One Year Rural Service Bond for MBBS doctors Reasonable: Karnataka High Court

Denying granting any interim relief, the HC bench comprising of Justice Sachin Shankar Magadum noted, "The service bonds calling upon the fresh doctors to undergo one-year Rural service appears to be reasonable."

The High Court single judge bench was listening to a plea filed by 180 MBBS doctors who challenged the State Government's June 8 notification which asked the 2021 MBBS graduates securing Government seats to register online for the Compulsory Rural Service under provisions of the Karnataka Compulsory Service to Candidates Completed Medical Courses Act 2012 (Compulsory Act).

Medical Dialogues had recently reported that the High Court, in an interim relief had previously directed the State Government not to compel those doctors from registering online for the Compulsory Rural Service for a period of two weeks.

Also Read: Interim Relief to 180 MBBS doctors, Karnataka HC asks State not to precipitate Compulsory Rural Service for 2 weeks

The petition claimed that the Karnataka Compulsory Service Training by Candidates Completed Medical Courses Act, 2012 is void and the same should be struck down on the ground that the 2012 Act is repugnant to the National Medical Commission Act, 2019.

Repugnancy in NMC Act?

Contending that 2012 Act is a State legislation whereas the NMC Act is a legislation Act passed by the Indian Legislature, the counsel for the petitioner, Shri K.G.Raghavan appearing for one of the petitioners submitted before the High Court that under Article 254(1), any provision of law made by the Legislature of a State is repugnant to the provision of law made by the Parliament to which Parliament is competent to enact.

He further pointed out that although under 2012 Act, the registration of a candidate in a State Register is conditional upon the completion of compulsory rural service, the NMC Act on the other hand permits license to any person who clears the National Exit Test to practice medicine. This way, under the NMC Act, a candidate has a choice to get enrolled either on the National Register or the State Register.

It had been further contended by the petitioners that the 2012 Act which is repealed by the NMC Act even otherwise is repugnant and therefore, has to be declared as void. The counsel for the petitioners thus submitted that "there is direct conflict between the State and Union legislations and therefore, the 2012 Act must be held to be repugnant to the NMC Act."

Referring to the judgments of the Apex Court in the case of Thirumuruga Kirupananda Variyar Thavathiru Sundara Swamigal Medical Educational and Charitable Trust vs. State of Tamil Nadu and Others, the counsel for the petitioners also argued that the NMC Act repeals the Indian Medical Council Act, 1956 and creates overarching scheme to regulate medical education and medical profession.

Finally, the counsel for the petitioners submitted that there is a sea change in the scheme of registration under the NMC Act. Although the previous regime under the IMC Act required a person to first be registered on the State Register to get registered under the Indian Medical Register, no such criteria is mentioned under the NMC Act. "Post NMC Act, a person need not satisfy the conditions laid down by the State Government in order to secure registration and obtain a license to practice medicine," he argued.

On the other hand, advocate N. Khetty representing the National Medical Commission (NMC) contended that the main ground of attack by the petitioners that the 2006 Rules are repugnant to the NMC Act, which has brought about a sea change pursuant to its replacing by the IMC Act is misconceived.

He argued that the NMC Act has brought about changes in the realm of academia and the medical profession. "The application and operation of the NMC Act is prospective," he said.

He further informed the Court that even under the IMC Act, the MCI, and Central Government did not frame a uniform law relating to compulsory service and probably in this background, the Apex Court in the case of Association of Medical Superspeciality Aspirants was pleased to issue a direction to frame laws relating to compulsory service. While issuing such directions, the Apex Court was pleased to uphold the previously obtained Bonds in all the States including Karnataka, he submitted.

"There is absolutely no change, let alone a sea change, was brought in by bringing the NMC Act with regard to compulsory service. Therefore, it is within the domain of State to frame law relating to compulsory service under Entry 25 and Entry 26 of List III and therefore, there is no repugnancy," he contended.

Meanwhile, the Additional Advocate General submitted before the Court that the 2012 Act is not at all applicable to the present petitioners and it is 2006 Rules which would bind the petitioners since they have executed Bonds under Section 11 of 2006 Rules.

"The present petitioners who have completed medicine have voluntarily executed the bond that they will provide service in Rural areas of Karnataka and now they cannot turn around and challenge the same," argued the AAG.

After listening to the contentions of all the parties, the HC bench examined as to whether the NMC Act has brought changes in the realm of academia and medical profession.

At this outset, the Bench observed, "The object of introducing NMC Act can be traced from the judgment rendered by the Constitution Bench of the Hon'ble Apex Court in the case of Modern Dental College & Research Centre. Therefore, if the IMC Act is compared with the new regime under the NMC Act, this Court would prima facie find that there is no sea change under the Act as contended by the learned Senior Counsel and other learned counsel appearing for the petitioners."

"The object of introducing NMC Act can be traced from the judgment rendered by the Constitution Bench of the Hon'ble Apex Court in the case of Modern Dental College & Research Centre (supra). Therefore, if the IMC Act is compared with the new regime under the NMC Act, this Court would prima facie find that there is no sea change under the Act as contended by the learned Senior Counsel and other learned counsel appearing for the petitioners. The IMC Act did not contemplate compulsory service though the previous regime had power which can be traced under the Entry 66 of List-I. Similarly under the new Act, the power to regulate compulsory service also vests under the NMC Act. But, however, the Legislature has not embarked upon bringing in the component of compulsory service within the ambit of NMC Act as of now. Therefore, what this Court would find, at this stage, is that the 2006 Rules which regulates compulsory service for having offered medical seats in Government Colleges under subsidized fee is not inconsistent or in conflict with the provisions of the NMC Act," the Court further noted.

Noting that the young doctors should not spend their valuable time in litigating and questioning the vires, the HC bench observed that the notification calling upon fresh doctors to undergo compulsory rural service for a period of one year is a product of executive action of the State under Article 162 of the Constitution of India and the same is exercised within the scheme of the Constitution.

"The legal relationship between the petitioners and the State is that latter will provide education in medicine by way of subsidized fees on the condition that qualified doctors would serve the rural areas of the State for a specific period of time. This has to be taken as a composite bargain between the State and the students and therefore, the students are bound to undergo compulsory rural service since they have voluntarily executed the Bonds," the judgment added.

Noting that the Supreme Court in the case of Association of Medical Superspeciality Aspirants had directed the Union of India and erstwhile Medical Council of India to bring in uniform policy regarding compulsory service, the HC bench noted that "The Union of India has not brought any legislation regarding compulsory rural service even under the NMC Act and therefore, this Court does not find any sea change under the NMC Act."

Bond rules are applicable to petitioner medicos: HC

Further mentioning that the Apex Court had upheld the legislative competence of the State Government to issue executive instructions imposing condition of service bonds and it had held that all doctors who have executed the compulsory bonds shall be bound by the conditions contained therein, the bench added,

"Therefore, the principles laid down by the Apex Court in the aforesaid judgment are squarely applicable to the present petitioners who have executed bonds while taking admissions for undergraduate course in medicine."

"The subject of compulsory service does not fall within the ambit of the NMC Act and therefore, it does not take the legislative competence of the State to implement the bond system and therefore, Article 254 of the Constitution of India has no application," read the judgment.

Ruling that the petitioners are unable to demonstrate that by the introduction of compulsory rural service, the standards of medical education as prescribed by the Union legislation is diluted or lowered down, the HC bench refused to grant any interim order and observed,

"The service bonds calling upon the fresh doctors to undergo one year Rural service appears to be reasonable."

Rural service would sensitize doctors to the miserable health conditions in rural areas

It was argued by the petitioner medicos that if they are compelled to undergo compulsory rural service, that may result in hindrance as the petitioners may not get sufficient time to prepare for the entrance test. This batch of fresh students may directly be inducted in COVID wards and therefore, it is not in the best interest of students who have just passed out with Undergraduate degree, they contended.

Dealing with this submission the court said,

"Currently 'Community Medicine' is a subject which is cursorily taught to medical students in their early years. Therefore, this Court is of the view that the rural service, in all probability, would sensitize them to the miserable health conditions in rural India and infuse a spirit of voluntary service within them. Therefore, compulsory rural service has to be undergone on priority basis. The medical students are also paid decent remuneration for compulsory rural service and therefore, most students should be willing to put in a year's rural service as they would acquire valuable practical experience."

"The new holistic kind of primary care should be practiced by new MBBS students and more medical students should be interested in such a career. These changes are possible only with a thorough reorganization of medical education. To prepare medical students and other health professionals for the new holistic approach will require a considerable broadening of their scientific basis and much greater emphasis on the behavioral sciences and on human ecology."

The court also considered the present situation of Covid-19 and asked the doctors to understand the concept of responsibility amid the pandemic

"We are in the midst of a global pandemic and the experts are anticipating a third wave.Therefore, the duty of care from a legal perspective distinguishes it from broader notion of duty of professionals and personal levels. Therefore, it is high time that the medical professionals understand the concept of duty in their response to COVID-19. The Doctors have a duty to treat and the State is looking upon the Doctors and is expecting them to come forward and counter this pandemic. It is high time that fair and responsible colleagueship, diverse medical specialties needs to be promoted in the prevailing circumstances. We have already seen a disaster which has threatened humanity and valuable lives are already lost. Therefore, the fresh graduates in the present context are a ray of hope for the public at large and if the State calls upon the fresh graduates to compulsorily serve for one year with substantial remuneration and if the State ensures that the Doctors and other health workers stay at their workplace, the threat to the public at large would be taken care of."

To view the official judgment, click on the link below.

Also Read: MBBS graduates Challenge Compulsory Rural Service: Karnataka HC issues Notice to Govt