By Arya Awasthi, Lex Maven –

In light of the Supreme Court’s recent judgment in the matter of The National Medical Commission vs Pooja Thandu Naresh & Ors. in Civil Appeal Nos. 2950-2951 of 2022 (arising out of SLP (Civil) Nos. 2536-2537 of 2022) has said unequivocally that the National Medical Commission is not obligated to offer temporary registration to a student who has not finished the whole course period from the Foreign Institute, including clinical training.

The Supreme Court has also said unequivocally that awarding temporary registration to finish an internship to a student who has not completed clinical training would jeopardize the citizens’ health and the health system at large. It was also made apparent that the National Medical Commission’s refusal to award temporary registration cannot be described as arbitrary, and that the Screening Regulations provide no evidence of the students’ clinical experience, if any. The court decided whether a foreign institute’s degree, even if it is for clinical training, is obligatory on the NMC and if the student must be provisionally registered.

Brief Facts of the case :

After passing the eligibility exam, the student was admitted to medical colleges in the People’s Republic of China under the “Eligibility Requirement for Taking Admission in an Undergraduate Medical Course in a Foreign Medical Institution Regulations, 2002.” The students claim that they have completed nine semesters of academic coursework, including clinical training on campus. However, because to the COVID-19 pandemic, clinical training for the disciplines of ophthalmology, otorhinolaryngology, and nuclear medicine in the 10th Semester was conducted online, and they were awarded the degree of Bachelor of Medicine and Bachelor of Surgery (MBBS) after qualifying in all subjects as per the teaching plan through May 2020 by the Foreign Institute.

According to the student, several of her classmates were awarded provisional registration by the Tamil Nadu Medical Council, but she was denied, prompting a slew of writ petitions to the High Court. The argument is that, because she has been deemed qualified by a foreign institute, the sole condition for provisional registration is that she pass the Screening Test under the Screening Test Regulations, 2002, Which she did pass, As a result, the statute criteria is met when combined with the Screening Regulations. As a result, the Medical Council’s refusal to grant interim registration is not legally justifiable.

Some of the statutory provisions of the Act relevant for the purpose of the present appeals read thus:

“13. (4-A) A person who is a citizen of India and obtains medical qualification granted by any medical institution in any country outside India recognised for enrolment as medical practitioner in that country after such date as may be specified by the Central Government under sub-section (3), shall not be entitled to be enrolled on any Medical Register maintained by a State Medical Council or to have his name entered in the Indian Medical Register unless he qualifies the screening test in India prescribed for such purpose and such foreign medical qualification after such person qualifies the said screening test shall be deemed to be the recognised medical qualification for the purposes of this Act for that person.

(4-B) A person who is a citizen of India shall not, after such date 4 as may be specified by the Central Government under subsection (3), be eligible to get admission to obtain medical qualification granted by any medical institution in any foreign country without obtaining an eligibility certificate issued to him by the Council and in case any such person obtains such qualification without obtaining such eligibility certificate, he shall not be eligible to appear in the screening test referred to in subsection

(4-A): Provided that an Indian citizen who has acquired the medical qualification from foreign medical institution or has obtained admission in foreign medical institution before the commencement of the Indian Medical Council (Amendment) Act, 2001 shall not be required to obtain eligibility certificate under this sub-section but, if he is qualified for admission to any medical course for recognised medical qualification in any medical institution in India, he shall be required to qualify only the screening test prescribed for enrolment on any State Medical Register or for entering his name in the Indian Medical Register.”

The medical body had filed an appeal against the high court’s orders quashing the Tamil Nadu Medical Council’s circulars requiring students to complete two months of mandatory rotatory residential internship, followed by one year of internship, before being granted permanent registration under the Indian Medical Council Act, which has since been repealed by the National Medical Commission Act, 2019.

Not Granting Provisional Certificate

The students stated that they were qualified doctors who had passed the Indian Screening Test. Despite this, the NMC denied them temporary registration. They did admit, however, that they had not undergone typical practical or clinical training, instead of completing the course solely online. This, it was contended, meets the requirements of Regulation 4(3) of the Screening Regulations. A student must complete his or her medical study at the same institute overseas for the “entire duration,” according to the Regulations. It was also stated that clinical training could not be offered online since it involves the diagnosis and in-person interaction with the patients.

Mr. S. Nagamuthu, learned senior counsel for the respondent-student argued that the Tamil Nadu Medical Council’s move is arbitrary and discriminatory because certain students have been given temporary registration not only by the Tamil Nadu Medical Council, but also by the Medical Councils of several states. As a result, denying a student provisional registration causes heartburn in the student who has not been given provisional registration. It was further argued that, according to Note V(2), the Screening Regulations give the candidate the option of completing his practical training/internship in the nation where he obtained the Foreign Medical Qualification or in India. The relevant section of the Note is as follows:

(2) Further Regulation 2{c) read with 2(e) of the Eligibility Requirement For Taking Admission in an Undergraduate Medical Course in a Foreign Medical Institution Regulations, 2002 and similarly, Regulation 2(c) read with 2(g) of the Screening Test Regulation, 2002, further grants an opportunity to the candidate to either complete his practical training I internship in the Country ‘from where he has acquired the Foreign Medical Qualification or in India. This is further clarified by Regulation 11 of the Screening Test Regulation, 2002.

The National Medical Commission vide its notice dated 30.09.2020. allowed Indian Medical Graduates to undergo only online classes of theory subjects which shall be supplemented by practical and Clinical training in physical form as per the MBBS Curriculum as and when the Medical Colleges gets re-opened. In order to bring Foreign medical Graduates at par with Indian Medical Graduates, the Candidates are required to reproduce Certificate of successful completion of theory as well as practical and Clinical training during the course of MBBS having being done in physical form in the Medica~ University and its affiliated Hospital.”

The Apex court disagreed with the Madras High Court’s decision, which indicated that instead of three months of clinical training in China, two months of training would suffice for provisional registration, in addition to the 12-month internship. The Panel stated “The courts are not experts in deciding an academic curriculum or the clinical training requirements that may be demanded of students,”

Though the pandemic forced students to return to India before finishing their clinical training abroad, the Court determined that they could not be registered without practical experience.

The Supreme Court further said that while the Covid-19 pandemic has undoubtedly presented new challenges to the globe, including Indian medical students from foreign institutions, granting them provisional registration to complete internships without completing clinical training would put the health of citizens and the health infrastructure at large at risks and in unsafe hands. 

On behalf of the NMC, Senior Advocate Vikas Singh testified that many students are suffering as a result of the Russia-Ukraine crisis War and pandemic and that their interests must be safeguarded without jeopardizing educational quality. A bench of Justices Hemant Gupta and V Ramasubramaian took into account the statement made and issued instructions to NMC. Which says:

• 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 National Medical Commission for a limited duration as may be specified by the National Medical Commission, on such charges which the National Medical Commission determines.

• It shall be open to the National Medical Commission to test the candidates in the scheme so framed in the manner within the next one month, which it considers appropriate to satisfy that such students are sufficiently trained to be provisionally registered to complete an internship for 12 months.

The top court ruled that the NMC’s refusal to give interim certificates to Pooja Thandu Naresh and others was not unreasonable since no doctor can be expected to care for the country’s residents without actual training.

The court said that “The argument that certain students have been granted provisional registration will not confer any right with the student to claim provisional registration so as to undergo the internship. There cannot be any equality in illegality,”

Conclusion

Students are the most valuable asset of the nation which could not be wasted, as it would have an impact on the lives of young students who had enrolled at foreign institutes as part of their career plans. As a result, Students’ skills and education should supplement the country’s health infrastructure. Thus, the students must complete genuine clinical training of such duration and at such institutes as the National Medical Commission may identify, and on such terms and circumstances, including the fees for providing such training, as the National Medical Commission may notify. With this remarkable judgment, The apex court maintained a perfect balance between the interest of students as well as ensuring the quality of medical services in India.