Rs 1 Crore Penalty for violation: NMC Notifies Final Maintenance of Standards of Medical Education Regulations 2023

New Delhi: With an aim to ensure smooth compliance with its functions in general and particularly to maintain high quality and standards in medical education, the National Medical Commission (NMC) has now published the Maintenance of Standards of Medical Education Regulations, 2023 or MSMER-2023.

Medical Dialogues had earlier reported that the Draft of these regulations was introduced in the public domain by the Director of the UG Medical Education Board of NMC, Shambhu Sharan Kumar on June 23, 2023. NMC introduced these regulations to make sure that high standards are being maintained in the medical education sector in India. 

Releasing the Draft, NMC had invited comments from the stakeholders and asked them to submit these comments within 30 days. Now, the Apex Medical Commission has notified the final MSMER-2023 regulations in the Official Gazette of India.

The issues discussed in these regulations include the mandate of annual disclosure, evaluation of the Annual Disclosure Report by NMC, details regarding joint or independent evaluation, consequence of compliance, penalties for non-compliance, and appeal by medical institute to NMC and/or Central Government.

As per the Gazette notification, these regulations shall come into force from the date of their publication in the official Gazette i.e. September 19, 2023. In the Chapter I of these Regulations, NMC mentioned about the short title of these regulations, date of commencement and the Commission also defined several relevant terms.

"...exercise of overall powers conferred by the National Medical Commission Act, 2019 and particularly by sections 10, 24, 25 and 57 of the said Act, National Medical Commission makes the following Regulations to ensure smooth compliance with its functions in general and particularly to maintain a high quality and high standards in medical education," NMC mentioned in the Gazette notification.

Annual Disclosure Report and Its Evaluation:

Mandate of Annual Disclosure:

Specifying the mandate of annual disclosure, NMC mentioned in the regulations that after being established, the medical college/institute is obligated to furnish an Annual Disclosure Report to the corresponding Board satisfying the conditions provided under the notified Minimum Standard Requirements (MSR) as specified by the Undergraduate Medical Education Board (UGMEB) of Postgraduate Medical Education Board (PGMEB) and the NMC regulations.

The Regulations further mentioned that the concerned Board may also seek additional information regarding the Annual Disclosure Report, as and when it deems it necessary to assess and otherwise also from the concerned medical college or agencies or or exercising control over that medical college or medical institution.

"It shall be the duty of the medical college or medical institution or the concerned agency or agencies exercising control over such medical college or medical institution to furnish the information (including additional information) to the concerned Board in the prescribed mode," NMC clarified in the Regulations.

Evaluation of Report:

As per the Regulations, the respective UG or PG Medical Education Board of NMC may undertake the evaluation of the Annual Disclosure Report to verify if the medical college or medical institution fulfils the required conditions prescribed by way of MSRs or NMC Regulations.

These criteria which shall be verified by the NMC Boards are as follows:

i. verification of physical infrastructure;

ii. availability of required number of qualified faculty for actual teaching and research and to undertake necessary student learning activities on a regular and continued basis;

iii. availability of adequate clinical material in terms of number of patients of different specialties, variety of patients to fulfil all round training of students, number of variety of procedures, surgeries, laboratory investigations, radiological investigations and other relevant investigations;

iv. assessment of the teaching methodology adopted;

v. the methods and modes of assessment, grading of the students;

vi. review of feedback from students;

vii. other parameters related to standards of medical education that may be added from time to time by the respective boards or NMC.

"Without prejudice to (1) above or elsewhere in these Regulations, at its sole discretion, the respective Board may seek any additional information or clarification or additional documents etc., from the medical college or medical institution while considering the Annual Disclosure Report referred above," NMC mentioned in the Regulations.

"The Medical College shall furnish such information or clarification or additional documents, etc., sought under sub-section (2) above at the earliest but not later than 30 days from the date of receipt of communication from the respective Board or such additional time to be provided by the respective Board on specific request from the applicant in that regard. Provided, the medical college or medical institution shall adhere to the prescribed format or pro-forma, while furnishing of information or clarification or additional documents etc., as required by the concerned Board," it further mentioned.

NMC further added in the regulations that if the applicant fails to submit such information or to clarify or provide additional documents within the prescribed time limit (including any additional time provided by the respective Board), then it shall be deemed as non-compliance with the Regulations and it shall also attract a penalty.

Joint or Independent Evaluation: 

Specifying the rules regarding Joint or Independent Evaluation, NMC mentioned in the notice that notwithstanding anything stated elsewhere in these regulations, any of the NMC Boards (other than the corresponding Board) individually or collectively, may cause to evaluate the accuracy and/or truth and/or veracity of the averments made out in the Annual Disclosure Report from the medical college or medical institution.

When such an evaluation is undertaken, the concerned medical college/institute shall be duty-bound to provide all necessary support to the concerned Board or Boards, in their course of evaluation. This shall also include the disclosure of documents, providing additional evidence and oral statements etc.

As per these Regulations, "...the concerned Board or Boards conducting evaluation under this provision, shall mandatorily share such conduct of an evaluation and its outcome to other Boards and NMC at the earliest but not exceeding seven days."

Further referring to the remedial measure or action contemplated by the concerned Board or Boards, NMC added, "After such inspection under this Regulation, if the concerned Board or Boards contemplate any remedial measure or action etc., such measure or action shall be intimated to the medical college or medical institution, through the concerned Board (UGMEB or PGMEB). Provided it shall be the administrative responsibility of the concerned Board to oversee that such measure or action intimated are duly complied with by the medical college or medical institution."

Consequence of Compliance: 

According to the MSMER-2023 regulations, a medical college or medical institute will be provided with a renewal certificate for continuation of the course/s and admission of students for the next/coming academic year, if the medical college/institute is found to be successfully meeting the requirements prescribed by UGMEB or PGMEB of the National Medical Commission.

"Any deficiency noted will attract penalties with or without the decision above," the Commission mentioned in the Regulations.

Penalties: 

The Regulations also mention in detail about the consequences of non-compliance with the Minimum Standards of Requirements as prescribed by the respective NMC Boards.

In case of non-compliance, the Board shall either penalize the concerned medical college/ institute or conduct further inquiry providing an opportunity to rectify the same.

"Where the respective Board has reason to believe that a medical institution has failed to comply with any statutory provision, regulations framed thereunder or has not complied with the Minimum Standards of Requirements as prescribed by their respective Boards, or has conducted themselves in any manner which is not in accordance with the goals of medical education and practice, the Board shall either penalize the medical college or medical institution and /or conduct further enquiry into such act and wherever needed provide an opportunity to rectify the same," mentioned the Regulations.

According to the Regulations, the Commission may impose several forms of penalty such as issue warning to the medical college to rectify or comply, impose monetary penalty up to Rs 1 crore, impose penalty up to Rs 5 lakhs to the faculties of the medical college for misconduct, withhold the accreditation process, recommend to the Medical Assessment and Rating Board (MARB) of NMC to withhold the application process for any new course including increase of seats in the existing course, reduce the number of students in the next or subsequent academic years, stop admission to one or more courses, recommend for withdrawal of permission, withhold or withdraw accreditation for up to five academic years.

The penalties, as mentioned in the MSMER-2023 Regulations are as follows:

a. Issuance of warning with direction to rectify/comply, as the case may be, by the medical institution;

b. Monetary penalty not exceeding INR one crore per violation or act of omission by the medical institution;

c. Monetary penalty not exceeding Rupees five lakh for the faculty/Head of the Department (HoD)/ Dean/Director/doctor submitting false declaration/documents/records (including patients’ records). Further, they can also be charged or penalized for misconduct under the Registered Medical Practitioner (Professional Conduct) Regulations in vogue.

d. Withholding the accreditation process;

e. recommending to MARB for withholding processing of application(s) for any new course including increase of seats in the existing course for that academic year or for such number of years.

f. Reducing the number of students in the next or subsequent academic years to be admitted by the medical institution;

g. Stoppage of admission to one or more of the courses in the next or subsequent academic years.

h. Recommending to NMC for withdrawal of permission; i. Withholding and withdrawal of accreditation for a period up to five academic years.

j. Further, these Regulations mentioned that "Any attempt to pressurize UGMEB, PGMEB or NMC through individuals or agency will lead to immediate halt of the processing of all applications/requests by the medical institution."

Provided that the medical institution, may be granted a reasonable opportunity to rectify the deficiencies and any further action shall be taken if it fails to meet the requisite norms.

Provided further that, the UGMEB, PGMEB or the NMC may also initiate criminal proceedings for furnishing false information, or fabrication of false documents as per the criminal law in force at that time.

Appeal to NMC: 

In these regulations, the Commission has also specified about the provision of appeal by an aggrieved person. The regulations mention that a medical college/institute or any such aggrieved person may file an appeal before the Commission with an appropriate fee as specified against any order. However, such an appeal has to be filed within sixty days of passing of such an order or lapse of time, as the case may be.

Appeal to the Central Government: 

If any applicant/medical college/medical institute is aggrieved by the Commission's decision as well or if the Commission fails to give its decision within forty-five days from the date of receipt of such an appeal, these Regulations specify that a second appeal can be filed before the Central Government within thirty days from the date of such order or lapse of time, as the case may be. The decision of the Central Government in this regard shall be final.

To view the MSMER 2023 Regulations, click on the link below:

https://medicaldialogues.in/pdf_upload/nmc-msmer-2023-221248.pdf

Also Read: NMC Releases Draft Maintenance of Standards of Medical Education Regulations 2023, Invites Comments