharashtra and others (2005) 6 SCC 537.  TMA Pai Foundation case (supra) has stated that there is nothing wrong if the entrance test being held by self financial institutions or by a group of institutions but the entrance test they conduct should satisfy the triple test of being fair, transparent and not exploitative.  TMA Pai Foundation (supra) and Inamdar (supra) repeatedly stated that the object of establishing an educational institution is not to make profit and imparting education is charitable in nature. Court has repeatedly said that the common entrance test conducted by private educational  institutions  must  be  one  enjoined  to  ensure   the fulfillment  of  twin object  of  transparency and merits  and  no capitation fee be  charged  and  there  should  not  be  profiteering. [Para 38
Facts, however, give contrary picture.  In Inamdar, this Court, in categorical terms, has declared that no capitation fee be permitted to be charged and no seat can be permitted to be appropriated by  payment of capitation fee. [Para 38]
The CBI’s investigation, however,  reveals  a  sorry  state  of  affairs, which  is  an  eye-opener  for  taking  appropriate  remedial measures in future so that medical  education  may  attain  the  goals envisaged by the IMC Act and the Regulations and serve the  community.  CBI had to charge-sheet none other than the then Union Minister of Health and Family Welfare, itself which depict how the educational system in this country is deteriorating. Many of regulatory bodies like MCI, AICTE, UGC etc. were also under serious clout in the recent years. CBI, in the year 2010, had to arrest the President of the MCI for accepting bribe to grant recognition to one Medical College in Punjab.  Later, it is reported that the CBI found that the President of the MCI and its family members possessed disproportionate assets worth of 24 crores.  We have referred to these instances  only  to indicate the falling  standards  of  our  educational  system  at  the highest level, sometime even at the level of  the  Central  Government making a serious inroad  to  the  right  to  life  guaranteed  to  the citizens of the country under Article 21 of the Constitution of India. [Para 39]
Mushrooming of large number of medical, engineering, nursing and pharmaceutical colleges, which has definitely affected the quality of education in this country, especially in the medical field which call for serious introspection. Private medical educational institutions are always demanding more number of seats in their colleges even though many of them have no sufficient infrastructural facilities, clinical materials, faculty members, etc. Reports appear in every now and then that many of the private institutions which are conducting medical colleges are demanding lakhs and sometimes crores of rupees for MBBS and for post-graduate admission in their respective colleges. [Para 40]
                Recently, it is reported that few MBBS seats were sold in private colleges of Chennai.  We cannot lose sight of the fact that these things are happening in our country irrespective of the constitutional pronouncements by this Court in TMA Pai Foundation that there shall not be any profiteering or acceptance of capitation fee etc. Central Government, Ministry of Health and Family Welfare, Central Bureau of Investigation or the Intelligence Wing have to take effective steps to undo such unethical practices or else self-financing institutions will turn to be students financing institutions. [Para 40]
We notice that the current policy of the Central Government in the higher education is to provide autonomy of institutions, but adoption of unfair practices is a serious violation of the  law.  Few States, like Karnataka, Tamil Nadu, Andhra Pradesh, Maharashtra, Kerala, Delhi etc. have  passed  some legislation to  prohibit demand/collection  of  capitation  fee  which  have  no  teeth, the institutions who indulges in such practices can  get  away  by  paying some fine, which is meager. [Para 41]
Need for Parliamentary Legislation for curbing unfair practices:
We, therefore, emphasise the extreme necessity of a Parliamentary Legislation for curbing these unfair practices, which is the demand of our society. “The Prohibition of Unfair Practices in Technical Educational Institutions, Medical Educational Institutions and University Bill, 2010” has already been presented to both the Houses of Parliament. It is reported that the States have welcomed such a legislation, but no further follow up action has been taken. We are confident, earnest efforts would be made to bring in proper legislation, so that unethical and unfair  practices  prevalent  in higher technical and medical institutions can be effectively curbed in the larger public interest. [Para 42]
·         K.S. Radhakrishnan, J., A.K. Sikri, J. Rohilkhand Medical College & Hospital, Bareilly vs. Medical Council of India & Another, Writ Petition (Civil) No.585 of 2013, Date of Judgment: September 06, 2013,


Unethical Practice where and how happening and destroying Quality of Medical Education in India

Need for Awareness about unethical Practices by the Private Medical Colleges
Unethical Practice where and how happening and destroying Quality of Medical Education in India
Hon’ble SC in a recent case Rohilkhand Medical College & Hospital, Bareilly vs. Medical Council of India & Another, made following observation which are important to know why Quality of Medical Education in India deteriorated and Faculty Members have been exploited or indulged in unethical practices. This awareness is important to prevent such practices in future.
SC Observations:
SC observed that we  have  noticed  that  the  Central  Government  had  accorded approval for 3rd batch of 100 students for the academic year 2008-09 on 26.09.2008, despite the repeated negative recommendations  made  by the MCI and before the grant of permission on 26.09.2008, the MCI  was not even consulted.  We have indicated the facts to show the situation that prevailed in the year 2008-09 and the manner in which permission was accorded for intake of 100 students by the Central Government. [Para 17]
The MCI, following its decision taken on 04.06.2013, vide its letter dated 20.06.2013 decided to convey its approval for renewal of permission for admission for the second batch of MBBS students against the increased intake i.e. from 100 to 150 seats to the College for the academic year 2013-14. The approval was granted taking into consideration of the assessment report dated 26/27-02-2013 submitted to the Board of Governors of MCI subject to certain conditions which are extracted herein below:
“I am further directed to inform that you and your institution are fully responsible to fulfil and maintain norms including the infrastructure both physical and human resource, teaching faculty and clinical material, etc. throughout the  academic  year, as stipulated in Regulation of Medical Council  of  India. In case false/wrong declaration or fabricated documents  have been used for procuring permission of the Board of Governors for the increased intake and  the  said  misconduct  is  brought  to notice or comes to the knowledge of MCI at any stage during the current academic year, your institution is not liable  to  be considered for renewal of permission against  increased  intake for the next  academic year and  this  renewal  of  permission against the increased intake for the next academic year and this renewal of permission against the increased intake is also liable to be revoked for current academic year. Besides, MCI is entitled to take all such measures against you and your college/ institution as permissible under the law.” [Para 19]
Unethical practices: Capitation Fees
We may notice with concern the unprecedented growth of the Technical and Medical Institutions in this country which has resulted in widespread prevalence of various unethical practices. Collection of large amount by way of capitation fee running into crores of rupees for MBBS and Post-Graduate seats, exorbitant fee,  donation  etc,  by many of such self financing institutions,  has  kept  the  meritorious financially poor students away from those institutions.  Pressure, it  is also seen, is being  extended  by  various  institutions,  for  the additional intake of students, not  always  for the  benefit  of  the student community and thereby serve the community, but for  their  own  betterment. [Para 24]
We are not commenting upon the acceptability, or otherwise, of the charges leveled against the Minister, bureaucrats or the Chairman of the College.  But the fact remains, the CBI after conducting an investigation had to charge-sheet them under Section 120B, 468, 471 IPC and Section 13(2) read with Section 13(1)(d) of the PC Act. CBI’s investigation prima facie establishes the criminal conspiracy between the Chairman of the College and the then Union Minister of Health and Family Welfare, Government of India, New Delhi along with the then Deputy Secretary, Ministry of Health and Family Welfare, New Delhi, two doctors, one is the head of Nephrology  VMMV and Safdarjung Hospital and  the other  is  Professor of Department of Community Medicine, VMMC and Safdarjung Hospital, New Delhi which  lead  to  the issuance of the order passed for the additional intake of 50  students for the academic year 2008-09 on 26.09.2008. For the prosecution of both the doctors necessary prior sanction was obtained from the competent authority by the CBI. [Para 25]
The CBI, in its charge-sheet, points out serious infirmities in the  report  submitted  by  the  central  team,  which  conducted  the  inspection of the College on 25.09.2008, which are as follow:
“The above chart clearly proves that accused Dr.Vindu Amitabh and accused Dr.S.K. Rasania were party to the larger conspiracy and they deliberately by way of limiting the shortage of faculty to 2% in their report; had glossed over the glaring deficiencies in the strength of the faculty members (15% i.e. 17 out of  115) and  thereby,  facilitated the private College in getting  permission of the Central Govt. [Para 26]
Their involvement in the criminal conspiracy is further established by the fact that during the inspection they did not ask the faculty members as to whether they (faculty members) were full timers or part-timers/merely called to make up the members for the purpose of inspection. The investigation has established that at least 5 doctors, namely, Dr.Harbeer Singh Sodhi, Dr.Anil Madan, Dr.Birendra Kumar Sinha, Dr.Jamaludin and Dr.Shiv Nath Banerjee, who have been shown as full time faculty members and residents in the records of Rohilkhand Medical College, Bareily during 2008, have confirmed that they had never worked as full-timers in the said College during 2008, but were rather, visiting faculty. These facts prove that the inspection report of accused Dr.Vindu Amitabh and accused Dr.S.K. Rasania was perfunctory and biased in favour to the private Medical College. [Para 26]
The investigation further disclosed that accused Dr.Vindu Amitabh and accused Dr.S.K. Rasania have claimed to have done personal inspection of the -wards and the departments. In their inspection report, they mentioned that the presence (of patients in the OPDs of all Departments was good, the bed occupancy was about 90% and that the ICU was full to its capacity. However, during the investigation, physical verification of 14 patients, who were shown present in the OPD registers on the date of inspection, i.e. 25.09.2003, was got conducted through the Postal Deptt. on the random basis. It was revealed that 09 of them were fake or non-existent.  The claim of the accused doctors of the Central Team of having done personal inspection of the  wards  and  the departments, which was one of the  important  criteria,  on  the basis of which they gave a green signal  to  the  College,  thus turns out to be devoid of merit and a falsehood. [Para 26]
Fake and forged Documents:
The investigation further revealed that the Central Team comprising of accused Dr. Vindu Amitabh  and  accused Dr.S.K. Rasania  has  stated  in  its  report  that  it  accepted  the photocopies of the declaration  forms,  submitted  to  MCI,  for verification.  During the investigation, it  has  been  revealed that declaration forms are provided by the College concerned, include details  of  all  faculty  members,  their  educational qualification,  appointment  letter,  identification documents (like PAN card, etc.) documents in support of their residence in the Medical College (like ration card, in order to certify their being permanent faculty members there). [Para 26]
Visiting Faculty used for MCI Inspection:
During the investigation, 5 so called faculty members (Dr.Harbeer Singh Sodhi, Dr. Anil Madan, Dr. Birendra Kumar Sinha, Dr.Jamaludin and Dr. Shiv Nath Banerjee) have stated that they used to be called only for the inspections of the said College. [Para 26]
They were at best, visiting faculty members.  Incidentally, the MCI rules have not provision for part-timers or visiting faculty members. Though the - said 5 doctors have owned their signatures on their Declaration Forms, they have denied receiving the appointment letters shown to be annexed with their respective declaration forms. They have also stated that the ration cards, residential certificates, Form-16 (Income Tax) etc. shown as having been issued in their names, were never given to them. Besides, it has been found that they are all bogus/fake and forged, as they (the doctors) were neither resident on the addresses shown in the records nor had they ever applied for any ration card. The District Supply Officer, Bareilly has denied their issuance and confirmed that the said ration cards are fake and forged.  It is pertinent to mention that the fake ration cards have been used by the College authorities to falsely establish before the MCI Inspectors that the said doctors were their permanent faculty members. Similarly no Form-16 was ever issued to them by the College. [Para 26]
The investigation further disclosed that in case of the aforesaid doctors, the appointment letters were issued in their name by the College authorities without their knowledge and the details of appointments do not even bear the signatures of their doctors/employees of the College in the acceptable column. This proves the fabrication and use of (forged) documents by the College authorities, for the purpose of obtaining the approval of Govt. of India on the recommendations of MCI/Central Team deputed by GOI.  However, the accused doctors i.e.  Dr.Vindu Amitabh and Dr.S.K. Rasania of the Central Team in pursuance of the criminal conspiracy did not confirm the genuineness of the documents put up by the College authorities and without verifying the documents accepted photocopies of the Declaration Forms and furnished a positive report in favour of the College on the very next day. It is pertinent to mention that despite mentioning about the presence -of such doctors, who were even practicing in Bareilly and the non-production of the  original  appointment  letters,  even when asked for, the said Central Team still went ahead to give clean chit to the College. ” [Para 26]
Capitation fees charged:
SC further added that we can also take judicial notice of the fact that many a times the medical colleges and engineering colleges and others are being established after availing large amounts by  way  of  loans  from the financial institutions and other borrowings, with no  funds  of  their own, and once the college gets approval and students  are  admitted,  loan availed of is being repaid from the capitation fee charged from the students and ultimately  that  amount constitute  their  capital. [Para 27]
Many a times, even without any sufficient facilities they put pressure on the various agencies and the Central Government and get approval overlooking the regulatory  authority,  like  MCI,  which  adversely affects the  quality  of  medical education  in  this  country.  For instance, the MCI has taken in the instant case a consistent view and sent negative reports to the Central Government, but overlooking all the reports submitted by the MCI, the Central Government got a  report of its own and granted permission vide its  letter  dated  26.09.2008. [Para 27]
CBI in its charge-sheet has categorically and clearly reported that this was done on the basis of bogus, fake and forged records. CBI noticed that the college authorities had produced fabricated  and  forged documents before the inspection team and  the  team  failed  to verify  the  correctness  or  otherwise  of  those   documents.  CBI investigation has revealed  that  fraud  has  been  practiced  by  the Central team as well as the college to get the sanction  for  the  3rd batch of MBBS students for the academic year 2008-09. [Para 27]
K.S. Radhakrishnan, J., A.K. Sikri, J. Rohilkhand Medical College & Hospital, Bareilly vs. Medical Council of India & Another, Writ Petition (Civil) No.585 of 2013, Date of Judgment: September 06, 2013,