FMGE not enough: Medicos with MBBS from abroad will have to do one year Compulsory Internship, says Kerala HC

Kerala: Through a recent decision, the Kerala High Court has upheld the decision of the Travancore - Cochin Medical Council (TCMC) that spells out mandatory one year CRRI for candidates who have pursued their MBBS from abroad to practice in the state

Petitioners included qualified doctors who obtained their MBBS Degree from foreign Medical Universities approved by the Medical Council of India (MCI) including 18 doctors who pursued their MBBS in China and one medico with MBBS degree from Nepal.

Pursuant to acquiring MBBS Degree, petitioners returned to India and in compliance with, the Undergraduate Medical Course in a Foreign Medical Institution Regulations, 2002, appeared for the screening test conducted by National Board of Examinations for Indian National with Foreign Medical Qualification, and they have secured the qualifying marks.

All petitioners then secured registration from various Medical Councils of different States in India. Thereafter, petitioners applied for permanent registration in Kerala before the Travancore - Cochin Medical Council (TCMC). According to the petitioners, though they are eligible and entitled for obtaining permanent registration, their application for registration was rejected by the TCMC assigning the reason that the Council has made it compulsory for all foreign medical graduates to complete a one-year internship in any institution within India approved by MCI, for the purpose of compulsory internship based on Council resolution dated 20.10.2017, which, according to them, is per se violation of Sec.37 of the Travancore-Cochin Medical Practitioners Act.

Objecting to the clause, the MBBS doctors then approached the state government. The government of Kerala in its reply stated that, in order to impose one-year CRRI for foreign medical degree holders, by the state medical council, the appropriate authority to bring about the amendment is the Central Government. Therefore, according to the petitioners, no such amendment is seen carried out in order to deny the petitioners' permanent registration application.

The state medical council in its defence submitted that, Compulsory Internship (CRRI) for foreign medical graduates is being insisted because of a host of things, particularly to acclimatize those medical graduates to the situation prevailing in Kerala in the medical field, especially instances such as sudden breakout of epidemics like NIPAH, contagious diseases etc., which are often related to the peculiar climatic conditions in the State, and the situation prevailing in the State of Kerala is not comparable to any other States in India, considering the large volume of ingress and egress of labourers world-wide and migrant workers as well.

The council also noted that imparting training to a medical graduate who has obtained medical degree from a foreign University, where the practical on hand training is inadequate when compared to the standard of medical education in India with that of the medical Universities in Far East and Europe, is absolutely necessary.

The council added that the foreign medical  graduates, by virtue of the decision of the Council, are actually provided with a great opportunity to do internship in Medical institutions approved by the MCI without having to pay significant amount as fee for training as in the case of other States, thus equipping them to meet any contingencies in their career. The foreign medical graduates are, therefore, required to undergo one year internship before getting the permanent registration essentially for the following reasons:

(a) To learn and gain clinical experience and exposure about the epidemiological and clinical profile of local community.

(b) To learn and understand regional language, culture of local community; and

(c) To learn and get exposure on the unique public health care delivery and referral system prevailing in the country”.

Further, it is pointed out that, with the medical qualification acquired by the petitioners, they are not qualified to practice even in China, the country from where they acquired their medical  degree, and as per the verification details received from Indian Embassy at China, for practising medicine in  that country, one has to pass National Medical Licensing Examination (NMLE), which consists of a clinical skill test and general written test. It is also understood that all the medical graduates from China are returning to India without qualifying this test, which means the foreign graduates from China are not even qualified to practice in the said country.

Therefore, the matter of granting permanent registration of foreign medical graduates was
considered very carefully and elaborately by the Council in its meeting held on 20.10.2017, and it was unanimously resolved to insist one year CRRI in any one of the MCI approved institutions in India before granting permanent registration with effect from 01.01.2018. The Council thereafter communicated this decision to State Governments and also to the MCI, vide letter dated 28.11.2017, and has implemented the above decision with effect from 01.01.2018.

The council further stated that the Government convened a high level meeting with the members of the Council in which the former was apprised of the situation which warranted the implementation of CRRI in the State. It is also submitted that, since public health is State subject, and Council is competent to advice the State Government in the matter of public health and the allied activities, and therefore, the State Government accepted the opinion rendered by the Council in this regard

The court after going through the evidence upheld the one-year CRRI decision of the council in this specific case

It is clearly discernible from the documents produced by the 1st respondent that, the National Medical Licensing Examination is a mandatory requirement to practice medicine in China. It is true, petitioners have participated in the screening test regulations conducted by the MCI, evident from the certificates produced, as per the provisions of the Medical Council of India Screening Test Regulations, 2002, wherein Regulation 3 stipulates that, an Indian citizen possessing a primary medical qualification awarded by any medical institution outside India who is desirous of getting provisional or permanent registration with the MCI, or any State Medical Council on or after 15.03.2002 shall have to qualify a screening test conducted by the prescribed authority for that purpose as per the provisions of Sec.13 of the Act, 1956.

....it is an admitted fact that, there is no case for the petitioners that they have passed the qualifying examination conducted by the National Medical Licensing Examination and, therefore, it cannot be said that the insistence made by the Travancore-Cochin Medical Council for compulsory internship is in any way bad or illegal....

The court also gave a green signal to one year internship insisted by the state medical council in general as well

The discussion of facts made above would make it clear that the intention behind the circular of TCMC is in public interest to ensure that the undergraduates who have secured degrees from foreign countries should be acclimatized to the situation in the State of Kerala, especially with respect to the specific diseases in the State and to meet up with the requirements for undertaking the treatments. Moreover, merely because the petitioners have passed the screening test, going by the provisions of the Screening Test Regulations, 2002 discussed above, it is clear that the same will not confer any other right whatsoever on a candidate. So much so, this Court need only look into whether there is violation of any statutory provisions consequent to the circular issued, however, on assimilation of the situations, I am of the view, none of the provisions of the Act and the Regulations are violated and the intention behind the circular is bonafide to protect the interest of the larger community by equipping the medical practitioners, with foreign degrees, with State specific situations.

The court then dismissed the writ petitions stating that the petitioners have not made out any case of arbitrariness, illegality, unfairness or any malafides on the part of the 1st respondent, justifying the interference of this Court under Article 226 of the Constitution of India.