1. Medical students qualifying from foreign institutions via online clinical training during pandemic seek provisional registration for internship under the Indian Medical Council Act. (Para 1 , 2 )
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2022 Supreme(SC) 385
SUPREME COURT OF INDIA
HEMANT GUPTA, V. RAMASUBRAMANIAN, JJ.
The National Medical Commission – Appellant
Versus
Pooja Thandu Naresh & Ors. – Respondents
Civil Appeal Nos. 2950-2951 of 2022 (Arising Out Of SLP (Civil) Nos. 2536-2537 of 2022)
Decided on : 29-04-2022
Advocates appeared:
For the Petitioner(s):Vikas Singh, Gaurav Sharma, Dhawal Mohan, Prateek Bhatia, Advocates
For the Respondent(s):Amit Anand Tiwari, AAG Joseph Aristotle S., Mary Mitzy, Devyani Gupta, Tanvi Anand, V. Ramasubramaniam, T. Harish Kumar, Navneet Dugar, Subham Kothari, M.P. Parthiban, K. K. Mani, T. Archana, Vinaj Rajput, Advocates
For the Petitioner(s):Vikas Singh, Gaurav Sharma, Dhawal Mohan, Prateek Bhatia, Advocates
For the Respondent(s):Amit Anand Tiwari, AAG Joseph Aristotle S., Mary Mitzy, Devyani Gupta, Tanvi Anand, V. Ramasubramaniam, T. Harish Kumar, Navneet Dugar, Subham Kothari, M.P. Parthiban, K. K. Mani, T. Archana, Vinaj Rajput, Advocates
IMPORTANT POINTS
(1) Grant of Medical Degree – National Medical Commission is not bound to grant provisional registration to student who has not completed entire duration of course from Foreign Institute including clinical training.
(2) Without practical training, there cannot be any Doctor who is expected to take care of citizens of country.
Headnote:
Eligibility Requirement for Taking Admission in an Undergraduate Medical Course in a Foreign Medical Institution Regulations, 2002 – Regulation 4(3) – Indian Medical Council Act, 1956 (Now repealed by National Medical Commission Act, 2019) – Grant of Medical Degree – Necessity of clinical training – Appellant is not bound to grant provisional registration to student who has not completed entire duration of course from Foreign Institute including clinical training – Pandemic has thrown new challenges to entire world including students but granting provisional registration to complete internship to a student who has not undergone clinical training would be compromising with health of citizens of any country and health infrastructure at large – Students had taken admission in medical colleges outside India for reason that they could not get admission in medical colleges in India – China alone has a number of Institutes offering medical courses conducted in English language – Act and Screening Regulations are framed in such a way that course completed by students is treated to be valid in India provided that medical qualification is recognised for enrolment of medical practitioner in that country – Medical course is permitted to be completed abroad to practice in India only on the basis of an endorsement that completion of such medical course entitles them to practice in said foreign country – Without practical training, there cannot be any Doctor who is expected to take care of citizens of country – Decision of appellant not to grant provisional registration cannot be said to be arbitrary – Argument that certain students have been granted provisional registration will not confer any right with student to claim provisional registration so as to undergo internship – There cannot be any equality in illegality – However, students were permitted to undergo medical course abroad and that they have completed their curriculum according to certificate granted by such Foreign Institute – Such national resource cannot be permitted to be wasted which will affect life of young students, who had taken admission in foreign Institutes as part of their career prospects – Services of students should be used to augment health infrastructure in the country – It would be necessary that students undergo actual clinical training of such duration and at such institutes which are identified by appellant and on such terms and conditions, including charges for imparting such training, as may be notified by appellant – Directions issued. (Paras 15, 16, 17, 19, 20, 22 and 25)
Facts of the case:
Present appeals are directed against orders dated 29.7.2021 and 20.9.2021 passed by the High Court of Judicature at Madras in the writ petitions filed for quashing the circulars issued by Tamil Nadu Medical Council on 12.11.2020 and 24.12.2020 and consequential orders of directing respondent No. 1/writ petitioner1 to undergo two months of Compulsory Rotatory Residential Internship, followed by one year of internship before granting permanent registration under Indian Medical Council Act, 1956 (now repealed by the National Medical Commission Act, 2019). Question to be examined is as to whether degree granted by Foreign Institute even in respect of clinical training is binding on the appellant and the student has to be provisionally registered.
Findings of Court:
The argument that if a student has a right, then such right can be enforced independent of the order passed by the courts is not tenable. Qualifying in the Screening Regulations is no proof of the clinical experience, if any, gained by the students. The Screening examination is based upon Optical Mark Reader (OMR) answers and has no correlation with any practical training. We do not find that in terms of the Screening Regulations, the students are entitled to the provisional registration.
Result : Appeals disposed of with directions.
Legal Category Hierarchy
Table of Contents
2. Whether online clinical training satisfies the requirement of studying for the entire duration at a foreign institute versus the necessity of physical training for registration. (Para 11 , 12 )
3. Clinical training is the backbone of medical education and cannot be substituted by online mode without compromising public health and safety. (Para 14 , 15 , 16 , 18 , 19 , 21 )
4. Provisional registration requires completion of the entire course duration, including clinical training, in physical form at the foreign institute to ensure medical competency. (Para 15 , 19 )
5. Appellant directed to frame a one-time scheme for clinical training and competency testing in India for similarly situated students before granting provisional registration. (Para 25 )
6. Does online clinical training satisfy the requirement of studying for the entire duration at a foreign institute for provisional registration?
No. The court held that clinical training involves diagnosis and patient interaction, which cannot be imparted online. Practical training is the backbone of medical education, and its absence means the requirement to study for the entire duration at the institute is not met. (Para 11 , 15 , 18 , 19 )
7. Does the grant of provisional registration to some similarly situated students entitle others to the same?
No. The court observed that there can be no equality in illegality. If registration was granted in violation of regulations, it does not confer a legal right on other students to claim the same. (Para 20 )
8. Does qualifying the Screening Test prove a candidate's clinical competence for provisional registration?
No. The court held that the Screening Test is based on Optical Mark Reader (OMR) answers and has no correlation with actual practical or clinical training gained by the students. (Para 21 )
9. How should the lack of physical clinical training due to the pandemic be addressed for foreign medical graduates?
To avoid wasting national resources, the court directed the framing of a one-time scheme allowing students to undergo actual clinical training in identified Indian medical colleges and pass a competency test before provisional registration. (Para 22 , 25 )
JUDGMENT :
HEMANT GUPTA, J.
1. The present appeals are directed against orders dated 29.7.2021 and 20.9.2021 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 on 12.11.2020 and 24.12.2020 and consequential orders of directing respondent No. 1/writ petitioner1[For short, the ‘student’] to undergo two months of Compulsory Rotatory Residential Internship, 2[For short, the ‘CRRI’] followed by one year of internship before granting permanent registration under the Indian Medical Council Act, 19563 [For short, the ‘Act] (now repealed by the National Medical Commission Act, 2019).
2. The brief facts leading to the present appeals are that the student and other similarly situated students after qualifying the eligibility test i.e. as per “The Eligibility Requirement for Taking Admission in an Undergraduate Medical Course in a Foreign Medical Institution Regulations, 20024[For short, the ‘Eligibility Regulations’] joined medical colleges in the People’s Republic of China, such as Qingdao University Faculty of Medicine5[For short, the ‘Foreign Institute’]. It is the stand of the students that they have undergone nine semesters of their academic course including clinical training on the campus. However, due to the outbreak of COVID-19 pandemic, the clinical training for the subjects of Ophthalmology, Otorhinolaryngology and Nuclear Medicine in the 10th Semester was done online and that they have been granted degree 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. According to the student, some of her fellow students have been granted provisional registration by the Tamil Nadu Medical Council but she has been declined such provisional registration which led to filing of number of writ petitions before the High Court. The argument is that since she has been declared qualified by the Foreign Institute, the only requirement before provisional registration is qualifying in the Screening Test in terms of the Screening Test Regulations, 20026[For short, the ‘Screening Regulations’]. As she has qualified such Screening Test, therefore, the condition in the statute read with the Screening Regulations stands satisfied. Hence, the decision of the Medical Council not to grant provisional registration is not justified in law.
3. The High Court in its order dated 29.7.2021 passed the following directions:
“i) The impugned circulars dated 12.11.2020 and 24.12.2020 passed by the third respondent, rejecting the claim of the petitioners are quashed, as far as the petitioners are concerned.
ii) The petitioners shall make their individual application to the third respondent for provisional registration for doing their CRRI along with the documents, as required by the second respondent, within a period of one week from the date of receipt of a copy of this order.
iii) On such application being made by the petitioners, the third respondent shall verify the original documents and consider their application for issuing certificate of provisional registration.
iv) The above said exercise shall be completed within two weeks from the date of receipt of the application from the petitioners.”
4. Subsequently, writ petitions were listed under the caption “for clarification” and thereafter an order was passed by the High Court with the following directions:
“(a) the petitioners who submit their applications to the Tamil Nadu Medical Council shall be provisionally registered and they shall be permitted to undergo the internship (CRRI);
(b) Taking into consideration the fact that the petitioners had not undergone the practical and clinical training during the MBBS Course in physical form in the medical university where they had undergone the course, there shall be a direction to the effect that the petitioners will undergo the internship for a period of 14 months and the additi
