Observations of the National Medical Commission Bill 2017

1. Composition of the National Medical Commission:

It is a three tier composition:
a) As per section (4) of the Bill, Composition of the National Medical Commission, which will have an effective membership of 25 of which only 5 members (Part Time) will be elected.
b) As per section (11) of the Bill, Composition of an Advisory Body to be known as the Medical Advisory Council. Totally Medical advisory council shall consists of about 60 members. All are nominated members.
c) As per section (16) of the Bill, Composition of 4 autonomous boards to be known as the UGME Board, PGME Board, MAR(Medical Assessment and Rating) Board and EMR(Ethics and Medical Registration) Board. Each board consists of 3 members only and all these members will be nominated by Central Government. Totally these four boards shall consists of 12 members. They will constitute further sub committees to assist them.
As such it is evident that the proposed commission will have 10% elected members (part time) and 90% nominated members. It is for this reason it will not have a desired ‘representative character’ with reference to ‘elected and nominated / appointed members’ whereas present Medical council of India has 75% elected members and 25% nominated members.
Further, a National Medical Commission ought to have a National character meaning thereby that it ought to have representation from across the country from amongst the relevant stakeholders. The present Indian Medical Council Act, 1956, vide its section 3 ensures that it had representation from all the States and Union Territories, all the Universities, from the Govt. of India through eight nominees and each State having a representation from amongst the registered medical graduates thus providing it the much desired National character. As against the proposed National Medical Commission Bill contemplates appointed members who by the very nature broadly would turn out to be ‘capital based’ than rendering a national character.
The composition of the various autonomous boards prescribed under the Bill does not include any elected member there under. As such, the relevance of elected members vis-a-vis their authority and jurisdiction is a big question mark left unanswered.

2. Un-wielding numbers in the name of spurning
One of the concerns raised was that the existing Indian Medical Council Act, 1956, provided for the composition of Medical Council of India, which has an exceptional large membership unwielding in character. However, the present proposed Bill contemplates a National Commission of 25 Members, a National Advisory Council which will include 25 members of the commission plus nearly 30 representatives of the State Govts. and Union Territories, Chairman University Grants Commission and Director National Accreditation and Assessment Council as Ex-officio members, four members nominated by the Central Govt. taking the overall number to well over 60.
In addition there will be four autonomous boards with three members including the Chairman taking it to 12, thus taking the number to a tally of 72.
Further at Section 8(7) it is provided that the Commission may engage, in accordance with the procedures specified by a regulation, such number of experts and professionals who have special knowledge of and experience in such fields including medical education, public health management, health economics, quality assurance, patient advocacy, health research, science and technology, administration, finance, accounts and law as it deems necessary to assist the commission in discharge of its function under this Act.
At Section 10(4) it is further prescribed that the commission may constitute sub-committees and delicate such of its power to such committees as may be necessary to enable them to accomplish specific task.
Further there is a provision to section 20(1) whereby each autonomous Board except the EMR board shall be assisted by such Advisory committees of experts as may be constituted by the commission for the efficient discharge of the functions of such boards under this Act.
Further at section 20(2) it is stipulated that the EMR board shall be assisted by such ethics committees of experts as may be constituted by the Commission for the efficient discharge of its functions. Thus, the number could be open ended.
Thus in the name of spurning the membership the provisions bring out inclusions in an open ended manner turning out to be an antithesis to the very aim and objective that came to be postulated.

3. Term of Membership of Commission:
The term of membership stipulated in the proposed Bill is 4 years in terms of Provisions included at section 6(1) of the proposed Bill. However, at Section 4(b) it is stated that “there shall be three members to be appointed on rotational basis from amongst the nominees of the States and Union Territories in the Medical Advisory Council for the term of two years in such manner as may be prescribed. This is discriminatory in as much as, as against a stipulated term of four years to all other members, a set of State Govt. nominees as members would have a term of two years only.
Further, as against the present provision in the existing Indian Medical Council Act, every State is represented by its member on the council for the full term of five years without any discrimination of any type. But in the present stipulation, each State apart from getting a restricted term of two years on a rotational basis, its next turn would come only after a gap of 10 years on rotation basis construing the total rotational strength of the states to be 30. This definitely has resulted in grossest possible marginalization of the representation to a State.

4. Secretary an appointee of the Govt. and not the commission :
The proposed Bill at its section 8(1) provides for that there shall be a secretariat for the commission to be headed by a Secretary to be appointed by the Central Govt. As such, the Secretary would be appointed by the Govt. of India and not by the Commission, which speaks as to how the Central Govt. has caught hold of the autonomy of the commission which is just a namesake with real authority vested in the Central Govt. in an exclusive manner.
Further, at section 8(2) it is stipulated that the Secretary of the commission shall be a person of outstanding ability and integrity possessing a postgraduate qualification in such areas as may be prescribed, paving a way that the Secretary of the National Medical Commission could be a person without possessing modern medicine qualification as the provision contemplates the incumbent to possess PG qualifications in such areas as may be prescribed.

5. Directions to State Medical Councils:
The proposed Bill at section 10(1)(f) authorises the commission to take such measures as may be necessary to ensure compliance by the State Medical Councils of the guidelines framed and regulations made under this Act for their effective functioning under this Act.
Further the proposed Bill at proviso to section27 (b) brings out that ‘provided that the EMR board shall ensure compliance of the Code of Professional and Ethical Conduct through the State Medical Council in a case were such medical council has been conferred power to take disciplinary actions in respect of professional or ethical misconduct by medical practitioners under respective State Acts.
The proposed Bill under section 30(2) entitles the Central Govt. to give direction to the State Medical Council for dispensation of task under their jurisdiction. All these provisions shall take away the autonomy vested with the State Medical Council and make them subservient to the Central Govt. This would be a great prejudice caused to the State Medical Councils.

6. Composition of Medical Advisory Council:
Under section 11(1) of the proposed Bill the Central Govt. is required to constitute an Advisory Body to be known as the Medical Advisory Council.
The composition of the said Council stipulated at section 11(2) at its sub section (c) provides for that one member to represent to each State who is the Vice Chancellor of a health University in that State to be nominated by that State Govt. However, at a proviso it brings out that ‘if there is no health university in any state or Union Territory the Vice Chancellor of a university within that state or Union Territory having the largest number of medical colleges affiliated to it shall be nominated by the State Govt. or the ministry of home affairs in the Govt. of India.
A health sciences university apart from including medical colleges has under its ambit colleges of other streams of health sciences as well. The Vice Chancellor of a health sciences university of a State therefore necessarily would not be a person possessing qualifications in modern medicine.
Further, in case of non-health sciences universities, whereunder apart from medicine faculty there are several other faculties, the Vice Chancellor of such a university to which maximum number of medical colleges would be affiliated in the State could be person who may not be even from the stream of health sciences. As such, the said proviso opens doors for representation of people as Vice Chancellor not only from non-medical faculty amongst health sciences but from the non-health sciences faculty as well.

7. Separate National Register :
Under section 31(8) the EMR Board shall maintain a separate National Register including the names of licensed Ayush Practitioners who qualifies the bridge course referred in Section 49(4) in such manner as may be specified by Regulations. By an explanation, Ayush Practitioner has been defined as a person who is a practitioner of Homeopathy or a practitioner of Indian Medicine as defined in Clause (e) of Sub-section 1 of section 2 of the Indian Medicine Central Council Act, 1970.
Section 49(4) contemplates bridge courses even for the practitioners of homeopathy to enable them to prescribe such modern medicines at such level as may be prescribed. This is materially inconsistent with the definition of the word ‘medicine’ as depicted at section 2(j) wherein it is defined as ‘medicine means modern scientific medicine in all its branches and include surgery and obstetrics but does not include veterinary medicine and surgery’.
It is worthwhile to note that the names of the BAMS and BHMS graduates are already registered with their respective councils. On availing the bridge course they would be incorporated in a separate register, which would mean that they would be having duel registrations with two registering councils, which is neither open nor permissible. Further, the disciplinary jurisdiction with reference to breach of ethics is not indicated as they have duel registrations to their credit. In a way a classical privileged group would stand created by virtue of the proposed Bill.
As such these are the flood gates that have been opened up in terms of the statutory provisions for backdoor entry into medical profession entitling practicing modern medicine.

8. licenciate examination
As per section (15) of the Bill, provision is made for introduction of licenciate examination mandatory after acquiring MBBS qualification. Without qualifying licenciate examination no person will be enrolled in the National register and would be entitled to practise and do further post graduate courses. Further the standard and level of licenciate examination would be such that the students belonging to backward communities would find it great difficulty to clear the same easily and handily. This would cause a great harm to them because they would neither be able to practice nor would be able to take admission to PG courses. In addition even the students learning in medical colleges situated in remote areas as well as backward areas/states they will also suffer in a similar manner. This handicap would be equally applicable to the students passing out from north-east region as well. The net result would be that thousands of students passing their MBBS examination belonging to backward communities learning from backward areas including north-east region would not be able to practice timely and also seek admission to PG courses for want of clearance of the licenciate examination because of its higher standards.
As per provisio to section33(1)(d) of the Bill, it stipulates that ‘the commission may permit a medical professional to perform surgery or practice medicine without qualifying the National Licenciate Examination, in such circumstances and for such period as may be specified by regulations’. This operationally means that without ascertaining of the required levels and certification thereto the commission would be permitting people to practice surgery and medicine in an open ended manner is nothing less than legalizing quackery in an operational sense and playing with lives of the people at large. Such sweeping powers are not only illegal but will give ample scope of manipulation and corruption.