MBBS Ineligibility for Candidate with Benchmark Locomotor Disability Upheld; Court Defers to Reasoned Expert Medical Opinion: Delhi High Court - 2024-11-12

Delhi High Court Upholds MBBS Ineligibility for Candidate with Locomotor Disability, Cites Expert Opinion While Urging NMC to Evolve Guidelines

New Delhi: The Delhi High Court recently dismissed an appeal by Kabir Paharia , a medical aspirant with a benchmark locomotor disability, upholding the National Medical Commission's (NMC) and successive medical boards' assessments that he was ineligible to pursue the MBBS course. The Division Bench, comprising Hon'ble The Chief Justice and Hon'ble Mr. Justice Tushar Rao Gedela , emphasized the limited scope of judicial review over reasoned expert medical opinions but directed the NMC to explore future possibilities for candidates with disabilities, aligning with previous directives.

The judgment, authored by Justice Tushar Rao Gedela , addressed Mr. Paharia 's challenge to the dismissal of his writ petition by a Single Judge on September 10, 2024. The appellant had also sought the quashing of a NEET Disability Certificate and an AIIMS medical report, and a declaration of his eligibility for medical courses.

Case Background: A Dream Derailed by Disability Assessment

Kabir Paharia , an SC-PwD category candidate, had secured 542 out of 720 marks in NEET (UG) 2024, with a PwD Category Rank of 176. His initial disability certificate dated December 9, 2023, recorded a 42% permanent disability (congenital amputation of multiple fingers in both hands and toes). However, Vardhman Mahavir Medical College - Safdarjung Hospital (VMMC-SJ Hospital), a designated Disability Certification Centre, assessed his disability at 68% on August 19, 2024, but deemed him "not eligible to pursue medical courses" due to "Bilateral upper limb involvement."

Aggrieved, Mr. Paharia approached the High Court. A Single Judge, on September 3, 2024, directed AIIMS , New Delhi, to form a medical board to assess his functional disability and eligibility. The AIIMS board, in its report dated September 6, 2024, also concluded he was ineligible. This led to the dismissal of his writ petition, prompting the present appeal (LPA-967/2024).

Appellant's Contentions: Plea for Reasonable Accommodation and Fair Assessment

Mr. Gaurav Agarwal, senior counsel for the appellant, argued: * The appellant, despite his disability, performed exceptionally well in NEET. * The VMMC-SJ assessment was flawed as it did not consider competency with assistive devices or "reasonable accommodation" under the Rights of Persons with Disabilities Act, 2016 (RPwD Act). * The initial medical boards lacked a doctor with a disability, contrary to Ministry of Health guidelines. * The AIIMS reports (both initial and a subsequent one dated September 30, 2024, from a reconstituted board including a doctor with disability) lacked detailed reasons and did not specify tests conducted or consideration of assistive devices. * The appellant’s willingness to restrict his career to medical teaching was not adequately considered. * He also challenged Footnote 3 to Appendix H-1 of the Competency Based Medical Education Curriculum (CBME) Regulations, 2023, as unconstitutional and violative of the RPwD Act.

Respondent's Stance: Deference to Expert Medical Opinion and Regulatory Framework

Mr. T. Singhdev, counsel for the NMC (Respondent No. 1), countered: * NMC regulations for PwD candidates align with the RPwD Act, including its limitations. * The appellant's prayer for re-evaluation was granted by the Single Judge, leading to the AIIMS assessment. * Both AIIMS medical board reports provided detailed reasons for ineligibility, considering all parameters, including assistive devices and "reasonable accommodation" by the reconstituted board. * The reconstituted board, which included a doctor with a disability, specifically noted that acquiring surgical competencies is a prerequisite for the MBBS program, making a teaching-only career path (without full clinical competency) unviable under current regulations, as even educators need medical registration. * Three independent medical boards consistently found the appellant ineligible, and the Court should not substitute its own opinion for that of experts.

Court's Analysis: Balancing Aspirations with Medical Realities and Patient Safety

The High Court expressed its "pain that the appellant who comes from a deprived strata of the society, yet brilliant to the core, is unable to give wings to his dreams." However, it underscored the "limitations which circumscribe the jurisdiction of Constitutional Courts lest the Court starts substituting its own opinion... to the one rendered by a body constituting highly experienced professionals."

The Court meticulously examined the AIIMS medical reports:

* The first AIIMS report (September 6, 2024) detailed the demanding nature of the MBBS course, emphasizing the need to acquire skills for procedures like suturing, resuscitation, and conducting deliveries. It noted: > "The Medical Board is of the opinion that the petitioner Sh. Kabir Paharia is NOT ELIGIBLE to pursue the MBBS graduation course. This Medical Board is of the opinion that this candidate will face certain difficulties in the course of time pursuing MBBS, because of the significant involvement of both hands with missing multiple fingers leading to limitations in acquiring and executing certain essential skills.”

* The second AIIMS report (September 30, 2024) , from a board reconstituted by the Court to include a doctor with a disability and to specifically consider assistive devices and reasonable accommodation, stated: > "This board also considered the possibility of reasonable accommodation with assistive devices or prostheses... According to NMC norms... 'Both hands intact, with intact sensations, sufficient strength and range of motion are essential to be considered for medical course'. The Medical Board confirms with the finding of the previous Medical Board and is of the opinion that the petitioner Sh. Kabir Paharia is NOT ELIGIBLE to pursue the MBBS graduation course as per the current NMC norms." This report also addressed the teaching prospect, noting, "Though the candidate may seek to pursue non surgical branches at a later date, acquiring and demonstrating competencies in these surgical disciplines is a prerequisite for completing the Medical Under Graduate Programme”.

The Court found these reports to be thorough and well-reasoned, contrary to the appellant's submissions. It cited Vidhi Himmat Kataria vs. State of Gujarat on courts not being medical experts and the Supreme Court's recent judgment in Omkar Ramchandra Gond Vs. Union of India (October 15, 2024), which mandates that Disability Assessment Boards provide reasons for ineligibility. The High Court found the AIIMS reports met this standard.

Final Decision and Future Directions

While dismissing the appeal, the Court reiterated directions from Neha Pudil vs. Union of India & Ors. , where a coordinate bench had urged the NMC to:

“explore the possibility of candidates, such as the petitioner, being able to pursue some of the disciplines, if not all, of medical education, considering the advancement of science and technology.”

The Court noted the NMC's submission before the Single Judge that "a fresh policy with regard to the aforesaid directions... has already been framed, however, the same would be applicable from the next academic year."

Consequently, the High Court directed that the Neha Pudil directions be "complied with by the respondent strictly within six (6) months." It added:

"Consequent thereto, the appellant would be at liberty to re-apply for the admission in NEET (UG) Programme and his condition would be re-assessed based upon the newly formulated guidelines of the respondent."

The judgment, therefore, while upholding the current ineligibility based on expert assessment and existing norms, leaves a window open for the appellant and similarly situated candidates, contingent on the evolution of NMC guidelines considering technological advancements and a more nuanced approach to disability in medical education.