National Medical Commission Bill
Time is right to end reliance on stop-gap medical watchdogs
Why in news?
- The government today revived the National Medical Commission (NMC) Bill that seeks to replace the Medical Council of India (MCI), besides reducing costs of medical education in the private sector.
The National Medical Commission (or NMC) Bill, 2017
- National Medical Commission: The Bill, introduced in Lok Sabha by Health Minister J P Nadda on December 29 last year, provides for the replacement of the MCI — which is elected by medical practitioners across the country — with a 25-member National Medical Commission selected by a search committee headed by the cabinet secretary. The chairperson and members of the NMC will have terms of four years each.
- A National Licentiate Examination for MBBS graduates will be introduced within three years of the Bill’s passage by Parliament.
- The exam will serve as the basis for granting licences for medical practice, and for admission to postgraduate courses.
- Medical Advisory Council: A Medical Advisory Council constituted by the central government will advise and make recommendations to the NMC.
- The Council will include –
- a member from each state and Union Territory,
- chairperson of the University Grants Commission (UGC), and
- director of the National Accreditation and Assessment Council, the country’s regulator of higher education institutions.
- Four autonomous Boards — appointed by the Centre and consisting of a president and two members — will work under the supervision of the NMC:
- an Under-Graduate and a Post-Graduate Medical Education Board,
- a Medical Assessment and Rating Board, and
- an Ethics and Medical Registration Board.
- This structure is in line with the recommendations of the expert committee led by the late Prof Ranjit Roy Chaudhury, set up by the union Health Ministry in July 2014 to study the norms for the establishment of medical colleges.
- The NMC Bill also allows practitioners of homoeopathy and Indian systems of medicine to prescribe allopathic medicine upon completion of a “bridge” course.
- The Bill marks a radical change in regulatory philosophy — in the NMC regime, medical colleges will need permission only once for establishment and recognition, with no need for annual renewal.
- Seats: Colleges can increase the number of seats on their own, subject to the current cap of 250.
- They can also start postgraduate courses on their own.
- However, fines for violation are steep — 1.5 times to 10 times the total annual fees charged.
- The Council will include –
- It is difficult to see why the government says in a recent press release that the Indian Medical Council Bill 2019 will “ensure transparency, accountability and quality in the governance of medical education in the country.”
- Extended supersession of the MCI by the BoG: Were it indeed so, why should the Bill simply provide for the extended supersession of the Medical Council of India (MCI) by the Board of Governors (BoG) for a further two years, with effect retrospectively from September 26, 2018, and for increasing the board strength from 7 to 12?
- If the BoG is the solution, then surely it should be instituted to provide regulation to the healthcare and medical education sector permanently, instead of being given periodic extensions.
- To be sure, the government did well to shut down the MCI—the erstwhile regulator’s was a terminal case of graft malignancy, so much so that a Parliamentary Standing Committee noted that the “MCI cannot be remedied”—and replace it with the BoG via an ordinance.
- Yet, the BoG was never meant to be the end.
- Indeed, the government had proposed the National Medical Commission (NMC) Bill, which was introduced in the Lok Sabha on December 29, 2017, and referred to a Standing Committee of Parliament on January 4, 2018.
- The Standing Committee presented its report in Parliament on March 20, 2018. More than a year after, the Bill is still hanging fire, and with the BoG’s term ending only in September 26, 2020, it would seem that the government believes that the NMC is unlikely to come any time before that.
Why does the Medical Council of India need to be replaced?
- In its 92nd report (submitted in March 2016), the Parliamentary Standing Committee for Health and Family Welfare examined MCI’s functioning, and identified problems such as –
- the failure to produce doctors, including specialists and super specialists;
- shortage of teachers in medical colleges;
- poor regulation of undergraduate and postgraduate medical education;
- opacity and alleged corruption in the functioning of the regulator and its lack of accountability and failure to discharge mandated responsibilities; and
- the prevalence of capitation fees in private medical colleges in violation of the law.
- The committee observed that there was a need for “check-and-balance mechanisms”, apart from “inputs from people with excellence and competence in other disciplines”.
- The problems with the MCI have been known for a long time—it was labelled a “den of corruption” by the Delhi High Court in 2001 and the allegations of graft being in the body’s DNA, with its former president Ketan Desai at the centre of these allegations, have been around since the late 1990s.
- However, bumbling governments at the Centre, over the last couple of decades, have only relied on hackneyed stop-gap solutions instead of administering a curative.
- The UPA, after Desai’s arrest on graft related charges in April 2010, first promulgated an ordinance to put in place a BoG to supersede the MCI for a year, and later, in July 2010, enacted a law to extend the BoG’s term till May 2013.
- The MCI was reconstituted in 2013 after the BoG’s term ended, but that was marred by the fact that Desai managed a nomination to the Council from his home state, Gujarat; he later had to resign.
- In May 2016, the Supreme Court set up an oversight committee to guide the MCI, with a tenure of one year.
- At the end of its term, the committee submitted a scathing report on the deep rot in MCI and how it summarily defied the committee’s directives.
- In July 2017, the Centre insisted on a second oversight committee that resigned in protest, against the MCI ignoring its directives, before its term ended.
- The NMC Bill, as was presented in Parliament, was not without points of concern, but it still was a radical change from the past—it was designed to bring in experts from non-medical domains that have intersections with healthcare regulation from a patient’s point of view.
- Yet, given the Standing Committee report was submitted a year ago, with a rich array of recommendations to correct the flaws in the Bill, the fact that NMC is nowhere on the horizon yet seems like allowing festering.
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