Dr KK Aggarwal
National
President IMA, Padma Shri Awardee
The Union
Cabinet recently rendered another blow to the medical profession with the
approval of the draft National Medical Commission Bill, 2017. The NMC will
"cripple" the democratic functioning of the medical profession by
making it completely answerable to the bureaucracy.
It is time that
the powers-that-be took urgent notice of this crisis and acted accordingly. The
medical profession is currently facing the darkest hour. Not only are patients
slowly losing faith in doctors and the profession as such, but are also
becoming violent against doctors with the slightest provocation. This bill is
only an addition to these existing woes and will exacerbate the situation for
the medical fraternity and the students of medicine.
The
structure of the NMC
The
federal character of MCI is not found in the NMC. All the state governments
have representation in MCI. Only five states in rotation will have
representation in NMC as a result of which it will take two decades for a state
to re-enter NMC. The Cabinet has cleared
NMC Bill with a 25-member commission appointed by the central government. Of
these members, 20 will be appointed by the search committee chaired by cabinet
Secretary. Nomination will be done for 12 ex-officio and 6 part-time members.
Three of these will be from disciplines such as management, law, medical
ethics, health research, consumer or patient rights advocacy, science and
technology, and economics. Only five will be elected by the registered
medical practitioners from amongst themselves from such regional
constituencies.
In effect, it
would resemble a situation where the whole parliament is getting dissolved in
favor of 25 nominated ministers by the President of India with only five
elected members of parliament, one from each zone of the country with no powers
to be re-elected.
The
chairperson, secretary, and members shall hold office for a term not exceeding
four years and shall not be eligible for any extension or reappointment and
will retire by age 70. This will lead to a possible backdoor entry of
bureaucrats after retirement.
In the MEDICAL ADVISORY COUNCIL, the Chairperson of the Commission shall
be the ex-officio Chairperson of the Council and hence will have no autonomy.
Every member of the Commission shall also be the ex-officio members of the
Council. Each Board shall be an autonomous body and shall consist of a
President and two Members, all nominated by the search committee. The
commission will be more of an appellant body for aggrieved decision of an
Autonomous Board within sixty days.
The four
autonomous boards
The bill
provides for the constitution of four autonomous boards entrusted with
conducting undergraduate and postgraduate education, assessment and
accreditation of medical institutions and registration of practitioners under
the NMC.
UGME
and PGME boards The UGME Board
will grant recognition to a medical qualification at the undergraduate level
and PGME Board shall grant recognition to the medical qualification at the
postgraduate and super-specialty levels. Both boards may seek directions from,
the Commission, as necessary. Any recommendations for UG and PG courses
shall be made by the three-member committee under the control of the central
government.
MAR
board This Board shall grant permission for
establishment of a new medical institution, carry out inspections of medical
institutions for assessing and rating. It can also hire and authorize any other
third-party agency or persons for carrying out inspections of medical
institutions and for assessing and rating them, as required. It also has the
power to impose monetary penalty (first time, second time, and third time in
ascending order) against a medical institution for failure to maintain the
minimum essential standards specified by the UGME Board or the PGME Board. All
the three monetary penalties imposed shall not be less than one-half,
and not more than ten times, the total amount charged. Such variation of 50% to
10 times will be the root cause of future corruption. It can also be
used as a political action to favor or destroy someone. It will also become
necessary to seek prior permission of the MAR Board to establish a new medical
college.
EMR
board This board shall maintain a National Register
and regulate professional conduct and promote medical ethics. The EMR Board or
State Medical Council shall also give an opportunity of hearing to the medical
practitioner or professional concerned before taking any action, including
imposition of any monetary penalty against such person. There will also
be a separate National Register for licensed AYUSH practitioner who qualifies
the bridge course (Homeopathy or a practitioner of Indian medicine).
Plight of
medical students
It has been
proposed to conduct UG-NEET in English or other languages with common
counselling. There will also be a uniform National Licentiate Examination
operational within three years with
no PG NEET and with common counselling. This makes it seem like there will be
one common licentiate exam. The addition of another exam indicates the height of insensitivity to the plight of medical students
who even otherwise undergo a long and tortuous academic career replete with
highly competitive exams.
The
NMC allows private medical colleges to charge at free will nullifying whatever
solace NEET brought. The government can fix fee for only 40% of the
seats in private medical colleges. No
medical college will survive if there is state central dispute in the fee
structure. Up to 40% will give a wide margin for corruption.
Determining who
is a qualified medical professional
As per the
bill, any person who qualifies the National Licentiate Examination shall have
his name and qualifications enrolled in the National Register or a State
Register, as the case may be (prospective). Foreign medical graduates shall
also have to qualify the National Licentiate Examination only. The
Commission, however, may permit a medical professional to perform surgery or
practice medicine without qualifying the National Licentiate
Examination, in such circumstances and for such period as may be
specified by regulations. It also indicates that a foreign citizen who is
enrolled in his country as a medical practitioner in accordance with the law
regulating the registration of medical practitioners in that country may
be permitted temporary registration in India for such period
and in such manner as may be specified by regulations. Any person who
contravenes any of the provisions of this section shall be punished with fine
which shall not be less than one lakh rupees, but which may extend to five lakh
rupees. The Central Government can approve the grants of such sums of money as
it may think fit. This will be credited to a fund called the “National
Medical Commission Fund" which shall form part of the public account of
India.
The course
structure
One a year,
there will be a joint sitting of the Commission, the Central Council of
Homoeopathy and the Central Council of Indian Medicine. This will
decide on the approval of specific educational modules or programs that may be
introduced in the UG and PG courses across medical systems. This discussion
will also entail developing bridges across the various systems of medicine and
promote medical pluralism.
Handing over
power to administrators
The central
government has the power to dissolve the commission if it has persistently
defaulted in complying with any direction issued by them. The central
government may, by notification, supersede the commission for such period, not
exceeding six months, as may be specified in the notification. Anywhere else in the world, the medical profession is
bestowed with reasonable autonomy with patient care and safety as the main
benefits of such autonomy. Regulators need to have autonomy and be
independent of the administrators. The NMC will be a regulator appointed by the
administrators under their direct control.
In conclusion
It
is not the first time that the government has made such a move. In 2005, the
then Union health minister, Dr Anbumani Ramadoss, tried unsuccessfully to bring
about a legislation to dissolve the MCI and set up another council under the
control of the Health Ministry, which was rejected. That scenario is repeating
itself today, with the difference that the union cabinet has given its approval
to the draft NMC. The Parliament has a larger role to play in protecting the
interest of the medical profession of the country. It is time to act.
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