New Delhi: In a major relief to the Foreign Medical Graduates from China who could not complete their Clinical Training due to the outbreak of Covid-19 pandemic, the Supreme Court has recently directed the National Medical Commission to frame a scheme for such students within two months so that they get to finish their clinical training in India.
The top court bench comprising of justices Hemant Gupta and V Ramasubramanian directed NMC, "i) 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 appellant for a limited duration as may be specified by the appellant, on such charges which the appellant determines.
ii) It shall be open to the appellant to test the candidates in the scheme so framed in the manner within next one month, which it considers appropriate as to satisfy that such students are sufficiently trained to be provisionally registered to complete internship for 12 months."
While making such observations, the bench also emphasized on the importance of clinical training and noted, "..without practical training, there cannot be any Doctor who is expected to take care of the citizens of the country."
The Apex Court was considering a plea moved by NMC against the Madras HC order dated 29.7.2021 and 20.9.2021. In those orders, the HC had quashed the circulars issued by Tamil Nadu Medical Council (TNMC) in which the council had directed a Foreign Medical Graduate to undergo two months of Compulsory Rotatory Residential Internship, followed by one year of internship before granting permanent registration under the Indian Medical Council Act, 1956, which has now been repealed by NMC Act, 2019.
The student concerned had taken admission in the medical institute in China. Many such similarly placed students contended that they had 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.
She contended that since she had 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, 2002. Therefore, considering the fact that she cleared the screening test, the decision of the TNMC in not granting provisional registration was not justified under the law, contended the student.
After due consideration of the case, the Madras HC bench had quashed the circulars issued by TNMC and had also directed the Medical Council to consider the applications of such students for issuing certificate of provisional registration.In another order, the HC bench clarified the directions and had mentioned that the candidates after getting the provisional registration, shall be allowed to under go CRRI programme. "..the petitioners will undergo the internship for a period of 14 months and the additional 2 months shall be utilized for providing practical and clinical training in the initial phase of their internship and thereafter, the regular internship shall follow for a period of 12 months (1 year)," the HC had directed in the order.
When the matter reached the Supreme Court, the top court bench referred to relevant portions of The Indian Medical Council Act, 1956 and the Eligibility Regulations and the Screening Regulations published by the Union Government back in 2002. Apart from these, the bench also referred to Foreign Medical Graduate Licentiate Regulations, 2021, which was published by NMC, the apex medical regulator and also the clarification issued by NMC regarding the foreign medical graduates who have acquired a foreign medical degree or primary qualification before the publication of FMGL Regulations 2021.
The bench also took note of the fact that the applicant student had admitted that she had not undergone the practical and clinical training in the physical form, though she has undergone the course through online mode for the entire duration, therefore, she satisfies the requirement under Regulation 4(3) of the Screening Regulations.
The counsel for the NMC, Mr. Vikas Singh argued that as per the statutory Regulations, the student has to study the medical course in the same institute located abroad for the "entire duration". He argued that that as per the dates of the semester and the date of departure of student from China, it shows that the student has not completed the ninth semester in part and tenth semester completely, therefore, the student is not eligible for provisional registration to undergo one year internship so as to be eligible for registration as a professional under the Act.
The argument of NMC was that clinical training cannot be imparted through online mode as it is the actual training involving diagnosis and interactions with the patients. There cannot be any online clinical training which will satisfy the requisite condition of the Screening Regulations.
On the other hand, the counsel for the respondent student relied upon Supreme Court order in the case of Medical Council of India v. J. Saai Prasanna & Ors and also contended that as per Note V(2), the Screening Regulations grant an opportunity to the candidate to either complete his practical training/internship in the country from where he has acquired the Foreign Medical Qualification or in India.
After considering the submissions by both the parties, the top court bench noted, "the reliance on the judgment of this Court in Medical Council of India is not applicable to the facts of the present case as after the judgment of the Andhra Pradesh High Court delivered on 2.5.2008, Regulation 4(3) of the Screening Regulations was inserted to make it mandatory that a candidate should have studied for the medical course at the same institute located abroad for the entire duration of the course. Though, this Court has delivered judgment after the amendment but the student had obtained the degree prior to the amendment of the Regulations. Therefore, such judgment would not be relevant in the present matter."
"The fact is that the student has admittedly not completed clinical training which was part of the curriculum in the tenth semester, may be she has not completed part of clinical training in the ninth semester as well as per the curriculum," the bench further observed.
Opining that the NMC is not bound to provide provisional registration to candidates with incomplete course duration, the bench noted, "The Eligibility Regulations are to ensure that a student meets the minimum eligibility condition as per the Graduate Medical Education Regulations, 1997, but after completing the curriculum, a candidate has to qualify the Screening Test, provided the entire duration of the course has been completed at the same institute located abroad. The question to be examined is as to whether the degree granted by the Foreign Institute even in respect of clinical training is binding on the appellant and the student has to be provisionally registered. We find that the appellant is not bound to grant provisional registration to the student who has not completed the entire duration of the course from the Foreign Institute including the clinical training."
At this outset, the bench also reminded, "No doubt, the pandemic has thrown new challenges to the entire world including the students but granting provisional registration to complete internship to a student who has not undergone clinical training would be compromising with the health of the citizens of any country and the health infrastructure at large."
Referring to the issue of Foreign Medical graduates, the bench noted, "The students had taken admission in medical colleges outside India for the reason that they could not get admission in the medical colleges in India. China alone has a number of Institutes offering medical courses conducted in English language. The Act and the Screening Regulations are framed in such a way that the course completed by the students is treated to be valid in India provided that the medical qualification is recognised for enrolment of the medical practitioner in that country. Obviously, none of the Indian students are going to practice medicine in the foreign country, therefore, the grant of degree to the Indian students has no corresponding obligation that such students actually practice medicine in that country."
"In other words, the medical course is permitted to be completed abroad to practice in India only on the basis of an endorsement that the completion of such medical course entitles them to practice in the said foreign country. The courses are designed in such a way to attract students to undertake admission in the Foreign Institutes so that such students, become eligible to practice medicine in India. The very framework of the Regulations was compromising the interests of the Indian nationals and the health infrastructure in India. However, the malice has been corrected by the 2021 Regulations but such Regulations are not applicable to the students who have taken admission in the Foreign Institutes prior to 18.11.2021," it added.
Further addressing the issue of online training in medical education, the bench referred to the top court order in the case of Orissa Lift Irrigation Corporation Limited v. Rabi Sankar Patro & Ors and noted, "Therefore, without practical training, there cannot be any Doctor who is expected to take care of the citizens of the country. Hence, the decision of the appellant not to grant provisional registration cannot be said to be arbitrary."
However, at the end of the judgment, the top court bench also considered the situation of FMGs and noted, "However, the fact remains that the students were permitted to undergo medical course abroad and that they have completed their curriculum according to the certificate granted by such Foreign Institute. Therefore, such national resource cannot be permitted to be wasted which will affect the life of young students, who had taken admission in the foreign Institutes as part of their career prospects. Therefore, the services of the students should be used to augment health infrastructure in the country. Thus, it would be necessary that the students undergo actual clinical training of such duration and at such institutes which are identified by the appellant and on such terms and conditions, including the charges for imparting such training, as may be notified by the appellant."
Therefore, in its order, the top court bench directed NMC to frame a scheme for such FMGs who have not completed their clinical training.
To read the top court order, click on the link below.
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