IMA 1 Voice: Stop NMC Team IMA 2016 Niti Aayog has recently put the proposed National Medical Commission Bill – 2016 on the public domain and had invited observations and comments from the stake holders. Over 9000 stake holders sent their comments and observations on the said Bill. In a stake holder’s meeting, IMA has come out with the following points and IMA feels that if the said bill is passed by the government in the forthcoming winter session, it will not be in the interest of the society. 1. There is nothing new in the proposed bill, instead the Niti Aaygo should have asked for suggestions to amend the existing IMC act 1956 and its subsequent amendments. 2. In the present bill the representative character, which is a must for any regulatory body, a fine balance between the elected and nominated members, has been completely given go by. In fact in the proposed bill, there is total exclusion of elected members. It will have 100% nominated members. 3. The present MCI under the IMC act has representations from all State Medical Councils, health science universities and registered medical practitioners. The same will be lost with the new bill. 4. Health is a state subject and the state doctors are regulated by the state medical councils. How can one justify no representation of state medical councils in NMC? Also the state Medical Councils are autonomous independent bodies but under Sec. 14(5) NMC can take action against state medical councils to ensure for compliance. 5. Also it is likely that the autonomy vested with the State Medical Councils which are independent creation of respective state legislation will go in the next phase. All State Medical councils are likely to be replaced by nominated councils in future. 6. The bill stipulates the denial of legitimate right of the medical education conferring universities in terms of their representation in the composition of the regulatory body in spite of they being the exclusive key player. 7. It is possible that in near future Niti Aayog may suggest similar bills to replace Dental Council of India, Nursing Council of India, Pharmacy Council of India etc. and it is possible to take similar steps even to non-medicals like Bar Council of India or Chartered Accountants of India. 8. The Bill in its present format will also do injustice to people of Jammu and Kashmir as the present bill does not talk about its applicability to Jammu and Kashmir when the existing IMC Act specifically mentions about it. 9. All the powers in NMC are vested with the Chairperson who will also be the ex-officio chairperson of medical advisory council. The Chairperson will be appointed or nominated by the Central Government. Loop holes have been kept in the criteria for selection: any one with over 20 years of experience in profession out of which 10 years shall be in a leadership role. The word leadership role has not been defined and probably kept to suit the nominators. The term of the chairperson also has been limited for maximum 2 terms of 4 years each and retirement age also has been kept at 70 years. 10. There are further ambiguities in the bill also. Sec. 12 (3) prohibits Chairperson after retirement for accepting employment in private medical college for 1 year but Sec. 12(5) allows central government to permit Chairperson to accept such appointments. 11. The Chairperson will always be on the mercy of the government as the government can remove the Chairperson on flimsy grounds such as physical, mentally incapable of performing duties, abusing position, making persistent defaults, not performing or not complying with actions of the Government. 12. The medical assessment and rating boards like the under graduate and post graduate education boards, although are designated to be autonomous yet they would be seeking directions from the Government through the commission in regard to its tasks dispensation. 13. Under Section 19(4) NMC may allow and sanction locally designed courses by individual institutions which will open the medical education beyond standards. 14. Under Sec. 20(1) and 23(1) President of the under graduate or the post graduate board is empowered to take all decisions on behalf of the board that means that all the powers are vested with the President and not with the board. 15. The said Boards under Section 25(2) would be entitled to hire 3rd party agencies for accreditation including empanelling the same which would be opening flood gates for the various private rating agencies. 16. Under Section 23 (3) the said Board would be evaluating the scheme for opening new medical colleges and make recommendation in regard to approval or disapproval without any necessity on onsite inspection and on the basis of paper assurances. Further by a provision to Sec 27(4), the Board is entitled to make relaxation for opening of a medical college in unserved area without defining the same and therefore opening an avenue for discretionary authority. As such the entire process would end up in dilution of the desired standards and resultant production of comprised graduates. 17. The Sec. 28(3) provides for a board of medical registration that would have a President and 2-Part time members which is different from the other boards namely, under graduate and post graduate rating board respectively. 18. There is no clarity proposed in the Bill pertaining to who will be the primary registering authority. 19. Under Sec. 29(2) (ii), all the professional organisations and associations of doctors have been brought under the Disciplinary jurisdiction of NMC without realising that the Association / organisations of doctors are not registered under the State Medical Register or the National Medical Register, as the case may be. 20. Under Sec. 29(2) (v) it is contemplated that the States or Union Territories where there is no State Councils, the same has to be put into place within 3 years from the date of the said Bill coming into force which is a direction contrary to the spirit of federalism. It has also been provided that during the transitory period the board of medical registration would have the trial jurisdiction for registered medical practitioners of the State/UT where there is no State Medical Council without bringing out as to what authority would have appellate jurisdiction. 21. The said Board under Sec. 30(2) would be administered by the President or a Part Time member in singular or a combination of both which is different from the other boards without indicating who would be assigning the said onus to the part time member. 22. Under Sec. 31(1) the Board has the requisite of the licentiate examination which in reality puts a question mark on the credibility of the universities conferring MBBS qualification. 23. NMC has proposed an Exit Exam but has simultaneously proposed that if the person does not clear the exam, he can be allowed to practice on the basis of mercy appeal. Under Sec. 31 (3) (d), exemption can be granted by the Commission to practice without clearing the national licentiate examination. This negates what is provided for under Sec. 31(1) read with Sec 17 of the proposed Bill. This discretionary power is open for misuse resulting in manipulation and corruption. 24. Under Sec. 32, governing recognition of qualifications no provision is made for renewal of the same. 25. Sec. 33(3) provides an opportunity to appeal to central government in respect of medical institutions outside India trying to set up institutions in India but no such provision is made for medical institutions in the country which brings out the grossest medical discrimination. 26. Sec. 35 makes the provision for “other medical qualifications granted by any other bodies which is opening Pandora’s Box in this regard. This would provide a back door entry for non MBBS doctors to enter in the register. The said provision gives absolute authority to the central government to include said other qualifications in schedule 4 which has not been defined. 27. Under Sec. 42(3) merger of National Board of Examinations is brought out with the PG Education Board which is solely aimed at a back door validation of qualifications granted by DNB and upon merger they would be included in schedule 1 of the IMC act. 28. Under Sec. 44, rules can be made by the central government but no modality is providing as to how regulations would be made and what will be the matters on which they would be made. 29. Sec. 45 provides central government with an overriding authority to not only direct the commission to amend the regulations but also direct them to make or revoke regulations amounting to usurpation of the authority of making even subordinate legislation which is un heard of. 30. Further in case the said direction is not implemented by the Commission the Government will Sue-motu can dispense the same on its own. That cannot be a more vulgar way of trampling upon the autonomy in such a high handed manner. The net result would be that the NMC powers which stands centralized in the hands of handpicked President would ultimately will be under the total dictates of the Government resulting in the Commission getting transformed into an extended Babudom of the government of India. IMA RESOLUTIONS For State Councils: Resolved that the National Medical Commission Bill 2016 explicitly takes away the total autonomy vested with State Medical Councils which are independent creation of the respective State legislation and makes them subordinate including sub servient, hence, the State Medical Councils need to oppose the same tooth and nail in their own interest in conformity with the subtle principles of Federalism. For General Public: Resolved that the National Medical Bill 2016 talks of prescribing of the chargeable tuition claimable by the private medical colleges for a % of seats there at from 0 up to 40% and leaving the rest outside the ambit of prescription resulting in fleecing of the poor and meritorious students in a brazen manner at the hands of exploitative private/ corporate sector and resultantly opening free vista for the open ended exploitation, and thereby adding to the cost of the medical education beyond the reach of the ordinary and poor. Hence the Bill needs to be abrogated forthwith in larger public interest. For Media: Resolved that the National Medical Commission Bill 2016, Intends to centralize the power and authority of prescribing the public good in a manner which operationally turns out to be ‘anti poor’ and exclusively catering to rich and thereby adds to the ever widening social divide needs to be opposed by the society at large. For Universities and Health Sciences Universities: Resolved that the National Medical Commission Bill 2016, stipulates denial of legitimate right of the medical education conferring universities in terms of their representation in the composition of the regulatory body in spite of they being the exclusive key player, hence the universities & health sciences universities need to oppose the same tooth & nail. For Professionals : Resolved that the National Medical Bill 2016 in its present form liberally, calculatedly and explicitly provides for the entry of persons without valid modern medicine registering qualification to be included in the State Medical Register and National Medical Register respectively, thereby getting them entitlement and legitimacy to practice modern medicine, negates the statutory purport of the modern medicine and tramples upon the same. Hence, this gross liberalization of indiscriminate in permissible broadening ending up in free flowing licensing to practice modern medicine by the undeserving at the cost of professional sanctity mandates abrogation of the said Bill. For Member of Parliamentarians: Resolved that the National Medical Commission Bill 2016, in view of the intrinsic anomalies, contradiction, inconsistencies, poor syntaxing and being inconsistent with inclusive dispensation of the desired public good and standardizing quality based medical education, thereby generating effectively trained health man power for an effective medical health care delivery system catering to the mandate of ushering in Welfare State needs to be abrogated. For Youth: Resolved that the National Medical Bill 2016 ultimately would add not only to the ever increasing cost of medical education, but also would end up in dilution of desired standard of the medical education which would not be commensurate with rightful and legitimate expectations of young generation of the country, hence for their insulation of the interests, the youth in general should insist of abrogation of the said ill intended Bill. For the Congress Party in Opposition : Resolved that the National Medical Bill 2016 which has been piloted by the present Govt. is exclusively intended to cater to and provide the coziest cushion to private and corporate players in enhancing their own capital interests and gains at the cost of sacrificing the legitimate right and interest of deserving young and meritorious generation of the country. Hence, the same needs to be abrogated unconditionally.. Proposed line of action: Resolved that the National Medical Bill 2016 which intends to replace IMC Act 1956 with amendments from time to time in reality is expected to cater to the very objectives which existingly are dealt with by the said Act , could be achieved better by updating the same in terms of vesting the MCI with the authority for accreditation of medical institutions, prescribing the national perspective development plan for establishment and geographical location of medical colleges, to tide over the mal distribution, being vested with the authority for prescribing service conditions and pay scales for medical teachers and invoking developmental grants vide 5 years planed period for medical education, hence the proposed bill needs to be abrogated. For State Governments: Resolved that the National Medical Commission Bill 2016, is a gross attempt towards usurping the legitimate authority of the State Government vested with it on the matter included in the concurrent list appended to the Constitution of India, therefore needs to pick up the emanating signals there from in the interest of upholding their rightful authority should insist on abrogation of the same, For Professional & Specialty Associations: Resolved that the National Medical Bill 2016 in its present form brings explicitly professional & specialty association under its ambit of disciplinary and ethical jurisdiction in spite of the fact that they are not registered under the State Medical Register or the National Medical Register, as the case may be, as an association, the same therefore amounts to annihilation of their statutory authority . As such the said Bill is required to be abrogated in order the uphold the honor, dignity and authority of the specialty / professions respectively. For State Governments : Resolved that the National Medical Bill 2016 in its present form is trampling upon principle of federalism , equity, equitability and explicit single meaning of the specific inclusion under it leaving open the area of ambiguity providing for lenient scope for wide varied & convenient interpretation which does not fit in to construing the same as an ideal peace of legislation in larger public good, hence, needs to be abrogated. For other Professional Councils: Resolved that the National Medical Bill 2016 at the cost of annihilation of even the vestiges of autonomy of a regulatory council with reference to MCI as of now would widen the same to devour the health professional councils created wider appropriate parliamentary enactments and also other professional councils need to get alarmed vide the said signal to nip the generated evil in bud by seeking its abrogation. For Society at large: Resolved that the National Medical Bill 2016 in spite of making laudable claim to achieve public good in reality is ending up in centralizing in the entire power and authority in the hands of the handpicked nominees nominated by the government in an autocratic manner and imposing the un required condition of the licentiate examination which defy the set out the democratic and constitutional norms ending up in catering to the cause of the rich and corporate at the cost of negating the claims and expectations of the deserving and the meritorious poor, and thereby bring out its ugly human face needs to be abrogated forthwith.