Supreme Court Upholds Denial of Essentiality Certificate for Medical College: V.N. Public Health and Educational Trust vs. State of Kerala (2021)

Date of the Judgment: 24 February 2021
Citation: V.N. Public Health and Educational Trust vs. State of Kerala & Ors. (2021) INSC 100
Judges: A.M. Khanwilkar, J., B.R. Gavai, J., Krishna Murari, J. (Majority Opinion by Krishna Murari, J.)

Can a State government deny an Essentiality Certificate (EC) to a medical college seeking to establish itself, even after initially granting it? The Supreme Court of India addressed this critical question in a case involving V.N. Public Health and Educational Trust, which sought to establish a medical college in Kerala. The court examined the scope of the State’s authority in granting and potentially withdrawing an EC, and whether such a process is merely a ministerial act. The Supreme Court ultimately ruled against the appellant, upholding the High Court’s decision and denying the grant of EC for the academic year 2020-2021.

Case Background

The V.N. Public Health and Educational Trust, the appellant, aimed to establish a medical college, having set up a 300-bed hospital in Walayar, Palakkad District in 2006. The Trust claimed to have the necessary infrastructure and had been seeking the required approvals since 2006. The Trust alleged that the State Government and the Kerala University of Health Sciences (KUHS) arbitrarily denied them the Essentiality Certificate (EC) and Consent of Affiliation (CoA), hindering their efforts to establish the medical college. The Trust stated that its hospital had 76 doctors, 380 nurses and paramedical staff, and multiple operation theatres, along with other facilities necessary for a medical college.

The appellant had previously been granted an EC on 24.01.2004, which was rejected by the Medical Council of India (MCI) due to an incorrect format. Subsequent ECs were issued on 18.06.2009 and 12.01.2011, but these were also rejected by the MCI for being beyond the prescribed time limit or because KUHS granted CoA belatedly. A renewed EC was issued on 10.06.2014, but a clerical error delayed its correction until 11.12.2015, leading to the rejection of the application for the 2014-2015 academic year. The application for the 2015-2016 academic year was also rejected by the Government of India due to an invalid CoA. Despite interim orders from the High Court, the appellant faced repeated rejections and delays.

Timeline

Course of Proceedings

The appellant filed multiple writ petitions before the High Court of Kerala, seeking directions to the State Government and KUHS to grant the EC and CoA. Initially, the High Court directed the State Government to consider the appellant’s application. However, the State Government rejected the application, leading to further litigation. The High Court, in one instance, directed the State Government to issue the EC, but this was challenged by the State in the Supreme Court. The Supreme Court set aside the High Court’s order and directed a joint hearing of the pending writ petitions. The Single Judge of the High Court allowed the writ petition, directing the State to issue/renew the EC for the Academic Year 2022-2023. This was modified by the Division Bench to consider the application for the Academic Year 2021-2022. The appellant, dissatisfied with the denial of relief for the 2020-2021 academic year, appealed to the Supreme Court.

Legal Framework

The Supreme Court examined the following legal provisions:

• Section 10-A of the Indian Medical Council Act, 1956: This section mandates that no person shall establish a medical college or open a new course of study without the prior permission of the Central Government. The provision outlines the process for submitting a scheme to the Central Government, which then refers it to the Medical Council of India (MCI) for recommendations. It also specifies factors to be considered, including the availability of minimum standards of medical education, adequate financial resources, and necessary facilities. The section states:
  
  “SECTION 10-A. PERMISSION FOR ESTABLISHMENT OF NEW MEDICAL COLLEGE, NEW COURSE OF STUDY ETC.
  (1) Notwithstanding anything contained in this Act or any other law for the time being in force:-
  (a) no person shall establish a medical college or
  (b) no medical college shall:-
  (i) open a new or higher course of study or training (including a postgraduate course of study or training) which would enable a student of such course or training to qualify himself for the award of any recognised medical qualification; or
  (ii) increase its admission capacity in any course of study or training (including a postgraduate course of study or training), except with the previous permission of the Central Government obtained in accordance with the provisions of this section.”
• Medical Council of India Establishment of Medical College Regulations, 1999: These regulations provide the qualifying criteria for establishing a medical college. Key requirements include obtaining an Essentiality Certificate (EC) from the State Government and a Consent of Affiliation (CoA) from a University. The regulations also specify the need for a 300-bed hospital and financial guarantees.
  
  “3. The establishment of a medical college – No person shall establish a medical college except after obtaining prior permission from the Central Government by submitting a Scheme annexed with these regulations.”
  
  “2. Qualifying Criteria – The eligible persons shall qualify to apply for permission to establish a medical college if the following conditions are fulfilled:-
  (3) that Essentiality Certificate in Form 2 regarding No objection of the State Government/Union Territory Administration for the establishment of the proposed medical college at the proposed site and availability of adequate clinical material as per the council regulations, have been obtained by the person from the concerned State Government/ Union Territory Administration.
  (4) that Consent of affiliation in Form-3 for the proposed medical college has been obtained by the applicant from a University.”
• The Kerala University of Health Sciences First Statute, 2013: This statute outlines the process for granting affiliation to colleges. It allows the University to appoint a commission to inspect the proposed site and verify the facilities. The grant of affiliation depends on the fulfillment of specified conditions, including infrastructure, staff, and other facilities.
  
  “Chapter XXI Clause 10. Grant of Affiliation
  (1) The University may appoint a commission to inspect the proposed site of a new college/or to make a physical verification of the facilities that may exist for starting the new college/course if the application is considered favorably by the University. The Commission will inspect the suitability of the proposed site, verify the title deeds as regards the proprietary rights of the management over the land(and buildings if any) offered, building accommodation provided if any, assets of the management, constitution of the registered body, capability of maintaining academic standards and all other relevant matters…….”
  
  “(2) The Grant of affiliation shall depend upon the fulfillment by the management of all the conditions that are specified here or that may be specified later for the satisfactory establishment and maintenance of the proposed institution/courses of studies and on the reports of inspection by the Commission or commission which the university may appoint for the purpose.”

Arguments

Appellant’s Arguments:

• The appellant argued that the issuance of an Essentiality Certificate (EC) is a ministerial act, limited to certifying the necessity of establishing a medical college. They contended that the State Government’s role is merely to verify the desirability and feasibility of the proposed location, and the availability of infrastructure.
• The appellant submitted that once an EC is issued, it cannot be withdrawn by the State Government. They relied on the judgment in Chintpurni Medical College & Hospital & Anr. Vs. State of Punjab & Ors. [(2018) 15 SCC 1], which stated that a State Government cannot terminate the existence of a medical college permitted by the Central Government.
• The appellant argued that the University’s role in granting Consent of Affiliation (CoA) is limited to ensuring qualifying criteria are met, and the University cannot assume the role of the MCI. They stated that the MCI Act and Regulations govern the establishment of medical colleges, and the University’s role is secondary.
• The appellant pointed out that they had been issued an EC and CoA in 2015, and therefore, they were entitled to the same in 2020 as well.

State Government’s Arguments:

• The State Government argued that granting an EC/CoA is not a ministerial job. They stated that they must verify that the norms of the MCI are satisfied, and that sufficient infrastructure and clinical materials are available. The State Government also provides an undertaking to accommodate students if the medical college fails to provide proper facilities.
• The State Government contended that the judgment in Thirumuruga Kirupananda Variyar Thavathiru Sundara Sawmigal Medical Educational & Charitable Trust Vs. State of Tamil Nadu & Ors. [(1996) 3 SCC 15], relied upon by the appellant, did not consider the responsibilities of the State Government and the local university under the 1999 Regulations.
• The State Government cited the Supreme Court’s judgment in Government of Andhra Pradesh & Anr. Vs. Medwin Educational Society & Ors. [(2004) 1 SCC 86], to support their argument that the State Government has to verify and certify that the norms of Medical Council of India are satisfied.
• The State Government argued that the quashing of an order based on policy does not automatically lead to the grant of an EC or CoA, and these must be considered as per prevailing norms.

University’s Arguments:

• The University argued that the CoA given in 2015 was provisional and based on a High Court order. It stated that the appellant institution did not fulfill the essential requirements for starting a medical college.
• The University contended that the MCI Regulations and the Statutes of KUHS mandate that CoA can only be granted after the institution fulfills all essential requirements.
• The University relied on an inspection conducted on 07.11.2020, which revealed significant deficiencies in infrastructure, including a shortage of ICU beds, lack of a blood bank, and inadequate laboratory facilities. The inspection also noted deficiencies in faculty and clinical materials.

Submissions Table

Issues Framed by the Supreme Court

The Supreme Court framed the following issues for consideration:

1. Whether Essentiality Certificate (EC) and Consent of Affiliation (CoA) should be granted for the year 2020-2021 to the appellant.
2. Whether grant of Essentiality Certificate by the State Government is only a Ministerial Act?
3. Whether Essentiality Certificate, once issued, can be withdrawn?

Treatment of the Issue by the Court

The following table demonstrates as to how the Court decided the issues:

Authorities

The Supreme Court considered the following authorities:

Cases:

• Thirumuruga Kirupananda Variyar Thavathiru Sundara Sawmigal Medical Educational & Charitable Trust Vs. State of Tamil Nadu & Ors. [(1996) 3 SCC 15] – The Court discussed the limited role of the State Government in issuing the Essentiality Certificate (EC), stating that it is only required to consider the desirability and feasibility of having the proposed medical college at the proposed location. The Court held that the EC cannot be withheld by the State Government on any policy consideration, as the policy in the matter of establishing a new medical college rests with the Central Government alone.
  
  “For the purpose of granting the Essentiality Certificate as required under the qualifying criteria prescribed under the scheme, the State Government is only required to consider the desirability and feasibility of having the proposed medical college at the proposed location. The Essentiality Certificate cannot be withheld by the State Government on any policy consideration because the policy in the matter of establishment of a new medical college now rests with the Central Government alone.”
  
  Supreme Court of India
• Chintpurni Medical College & Hospital & Anr. Vs. State of Punjab & Ors. [(2018) 15 SCC 1] – The Court held that a State Government cannot exercise any power that could terminate the existence of a medical college permitted by the Central Government. The purpose of the EC is limited to certifying to the Central Government that it is essential to establish a medical college. The Court stated that once the State Government has certified that the establishment of a medical college is justified, it cannot later say that there was no justification. The Court further held that the power to issue an EC is exhausted once exercised, except in cases of fraud.
  
  “It would be impermissible to allow any authority including a State Government which merely issues an Essentiality Certificate, to exercise any power which could have the effect of terminating the existence of a Medical College permitted to be established by the Central Government. Thus, the State Government may not do either directly or indirectly. Moreover, the purpose of the Essentiality Certificate is limited to certifying to the Central Government that it is essential to establish a Medical College. It does not go beyond this. In other words, once the State Government has certified that the establishment of a Medical College is justified, it cannot at a later stage say that there was no justification for the establishment of the College. Surely, a person who establishes a Medical College upon an assurance of a State Government that such establishment is justified cannot be told at a later stage that there was no justification for allowing him to do so. Moreover, it appears that the power to issue an Essentiality Certificate is a power that must be treated as exhausted once it is exercised, except of course in cases of fraud. The rules of equity and fairness and promissory estoppel do not permit this Court to take a contrary view.”
  
  Supreme Court of India
• Government of Andhra Pradesh & Anr. Vs. Medwin Educational Society & Ors. [(2004) 1 SCC 86] – The Court emphasized the responsibility of the State Government to verify and certify that the norms of the Medical Council of India are satisfied when granting an EC.
  
  Supreme Court of India
• Medical Council of India Vs. Principal, KMCT Medical College & Anr. [(2018) 9 SCC 766] – The Court held that the decision taken by the Union of India based on the recommendation of an expert body cannot be interfered with lightly. Interference is permissible only when the college demonstrates jurisdictional errors, perversity, or malafides.
  
  Supreme Court of India
• Medical Council of India Vs. The Chairman, S.R. Educational and Charitable Trust and Another [(2018) SCC Online SC 2276] – The Court cautioned against orders that may ruin the careers of students. It emphasized that once permission to admit students is granted, it should not be conditional. The Court stressed that permitting unequipped medical colleges to impart substandard education would be dangerous and against the right to life.
  
  Supreme Court of India
• Sukh Sagar Medical College and Hospital Vs. State of Madhya Pradesh and Ors. [(2020) SCC Online SC 851] – The Court clarified that while the act of the State in issuing an EC is quasi-judicial, the State Government can cancel/revoke/withdraw the EC if the substratum for issuing the EC has disappeared or for other reasons of like nature. The Court departed from the view taken in Chintpurni Medical College, stating that the State Government cannot wait indefinitely if the college fails to fulfill the spirit behind the EC.
  
  “25. We are conscious of the view taken and conclusion recorded in Chintpurni Medical College (Supra). Even though the fact situation in that case may appear to be similar, however, in our opinion, in a case such as the present one, where the spirit behind the Essentiality Certificate issued as back as on 27.08.2014 has remained unfulfilled by the appellant-college for all this period (almost six years), despite repeated opportunities given by the MCI, as noticed from the summary/observation in the assessment report, it can be safely assumed that the substratum for issuing the Essentiality Certificate has completely disappeared. The State Government cannot be expected to wait indefinitely, much less beyond period of five years, thereby impacting the interests of the student community in the region and the increased doctor-patient ratio and denial of healthcare facility in the attached hospital due to gross deficiencies. Such a situation, in our view, must come within the excepted category, where the State Government ought to act upon and must take corrective measures to undo the hiatus situation and provide a window to some other institute capable of fulfilling the minimum standards/norms specified by the MCI for establishment of a new medical college in the concerned locality or within the State. Without any further ado, we are of the view that the appellant-college is a failed institute thus far and is unable to deliver the aspirations of the student community and the public at large to produce more medical personnel on year to year basis as per the spirit behind issuance of the subject Essentiality Certificate dated 27.08.2014. To this extent, we respectfully depart from the view taken in Chintpurni Medical College (Supra).”
  
  Supreme Court of India
• Mridul Dhar (Minor) & Anr. Vs. Union of India & Ors. [(2005) 2 SCC 65] – The Court emphasized the necessity of proper facilities and infrastructure, including a teaching faculty and doctors, along with adherence to time schedules for imparting high-quality medical education.
  
  “It cannot be doubted that proper facilities and infrastructure including a teaching faculty and doctors is absolutely necessary and so also the adherence to time schedule for imparting teaching of highest standards thereby making available to the community best possible medical practitioners.”
  
  Supreme Court of India

Statutes and Regulations:

• Section 10-A of the Indian Medical Council Act, 1956
• Medical Council of India Establishment of Medical College Regulations, 1999
• The Kerala University of Health Sciences First Statute, 2013

Authorities Table

Judgment

How each submission made by the Parties was treated by the Court?

How each authority was viewed by the Court?

• The Court distinguished the facts of Thirumuruga Kirupananda Variyar Thavathiru Sundara Sawmigal Medical Educational & Charitable Trust Vs. State of Tamil Nadu & Ors. [(1996) 3 SCC 15] stating that the state has to verify the norms of MCI.
• The Court distinguished the facts of Chintpurni Medical College & Hospital & Anr. Vs. State of Punjab & Ors. [(2018) 15 SCC 1] and partially overruled it by relying on the judgment of Sukh Sagar Medical College and Hospital Vs. State of Madhya Pradesh and Ors. [(2020) SCC Online SC 851] stating that the State Government can withdraw the EC if the substratum disappears.
• The Courtrelied on Government of Andhra Pradesh & Anr. Vs. Medwin Educational Society & Ors. [(2004) 1 SCC 86] to emphasize the State’s responsibility to verify MCI norms.
• The Court relied on Medical Council of India Vs. Principal, KMCT Medical College & Anr. [(2018) 9 SCC 766] to state that the decision taken by the Union based on the expert body’s recommendation cannot be interfered with lightly.
• The Court relied on Medical Council of India Vs. The Chairman, S.R. Educational and Charitable Trust and Another [(2018) SCC Online SC 2276] to caution against conditional permissions and substandard medical education.
• The Court relied on Mridul Dhar (Minor) & Anr. Vs. Union of India & Ors. [(2005) 2 SCC 65] to emphasize the importance of proper infrastructure and adherence to time schedules.
• The Court also considered Section 10-A of the Indian Medical Council Act, 1956, Medical Council of India Establishment of Medical College Regulations, 1999, and The Kerala University of Health Sciences First Statute, 2013 to understand the legal framework.

Final Decision:

The Supreme Court upheld the High Court’s decision, denying the grant of the Essentiality Certificate for the academic year 2020-2021. The Court found that the appellant had failed to meet the necessary standards and time schedules. The Court also clarified that the issuance of an EC is not a ministerial act and that it can be withdrawn under specific circumstances.

Ratio Decidendi

The ratio decidendi of the case can be summarized as follows:

• Issuance of Essentiality Certificate (EC) is not a ministerial act: The State Government is required to verify that the norms of the Medical Council of India (MCI) are satisfied, and that sufficient infrastructure and clinical materials are available. The State also provides an undertaking to accommodate students if the medical college fails to provide proper facilities.
• EC can be withdrawn under certain circumstances: An EC can be withdrawn if it was obtained by fraud, if the substratum on which it was granted disappears, or for other similar reasons. This is a departure from the view taken in Chintpurni Medical College, which stated that the power to issue an EC is exhausted once exercised.
• Consent of Affiliation (CoA) from the University is essential: The University must ensure that all essential requirements are met before granting CoA. The University cannot act as a mere rubber stamp.
• Adherence to time schedules and norms is crucial: Medical colleges must adhere to time schedules and norms prescribed by the MCI and the University. The quality of medical education is paramount, and substandard education cannot be permitted.

Obiter Dicta

The obiter dicta in this case includes:

• Importance of quality medical education: The Court emphasized the significance of maintaining high standards in medical education. It stressed that permitting unequipped medical colleges to impart substandard education would be dangerous and against the right to life.
• Role of expert bodies: The Court highlighted the importance of respecting the decisions of expert bodies like the MCI. It stated that the decisions taken by the Union of India based on the recommendations of an expert body should not be interfered with lightly.
• State’s responsibility: The State Government has a responsibility to ensure that medical colleges meet the required standards and have the necessary infrastructure. The State also undertakes to accommodate students if the medical college fails to provide proper facilities.

Flowchart of the Decision-Making Process

Ratio Table

Sentiment Analysis Table