Internship in India not Mandatory if done already in abroad: Kerala HC to Foreign Medical Graduates

To be more specific, the High Court bench comprising of Justice PB Suresh Kumar has recently made it clear that medical graduates who have already done their one year internship abroad, need not do another internship in India for obtaining registration as a doctor in India.

"In other words, a person who obtains medical qualification granted by medical institutions outside India recognised for enrolment as medical practitioner in that country and who clears the Screening Test in terms of Section 13(4A) of the IMC Act, is entitled to be enrolled as a medical practitioner on any State Medical Register, if he has already undergone one year internship," noted the Kerala HC bench as it disposed of three petitions filed by a doctor.

The case concerns a petitioner doctor who had pursued her medical degree from Dubai Medical College for Girls and afterward she underwent one year internship in various teaching hospitals under the Dubai Health Authority as per the norms prevailing in that country in order to become eligible for being enrolled as a medical practitioner. Consequently, she cleared the licensing examination and obtained the registration as a medical practitioner from Dubai Health Authority. Meanwhile, the doctor back in June 2019, cleared the Screening Test in India as per the terms of Section 13(4A) of the IMC act in order to become registered in the State Medical Register in India as well.

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However, the petitioner doctor submitted that even though on the strength of the medical qualification, and the qualification in the Screening Test, she was entitled to practice medicine in India, when she approached the Kerala State Medical Council for the provisional registration, the council directed her to submit an affidavit stating that the provisional registration would not be used by her for any other purpose other than doing Compulsory Rotatory Residential Internship (CRRI) in any one of the institutions approved by the Medical Council of India.

According to the petitioner, since she has already undergone internship in the country of education as part of the medical course undertaken by her, she is entitled to permanent registration straightaway in the State.

Thus, after obtaining the provisional registration, the doctor approached the High Court seeking a declaration that she is entitled to permanent registration to practice medicine in the State and also for a direction to the State Medical Council to grant permanent registration to her.

Meanwhile, the State Medical Council, in a counter affidavit stated that CRRI in any one of the medical institutions approved by the Medical Council of India is insisted for foreign medical graduates before granting permanent registration to them with effect from 01.01.2018 in order to ensure that they learn and gain clinical experience and exposure about the epidemiological and clinical profile of local community, understand the regional language, and get exposure to the unique public health care and delivery and referral system prevailing in the country.

The Council further contended that since the petitioner doctor has not obtained the Eligibility Certificate in terms of Section 13(4B) of the IMC Act before securing admission in the medical institution abroad, the Eligibility Certificate obtained by the petitioner after joining for the course being contrary to the provisions of the IMC Act and invalid, the petitioner was ineligible to appear for the Screening Test, for her medical qualification cannot in the circumstances be considered as a medical qualification in terms of the provisions of the IMC Act.

In fact, the State Council further submitted that the applications for registration ( both permanent and provisional) by the Foreign Medical Graduates are being considered and disposed of by the State Medical Council in accordance with the instructions issued by the Medical Council of India.

The counsel for the petitioner placed reliance on the Screening Test Regulations, 2002 framed by MCI and pointed out that the State Medical Council cannot insist a foreign medical graduate who has already undertaken one-year internship as part of the medical course to undergo CRRI for claiming permanent registration.

It was also argued by the learned counsel for the petitioner that as the Medical Council of India has issued Eligibility Certificate to the petitioner and permitted her to undertake the Screening Test, the State Medical Council cannot examine the eligibility of the petitioner to obtain the Eligibility Certificate and appear for the Screening Test.

However, the council for the State Medical Council argued that the decision of the State Council cannot be said to be contrary to IMC Act as the said decision only reflects an additional requirement insisted by a State Medical Council for obtaining registration and the authority of the State Medical Council functioning under an independent statute to take such a decision cannot be questioned by the petitioner.

He further insisted that the petitioner is not entitled to permanent registration without undergoing CRRI, since she has undertaken the Screening Test provided for in terms of Section 13(4A) before completing the one year internship.

While considering the question if a person who has not undertaken internship as part of the medical course undertaken by him/her abroad is eligible to appear in the Screening Test, the High Court bench referred to Section 13(4A) of the IMC Act which defines terms like "Primary Medical Qualification", "Provisional Registration", "Registration", and Eligibility Criteria for the Screening Test.

Taking note of the fact that Regulation 11 of the Regulations doesn't insist on internship for appearing in the Screening Test, the HC bench noted,

"The State Medical Council does not have a case that the petitioner did not possess a primary medical qualification as defined in the Regulations at the time when she applied for and cleared the Screening Test. In other words, the stand of the State Medical Council that only students who have completed internship as part of the medical course undertaken by them in the medical institution abroad are entitled to appear for the Screening Test is unsustainable."

Further, the court considered the question if a person who obtains Eligibility Certificate in terms of Section 13(4B) of the IMC Act after taking admission in a medical institution abroad, be denied enrolment on a State Medical Register, the HC bench referred to an earlier decision of the Delhi High Court and noted,

"The omission, if any, on the part of a student in obtaining Eligibility Certificate before taking admission in a medical institution abroad cannot not be an impediment for claiming registration, if he/she was entitled to Eligibility Certificate, had he/she applied for the same."

"Section 13(4B) of the IMC Act itself provides that in case any person obtains any medical qualification without obtaining Eligibility Certificate, he shall not be eligible to appear for the Screening Test. In other words, going by the said provision, the consequence of omission to obtain Eligibility Certificate is only that the candidate concerned will not be eligible to appear for the Screening Test," noted the Court.

Finally, the Court addressed the question if a person who obtains a medical qualification from a medical institution abroad and undertakes one year internship thereafter in the country of education and satisfies all other eligibility criteria for enrolment on a State Medical Register should be insisted to undergo CRRI, the Court referred to Section 13(4A) of the IMC Act.

The said section provides that a person who obtains medical qualification granted by any medical institution in any country outside India recognised for enrolment as medical practitioner in that country is entitled to be enrolled on a State Medical Register if he/she clears the Screening Test.

Further Regulation 11 of the Regulations clarify that candidates after qualifying the Screening Test may apply to any State Medical Council for registration and the State Medical Councils shall issue provisional registration to such candidates, who are yet to undergo one year internship in an approved institution and issue permanent registration to such eligible candidates who have already undergone one year internship, as the case may be.

"In other words, a person who obtains medical qualification granted by medical institutions outside India recognised for enrolment as medical practitioner in that country and who clears the Screening Test in terms of Section 13(4A) of the IMC Act, is entitled to be enrolled as a medical practitioner on any State Medical Register, if he has already undergone one year internship," clarified the Kerala High Court bench.

Observing that the petitioner doctor had obtained a medical qualification outside India and that she has completed one-year internship after acquiring the primary medical qualification, the Court opined, "If that be so, according to me, the State Medical Council is obliged to grant permanent registration to the petitioner and they cannot insist that the petitioner shall undergo CRRI for the said purpose."

"A person who is entitled to registration in a State Medical Register in terms of the provisions of the IMC Act cannot be denied registration by the State Medical Council. As evident from Section 13(4A) of the IMC Act, the medical qualifications of foreign medical graduates who satisfy the requirements in the said provision are deemed to be recognised medical qualifications for the purpose of the IMC Act for such persons," further stated the judgment.

Thus, the High Court disposed of the petitions with a direction to the State Medical Council to permit the petitioner to apply for the permanent registration, and if applied, grant permanent registration to the petitioner within two months without insisting her to undergo CRRI.